Background: The Swedish Child Healthcare (CHC) system aims to provide equal and fair health care for all children and families in Sweden. Currently in Sweden, the CHC offers every family two home visits during the child's 1st year of life. During 2019, an extended home visit programme, called Grow Safely, was started in the region of Scania for first-time parents. The aim of the extended home visit programme was to provide support for first-time parents in order to improve the overall health of the child and family and contribute to better conditions for equal health. Instead of two home visits during the 1st year, a subsample of first-time parents would receive six visits during the child's first 15 months. These six visits would be conducted by CHC nurses and social workers, midwives, and dental assistants. In the present paper, we describe a research project related to the regional extended home visit programme; the project aims to illuminate the experiences of the participants and to investigate the perceived benefits of the programme in relation to improved health, social and emotional interaction between parent and child, and attitudes toward authorities and surrounding society.

Method/Analysis: In order to evaluate the introduction of the intervention, three qualitative interview studies and one quantitative study with follow-up questionnaires will be conducted. Since the research project also comprises studies focusing on the implementation and expectations of politicians, civil servants, organizational managers, and professionals working within the programme, interviews within these fields will be conducted.

Discussion: Sweden has a well-established CHC programme, but improvements are always possible. Previous research has shown that home visits are an effective tool to improve both the child's physical and mental health as well as the parents' well-being. However, this kind of intervention involves a significant investment from all organizations involved in the home visits; hence, it is important that the intervention is evaluated. The research project described in the present paper intends to examine the impact of the intervention, and its findings will aid decisionmakers in determining the future of the home visit programme.

Background: Little is known about physical activity among newly arrived refugees and what impact physical activity might have on their health, as measured by mental wellbeing, vitality, stress and sleep quality. Thus, this study sought to investigate the relationship between physical activity and wellbeing among refugees who were newly arrived in Sweden. Methods: The present study was based on the results from a survey, conducted in 2015-2016 among newly arrived adult refugees who spoke Arabic, Pashto, Somali or Dari, participated in a mandatory public integration support programme in the Scania region of Sweden and agreed to participate in the survey. Ultimately 681 participants completed the survey (a response rate of 39.5%). Results: We found a significant association between physical activity and mental wellbeing, vitality, stress and sleep quality among newly arrived refugees. Conclusions: Newly arrived refugees need to be informed about the importance of prioritizing physical activity for their health and wellbeing, regardless of their external circumstances, and supported in their attempts to do so.

This article puts intimate partner homicide (IPH) into a process perspective, and describes the situational precursors that constitute the build-up, that is, the first stage of the IPH process that precedes the deed. Fifty court files, from cases involving 40 male and ten female perpetrators, underwent thematic analysis. Our findings indicate that the build-up phase of an IPH is complex and encompasses several different features, of which some are clearly gendered. The results point to an escalation during the build-up: of possessiveness and violent behaviour in male-to-female cases, of alcohol/drug abuse, of mental health problems and/or of fears for the future, often connected to separation. Concurrent with previous research we found that women often kill in the context of their own victimisation. There were, however, other situations and motives that also stood out as being pertinent.The practical implications of these findings are that practitioners should be particularly attentive to escalation of known risk factors, especially male possessiveness, and be aware that (the victim wanting) a separation may initiate escalation with lethal consequences.

Key messages: IPH is a process that builds up over time.

Risk factors for IPH should be contextualised, in order to determine which are pertinent at the time of the crime.

The build-up to an IPH is complex, with several overlapping features. Some of these are clearly gendered and thus differ between male and female perpetrators.

PURPOSE: This study was carried out in order to evaluate children's experiences after taking part in the pilot clinical intervention "See Me" aimed at supporting children as relatives.

METHOD: A qualitative explorative design with interviews was chosen, with analyses using an inductive approach. Interviews were conducted with 19 children (9 aged 7-12 years and 10 aged 13-18 years). The younger children were asked to draw a picture of a person in hospital, using the Child Drawing: hospital (CD:H) instrument to measure the child's level of anxiety. The older children completed the Caring Professional Scale (CPS) as a measure of the caring approach in their encounter with the nurse.

RESULTS: The interviews with the children show that: they felt expected and welcomed at the hospital; they needed knowledge about their parent's situation; they needed information and participation based on their individual situation; and they needed the nurse to offer them information and support. The results from the pictures showed that one child had above-average levels of anxiety. The older children reported that the nurses were Competent Practitioners, but to a lesser degree that they were Compassionate Healers.

CONCLUSIONS: The results of this pilot study indicate that the structure of "See Me" could be used as a starting point to ensure that children as relatives receive information, advice, and support. Further the results indicate that both CD:H and CPS could be used to evaluated children's experiences of support when a parent has a long-term illness.

BACKGROUND: Patients with chronic diseases create their own subjective beliefs about their conditions based on their illness perceptions. In the common-sense model, illness perceptions constitute personal beliefs about illness with regard to five components: identity, timeline, cause, control/cure, and consequences. Patients' illness perceptions affect both their management of their disease and their adherence to treatment. Since patients with peripheral arterial disease need life-long treatment for secondary prevention, generating knowledge about illness perceptions in patients with peripheral arterial disease is essential.

OBJECTIVES: To systematically review and synthesise the literature on illness perceptions in patients with peripheral arterial disease.

DESIGN: A systematic review DATA SOURCES: PubMed, CINAHL, and PsycINFO.

REVIEW METHODS: A systematic search strategy was conducted in December 2017, with an update in July 2019. Two team members independently screened all titles and abstracts. A relevance and quality appraisal of the studies was performed. The references from the included studies were evaluated for additional studies. The data from 14 studies were extracted and synthesised using a "best-fit" approach to framework analysis. A deductive analysis was conducted using the common-sense model. The data not suitable for the framework were analysed separately using inductive conventional content analysis, yielding an additional component representing the retrospective consequences of peripheral arterial disease.

FINDINGS: The findings showed diversity in illness perceptions in each of the five components of the framework as well as in the additional component. The findings showed participants' lack of understanding of the chronic nature of the disease, i.e., about the timeline, the identity of the symptoms and the cause of the disease. The patients' beliefs about control and cures varied from having high motivation to engage in physical activity to thinking that walking could make their situations worse. There was fear about the future, as patients perceived disease progression and decreasing control to be consequences of their illness. Living with the disease, the emphasis in the additional component, was a process for regaining control and adapting to their situations.

CONCLUSIONS: Patients with peripheral arterial disease shape their own understandings of their conditions. These beliefs may influence their management of their disease and adherence to treatment. Therefore, the current study suggests that illness perceptions should be addressed when planning secondary prevention for patients with peripheral arterial disease.

BACKGROUND: Hip fractures represent a major clinical burden for patients. Studies on the effect of preoperative carbohydrate loading before different surgical interventions have shown promising results but have not been tested in patients with hip fracture.

