Bakgrund

Sjuksköterskor i psykiatrisk vård bör arbeta med att planera vården i samarbete med patienten och spendera tid på att skapa terapeutiska relationer. Samtidigt menar många sjuksköterskor att de saknar den tid som krävs för att samtala med patienterna.

Syfte

Aktuell tidsstudie genomfördes för att undersöka hur sjuksköterskor i psykiatrisk heldygnsvård fördelar den tid de har tillgänglig under ett arbetspass.

Metod

12 sjuksköterskor på sex vårdavdelningar vid en psykiatrisk klinik i södra Sverige observerades. Totalt utfördes strukturerade observationer under 129 timmar och 23 minuter. Tidfördelning, aktivitetsfrekvens och avbrott registrerades.

Resultat

Läkemedelshantering var den största kategorin av den uppmätta tiden (17,5 %), följt av indirekt omvårdnad (16 %). Relativt lite tid lades på direkt omvårdnad, den tredje största kategorin (15,3 %) medan en oväntad stor del av tiden (11,3 %) lades på verksamhetsrelaterade uppgifter. Sjuksköterskor avbröts också vid 75 % av alla tillfällen då de arbetade med läkemedelshantering. Således spenderade sjuksköterskor förhållandevis lite tid på direkt omvårdnad och läkemedelshanteringen avbröts ofta. Det är svårt att bygga terapeutiska relationer med syfte att lägga en grund för hållbar psykiska hälsa om relativt lite tid spenderas tillsammans med patienten. Det är oroande att både patientsäkerhet och sjuksköterskors arbetstillfredsställelse riskeras på detta sätt.

Background

During the last decade, type 2 diabetes (T2D) prevalence has increased worldwide, especially among children and young adults. Diabetes is a chronic disease that if not diagnosed in time can lead to serious health complications and put pressure on the societal resources. The aim of this study was to evaluate the economic impact of the increased T2D prevalence in Malmö over time on the regional health care organization.

Methods

A longitudinal population-based study in Malmö, within the Cities Changing Diabetes project. Data was collected from the Patient Administrative System in Region Skåne, classifying T2D by the ICD E11 code. The health care cost (HCC) has been adjusted by the Consumer Price Index (CPI) to 2020 prices.

Results

The prevalence of T2D increased from 2,5% in 2011 to 4,3% in 2018. The increase in T2D prevalence was most noticeable for residents 18 - 64 years. The overall HCC for treating residents with T2D was approximately €47,2 million in 2011 and €90,7 million in 2018. The HCC in 2018 was higher for males than for females (€54,6 million vs €36,2 million). In 2018, the cost was €49,9 million for those 18 - 64 years and €40,5 million for those being 65 years or older. The overall HCC increased during the study period (3,3 times for those 18 - 64 years and 1,4 times for those being 65 years or older). For the age group 18 - 64 the HCC per resident was €5 000 in 2011 and €5 300 in 2018. The HCC per resident for all age groups, has not changed markedly, from €6 200 in 2011 to €6 100 in 2018 as well as the number of health care visits (23 in 2011 and 29 in 2018).

Conclusions

The HCC for T2D has increased markedly since 2011. This increase is most noticeable for people under 65 years. The overall HCC for these patients and its change over time puts an increased strain on the health care provider Region Skåne, mainly due to increased prevalence.

Key messages 

• The overall HCC during 2011 – 2018 has increased 2 times for residents with T2D and 1.5 times for residents without T2D. This increase is likely to continue if the current trend remains.
• The main driving force behind the increase in HCC over time is the increase in T2D prevalence and not in HCC per resident.

Background

Type-2 diabetes is a progressive disease and very much linked to health equity prerequisites and poverty. Its long-term complications include cardiovascular diseases, blindness, amputation and kidney failure. The aim of the study was to explore diabetes type 2 (T2D) prevalence in Malmö, a socioeconomically diverse and multicultural city with a relatively young population.

Methods

The study is a part of the Cities Changing Diabetes project related to the 14 geographical developing areas CTC (Community That Care) in Malmö. The whole city has been divided into 14 areas based on socioeconomical homogeneity as well as shared local area affiliation. Results are obtained from the Patient Administrative System (ICD E11 code) in regional health care as well as from Statistics Sweden.

Results

The prevalence of T2D was 4.3% in 2018. It has increased since 2011 mostly noticeable for residents between 18 and 64 years of age. There are considerable differences in T2D prevalence by CTC-areas where the highest observed prevalence rate was 6.4% and the lowest was 2.6%. The areas with the lower prevalence rates have a high level of education as well as high average household income. The opposite is observed in the areas with the highest prevalence rates where the residents have lower educational level as well as low average income. Two of the three CTC-areas with the highest T2D prevalence rates consists of a younger population as compared to the city in general whereas the third consists of the oldest population in the city.

Conclusions

The prevalence of T2D has increased during the last decade in Malmö. There are significant differences in T2D prevalence within the city related to contextual and socioeconomic factors. The highest T2D prevalence occurs in the area with the lower income and lower level of education.

Key messages 

• Promotive actions need to be specifically targeted at younger populations in the city of Malmö to prevent the increase in type-2 diabetes and its complications.
• Contextual factors need to be taken into consideration in the development of sustainable primary and secondary preventive actions for type-2 diabetes in community care and the health care system.

Background: Despite available knowledge how to prevent the risk of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes, these risks still frequently occur and cause a major burden for older persons; furthermore, for the health care system, they are extremely costly. One way to combat these risks is to register the prevention process in quality registries. However, the increasing older population worldwide is going to put high demands on those working with this group of people. Objective: To explore how nurse aides, registered nurses and managers in nursing homes experience working with the prevention of pressure ulcers, malnutrition, poor oral health and falls in general and according to the quality register Senior Alert care process. Methods: A qualitative study was conducted in nursing homes in a municipality in southern Sweden. We purposively sampled nurse aides, registered nurses and managers (n = 21) working in nursing homes registered in the quality register Senior Alert, who then participated in one of five focus group semistructured digital interviews held between February and April 2020. The interviews were audio recorded. Data were analysed using reflexive thematic analysis. Results: Our findings explore how nurse aides, registered nurses and managers experience working with the prevention of pressure ulcers, malnutrition, poor oral health and falls in nursing homes both in general and according to Senior Alert. The following four themes were generated during the analysis: (1) is included in the everyday work, (2) requires team effort, (3) requires handling many challenges and (4) requires finding strategies. Conclusion: The prevention of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes is complex. There is a commitment and responsibility among nurse aides, registered nurses and managers regarding preventive work and team effort, and finding useful strategies is necessary for the work to be successful. However, challenges, both at the individual and organizational levels, are involved, which implies that smoother organizational routines facilitating this preventive work are needed. Although nurse aides, registered nurses and managers are good at finding strategies that facilitate this work, one of the main challenges seems to lie in the variety of knowledge found among those working in nursing homes, particularly among nurse aides. This challenge was voiced by all the professionals, which suggests the need for a tailored educational intervention aimed at increasing the related knowledge among those working in nursing homes to enhance preventive work.

Although colonoscopy is a common examination, there is limited research focusing on how patients experience this procedure. It is important that a colonoscopy is tolerated, as it may lead to lifesaving diagnostics and treatment. This study aims to explore adult patients' experience of undergoing a colonoscopy regarding the time prior to, during, and after the procedure. This was a qualitative study with individual interviews (n = 24) and a purposeful sample that was analyzed using thematic analysis. The analysis revealed four themes. The first, "making up one's mind," describes how the participants gathered information and reflected emotionally about the forthcoming procedure. The hope of clarification motivated them to proceed. In the theme "getting ready," self-care was in focus while the participants struggled to follow the instructions and carry out the burdensome cleansing. The next theme, "going through," illuminates' experiences during the colonoscopy and highlights the importance of feeling involved and respected. The last theme, "finally over," is characterized by experiences of relief, tiredness, and a desire for clarity. The healthcare professionals' ability to meet the participants' needs is vital, given that the experiences are highly individual. These findings contribute to a variegated image of how patients experience the process of undergoing a colonoscopy.

When compared to the general population, socioeconomically disadvantaged communitiesfrequently experience compromised health. Monitoring the divide is challenging since standardizedbiomedical tests are linguistically and culturally inappropriate. The aim of this study was to developand test a unique mobile biomedical testbed based on non-invasive analysis, as well as to explorethe relationships between the objective health measures and subjective health outcomes, asevaluated with the World Health Organization Quality of Life survey. The testbed was evaluated in asocioeconomically disadvantaged neighborhood in Malmö, which has been listed as one of the twelvemost vulnerable districts in Sweden. The study revealed that compared to conventional protocolsthe less intrusive biomedical approach was highly appreciated by the participants. Surprisingly, thecollected biomedical data illustrated that the apparent health of the participants from the ethnicallydiverse low-income neighborhood was comparable to the general Swedish population. Statisticallysignificant correlations between perceived health and biomedical data were disclosed, even thoughthe dependences found were complex, and recognition of the manifest complexity needs to beincluded in further research. Our results validate the potential of non-invasive technologies incombination with advanced statistical analysis, especially when combined with linguistically andculturally appropriate healthcare methodologies, allowing participants to appreciate the significanceof the different parameters to evaluate and monitor aspects of health.

Background: Gastrointestinal (GI) symptoms similar to irritable bowel syndrome (IBS) are often present in women with endometriosis and microscopic colitis (MC). The objective of this study was to estimate GI symptoms in IBS, endometriosis, and MC, to compare the clinical expression of the diseases. Methods: Women with IBS, endometriosis, and MC were identified by diagnosis codes at a tertiary center. The patients had to complete the visual analog scale for IBS to estimate specific GI symptoms. Women fulfilling Rome III criteria for IBS were diagnosed as IBS (n = 109) and divided into subgroups depending on predominating symptoms. Women diagnosed with endometriosis (n = 158) and MC (n = 88) were evaluated whether they also fulfilled the Rome III criteria for IBS. Results: Women with IBS experienced aggravated abdominal pain, diarrhea, bloating and flatulence, nausea and vomiting, the urgency to defecate, the sensation of incomplete evacuation and intestinal symptom's influence on daily life, and impaired psychological wellbeing, compared to women with endometriosis. When patients with endometriosis also fulfilled the criteria for IBS, all symptoms in the 2 cohorts, except intestinal symptom's influence on daily life, were equal. Women with IBS or diarrhea-predominated IBS experienced aggravated abdominal pain, bloating and flatulence, intestinal symptom's influence on daily life, and impaired psychological well-being compared to MC, but at equal levels as MC with IBS-like symptoms. Conclusions: Women with IBS generally experience aggravated GI symptoms and impaired psychological well-being compared to endometriosis and MC. Patients with endometriosis or MC, in combination with IBS, express similar symptoms as patients with sole IBS.

BACKGROUND: Co-production of health is defined as 'the interdependent work of users and professionals who are creating, designing, producing, delivering, assessing, and evaluating the relationships and actions that contribute to the health of individuals and populations'. It can assume many forms and include multiple stakeholders in pursuit of continuous improvement, as in Learning Health Systems (LHSs). There is increasing interest in how the LHS concept allows integration of different knowledge domains to support and achieve better health. Even if definitions of LHSs include engaging users and their family as active participants in aspects of enabling better health for individuals and populations, LHS descriptions emphasize technological solutions, such as the use of information systems. Fewer LHS texts address how interpersonal interactions contribute to the design and improvement of healthcare services.

OBJECTIVE: We examined the literature on LHS to clarify the role and contributions of co-production in LHS conceptualizations and applications.

METHOD: First, we undertook a scoping review of LHS conceptualizations. Second, we compared those conceptualizations to the characteristics of LHSs first described by the US Institute of Medicine. Third, we examined the LHS conceptualizations to assess how they bring four types of value co-creation in public services into play: co-production, co-design, co-construction and co-innovation. These were used to describe core ideas, as principles, to guide development.

RESULT: Among 17 identified LHS conceptualizations, 3 qualified as most comprehensive regarding fidelity to LHS characteristics and their use in multiple settings: (i) the Cincinnati Collaborative LHS Model, (ii) the Dartmouth Coproduction LHS Model and (iii) the Michigan Learning Cycle Model. These conceptualizations exhibit all four types of value co-creation, provide examples of how LHSs can harness co-production and are used to identify principles that can enhance value co-creation: (i) use a shared aim, (ii) navigate towards improved outcomes, (iii) tailor feedback with and for users, (iv) distribute leadership, (v) facilitate interactions, (vi) co-design services and (vii) support self-organization.

CONCLUSIONS: The LHS conceptualizations have common features and harness co-production to generate value for individual patients as well as for health systems. They facilitate learning and improvement by integrating supportive technologies into the sociotechnical systems that make up healthcare. Further research on LHS applications in real-world complex settings is needed to unpack how LHSs are grown through coproduction and other types of value co-creation.

BACKGROUND: Pursuing the vision 'for a good life in an attractive region,' the Region Jönköping County (RJC) in Sweden oversees public health and health-care services for its 360 000 residents. For more than three decades, RJC has applied 'quality as strategy,' which has included increasing involvement of patients, family and friends and citizens. This practice has evolved, coinciding with the growing recognition of co-production as a fundamental feature in health-care services. This study views co-production as an umbrella term including different methods, initiatives and organizational levels. When learning about co-production in health-care services, it can be helpful to approach it as a dynamic and reflective process.

OBJECTIVE: This study aims to describe the examples of key developmental steps toward co-production as a system property and to highlight 'lessons learned' from a Swedish health system's journey.

METHOD: This qualitative descriptive study draws on interviews with key stakeholders and on documents, such as local policy documents, project reports, meeting protocols and presentations. Co-production initiatives were defined as strategies, projects, quality improvement (QI) programs or other efforts, which included persons with patient experience and/or their next of kin (PPE). We used directed manifest content analysis to identify initiatives, timelines and methods and inductive conventional content analysis to capture lessons learned over time.

RESULTS: The directed content analyses identified 22 co-production initiatives from 1997 until today. Methods and approaches to facilitate co-production included development of personas, storytelling, person-centered care approaches, various co-design methods, QI interventions, harnessing of PPEs in different staff roles, and PPE-driven improvement and networks. The lessons learned included the following aspects of co-production: relations and structure; micro-, meso- and macro-level approaches; attitudes and roles; drivers for development; diversity; facilitating change; new perspectives on current work; consequences; uncertainties; theories and outcomes; and regulations and frames.

CONCLUSIONS: Co-production evolved as an increasingly significant aspect of services in the RJC health system. The initiatives examined in this study provide a broad overview and understanding of some of the RJC co-production journey, illustrating a health system's approach to co-production within a context of long-standing application of QI and microsystem theories. The main lessons include the constancy of direction, the strategy for improvement, engaged leaders, continuous learning and development from practical experience, and the importance of relationships with national and international experts in the pursuit of system-wide health-care co-production.

BACKGROUND: Pediatric healthcare today shows a rising demand for research focusing on children's perspectives on and consumer satisfaction with the nursing care they receive. Therefore, the purpose of this study was to translate and adapt the Consumer Emergency Care Satisfaction Scale (CECSS), a paper-based, self-administered 19-item questionnaire originally developed in the United States and targeted towards adults, and then test the new version in Swedish pediatric emergency departments.

METHODS: The study was designed with a two-phase approach. Firstly, a forward-backward translation of the CECSS, involving expert consensus, was performed, and then the questionnaire was adapted for children aged 10-18 and assessed for face and content validity. Secondly, the translated and adapted questionnaire was tested with a clinical sample for construct validity, internal consistency, and reliability. This last aspect was assessed using a structured telephone interview 7-10 days after the participant visited a pediatric emergency department. All children participating in this study gave their assent (< 15 years) or consent (≥ 15 years), and their guardian's written informed consent was also obtained.