AIM: This study aimed to investigate the effects of preoperative oral carbohydrate drinks on the postoperative energy intake and incidence of complications after hip fracture surgery.

METHOD: This was a pilot study using a quasi-experimental design with a control group and an intervention group.

RESULT: The number of patients affected by more than one complication was higher in the control group than in the intervention group. According to the logistic regression analysis, the risk of any postoperative complication was reduced by approximately 50% OR (95% CI) 0.508 (0.23-1.10) in patients in the IG compared to those in the CG (p = 0.085).

CONCLUSION: The result of this pilot study indicated that using preoperative carbohydrate drinks can decrease the number of postoperative complications in patients with a hip fracture. Furthermore, the number of patients who meet their energy needs during the first three days postoperatively might increase. More research is needed to confirm the effect of preoperative carbohydrate drinks.

Purpose: There have been calls for more knowledge of activities of daily living (ADL) performance in order to address interventions in pulmonary rehabilitation effectively. Everyday technology (ET) has become an integrated dimension of ADL, impacting the ways in which ADL is performed. To improve everyday functioning and quality of life, the use of ADL and ET use needs to be evaluated and addressed effectively in interventions. Therefore, the aim of this study was twofold: 1) to explore the quality of ADL performance, and 2) to investigate the relationship between observation and self-reported ADL performance and ability to use everyday technologies in people living with COPD.

Methods: This cross-sectional study involved 84 participants aged 46-87 years. Participants were recruited through healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were collected using standardized assessments that investigated different ADL perspectives: self-reported ADL tasks and ET use, observed motor and process ability, and need for assistance. Data were analysed and presented using descriptive statistics and Pearson's correlation coefficient.

Results: The most affected ADL tasks were mobility within or outside the home, lower dressing, bathing, pedicuring, cooking, shopping, cleaning and washing clothes. New insights into the quality of ADL performance in people living with COPD were presented in terms of detailed ADL motor skills and ADL process skills, as well as the predicted need for support to function in the community. Moreover, new insights into the relationship between observation and self-reported ADL performance (r=0.546, p<0.01; r=0.297, p<0.01) and between ADL performance and self-perceived ability to use ET (r=0.524, p<0.01; r=0.273, p<0.05; r=0.044, p=0.692) were presented.

Conclusion: Overall, the knowledge from the present study is valuable for focusing interventions that address challenging ADL performance and ET use through relevant and realistic activities. The ability to use ET is important to evaluate and target pulmonary rehabilitation.

OBJECTIVE: Globally, the role of nurse practitioner is evolving to meet increased healthcare demands. Nevertheless, there are factors hindering the development of this role, one of which involves differences in nurse practitioner education worldwide. Therefore, the objective of the present study is to identify what is known in the research field on the content of nurse practitioner educational programmes.

DESIGN AND DATA SOURCES: The literature scoping review follows a six-stage methodological framework including: i) formulate research questions, ii) identify relevant studies, iii) select studies, iv) chart data, v) collate, summarize and report the results, vi) consultations. Data bases searched included CINAHL, PubMed and ERIC and were followed by manual searching of reference list in the included papers. Of the 1553 papers identified, 16 met the aim of this study.

REVIEW METHODS: To answer the research questions 'what is the content of curricula in nurse practitioner education?' a deductive content analysis was used.

RESULTS: Two main categories emerged. The first was related to the professional nurse practitioner role and includes research and nursing theories, leadership and collaboration, and organizational, political, economic, regulatory and legislative issues. The second is related to becoming an autonomous practitioner and includes health promotion and disease prevention, and other medically oriented content.

CONCLUSIONS: The content identified is consistent with the core competencies that nurse practitioners are expected to have after graduation, which have been described by the International Council of Nurses and by other researchers. Given the lack of recent research in nurse practitioner education, the results of the present study advance knowledge in this research field. Additionally, this study may be of practical value in developing new nurse practitioner educational programmes.

Background: Palliative care focuses on identifying, from a holistic perspective, the needs of those experiencing problems associated with life-threatening illnesses. As older people approach the end of their lives, they can experience a complex series of problems that health-care professionals must identify and document in their patients’ records. Documentation is thus important for ensuring high-quality patient care. Previous studies of documentation in older people’s patient records performed in various care contexts have shown that such documentation almost exclusively concerns physical problems. This study explores, in the context of Swedish specialised palliative care, the content of documentation in older people’s patient records, focusing on documented problems, wishes, aspects of wellbeing, use of assessment tools, interventions, and documentation associated with the person’s death.

Methods: A retrospective review based on randomly selected records (n = 92) of older people receiving specialised palliative care, at home or in a palliative in-patient ward, who died in 2017. A review template was developed based on the literature and on a review of sampled records of patients who died the preceding year. The template was checked for inter-rater agreement and used to code all clinical notes in the patients’ records. Data were processed using descriptive statistics.

Results: The most common clinical notes in older people’s patient records concerned interventions (n = 16,031, 71%), mostly related to pharmacological interventions (n = 4318, 27%). The second most common clinical notes concerned problems (n = 2804, 12%), pain being the most frequent, followed by circulatory, nutrition, and anxiety problems. Clinical notes concerning people’s wishes and wellbeing-related details were documented, but not frequently. Symptom assessment tools, except for pain assessments, were rarely used. More people who received care in palliative in-patient wards died alone than did people who received care in their own homes.

Conclusions: Identifying and documenting the complexity of problems in a more structured and planned way could be a method for implementing a more holistic approach to end-of-life care. Using patient-reported outcome measures capturing more than one symptom or problem, and a systematic documentation structure would help in identifying unmet needs and developing holistic documentation of end-of-life care.

Registered nurses [RNs] are within the frontline of professional nursing and are expected to provide a diverse range of health care services to a varied and heterogenic group of patients. They are bound by a code of ethics that mandates that nurses respect all human rights regardless of the patient’s abilities or functional status. However, research implies that RNs do not feel adequately prepared to support patients with intellectual and developmental disabilities [IDD], and that patients with IDD are often misinterpreted and misunderstood in care. Gaining in-depth knowledge about how RNs can experience nursing for this group of patients is therefore of great importance. The overall aim of this thesis was to describe, appraise, integrate and synthesise knowledge concerning nursing for patients with IDD. A further aim was to explore and describe Swedish RNs’ perceptions of providing care for patients with IDD within a home health care setting.

This thesis consisted of two studies designed to investigate various aspects of nursing and caring for patients with IDD. Paper I was a systematic review using a meta-ethnographic approach, and Paper II was an interview study using a qualitative descriptive, interpretive design. Data was collected by systematic data base searches (Paper I), and by individual interviews (Paper II). The systematic review comprised 202 RNs (Paper I) and the qualitative descriptive study comprised 20 RNs. 

In the systematic review, data was analysed by a Line of Argument Synthesis [LOAs] as described by Noblit and Hare (1988), while the data in Paper II was analysed by content analysis.  

Nurses’ experiences and perceptions of nursing patients with an IDD could be understood from 14 LOAs. Six of these were interpreted to reflect a tentatively more distinctive and unique conceptualisation of RNs’ experience of nursing for this group of patients. The remaining eight LOAs were interpreted to reflect a conceptualisation of nursing per se that is a universal experience regardless of context or patient group (Paper I). In Paper II, the nurse’s perceptions were interpreted to be reflected by three overarching categories: Nursing held hostage in the context of care, Care dependant on intuition and proven experience and Contending for the patient’s right to adequate care.  

Absence of understanding and knowledge about IDD might be an explanation for the “otherness” that still appears to surround this group of patients. Concentrating on the person behind the disabilities label as well as on abilities instead of disabilities could be a reasonable approach in nursing care for patients with IDD. Thus, implementing nursing models focusing on person-centred care could support RNs to moderate the health and care inequalities that are still present among patients with IDD (Paper I). 

As a result of the home health care context and its organisation, the RNs perceived themselves as unable to provide care in accordance with their professional values. Not mastering the available augmentative and alternative communication tool additionally meant having to provide care based on second-hand information from support staff. The RNs also perceived that caring for this group of patients involved a daily battle for the patient’s rights to receive the right care at the right place and time and by the right person (Paper II). Hence, a broad base of evidence on what actually works best in clinical practice for this group of patients, particularly in the home care context, is still needed.

Methods

This study is a qualitative interview study. The authors used the stimulated recall interview (SRI) with nurses working at a children's hospital in southern Sweden for the data collection. In total twelve nurses were interviewed and qualitative content analysis was used for the data analysis.

Results

The results are presented as one theme: Need for higher competencies and evidence, and three categories: Routines can enable pain assessment, Trusting one's own assessment of the whole picture, and Pain assessment scales as an extra workload. The interviewed nurses acknowledged that pain assessment tools are a vital part of the field of pain treatment. They also had trust issues with measuring and estimating pain by means of a tool such as pain scale. Furthermore, their opinion was that too many different tools and methods add up towards a more blurry and stress‐related environment and due to a lack of consistent routines, pain assessment is seen as a work‐related burden in the daily routines.

Conclusion

Results from the present study indicated that nurses need clear routines in combination with continued education regarding pain assessment with pain scales, which might be the key to successful pediatric pain assessment and thus to better pain management within pediatrics.

BACKGROUND: Children are more vulnerable than adults to environmental risks. Also, children have little control over their environment. Unlike adults, they may be both unaware of risks and unable to make choices to protect their health. Children living in especially vulnerable areas might be even more at risk due to socioeconomic factors, immigration, and high crime rates. Therefore, the aim of this study was to describe the perceptions that schoolchildren from a socially vulnerable area have of safe environments.

METHODS: 52 nine-year-old schoolchildren from a socially vulnerable area participated in this study. The data collection consisted of an environmental walk with photovoicing, followed by rating of the photos, and a focus-group discussion elaborating on the photos and ratings. Six focus groups, with 6-8 children in each group, were conducted and analyzed using an inductive content analysis.

RESULTS: The results show that, according to the children, places that they think are bright and beautiful, where they can do fun things with others and do not risk being exposed to danger, create safety. To increase safety, the children suggested cleaning up, making the environment beautiful with grass and flowers, and painting it in nice colours. Furthermore, they suggested that building features that increase the opportunities to play and engage in activities together with others, would improve safety and enhance protection and surveillance.

CONCLUSIONS: All children have the right to protection and safety. Therefore, it is important to create safe environments for all children by listening to children's own voices.

Background:Understanding the dynamics and aspects of how activity choices impact health and well-being in people living with chronic obstructive pulmonary disease (COPD) is important to inform rehabilitation. Aim:To describe, firstly, how much time people living with COPD spend on work, daily living tasks, recreation and rest; secondly, how this population perceived competence, importance and enjoyment related to these activities; thirdly, if differences in such perceptions and time use were associated with the living situation and COPD severity. Material and methods:This cross-sectional study involved 76 participants (+45 years, COPD, living in ordinary homes), who completed the Occupational Questionnaire (OQ). Descriptive statistics and group comparisons were performed. Results:Most of the participants' time were spent on daily living activities and recreational activities. Participants spent approx. 80% of their recorded time in OQ on activities they valued, enjoyed and in which they felt competent. Participants living alone scored significantly lower on enjoyment in restful activities than those living in couples (p < 0.05). No statistically significant difference in perceived competence, importance or enjoyment was found in relation to COPD severity. Conclusions and significance:Findings underscore the importance of targeting overall daily activity repertoires including compositions of activity types, time use and perceived competence, importance and enjoyment.

BACKGROUND: Limited scientific evidence for prevention and treatment of diabetic foot ulcers in elderly with comorbidities.

AIM: To explore patient-related factors and outcomes in patients ≥75 years with diabetes and a foot ulcer.

METHOD: Sub-analysis of consecutively presenting patients ≥75 years (N = 1008) from a previous study on 2,480 patients with diabetic foot ulcer treated in a multidisciplinary system until healing. Patient characteristics: age - 81(75-96); diabetes type 2-98.7%; male/female - 49/51%; living with a spouse - 47%; nursing home 16%; or with home nursing 64%.

RESULT: Primary healing was achieved in 54%, minor amputation 8%, major amputation 9%, auto-amputation 2%, and 26% of the patients died unhealed. Among the oldest (88-96 years), 31% healed without any amputation. Extensive comorbidities were frequent: neuropathy 93%, visual impairment 73%, cardiovascular disease 60%, cerebrovascular disease 34%, and severe peripheral disease in 29% of the patients. Out of patients (80%) living in institutions or dependent on home nursing, 56% healed without amputation, compared to 44% of patients living in their own home without any support from social services or home nursing.

CONCLUSION: Healing without major amputation was achieved in 84% of surviving patients ≥75 years, despite extensive comorbidity and dependency.