RESULTS: The paper-based, self-administered 19-item Swedish version of the CECSS was tested on a clinical sample consisting of 203 nonurgent children (boys: n = 109, 53.7 % and girls: n = 94, 46.3 %) between 10 and 18 years (mean age 13.8, SD 2.29). The factor analysis revealed three factors that explain 63.1 % of the total variation in the 15 items. The Cronbach's alphas for the three dimensions (caring, teaching, and clinical competence) varied between 0.79 and 0.88. The intraclass correlation coefficient (ICC) for the entire Swedish version of the CECSS was 0.58, and the ICCs for the three dimensions varied between 0.56 and 0.71.

CONCLUSIONS: The results show that the developed Swedish Pediatric Consumer Emergency Care Satisfaction Scale (p-CECSS-S) is a valid, stable and easy-to-use-questionnaire that can be used to assess children's satisfaction with nursing care.

Purpose: Children's visits to the ICU are still restricted, and more focus on the child's own needs and experiences are needed. The aim of this study is to illustrate the meaning of being a visiting child of a seriously ill parent receiving care at the ICU.

Method: A qualitative descriptive design was used, with open-ended interviews with seven children (6-18 years) performed and analysed using a phenomenological research approach.

Findings: Being a visiting child of a seriously ill parent receiving care at the ICU is described as a life situation taking place in an unfamiliar environment, characterized by a heartfelt, genuine desire to be there, in an interdependence entailing offering a loved one the help they need while at the same time being seen in a compassionate way and being able to share, revealing a sudden awakening of an inner truth of reality and a sense of a healing wisdom of understanding.

Conclusions: The children felt good when they visited their ill parent, but at the same time not fully involved, and desired a more compassionate, caring approach by the nurses. Improvements are needed in how to approach visiting children in a more individual and caring way.

Background: Since the number of persons diagnosed with multi-morbidity is increasing, there is a need for generic instruments to be able to assess, measure and compare ADL ability across diagnoses. Accordingly, the ADL-Interview (ADL-I) was developed to be used in rehabilitation research and clinical practice. The aim of this study was to investigate if the ADL-I can be used to provide valid and reliable ADL ability measures across gender and diagnostic groups. Methods: ADL-I data were extracted from an existing research database on persons with chronic conditions including medical, rheumatological, oncological, neurological, geriatric and psychiatric diagnoses. Data were analysed based on Rasch Measurement methods to examine: the psychometric properties of the rating scale; ADL item and person fit to the Rasch model; if the difficulty of the ADL tasks differs across gender and diagnostic groups, and if the ADL-I provides precise and reliable measures of ADL ability. Results:Data on n = 2098 persons were included in the final analysis. Initial evaluation of the 0-3 rating scale revealed threshold disordering between categories 1 and 2. After removal of 16 underfitting items, the variance explained by the Rasch dimension increased from 54.3 to 58.0%, thresholds were ordered, but the proportion of persons with misfitting ADL-I measures increased slightly from 8.7 to 9.1%. The person separation index improved slightly from 2.75 to 2.99 (reliability = 0.90). Differential test function analysis, however, supported that the 16 underfitting items did not represent a threat to the measurement system. Similarly, ADL items displaying differential item functioning across gender and diagnoses did not represent a threat to the measurement system. The ADL items and participants were well distributed along the scale, with item and person measures well targeted to each other, indicating a small ceiling effect and no floor effect. Conclusions: The study results overall suggest that the ADL-I is producing valid and reliable measures across gender and diagnostic groups among persons within a broad range of ADL ability, providing evidence to support generic use of the ADL-I.

Background Migrants are often more vulnerable to health issues compared to host populations, and particularly the women. Therefore, migrant women's health is important in promoting health equity in society. Participation and empowerment are central concepts in health promotion and in community-based participatory research aimed at enhancing health. The aim of this study was to identify conditions for health promotion together with women migrants through a community-based participatory research approach. Methods A community-based participatory research approach was applied in the programme Collaborative Innovations for Health Promotion in a socially disadvantaged area in Malmo, Sweden, where this study was conducted. Residents in the area were invited to participate in the research process on health promotion. Health promoters were recruited to the programme to encourage participation and a group of 21 migrant women participating in the programme were included in this study. A qualitative method was used for the data collection, namely, the story-dialogue method, where a process involving issue, reflections and actions guided the dialogues. The material was partly analysed together with the women, inspired by the second-level synthesis. Results Two main health issues, mental health and long-term pain, were reflected upon during the dialogues, and two main themes were elaborated in the process of analysis: Prioritising spare time to promote mental health and Collaboration to address healthcare dissatisfaction related to long-term pain. The women shared that they wanted to learn more about the healthcare system, and how to complain about it, and they also saw the togetherness as a strategy along the way. A decision was made to start a health circle in the community to continue collaboration on health promotion. Conclusions The community-based participatory research approach and the story dialogues constituted an essential foundation for the empowerment process. The health circle provides a forum for further work on conditions for health promotion, as a tool to support migrant women's health.

BACKGROUND: Enjoying cultural events such as musical performances is a human right as well as contributing to quality of life. However, older people who live in nursing homes are often excluded from such events. Music interventions for older people with cognitive decline have been shown to have a positive effect on their mood and behaviour, particularly in terms of anxiety, agitation and irritability.

AIM: To investigate the effect of musical interventions in nursing homes from the perspective of older people, their relatives and caregivers.

METHOD: Musical performances were held at 11 nursing homes in Sweden. These performances were followed by semi-structured interviews that aimed to capture the experiences of the older people, their relatives and caregivers. The interviews were analysed by qualitative thematic analysis.

FINDINGS: Four relational themes were generated from the analysis: music enhances well-being for the body and soul, music evokes emotions and a 'spark of life', music adds a 'silver lining' to everyday life, and music inspires a journey of the imagination through time and space.

CONCLUSION: The music concerts had a positive effect on older people, their relatives and caregivers. Providing cultural encounters in nursing homes is an important caring intervention.

Purpose: Current guidelines primarily use medication levels to distinguish severe asthma from other types of asthma. In addition, severe asthma must also be uncontrolled at high-intensity treatment or become uncontrolled if treatment level is decreased. To date, only a few studies have used this definition to investigate the prevalence and clinical characteristics of severe asthma in population-based samples. Therefore, the aim of this study was to evaluate the prevalence and clinical characteristics of individuals with severe asthma in the population-representative West Sweden Asthma Study. Materials and Methods: In this cross-sectional population-based study, a randomly selected sample (n=1172) and a separate asthma sample (n=744) underwent clinical examinations, completed a structured interview and responded to questionnaires. Severe asthma was defined as at least one feature of uncontrolled asthma despite treatment in line with the Global Initiative for Asthma (GINA) steps 4/5. This treatment level required a minimum medium dose of inhaled corticosteroids (ICS) plus a second controller or oral corticosteroids. Results: The prevalence of severe asthma was 1.1% in the adult random sample and 9.5% within the asthma sample. Individuals with severe asthma were older and had more symptoms, activity limitations, heart disease and blood neutrophils compared to those with other asthma. They also had lower lung function and despite these impairments, 32% did not have annual contact with a healthcare provider. Conclusion: The prevalence of severe asthma was higher compared to previous studies, and many individuals with severe asthma did not have regular contact with healthcare providers. Due to the high burden of symptoms and impairments for individuals with severe asthma, it is important that the healthcare system implement strategies to improve follow-up and evaluate these patients according to existing guidelines.