Objective: To investigate the current prevalence of physician-diagnosed obstructive airway diseases by respiratory symptoms and by sex in Sweden and Finland.Method: In 2016, a postal questionnaire was answered by 34,072 randomly selected adults in four study areas: Västra Götaland and Norrbotten in Sweden, and Seinäjoki-Vaasa and Helsinki in Finland.Results: The prevalence of asthma symptoms was higher in Norrbotten (13.2%), Seinäjoki-Vaasa (14.8%) and Helsinki (14.4%) than in Västra Götaland (10.7%), and physician-diagnosed asthma was highest in Norrbotten (13.0%) and least in Västra Götaland (10.1%). Chronic productive cough was most common in the Finnish areas (7.7-8.2% versus 6.3-6.7%) while the prevalence of physician-diagnosed chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) varied between 1.7 and 2.7% in the four areas. Among individuals with respiratory symptoms, the prevalence of asthma was most common in Norrbotten, while a diagnosis of COPD or CB was most common in Västra Götaland and Seinäjoki-Vaasa. More women than men with respiratory symptoms reported a diagnosis of asthma in Sweden and Seinäjoki-Vaasa but there were no sex differences in Helsinki. In Sweden, more women than men with symptoms of cough or phlegm reported a diagnosis of CB or COPD, while in Finland the opposite was found.Conclusion: The prevalence of respiratory symptoms and corresponding diagnoses varied between and within the countries. The proportion reporting a diagnosis of obstructive airway disease among individuals with respiratory symptoms varied, indicating differences in diagnostic patterns both between areas and by sex.

Purpose Patients sustaining a hip fracture have a high mortality rate during the first postoperative year and the Sernbo score may stratify patients into a high, intermediate and low risk of death during this period. We assessed its predictive properties on patients from the National Swedish Hip Fracture Register. Patients and methods 55,716 hip fracture patients, 69% women older than 65 years at surgery (registered between 2010 and 2015) with complete Sernbo scores and mortality data were studied. Receiver-operating characteristics analyses (ROC) were used. Validation of Sernbo score was performed. Results The overall 1-year mortality rate was 26%-and 17%, 27.4% and 55.6% in the low, intermediate and high-risk groups, respectively. The ROC analysis indicated a predictive ability of the Sernbo score, with an AUC of 0.69 (CI 0.68-0.69). Conclusion In this registry-based study, the easy-to-use Sernbo scoring system proved to be appropriate and useful way to identify hip fracture patients with a high-risk mortality during the first postoperative year.

Background The increasing proportion of older people worldwide is challenging society and the healthcare sector to develop new solutions, such as involving volunteers, especially to combat loneliness among older people. Loneliness is a broad concept comprising, for example existential loneliness - a deep feeling of aloneness in the world. We know little about volunteers' experience of encountering older people's loneliness in general and existential loneliness in particular. Such knowledge is important in order to develop high-quality volunteering. Aim This study aimed to describe volunteers' experience of becoming and being a volunteer, and encountering older people's loneliness in general and existential loneliness in particular. Methods This descriptive qualitative study is based on eight focus group interviews and twelve individual interviews with volunteers from different organisations, analysed using conventional content analysis. Findings Being a volunteer meant being a fellow human being, alleviating loneliness for others and oneself. Becoming a volunteer was a way of finding meaning, and volunteering made the volunteers feel rewarded and simultaneously emotionally challenged. Being a volunteer also meant acting on one's values, challenging boundaries when necessary. Encountering loneliness, including existential loneliness, required sensitivity to others' needs for both closeness and distance. Conclusion Being a volunteer benefitted not only the older persons the volunteers met, but also the volunteers' own sense of meaning, by alleviating their own loneliness. Sharing existential thoughts and having meaningful conversations about life and death are challenging, but can contribute to the personal growth of the volunteers themselves. It is important to remember that not all volunteers are confident in having existential conversations, so it is important to pay attention to each volunteer's prerequisites and needs. In addition, there is a need for support to volunteers' engagement such as clarifying their role and clarifying the responsibility and expectations from health and social care.

Introduction: Good communication is crucial for safe and effective nursing care and is necessary in building interpersonal relationships with patients. The increase of global interactions in health care adds to the necessity of developing culturally competent communication in nursing. The purpose of the study was to gain a deeper understanding of interpersonal communication as experienced by nurses working in culturally diverse hospitals in India. Method: A descriptive qualitative method, analyzing 12 semistructured interviews conducted with nurses at two hospitals. Results: The study's themes focus on tools and techniques for working with culturally diverse patients and how to sustain the quality of care in diverse hospital settings. Language resources, language tools, and cultural knowledge were useful aids for nurses when communicating with transcultural patients. It helped the nurses gain confidence and foresee patient needs. Discussion: Highlighting transcultural interpersonal communication techniques within nursing offers a safer and more productive practice of nursing care.

Background: Increasingly services and interventions involve everyday information communication technologies (EICTs) in provision, however, use of EICTs among people with dementia is little known. Therefore, this study aimed to investigate the relevance, use, and ability to use EICTs between a group of older adults with dementia and a comparison group with no known cognitive impairment. Method: Interviews with 35 people with dementia, 34 comparison participants using the standardized Everyday Technology Use Questionnaire. Variables were compared using descriptive statistics, t-tests and correlation analyses. Results: Median 7 EICTs (maximum 31) were relevant to the group with dementia; significantly less than the comparison group's 11 (p< .05, d= 0.64). The difference in use appeared more pronounced (group with dementia 5, comparison group 10.5; p< .001, d= 0.93). Large, significant relationships were evident between ability to use technology, and relevant or used EICTs in the group with dementia. No such relationships in the comparison group. Conclusion: Differences in the amounts of EICTs relevant and used among people with and without dementia are further reflected in the dementia group's ability to use technology. Accommodating the demands that EICTs place on users and harnessing the dominant EICT relevancies and abilities of people with dementia better contributes towards an inclusive, dementia-friendly society.

Background: The Pediatric Evaluation of Disability Inventory (PEDI) is an assessment to evaluate children’s performance in activities of daily living.

Aims: The study investigated if the normative standard scores of the PEDI are applicable to the German version of the PEDI (PEDI-G) in Germany, Austria and Switzerland, and whether there are differences in the applicability of the PEDI-G between the three countries.

Materials and methods: 75 children with normal development (35 girls, 40 boys) from Germany (n = 17), Austria (n = 16), and Switzerland (n = 42) aged between 0.9 month and 7.3 years (SD = 2.03) participated in the study. Descriptive statistics, independent samples t-tests, univariate analyses of variance (ANOVA) and post hoc Tukey tests were applied.

Results: No significant differences were identified. However, the German-speaking sample showed higher scores for the domain social function in both scales and in the Caregiver Assistance Scale self-care. Lower scores were identified in the Functional Skills Scale mobility.

Conclusions and significance: The results support that the normative standard scores of the PEDI are applicable to the PEDI-G and for Austria, Germany and Switzerland, as no significant differences between the countries were identified. However, the generalizability of the results is limited due to sample size and recruitment procedures.

RATIONAL: Life satisfaction is strongly associated with participation in everyday life activities. Yet, older adults with cognitive impairments have been found to experience difficulties in accessing and engaging in more complex everyday activities, especially, if these involve everyday technology. Considering the rapidly advancing technological landscape, this may substantially affect individuals' life satisfaction and their participation in meaningful community-based and home-based activities.