Background: Forefoot gangrene in patients with diabetes is a severe form of foot ulcers with risk of progress and major amputation. No large cohort studies have examined clinical characteristics and outcome of forefoot gangrene in patients with diabetes. The aim was to examine clinical characteristics and outcome of forefoot gangrene in patients with diabetes admitted to a diabetic foot centre. Methods: Patients with diabetes and foot ulcer consecutively presenting were included if they had forefoot gangrene (Wagner grade 4) at initial visit or developed forefoot gangrene during follow-up at diabetic foot centre. Patients were prospectively followed up until final outcome, either healing or death. The median follow-up period until healing was 41 (3-234) weeks. Results: Four hundred and seventy-six patients were included. The median age was 73 (35-95) years and 63% were males. Of the patients, 82% had cardiovascular disease and 16% had diabetic nephropathy. Vascular intervention was performed in 64%. Fifty-one patients (17% of surviving patients) healed after auto-amputation, 150 after minor amputation (48% of surviving patients), 103 had major amputation (33% of surviving patients) and 162 patients deceased unhealed. Ten patients were lost at follow-up. The median time to healing for all surviving patients was 41 (3-234) weeks; for auto-amputated, 48 (10-228) weeks; for minor amputated, 48 (6-234) weeks; and for major amputation, 32 (3-116) weeks. Conclusion: Healing without major amputation is possible in a large proportion of patients with diabetes and forefoot gangrene, despite these patients being elderly and with extensive co-morbidity.

Risk factor studies on male-perpetrated intimate partner homicide (IPH) are often compared with studies on intimate partner violence (IPV) or non-partner homicide perpetrators. This not only excludes female perpetrators, but also fails to take socio-demographic and psychosocial differences between perpetrators and the general population into consideration. The aim of this study was to examine male- and female-perpetrated IPH cases, and to compare socio-demographic factors in IPH perpetrators and in matched controls from the general population. Data were retrieved from preliminary inquiries, court records and national registers for 48 men and 10 women, who were perpetrators of IPH committed in 2000–2016 and residing in Region Västra Götaland, Sweden. The control group consisted of 480 men and 100 women matched for age, sex and residence parish. Logistic regression, yielding odds ratios (OR) with 95% confidence intervals (CI), was performed for male perpetrators and male controls to investigate associations for selected socio-demographic and psychosocial characteristics. This was not performed for females due to the small sample size. Female perpetrators were convicted of murder to a lesser extent than male perpetrators. No woman was sentenced to life imprisonment while five men were. Jealousy and separation were the most common motivational factors for male perpetration while the predominant factor for female perpetrators was subjection to IPV. Statistically significant differences were found between male perpetrators and male controls in unemployment rate (n = 47.9%/20.6%; OR 4.4; 95% CI 2.2–8.6), receiving benefits (n = 20.8%/4.8%; OR 5.2; 95% CI 2.3–11.7) and annual disposable income (n = 43.8%/23.3% low income; OR 5.2; 95% CI 1.9–14.2) one year prior to the crime. Female IPH perpetrators were less educated than female controls (≤ 9-year education 30%/12%) and were more often unemployed (70%/23%) one year before the crime. Male and female IPH perpetrators were socio-economically disadvantaged, compared with controls from the general population.

Background & aim: Women and men with diabetes, type 1 (T1D) and type 2 (T2D) develop complications in small and large blood vessels as well as in nerve pathways over time. In men, erectile dysfunction is a well-documented complication. However, sexual dysfunction in women with different types of diabetes is less studied. Sexual dysfunction is associated with lowered health-related quality of life and depression. The aim of the study was to investigate self-reported sexual function and signs of depression in middle-aged women with long-lasting T1D. 

Methods: A cross-sectional questionnaire study including the Female Sexual Function Index (FSFI) and the Patient Health Questionnaire (PHQ-9) together with background questions was designed. The sample was women aged 45-66 with T1D for at least 15 years, identified from clinical medical records at four hospitals in southern Sweden. Descriptive statistical analysis of background factors, depression, and self-reported sexual dysfunction, as well as correlation and regression analysis, are presented. 

Results: A total of 212 women completed the questionnaire, mean age 54.1 (SD: 5.83), mean years with T1D 36.2 (SD: 11.42). Almost half of the women had sexual dysfunction (45.2%; FSFI < 26.55, max 36) and the mean full score was 23.73 (SD: 10.57). The FSFI domains are desire, arousal, lubrication, orgasm, satisfaction and pain. Symptoms of depression measured by PHQ-9 were reported by 39.8%. A low FSFI was significantly associated with severe depression (p<0.001). 

Conclusions: Problems with sexual dysfunction and depression in middle-aged women with long-lasting T1D are common and may be unreported unless addressed in clinical care. Nurses could start asking women about problems with lubrication and vaginal pain in relation to sexual activity. Lubricants or local estrogen therapy could prevent those problems. Routinely assessing depressive status is equally important in improving quality of life for women with T1D. 

Infectious diseases exacerbated by Antimicrobial Resistance (AMR) are of increasing concern in Sweden, with multi-drug resistant strains associated with new resistance mechanisms that are emerging and spreading worldwide. Existing research has identified that sub-optimal living conditions and poor access to healthcare are significant factors in the spread and incubation of AMR strains. The article considers this linkage and the effort to control the spread of AMR in relation to migrants, highlighting deficiencies in public policy where such individuals are often increasingly exposed to those conditions that exacerbate AMR. In many of the richest countries, those conditions are not accidental, but often direct goals of policies designed with the goal of deterring migrants from staying within host countries. Without engaging with the politics around migration control, the article points to urgent need for more holistic assessment of all public policies that may, however unintentionally, undermine AMR control through worsening living conditions for vulnerable groups. The consequences of prioritizing policies meant to deliberately worsen the living conditions of migrants over avoiding those conditions that accelerate AMR spread, are today made ever apparent where new AMR strains have the potential to dwarf the societal effects of the current Covid-19 pandemic.

Aim To explore child health professionals' experiences of the early implementation of the rotavirus vaccination in the two regions that first introduced this vaccination in Sweden. Methods A descriptive and repeated cross-sectional study based on a digital study-specific questionnaire with a baseline in 2014 and with a 2-year follow-up in 2016. The study population consisted of nurses and doctors working in child health centres in the health care regions of Stockholm and Jonkoping. Results In Stockholm, a larger proportion of the respondents (n = 355) had concerns in 2014, in comparison with the respondents in Jonkoping (n = 101), mostly about the vaccination being a new and time-consuming task (60% versus 23%). In 2016, the overall attitude to vaccination was more positive in both regions and the levels of concern about increased workload were reduced (Stockholm, n = 519, 39%, versus Jonkoping, n = 96, 10%). Challenges before and after the introduction in both regions were particularly related to how to give information about the vaccine's potential increased risk of intussusception. Conclusion The gap between respondents' knowledge, attitudes and concerns pre- and post-vaccination introduction was larger in Stockholm compared to Jonkoping. In both regions, overall, the implementation of the rotavirus vaccination was perceived as being easier than expected.

In Sweden, there is a lack of nurses with competence in intensive and critical care as well as experienced critical care nurses with a formal education in preceptorship. Using the peer learning model could be one way to assure the quality of critical care practice placements for post-graduate nursing students as this model requires only one preceptor for every two students. This study's aim was to examine the experience of preceptors regarding peer learning at a university hospital intensive care unit. The study followed a qualitative descriptive design. The participants were nine preceptors with experience working as critical care nurses ranging from 3 to 24 years. Each preceptor was interviewed individually using a semi-structured interview guide. The data were subjected to conventional inductive content analysis. The analysis reveals three categories: collaboration and communication; responsibility; and psychosocial environment. Some preceptors felt responsible for the delivery of adequate clinical practice despite students having difficulties in communicating and collaborating with each other or being at different experience levels. While preceptors and students need more preparation and knowledge about peer learning it can, nevertheless, contribute to the development of collaboration and communication skills within the intensive care setting.

BACKGROUND: Reliable and valid measurement is the foundation of evidence-based practice. The self-administered Foot Health Assessment Instrument (S-FHAI) was recently developed to measure patients' evaluations of their own foot health. Evidence regarding the psychometric properties of the S-FHAI is limited. The aim of this study was to investigate those properties by using a Rasch analysis.

METHODS: This methodological study analysed secondary data that was collected from nurses (n = 411) in 2015. The psychometric properties of the S-FHAI were evaluated using the Rasch model. Unidimensionality was analysed first, followed by item functioning, person misfit and differential item functioning (DIF).

RESULTS: The S-FHAI demonstrated evidence of unidimensionality, with an acceptable item fit according to the Rasch model. Person fit and person separation were low, however, indicating restricted separation among different respondents. Item separation was high, demonstrating clear discrimination between the items. No DIF was detected in relation to gender, but significant DIF was demonstrated in relation to age for 6 of the 25 items.

CONCLUSIONS: The S-FHAI has potential for use in investigating self-reported foot health. The Rasch analysis revealed that the psychometric properties of the instrument were acceptable, although some issues should be addressed to improve the scale. In future, it may be beneficial to analyse the sensitivity of the items and to test the S-FHAI in more diverse patient populations.

Although the concept of clinical education wards has shown encouraging outcomes regarding nursing students' satisfaction with clinical placements in somatic care, the existing research in a psychiatric context is sparse. This study aims to explore nursing students' experience during clinical education at a psychiatric clinical education ward. A qualitive descriptive study with content analysis, using interviews with 16 bachelor's degree nursing students was conducted. The results indicated that an enriched and adapted learning environment focusing on psychiatric nursing with peer learning supported independence and progression into the future nursing role.

The role and position of users in health and welfare has recently changed to become more active in co-production of care. When more co-production is preferred, challenges related to power need to be considered. In this paper, power is seen as the possibility to influence. The paper focuses on power in co-produced improvement work by introducing a reflection model based on Franzén’s power triangle, further developed from improvement coaches’ perceptions. First, empirical data from interviews with improvement coaches were analyzed and then the theoretical model was created. Twelve coaches were included in the interviews, all of them with experience of co-production and improvement work within a region in southeast Sweden. By combining the empirical results with the power triangle, a reflection model concerning power dimensions was developed. The results showed the necessity of reflection regarding several power-related factors. Resources were found to be important and depending on contextual settings. Attitudes and perceptions among personnel and users were also vital. To accomplish co-production, the power dimension must be considered, and the power triangle acknowledges different power dimensions and how they affect each other. The model has a systematic character and allows adjustments to the power dimensions within any other context. It can inspire and be used by improvers working with co-production to promote deeper professional and organizational reflection and thereby contribute to new insights on how to balance power in co-producing health and welfare services. © 2021, The Author(s).

Background: Everyday life outside home and accessing a variety of places are central to occupation. Technology is ever more taken for granted, even outside home, and for some may culminate in occupational injustice. This study aims to explore the association between everyday technologies (ET), particularly out of home, and the number of places older adults with and without dementia go to, in rural and urban environments. Method: The Everyday Technology Use Questionnaire, and Participation in Activities and Places Outside Home Questionnaire, were administered with 128 people in England. Six logistic regression models explored the association between ET and the number of places people went to, with other demographic factors (i.e., rurality, diagnosis, deprivation). Results: The amount of out of home technologies a person perceived relevant and relative levels of neighbourhood deprivation were most persistently associated with the number of places people went to. Associations with ability to use technology, diagnosis, and education were more tentative. In no model was rurality significant. All models explained a low proportion of variance and lacked sensitivity to predict the outcome. Conclusion: For a minority of people, perceptions of the technological environment are associated with other personal and environmental dimensions. Viewed kaleidoscopically, these associations assemble to generate an impermanent, fragmented view of occupational injustice that may jeopardise opportunities outside home. However, there will be other influential factors not identified in this study. Greater attention to the intersections between specific environmental dimensions may deepen understanding of how modifications can be made to deliver occupational justice.

Introduction Older persons with cognitive impairment have often been disregarded in providing information on their own perceptions. This study explored the number of relevant everyday technologies and the ability to use everyday technologies as perceived by persons with cognitive impairment in comparison with their proxies' estimates using the Short Everyday Technology Use Questionnaire. Method In this cross-sectional study, persons with cognitive impairment (n = 21) and their proxies (n = 21) were interviewed on separate occasions with the Short Everyday Technology Use Questionnaire, which measures the number of relevant everyday technologies and the ability to use everyday technologies. The data were analysed with t-tests, z-comparisons, and Fisher's exact test. The level of significance was set at p < 0.05. Results At the group level, no significant differences were found between persons with cognitive impairments' perceptions and their proxies' estimates regarding the number of relevant everyday technologies or the ability to use everyday technologies. On the individual level, significant differences were found in the ability measures within four out of the 21 dyads. Conclusion The persons with cognitive impairment and their proxies verified each other's responses, providing evidence that persons with cognitive impairment should be the primary source for information about their own everyday technology use.

Aims and objectives To map the existing literature on support models provided to family members during the cancer trajectory. Background Cancer diagnosis, treatment and survivorship have a profound influence on the surrounding family members. This scoping review is part of the development of a support model for family members of persons diagnosed with colorectal cancer. Design The method was guided by the Arksey and O'Malley framework, described in the Joanna Briggs Institute guidelines, and the reporting is compliant with PRISMA-ScR Checklist. Searches were conducted in PubMed, CINAHL and PsycINFO from November 2019-February 2020 with no limitation in publication year or study design. Complementing searches were conducted in reference lists and for grey literature, followed by an additional search in September 2020. Inclusion criteria were primary research about support provided by health care, to family members, during cancer, of an adult person, in Swedish or English, of moderate or high methodological quality. Quality was assessed using the Joanna Briggs Institute critical appraisal tools. Data were extracted using a charting form. Result A total of 32 studies were included in the review describing 39 support models. Conclusion The mapping of the existing literature resulted in the identification of three themes of support models: psychoeducation, caregiver training and psychological support. In addition, that future research should target a specific diagnosis and trajectory phase as well as include family members and intervention providers in model development. Relevance for clinical practice Knowledge from the literature on both the needs of the family members and existing support models should be incorporated with the prerequisites of clinical practice. Clinical practice should also be complemented with structured assessments of family members' needs conducted regularly.

GamTest is a self-rating scale of negative consequences of gambling, included in the popular responsible gambling tool Playscan as part of an overall risk assessment and feedback feature. Two previous psychometric evaluations of this instrument yielded contradictory results: in an online high-gambling population, a five-factor model was supported and the instrument had overall good psychometric properties, but in a low-gambling population, the same factor structure was not supported. Because GamTest is used with both low- and high-gambling populations, more psychometric research is needed to fully understand how the instrument works. The current study examined, for the first time, psychometric performance among a sample of low-gambling respondents using a Rasch analysis. Results indicated that the instrument could be improved by decreasing the scale-steps and removing several problematic items demonstrating misfit. Furthermore, the findings indicated that some items functioned differently depending on gender, and that a shortened, improved nine-item version could not differentiate between different levels of risk. Our findings suggest that the instrument would arguably benefit from being adapted for use in a low-gambling population.

BACKGROUND: Despite healthcare scholars valuing diversity, current cultural awareness training does not address mechanisms that drive societal patterns, that generates cultural insensitivity and reinforces stereotypes of minority groups. The influence of culture on thinking is an important issue because of potential ethnocentric biases on the design, data collection, analysis, and dissemination of research.

OBJECTIVES: Using internationalization-at-home activities to explore the mechanisms that enhance the development of cultural awareness in postgraduate health and social science research students.

DESIGN AND METHODS: A pragmatic critical realist study, qualitatively dominant, using mixed-methods to integrate and analyze qualitative and quantitative data. Data were collected pre- and post-internationalization-at-home activities. Qualitative data were collected from online discussion forums and focus groups, and quantitative data were collected from a pre-test and post-test measure of cultural awareness.

SETTING AND PARTICIPANTS: Eighteen research students in postgraduate health and social science programs from three universities (Australia, Hong Kong, and Sweden) participated in five formal internationalization-at-home webinars and informal international group activities.