OBJECTIVES: This study aimed to explore the associations between life satisfaction, ability to use everyday technology and number of relevant everyday technologies used in older adults (n = 117) with and without mild cognitive impairment (MCI) and Alzheimer's disease (AD). It also aimed to understand the role of depression, activity involvement and diagnosis regarding life satisfaction in this sample.

METHOD: Descriptive statistics, Mann-Whitney U tests and t-tests were applied to compare those satisfied and those dissatisfied with life regarding ability to use everyday technology and number of relevant everyday technologies used.

FINDINGS: The number of relevant community-based everyday technologies currently not used was significantly associated with being dissatisfied with life (p < 0.05). Further, depression and withdrawal from activities and interests significantly differed across life satisfaction groups, while no group differences were found regarding overall number of everyday technologies in use and ability to use everyday technology.

CONCLUSION: Attention from healthcare professionals and researchers to early withdrawal from activities that rely on community-based everyday technologies is called for, especially in older adults with depression. Preventing everyday technology-related barriers in community life may increase life satisfaction.

Objective: To study asthma exacerbations, healthcare utilization and health status among subjects with asthma with different treatment regimens and levels of asthma control. Methods: In 2012-2014, n = 1425 adults from a population-based asthma cohort within the OLIN studies (Obstructive Lung disease in Northern Sweden) were invited to a follow-up including spirometry and a structured interview, n = 1006 participated. Asthma Control Test (ACT) was used to detect uncontrolled asthma, and physical and mental dimensions of health were measured with SF-8. Pharmacological treatment use was classified by Global Initiative for Asthma treatment steps. Out of n = 830 with current asthma, n = 714 answered ACT (57% women, 32-92 years) and were included in the study. Results: Uncontrolled asthma increased per treatment step (no treatment 9.9%, treatment step 1-3 24.1%, and treatment steps 4-5 39.9%, p < 0.001). A higher proportion of subjects with uncontrolled asthma reported exacerbations, healthcare utilization, and worse health status than those with controlled asthma. The proportion of subjects reporting exacerbations, healthcare visits, emergency room visits and regular follow-up visits increased per treatment step. Worse health was associated with uncontrolled asthma, but not with the level of treatment. A higher proportion of women than men reported exacerbations, any healthcare visits, and lower health. Regular follow-up visits to a physician were uncommon (women 21.2% vs. men 14.6%, p = 0.022). Conclusions: Uncontrolled asthma is common in all treatment steps, and is associated with worse health status. However, health status did not differ by treatment steps. Identifying subjects with uncontrolled asthma regardless of treatment regimens should be a priority, thus follow-up visits are important.

Background: Activities of daily living (ADL) are crucial for children because they enable them to participate in everyday life. For the evaluation of children`s ADL performance, health professionals such as occupational therapists use standardized ADL assessments. To implement assessments into practice it is important that the score generated from an assessment can be viewed as a unidimensional measure. Aim: To investigate the factor structure of the German Pediatric Evaluation of Disability Inventory (PEDI-G) in a sample of typically developing children and children with an impairment. Material and Methods: An exploratory factor analysis (EFA) with factor rotation was performed to assess the factor structure for the PEDI-G domains (self-care, mobility and social function) of the Functional Skills Scale and the Caregiver Assistance Scale. Results: 262 children (118 (45%) girls and 144 (55%) boys) participated in this study. Their mean age (SD) was 4 years (SD 1.91). Results suggest that the PEDI domains of the Functional Skills Scale and the Caregivers Assistance Scale can be used as unidimensional measures to evaluate child`s ability to perform activities of daily living. Conclusion: The results of this study support the use of the PEDI-G for research and practice in Austria, Germany and Switzerland.

Aim: The aim of this study was to illuminate registered nurses’ (RNs) perceptions of Trust-Based Public Management (TBPM) in Swedish health care. Design: This study follows a phenomenografic approach guided by Ference Marton’s philosophy. Methods: Semi-structured interviews were used to identify variations in RNs’ perceptions of TBPM. Between February and April 2019, 24 RNs from five Swedish public healthcare departments participated in the study. Results: The results show that none of the participants had previously heard about the work of the Swedish Delegation for TBPM. The study revealed perceptions those politicians and managers were absent from the workplace, that power had been displaced to HR, and that perceptions of trust in the leadership and of working to guidelines varied. Perceptions varied between RNs employed by the municipalities and by the hospitals concerning administration, the time allotted for work, cooperation, and education.

Background: The world is facing increased migration as well as increased diabetes prevalence including earlier disease debut than ever before. Sedentary lifestyle and obesity constitute risk factors for development of diabetes type 2, the most common diabetes type among adults. It is thus important to increase the awareness of diabetes prevalence and of those being at risk for the disease. The aim was to focus on self-reported diabetes and weight in recently arrived migrants (RAM) in comparison with the rest of the population of Scania.

Methods: A cross-sectional study was used to collect data through random sampling using a self-administrated questionnaire. 10 000 questionnaires in Arabic were sent to adult RAM in Scania born in Syria or Iraq and 10 000 questionnaires to a random sample of the Scania population as a control group. The overall response rate was 32.8 %, 3461 were male and 3105 were female and the overall mean age was 44.7 (range 22 -70).

Results: 170 RAM and 147 controls reported diabetes, 741 RAM and 585 controls reported a body mass index (BMI) ≥ 30 kg/m2. A significantly higher prevalence of self-reported diabetes was observed among RAM (6.2% compared to 4.9%, p-value = 0.02). In comparison with age, significantly (p-value < 0.05) higher prevalence was present in RAM as compared to the control group in all age categories except the age category 65-80 where the difference was borderline significant (p-value = 0.056). With regard to BMI no significant difference was observed between the RAM and the control group having diabetes, but independently of diabetes the prevalence of BMI 25-30 kg/m2 and BMI ≥ 30 kg/m2 was significantly higher in RAM (p-value < 0.01).

Conclusions: Self-reported diabetes is more prevalent in RAM as compared to a control group representing the rest of the population in Scania. Considerably large amount of the respondents in both groups are overweight or obese and are therefore to be considered at risk for developing diabetes type 2.

Key messages 

Self-reported diabetes in Scania is more prevalent in RAM from Iraq and Syria than in the rest of the population in Scania.Health care services need to address that a large number of the population in Scania is being overweight or obese, which is even more prominent in RAM from Iraq and Syria.

BackgroundIn the light of the growing number of refugees that the world has faced during the last years it is reasonable to suggest that the number with both physiological and mental health needs will raise and result in increased public health challenges. Physical activity with its well documented positive impact on both mental and physical health might be one way for refugees to promote health. The importance of investigating participation in physical activity in this group and the impact it might have on their health and wellbeing cannot be underestimated. Few studies exists in the field and therefore, this study aimed to investigate physical activity in relation to mental well-being, vitality, stress and sleep quality among newly arrived refugees in Sweden. 