RESULTS: Participants reported four mechanisms counteracting structures (i.e., ethnocentric biases) toward the emergence of cultural awareness: 1. awareness of cultural issues motivating people toward achieving a common goal; 2. reflexivity within psychological safety; 3. deliberations that challenge the veracity of individual assumptions; 4. courage coupled with curiosity. When some or all the mechanisms occurred, properties of enhanced cultural awareness emerged, as confirmed by the quantitative data.

CONCLUSIONS: Cultural awareness training should emphasize social relations to allow cultural safety to develop for postgraduate health and social science research students. Without skills revealing unconsciously held ethical values, this study argues that postgraduate health and social science students may inadvertently reconstitute and reinforce in their research the discrimination of underserved groups.

BACKGROUND: The number of errors in medication management in nursing homes is increasing, which may lead to potentially life-threatening harm. Few studies on this subject are found in the municipal nursing home setting, and causes need to be identified. The aim of this study was to explore perceptions of errors connected to medication management in nursing homes by exploring the perspective of first-line registered nurses, registered nurses, and non-licensed staff involved in the care of older persons.

METHODS: A qualitative research approach was applied based on semi-structured interviews with 21 participants at their workplaces: Seven in each of the occupational categories of first-line registered nurses, registered nurses, and non-licensed staff. Subcategories were derived from transcribed interviews by content analysis and categorized according to the Man, Technology, and Organization concept of error causation, which is as a framework to identify errors.

RESULTS: Mistakes in medication management were commonly perceived as a result of human shortcomings and deficiencies in working conditions such as the lack of safe tools to facilitate and secure medication management. The delegation of drug administration to non-licensed staff, the abandonment of routines, carelessness, a lack of knowledge, inadequate verbal communication between colleagues, and a lack of understanding of the difficulties involved in handling the drugs were all considered as risk areas for errors. Organizational hazards were related to the ability to control the delegation, the standard of education, and safety awareness among staff members. Safety issues relating to technology involved devices for handling prescription cards and when staff were not included in the development process of new technological aids. A lack of staff and the lack of time to act safely in the care of the elderly were also perceived as safety hazards, particularly with the non-licensed staff working in nursing homes.

CONCLUSIONS: The staff working in nursing homes perceive that the risks due to medication management are mainly caused by human limitations or technical deficiencies. Organizational factors, such as working conditions, can often facilitate the occurrence of malpractice. To minimize mistakes, care managers need to have a systemwide perspective on safety issues, where organizational issues are essential.

BACKGROUND: With rapidly ageing population worldwide, loneliness among older adults is becoming a global issue. Older migrants are considered being a vulnerable population and ethical issues are often raised in care for elderly. A deeper sense of loneliness, existential loneliness is one aspect of loneliness also described as the ultimate loneliness. Making oneself understood or expressing emotions, have shown to be particularly challenging for older migrants which could lead to experience of existential loneliness. Ageing and being a migrant are potential triggers for experiencing existential loneliness. There appears to be, however, little known about being a migrant experiencing existential loneliness in old age.

AIM: This study explored older migrants' experience of existential loneliness.

RESEARCH DESIGN: Qualitative study.

PARTICIPANTS AND RESEARCH CONTEXT: Data were collected through interviews (n = 15) with older (>65) migrants' in Swedish nursing homes or senior citizen centres. A thematic analysis was performed to analyse the data.

ETHICAL CONSIDERATIONS: The study was conducted in accordance with the principles of research ethics.

FINDINGS: The result was described in terms of three themes: (1) Choices made in life, (2) seeking reconciliation with life and (3) thoughts about death and dying in a foreign country.

DISCUSSION: Ethical reflection and knowledge about how older migrants' life story can lead to experiencing existential loneliness, could be of use in care for older migrants'.

CONCLUSION: This study indicates that the experience of existential loneliness derived from being a migrant is a long-term and significant process. Migration was a hope of creating a meaningful life, the experience of existential loneliness occurred as migrants sought reconciliation with life, reflected upon their past choices, and thought about death and dying in a foreign country.

BACKGROUND: Although pressure ulcers, malnutrition, poor oral health and falls are common among older persons, causing deteriorated health status, they have not been studied altogether among older persons receiving different types of municipal health care. The aim of this study was to determine the prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls among older persons aged ≥65 years receiving municipal health care in southern Sweden.

METHODS: A retrospective cross-sectional study (n = 12,518 persons aged ≥65 years) using data from the national quality registry Senior Alert was conducted. The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was calculated based on categorical data from the instruments available in Senior Alert. T-tests, chi-square test, the Mantel- Haenszel test and logistic regression models were performed.

RESULTS: The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was 27.9, 56.3, 34.2 and 74.5% respectively. Almost 90% of the older persons had at least one health risk. The prevalence of risk for pressure ulcers, poor oral health and falls was significantly higher in dementia care units compared to short term nursing care, home health care and nursing homes. The prevalence of risk for malnutrition was significantly higher among older persons staying in short term nursing care compared to other types of housing. The odds of having a risk for malnutrition were higher in short term nursing care compared to other types of housing. The oldest age group of 95-106 years had the highest odds of having a risk for falls. The presence of multiple health risks in one subject were more common in dementia homes compared to nursing homes and home health care but not compared to short term nursing care.

CONCLUSION: The prevalence of risk for pressure ulcers, malnutrition, poor oral health and falls was high, implying that these health risks are a great concern for older persons receiving municipal health care. A comprehensive supporting preventive process to prevent all the investigated health risks among older persons receiving municipal health care is recommended.

Objectives: The aim of the present study is to determine how marital status and certain post-migration family structures are associated with the risk of mental illness among recently arrived Arabic- speaking refugees in Sweden. 

Methods: A cross-sectional study was conducted during 2015 and 2016. The study population was recruited by inviting all adult refugees who participated in the mandatory public integration support programme. All refugees that participated had received refugee status. A total of 681 of the invited participants returned the GHQ-12 questionnaires, through which the risk for mental illness was measured and only Arabic- speaking refugees (N=638) were included in the analyses. 

Results: Marital status per se was not associated with a risk for mental illness. However, for the whole study sample there was a statistical significant odds ratio of 1.72 (95% CI 1.03–2.86). For male Arabic-speaking refugees with a spouse or child left behind in the home country there was a borderline significant increased risk for mental illness, odds ratio = 1. 87 (95% CI 0.99–3.56). The risk for female Arabic-speaking refugees was non-significant, odds ratio = 1.35 (95% CI 0.55–3.33). 

Conclusions: Arabic- speaking refugees who were separated from family members reported an increased risk for mental illness after arriving in the host country. Actions to facilitate family reunion after arriving as a refugee (in Sweden) seems to be an important factor to promote mental health among refugees. 

OBJECTIVES: To compare short- and long-term emotional distress (grief, anxiety, depressive symptoms) after early miscarriage in women randomized to expectant management or misoprostol treatment, and to compare satisfaction with treatment.

METHODS: This is a randomized controlled trial (ClinicalTrials.gov ID: NCT01033903) comparing expectant management with misoprostol treatment of early miscarriage. If the miscarriage was not complete on day 31 after inclusion surgical evacuation was recommended. Main outcome measures were grief, anxiety, depressive symptoms and client satisfaction assessed by validated psychometric self-assessment instruments, i.e. Perinatal grief scale (PGS), Spielberger State-Trait Anxiety Inventory (STAI-S Form-Y), Montgomery-åsberg Depression Rating Scale Self-report version (MADRS-S) and Client Satisfaction Questionnaire (CSQ-8). There were four assessment points: the day of randomization, the day when the miscarriage was judged to be complete, and 3 months and 14 months after complete miscarriage. Analysis was by intention to treat.

RESULTS: 90 women were randomized to expectant management and 94 to misoprostol treatment. The psychometric and client satisfaction scores were similar in the two treatment groups at all assessment points. At inclusion, 41% (35/86) of the women managed expectantly and 37% (34/92) of those treated with misoprostol had STAI-state scores >46 ("high levels of anxiety") and 9% (8/86) and 10% (9/91) had symptoms of moderate or severe depression (MADRS-S score >20). In both treatment groups, symptom scores for anxiety and depression were significantly higher at inclusion than after treatment and remained low until 14 months after complete miscarriage. Grief reactions were mild. The median PGS score in both treatment groups was 40.0 at 3 months and 37.0 at 14 months after complete miscarriage. Four women treated with misoprostol and two women managed expectantly had PGS scores >90 (indicating deep grief) 3 months after complete miscarriage. One woman managed expectantly had PGS score >90 after 14 months. More than 85% of the participants in both groups would recommend the treatment they received to a friend.

CONCLUSIONS: The psychological response to and recovery after early miscarriage did not differ between women treated with misoprostol and those managed expectantly. Satisfaction with treatment was high in both treatment groups. Our findings support patient involvement when deciding on management of early miscarriage. This article is protected by copyright. All rights reserved.

Background. Persons living with dementia face a reduction of their life space outside home and disengagement from participation, linked to places visited. Purpose. This study explored stability and change in perceived participation in places visited outside home and its relationship with occupational gaps among older adults. Method. Older adults living with (n = 35) or without (n = 35) dementia were interviewed using the Participation in ACTivities and Places OUTside Home (ACT-OUT) questionnaire and the Occupational Gaps Questionnaire (OGQ). Data analysis used descriptive and inferential statistics. Findings. The group of people living with dementia reported significantly fewer places (p < .001) visited than the comparison group and having abandoned more places visited (p < .001) than the comparison group. The number of occupational gaps was significantly different between groups (p < .001). Implications. Participation outside home is not influenced in a uniform and straightforward way for persons living with dementia; the shrinking world effect appears differently in relation to types of places.

The nursing program is intended to prepare students for future occupational life. One role for nurses in thenursing occupation includes being prepared to communicate well in various patient situations. The aim of thisstudy was to describe variations in nursing students’ conceptions of a drama workshop to practically illustratecommunication in nurses’ work. This qualitative study was conducted at a university in southern Sweden. Interviewswith 15 nursing students were conducted and the data were analyzed using a phenomenographicapproach. Four descriptive categories were identified through the analysis: ‘Conceptions in relation to thedevelopment of empathy’, ‘Conceptions in relation to “my” learning’, ‘Conceptions in relation to personaldevelopment of professional identity’ and ‘Conceptions in relation to the understanding of applying pedagogythrough drama as a method’. This study illustrates that the use of drama in nursing education can increasenursing students’ understanding of professional communication relating to the care of patients. To use drama asan educational method provides opportunities to develop nurses’ professional identity and professional role.Moreover, drama can act as a teaching strategy that increases the understanding of theory through practical exercises.

PURPOSE: The experience of cancer could lead to positive psychological changes following the struggle with diagnosis and treatment. Understanding post-traumatic growth and its influencing factors in women affected by gynecological cancer is essential to enhance their possibility of achieving positive changes. The purpose of this study was to describe the post-traumatic growth level and explore the influencing factors of post-traumatic growth in Chinese women diagnosed with gynecological cancer.

METHOD: A cross-sectional survey with a convenience sampling method was employed to collect data using the Post-traumatic Growth Inventory (PTGI), Distress Disclosure Index (DDI), Medical Coping Modes Questionnaire (MCMQ), and Multidimensional Scale of Perceived Social Support (MSPSS). The questionnaires were administered to 344 participants recruited from two hospitals in Hefei City, the capital of Anhui Province in China, between March 2018 and March 2019. All statistical analyses were performed using nonparametric tests. The Mann-Whitney U Test was used to distinguish the intergroup differences. Correlations were evaluated with Spearman rank correlation coefficients.

RESULTS: Total score for PTGI was 56.5 (range 48.0-68.0). The subscale with the highest centesimal score in the PTGI was appreciation of life and the lowest was spiritual change. The top five items with the highest scores of PTGI belonged to appreciating life, personal strength, and relating to others. Self-disclosure, confrontation, avoidance, acceptance-resignation, perceived social support, education level, cancer type and the place they lived had significant influence on post-traumatic growth.

CONCLUSIONS: The findings indicate that women who have high levels of perceived social support, confrontation, avoidance, self-disclosure and education level tend to experience more post-traumatic growth, while, conversely, high levels of acceptance-resignation have a negative influence on promoting post-traumatic growth. These meaningful findings propose new perspectives for promoting post-traumatic growth in Chinese women diagnosed with gynecological cancer.

INTRODUCTION: Despite the rapidly increasing population of older adults, little is currently known about sexual activity and sexual satisfaction among the oldest people.

AIM: The present study aimed to investigate sexual activity and sexual satisfaction among people of ≥60 years of age. We also examined whether sexual activity and sexual satisfaction were influenced by age, gender, cohabiting, socioeconomic factors, education, functional ability, and self-reported health.

METHODS: We performed a descriptive analysis of self-stated sexual activity and sexual satisfaction among 1680 participants who were 60 years and older from the Swedish National Study on Aging and Care. Chi-square tests and logistic regression were used to analyze relationships between factors.

MAIN OUTCOME MEASURE: Sexual activity and sexual satisfaction.

RESULTS: Among participants aged ≥90 years, about 10% were sexually active. Within the total study population, 46% (654/1680) were sexually active. Overall, sexually activity was more commonly reported by men (55%) than women (40%). However, men in all age cohorts reported sexual dissatisfaction more commonly than women. In the total sample, 24% (246/1680) reported dissatisfaction with their sex life. Sexual activity and sexual satisfaction were positively associated with self-reported health and cohabitation.

CONCLUSION: The present results suggest that sexual activity is present throughout life. For persons older than 90 years, about 10% of participants were sexually active, regardless of gender. Every third man reported dissatisfaction with his sex life. Women were more satisfied with their sex lives than men, and this difference varies more widely among age cohorts. These findings confirm that it is important that health professional take sexuality into account during caring encounters with older persons. M Stentagg, L Skär, JS Berglund, et al. Cross-Sectional Study of Sexual Activity and Satisfaction Among Older Adult's ≥60 Years of Age. Sex Med 2020;XX:XXX-XXX.

BACKGROUND: In the light of the existence of social inequalities in health, a CBPR (Community Based Participatory Research) programme for health promotion started in Malmö, Sweden, in 2017. The programme was based on a penta-helix structure and involved a strategic steering group with representatives from academia, voluntary organisations, the business sector, the public sector, and citizens from the community where the programme took place. The aim of this study was to explore how the penta-helix collaboration worked from the perspectives of all partners, including the citizens.

METHODS: Individual interviews, that were based on a guide for self-reflection and evaluation of CBPR partnerships, were conducted with the representatives (N = 13) on three occasions, during the period 2017-2019. A qualitative content analysis was used to analyse the interviews.

RESULTS: Six themes emerged from the analysis, including Challenges for the partners in the penta-helix collaboration; Challenges for the professionals at the local level; Citizen-driven processes are important for the penta-helix collaboration; Health promoters are essential to build trust between different sectors of society; Shift of power; and System changes take time. The analysis shows that the penta-helix collaboration worked well at the local level in a governance-related model for penta-helix cooperation. In the overall cooperation it was the citizen-driven processes that made the programme work. However, the findings also indicated an inflexibility in organisations with hierarchical structures that created barriers for citizen involvement in the penta-helix collaboration.

CONCLUSION: The main issue uncovered in this study is the problem of vertically organised institutions where discovery and innovation processes flow down from the top, thereby eliminating the essential input of the people and community that they are supposed to serve. The success of the programme was based on an interprofessional cooperation at a local level, where local professions worked together with voluntary organisations, social workers, CBPR researchers from the university, citizens and local health promoters.