MethodsThe study was based on the results from a survey, conducted in 2015 - 2016 among newly arrived adult refugees who spoke Arabic, Pashto, Somali or Dari, participated in a mandatory public integration support programme in the Scania region of Sweden and agreed to participate in the survey. Ultimately 681 participants completed the survey (a response rate of 39,5%). 

ResultsWe found a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees.

ConclusionsNewly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, regardless of their external circumstances, and supported in their attempts to do so.

Key messages There is a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees.Newly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, and supported in their attempts to do so.

BackgroundEstablishing oneself in a new country is especially challenging for forced migrants affecting both physical and mental health. The Swedish introduction system includes a mandatory civic orientation program conducted in the refugeés native language, covering different aspects of the Swedish society. MILSA has advocated for including health promotion as a key component in the introduction system, stating that culturally sensitive health communication is a human right for refugees. Through this work, health communication is now included in the program in many parts of Sweden. However, there are challenges due to a lack of professional recognition related to the absence of a recognized training. In order to create a national capacity for a quality based civic and health communication, MILSA has developed a national training program carried out in collaboration with five universities, actors on local, regional, and national levels as well as NGOs and experts in different areas. 

MethodsA web-based program including six physical workshops is given nationally. The program consists of 22 modules targeting society and public health issues but also pedagogy, leadership and communication. Evaluation studies are included in the program targeting the education itself and as well as investigating effects on the refugees.

ResultsThe program has been running for three years ending in autumn 2020 including four admission periods. The early evaluation showed very encouraging results where participants reported a deeper knowledge of civics and public health, resulting in being more secure and comfortable in their daily work, including improvements regarding skills in pedagogy, leadership and conflict management.

ConclusionsThe need for an educational platform is recognized by many stakeholders in Sweden. The program has received a very positive evaluation. Due to this, MILSA has initiated a process of establishing a national commissioned program on permanent basis.

Key messages The program has been highly regarded by the communicators, due to the gained knowledge in their everyday work.The importance of health communication and professional development and its value for the recipients of civic orientation is recognized by many stakeholders within but also outside the country.

BackgroundAs there is incontrovertible evidence of the essential prerequisite of regular physical activity it is also important to understand how different life change events may impact individual's participation in physical activity. Pregnancy and the transition to parenthood have been found to be life change events associated with decreased physical activity among women however, the examination of changes of physical activity in the male parent during this major life change event has been largely neglected in scientific literature and a significant research gap can be found. In the light of this, this longitudinal study aimed to follow changing physical activity patterns among women and med during pregnancy and eight months postpartum compared to pre-pregnancy.

MethodsThe study involved 123 women and 112 men (partners of the women) from the municipality of Karlskrona, Sweden. We measured the self-reported amount of physical activity performed outdoors and indoors before pregnancy (calculated from one month before pregnancy), throughout the entire pregnancy, and eight months postpartum. 

ResultsWe found similar trends among both women and men in decreasing frequency of physical activity during pregnancy and eight months postpartum as compared to pre-pregnancy, however, overall physical activity levels did not change.

ConclusionsOur findings contribute new knowledge about changes in men's physical activity patterns from pre-pregnancy to pregnancy and postpartum and is an important contribution in research, as the area is very limited. As couples seem to change activity patterns similarly, it is important to promote family-based physical activity initiatives and encourage couples to be active together during pregnancy and postpartum. 

Key messages Couples seem to change physical activity patterns similarly during pregnancy and postpartum. as compared to pre-pregnancy.It is important to promote family-based physical activity initiatives and encourage couples to be active together during pregnancy and postpartum.

IMPORTANCE: Occupational therapy education and practice has changed over time; however, items on the American Occupational Therapy Association's (AOTA's) Fieldwork Performance Evaluations (FWPEs) for the Occupational Therapy Student (OTS) and Occupational Therapy Assistant Student (OTAS) have not been updated in more than two decades.

OBJECTIVE: To explore evidence of validity in relation to test content of the revised FWPEs for the OTS and OTAS.

DESIGN: A qualitative study using cognitive interviews was conducted to gather perspectives on the revised FWPEs, including updated items and a proposed rating scale. A content analysis approach was used to link patterns in responses to stable, meaningful constructs to further align and refine content of the tool before further validation.

SETTING: Fieldwork sites and academic settings.

PARTICIPANTS: Eighteen fieldwork educators (FWEs) and academic fieldwork coordinators.

RESULTS: Seven areas for refinement were identified: (1) relevance to a variety of practice settings, (2) overlapping and redundant items, (3) long item statements, (4) double- and triple-barreled item statements, (5) alignment between OTS and OTAS items, (6) further alignment with AOTA and Accreditation Council for Occupational Therapy Education documents and contemporary practice, and (7) wording and features of the proposed rating scale. The findings guided revisions of FWPE content.

CONCLUSIONS AND RELEVANCE: Cognitive interviewing was a critical step in refining the FWPE items to support content validity. The issues identified may not have been detected using traditional approaches to survey development and therefore were critical in maximizing the validity and usefulness of the final items, which will ultimately benefit fieldwork educators and students.

WHAT THIS ARTICLE ADDS: This study resulted in refinements to FWPE items before the next step in the validation process, ultimately improving the final FWPE items. In addition, this article outlines a process that other researchers can use to validate similar tools.

OBJECTIVE: This study aimed to describe registered nurses' (RNs) experiences of providing respiratory care in relation to hospital acquired pneumonia (HAP), specifically among patients with acute stroke being cared for at in-patient stroke units.

BACKGROUND: One of the most common and serious respiratory complications associated with acute stroke is HAP. Respiratory care is among the fundamentals of patient care, and thus competency in this field is expected as part of nursing training. However, there is a paucity of literature detailing RNs' experiences with respiratory care in relation to HAP, specifically among patients with acute stroke, in the context of stroke units. As such, there is a need to expand the knowledge base relating to respiratory care focusing on HAP, to assist with evidence-based nursing.

DESIGN: A qualitative descriptive study.

METHOD: Eleven RNs working in four different acute stroke units in Southern Sweden participated in the current study. The data were collected through semi-structured interviews, and the transcribed interviews were analysed using inductive content analysis.

RESULTS: Three overarching categories were identified: (1), awareness of risk assessments and risk factors for HAP (2) targeting HAP through multiple nursing care actions, and (3) challenges in providing respiratory care to patients in risk of HAP. These reflected the similarities and differences in the experiences that RNs had with providing respiratory care in relation to HAP among in-patients with acute stroke.

CONCLUSIONS: The findings from this study suggest that the RNs experience organisational challenges in providing respiratory care for HAP among patients with acute stroke. Respiratory care plays a vital role in the identification and prevention of HAP, but our findings imply that RNs' knowledge needs to be improved, the fundamentals of nursing care need to be prioritised, and evidence-based guidelines must be implemented. RNs would also benefit from further education and support, in order to lead point-of-care nursing in multidisciplinary stroke teams.