Rectal cancer surgery has developed to be highly technological and precise. Nevertheless, postoperative symptoms can affect patients for a long time after surgery and might also be persistent. The purpose of this study was to describe the level of postoperative symptoms 6 months after rectal cancer surgery as well as differences in symptoms with regard to surgical procedure. Data from 117 patients recovering from rectal cancer surgery were collected 6 months after surgery using the Postoperative Recovery Profile (PRP) questionnaire measuring self-reported postoperative symptoms. Results showed that the majority of patients had no or mild problems with the 19 symptoms recorded in the questionnaire. There was a significant difference between surgical procedures: patients after anterior resection experienced mild problems in gastrointestinal function (physical domain) and interest in their surroundings (social domain), whereas most patients after abdominoperineal resection and abdominoperineal resection with myocutaneous flap showed no problems. In all groups, a considerably high proportion of patients reported severe problems in sexual activity (physical domain). Findings in this study emphasize that healthcare professionals should pay attention to patients recovering from anterior resection especially regarding problems in the gastrointestinal function. Moreover, there is a need to acknowledge eventual sexual dysfunctions in all rectal cancer patients.

Objectives Formative peer assessment focuses onlearning and development of the student learning process.This implies that students are taking responsibility forassessing the work of their peers by giving and receivingfeedback to each other. The aim was to compile researchabout formative peer assessment presented in higherhealthcare education, focusing on the rationale, theinterventions, the experiences of students and teachersand the outcomes of formative assessment interventions.Design A scoping review.Data sources Searches were conducted until May 2019in PubMed, Cumulative Index to Nursing and Allied HealthLiterature, Education Research Complete and EducationResearch Centre. Grey literature was searched in LibrarySearch, Google Scholar and Science Direct.Eligibility criteria Studies addressing formative peerassessment in higher education, focusing on medicine,nursing, midwifery, dentistry, physical or occupationaltherapy and radiology published in peer-reviewedarticlesor in grey literature.Data extractions and synthesis Out of 1452 studies,37 met the inclusion criteria and were critically appraisedusing relevant Critical Appraisal Skills Programme, JoannaBriggs Institute and Mixed Methods Appraisal Tool tools.The pertinent data were analysed using thematic analysis.Result The critical appraisal resulted in 18 includedstudies with high and moderate quality. The rationale forusing formative peer assessment relates to giving andreceiving constructive feedback as a means to promotelearning. The experience and outcome of formativepeer assessment interventions from the perspectiveof students and teachers are presented within threethemes: (1) organisation and structure of the formativepeer assessment activities, (2) personal attributes andconsequences for oneself and relationships and (3)experience and outcome of feedback and learning.Conclusion Healthcare education must considerpreparing and introducing students to collaborativelearning, and thus develop well-designedlearningactivities aligned with the learning outcomes. Since peercollaboration seems to affect students’ and teachers’experiences of formative peer assessment, empiricalinvestigations exploring collaboration between studentsare of utmost importance.

Plasma cystatin C and shrunken pore syndrome (SPS) are associated with increased mortality in older adults. The objective was to assess the association between these markers of kidney function at admission and mortality in hip fracture patients. Hip fracture patients presenting at Lund University Hospital were eligible for inclusion. Cox regression was used to assess association between plasma cystatin C, creatinine, cystatin C- or creatinine-based estimations of glomerular filtration rate (eGFR(CYS) and eGFR(CREA)), or SPS (defined as eGFR(CYS)/eGFR(CREA) < 0.7) and mortality during one year follow up. Improvement in discrimination relative to the Nottingham Hip fracture score was assessed by Receiver Operational Characteristics (ROC) analysis and calculation of Net Reclassification Index (NRI). 996 patients were included in the study. Cystatin C, creatinine, eGFR(CYS) and eGFR(CREA) were associated with one-year mortality in both unadjusted and adjusted analyses. The association with mortality was stronger for cystatin C and for eGFR(CYS) than for creatinine and eGFR(CREA). Patients with SPS had doubled mortality compared with patients without SPS (43.7 and 20.2%, respectively, p < .001). Hazard ratio for SPS in the adjusted analysis was 1.66 (95%CI; 1.16-2.39, p = .006). None of the markers improved discrimination compared to the Nottingham Hip Fracture Score using ROC analysis whereas eGFR(CYS) and eGFR(CREA) improved NRI. Our conclusion is that plasma concentrations of creatinine or cystatin C, eGFR(CYS) or eGFR(CREA) or SPS at admission in hip fracture patients are associated with mortality when known risk factors are accounted for. Identification of high risk patients may be improved by eGFR(CYS) or eGFR(CREA).

Background: Patient harm is a global crisis fueling negative outcomes for patients around the world. Working together in an international learning collaborative fostered learning with, from and about each other to develop evidence-based strategies for developing quality and safety competencies in nursing.

Aims: To report student outcomes from an international learning collaborative focused on patient safety using the Quality and Safety Education for Nurses competency framework.

Methods: A global consortium of nursing faculty created an international learning collaborative and designed educational strategies for an online pre-workshop and a 10-day in-person experience for 21 undergraduate and graduate nursing students from six countries. A retrospective pre-test post-test survey measured participants' confidence levels of patient safety competence using the health professional education in patient safety survey and content analysis of daily reflective writings.

Results: Statistical analysis revealed student confidence levels improved across all eight areas of safe practice comparing-pre and post-education (significance, alpha of P < 0.05). Two overarching themes, reactions to shared learning experiences and shared areas of learning and development, reflected Quality and Safety Education for Nurses competencies and a new cultural understanding.

Conclusions: The international learning collaborative demonstrated that cross-border learning opportunities can foster global development of quality and safety outcome goals.

The aim of the thesis was to translate, psychometrically test, and further develop the Behavioral Pain Scale for pain assessment in intensive care and to analyze if any other variables (besides the behavioral domains) could affect the pain assessments. Furthermore, the aim was to explore the patients’ experience of pain within the intensive care.

The Behavioral Pain Scale (BPS), consisting of the domains “facial expression,” “upper limbs,” and “compliance with ventilator/vocalization,” was translated andculturally adapted into Swedish and psychometrically tested in a sample of 20 patients(study I). The instrument was then further developed within one of the domains and tested for inter-rater reliability, discriminant validity, and criterion validity (study II). The method for analysis in both study I and II was a method specifically developed for paired, ordered, and categorical data. To describe and analyze the process of pain assessment, a General Linear Mixed Model was used to investigate what variables, besides the behaviors, could be associated with the observers’ own assessment of the patients’ pain (study III). Further, the patients’ experiences of pain when being cared for in intensive care were explored (study IV) through interviews with 16 participants post intensive care. Qualitative thematic analysis with an inductive approach was used for the analysis.

The first psychometric tests of the BPS (study I) showed inter-rater reliability with agreement of 85%. For the discriminant validity, all domains, except “compliance with ventilator,” indicated discriminant validity.

Therefore, in study II, a developed domain of “breathing pattern” was tested alongside the original version. The BPS showed discriminant validity for both the original and the developed version and an inter-rater reliability with agreement of 76-80%. Wheninspecting the respective domains there was a difference in discriminant validity between the original domain of “compliance with ventilation” and the developed domain of “breathing pattern,” showing higher values on the scale for the developed domain during turning. For criterion validity, the BPS showed a higher sensitivity than the observers, who on the contrary had a higher specificity.The General Linear Mix Model (study III) showed that heart rate could be associated with the observers’ assessments of pain. For the behavioral signs, the result indicated that breathing pattern was most associated with the observers’ pain assessment, whilst facial expression did not show any impact on the observers’ assessments.

The patients’ experiences of pain (study IV) in intensive care were described as generating a need for control; they experienced a lack of control when pain was present and continuously struggled to regain control. The experience of pain was not only related to the physical sensation but also to psychological and social aspects, along with the balance in the care given, which was important to the participants.

In conclusion, the translated and developed version of the Swedish BPS showed promising psychometric results in assessing pain in the adult intensive care patients. Still, other signs, besides behavioral, is possibly used when pain assessing and therefore information about and training in pain assessment are needed to enhance the assessments that are made. Also, the patients’ own experiences highlight the importance of individualizing and adapting pain assessment and treatment to the needs of each patient. Making them a part of the team could enhance their feeling of control, thereby supporting them in facing the experience of pain.