Purpose. The aim of this study was to strengthen the healthcare professionals' readiness to support patients who have asthma, an allergy, and COPD for better medication adherence. Methods. The design was an educational intervention in a study population (n = 70) consisting of 66 nurses and four other allied healthcare professionals working in primary care with patients diagnosed with asthma, allergy, or COPD in a county in southern Sweden. As part of two training days, an educational intervention-consisting of lectures and workshops-was conducted. Both qualitative and quantitative data were collected. The qualitative data were collected during the workshops when the participants worked with fictitious patient cases. They documented in writing how they, based on the theoretical content in the educational intervention in combination with their clinical experiences, reasoned that the fictitious patients could be supported for better adherence. This documentation constituted qualitative data. The quantitative data were collected through questionnaires, which the participants completed before and after the intervention. Data from the questionnaires were statistically analyzed using descriptive statistics and paired t-tests. The qualitative data collected from the workshops were analyzed with content analysis. Results. The intervention increased the participants' knowledge of adherence (pre mean 3.95 versus post mean 4.18, p=0.001) and how to better support patients' adherence to medication (pre mean 3.71 versus post mean 3.98, p=0.001). Moreover, their knowledge of how to measure patients' adherence behavior (pre mean 3.02 versus post mean 3.54, p=0.001) and how to communicate with patients effectively about adherence was heightened (pre mean 3.92 versus post mean 4.13, p=0.011). Furthermore, participants felt that their readiness to support patients for better adherence had strengthened (pre mean 3.78 versus post mean 4.13, p=0.001). Individual adherence support for three fictitious patients with different adherence issues was developed. Conclusion. An educational intervention focusing on adherence and communication equipped healthcare professionals with tools to support patients with asthma, an allergy, or COPD for better medication adherence.

OBJECTIVE: Dementia is a common but underdiagnosed health problem. Instruments developed for initial screening exist internationally but are not available within the Swedish primary healthcare sector. This systematic review aimed to evaluate the diagnostic test accuracy of the Eight-item Informant Interview to Differentiate Aging and Dementia in identifying symptomatic dementia within a context similar to the Swedish primary healthcare sector.

DESIGN: reference lists up to November 2019. Eligibility criteria were the reporting of Diagnostic test accuracy outcomes for the Eight-item Informant Interview to Differentiate Aging and Dementia's ability to identify dementia according to internationally approved criteria. The population of interest was selected within the community or primary care. QUADAS-2 was used for quality assessment, and data were analysed with a narrative approach.

RESULTS: Five studies with a total of 13,345 participants were included. With sensitivity (88-100%), specificity (67-91%), positive and negative predictive values (28-63%; 96-100%) respectively, the results show that the Eight-item Informant Interview to Differentiate Aging and Dementia has good ability to identify true positives, false negatives and predict low-risk dementia. That is, the Eight-item Informant Interview to Differentiate Aging and Dementia has a greater ability to predict people who are at risk of not having dementia than to correctly identify those at risk of having dementia within the target population.

CONCLUSION: The results show that the Eight-item Informant Interview to Differentiate Aging and Dementia has the ability to identify persons with symptomatic dementia within the target population. Thus, an evaluation of its potential benefits should be considered and evaluated within the Swedish primary healthcare context. KEY POINTS Dementia is a common but underdiagnosed health problem. Instruments developed for initial screening exist but are not available within the Swedish primary healthcare sector. We found that the Eight-item Informant Interview to Differentiate Aging and Dementia (AD8), has the ability to identify individuals with symptomatic dementia within the target population. The Eight-item Informant Interview to Differentiate Aging and Dementia (AD8), has the potential to increase the possibility for timely detection of individuals with symptomatic dementia.

Didaktik är ett för lärare centralt praktik-teoretiskt kunskapsområde. Området har en lång historia inom akademin, men har aldrig slagit igenom vare sig inom akademin eller i skolan. Det är dags att ändra på det – gör didaktik till huvudområde inom lärarutbildning, på samma sätt som vårdvetenskap är huvudområde inom sjuksköterskeutbildning.

Background: The project “Precision Health and Everyday Democracy” (PHED) is a transdisciplinary partnership that combines a diverse range of perspectives necessary for understanding the increasingly complex societal role played by modern health care and medical research. The term “precision health” is being increasingly used to express the need for greater awareness of environmental and genomic characteristics that may lead to divergent health outcomes between different groups within a population. Enhancing awareness of diversity has parallels with calls for “health democracy” and greater patient-public participation within health care and medical research. Approaching health care in this way goes beyond a narrow focus on the societal determinants of health, since it requires considering health as a deliberative space, which occurs often at the banal or everyday level. As an initial empirical focus, PHED is directed toward the health needs of marginalized migrants (including refugees and asylum seekers, as well as migrants with temporary residency, often involving a legally or economically precarious situation) as vulnerable groups that are often overlooked by health care. Developing new transdisciplinary knowledge on these groups provides the potential to enhance their wellbeing and benefit the wider society through challenging the exclusions of these groups that create pockets of extreme ill-health, which, as we see with COVID-19, should be better understood as “acts of self-harm” for the wider negative impact on humanity.

Objective: We aim to establish and identify precision health strategies, as well as promote equal access to quality health care, drawing upon knowledge gained from studying the health care of marginalized migrants.

Methods: The project is based in Sweden at Malmö and Lund Universities. At the outset, the network activities do not require ethical approval where they will not involve data collection, since the purpose of PHED is to strengthen international research contacts, establish new research within precision strategies, and construct educational research activities for junior colleagues within academia. However, whenever new research is funded and started, ethical approval for that specific data collection will be sought.

Results: The PHED project has been funded from January 1, 2019. Results of the transdisciplinary collaboration will be disseminated via a series of international conferences, workshops, and web-based materials. To ensure the network project advances toward applied research, a major goal of dissemination is to produce tools for applied research, including information to enhance health accessibility for vulnerable communities, such as marginalized migrant populations in Sweden.

Conclusions: There is a need to identify tools to enable the prevention and treatment of a wide spectrum of health-related outcomes and their link to social as well as environmental issues. There is also a need to identify and investigate barriers to precision health based on democratic principles.

The overall aim of this thesis was to illuminate the meanings of existential loneliness(EL) and describe how it was eased, as narrated by frail older people, as well as toexamine existential aspects documented in patient records in specialised palliative care.Two of the constituent studies of this thesis were qualitative with an explorative anddescriptive design (i.e., studies I and II), and two studies were based on a retrospectivepatient record review, of which one was quantitative with an exploratory design (StudyIII) and the other was qualitative with a descriptive design (Study IV). The datacollection for studies I and II was based on individual interviews with frail older people75 or more years old. Studies III and IV were based on a randomly selected sample ofpatient records of frail older people who died in specialised palliative care during 2017.The data were collected using a pilot-tested review template to identify aspects of thedocumentation relating to the aims of the studies.The findings of Study I indicated that EL was a negative experience. Four themeswere identified related to meanings of EL: being trapped in a frail and deterioratingbody, being met with indifference, having nobody to share life with, and lacking purposeand meaning. The first theme was considered an overarching theme due to its closeinterrelatedness with the other three themes. The comprehensive understanding of ELamong frail older people was ‘being disconnected from life’, an experience of at leastmomentary abandonment, being left to one’s fate, and living a meaningless life. Study IIshowed that existential loneliness was eased when being acknowledged by others, beingthe focus of others’ concern, encountering intimacy, and having meaningful exchangesof thoughts and feelings. It was further eased when the participants could bracketnegative thoughts and feelings, that is, when they could adjust and accept the presentsituation, view life in the ‘rear-view mirror’, be in contact with spiritual dimensions, andwithdraw and distract themselves. Existential loneliness could be either in the forefront(i.e., feelings of ill-being) (Study I) or in the background (i.e., feelings of well-being)(Study II). The findings of Study III indicated that performed interventions were the14most common subject of documented clinical notes, mostly related to pharmacologicalinterventions. Pain was the most common documented problem, followed by circulatoryproblems, nutrition problems, and anxiety. Clinical notes concerning wishes and wellbeing-related details were documented, but not frequently. Overall symptom assessmenttools, especially multi-dimensional tools, were used to a small extent. More people whoreceived care in palliative in-patient wards died alone than did people who received carein their own homes. Study IV was based on notes extracted from 84 patient records.The results indicated that documented existential aspects had both negative and positiveconnotations and were related to the patients’ loss of freedom and self-determination,loneliness and community, anxiety and inner peace, and despair and hope. The notesconcerning existential aspects were, however, not recorded in a structured way and nocare plans relating to existential aspects were found.According to the studies, both ill-being and well-being were evident, and the livedbody occupied a central position in all studies. The frail body increased the patients’vulnerability and limited their living space. Meaningful activities and meaningfulcommunity and exchange with others eased the existential loneliness. Existentialloneliness remains invisible to others as long as nobody talks about it, and it remainsinvisible in the documentation as long as it is not documented in a structured way.This thesis demonstrates the importance of making existential loneliness and existentialaspects visible in encounters with frail older people and in the clinical documentation.

BACKGROUND: Cultural awareness and cultural competence have become important skills in higher education as populations continue to grow in diversity around the world. However, currently, there are few instruments designed to assess student awareness of the aspects of culture, and the existing instruments need further development and testing for use with different target populations. Therefore, the aim of this study was to test the psychometric properties of a modified version of the Cultural Awareness Scale (CAS) for use in higher education within the health and social care fields.

METHODS: A modified version of the CAS was developed, which was tested psychometrically using cross-sectional data. In total, 191 undergraduate students from different health and social care undergraduate programs in Sweden and Hong Kong responded to a call to test the modified instrument.

RESULTS: The results showed that the modified CAS is a four-factor measure of cultural awareness and possesses satisfactory internal consistency. Results also support the use of the modified CAS as a generic tool to measure cultural awareness among students in higher education within the health and social care fields.

CONCLUSION: The modified CAS showed satisfactory psychometric properties and can be recommended as a generic tool to measure cultural awareness among students in higher education within the health and social care fields. However, further psychometric testing on the effectiveness of the modified CAS as a tool to evaluate the efficacy of cultural awareness interventions is required.

BACKGROUND: COPD has increased in prevalence worldwide over several decades until the first decade after the millennium shift. Evidence from a few recent population studies indicate that the prevalence may be levelling or even decreasing in some areas in Europe. Since the 1970s, a substantial and ongoing decrease in smoking prevalence has been observed in several European countries including Sweden. The aim of the current study was to estimate the prevalence, characteristics and risk factors for COPD in the Swedish general population. A further aim was to estimate the prevalence trend of COPD in Northern Sweden from 1994 to 2009.

METHODS: /FVC < lower limit of normal (LLN) criterion.

RESULTS: Based on the fixed ratio definition, the prevalence of COPD was 7.0% (men 8.3%; women 5.8%) in 2009-2012. The prevalence of moderate to severe (GOLD ≥ 2) COPD was 3.5%. The LLN based results were about 30% lower. Smoking, occupational exposures, and older age were risk factors for COPD, whereof smoking was the most dominating risk factor. In northern Sweden the prevalence of COPD, particularly moderate to severe COPD, decreased significantly from 1994 to 2009, and the decrease followed a decrease in smoking.

CONCLUSIONS: The prevalence of COPD has decreased in Sweden, and the prevalence of moderate to severe COPD was particularly low. The decrease follows a major decrease in smoking prevalence over several decades, but smoking remained the dominating risk factor for COPD.

Objective: This cross-sectional study aimed to present how the unique cancer experience in childhood influences young adults' quality of life (QOL). Methods: Qualitative and quantitative methods were used to code and analyze a study-specific questionnaire (133 items). These data are presented in accordance with a conceptual QOL/health-related QOL model. Results: The participants included 34 women and 28 men (n = 62) diagnosed with solid tumors/lymphoma in the period 1983-2003, who had been treated at the same childhood cancer center in Sweden. The current mean age was 28.7 years (range: 18-45, standard deviation [SD]: 6.3, median value: 28.5), the mean age at diagnosis was 12.9 years (range: 8-17, SD: 2.3, median value: 13), and the mean time elapsed since treatment was 15.7 years (range: 4-28, SD: 2.4, median value: 15). The response rate was 65%. Higher levels of psychological maturity were reported by women versus men (P = 0.01) and by survivors diagnosed with cancer during adolescence versus school age (P = 0.04). Male participants reported lower levels of physical limitations (P = 0.03) and emotional distress when being of treatment and in contact with health care services (P = 0.04). The strongest factor influencing QOL during therapy was parental support (97%), while the strongest factors after therapy were to live a life similar to peers (82%) and to be satisfied with one's life situation (81%). During treatment, limitations influencing QOL were related to lack of school support (2%), and after treatment, to deteriorated relationships with siblings (5%). Conclusions: Life-threatening diseases at young ages have long-term psychosocial effects with ambiguous results at multiple levels. To capture these experiences, we recommend clinical studies that are based on conceptual clarifying frameworks and adopt a quantitative and qualitative research approach.

Currently, there are few studies which examine targeted family-focused support when a family member is diagnosed with breast cancer. Thus, the aim of this study was to explore families' experiences of participating in a family nursing intervention identified as Brief Family Health Conversations (BFamHC) following the diagnosis of breast cancer. Semi-structured family interviews were conducted with nine families (including 29 family members) 2 weeks following the family-focused intervention of three sessions of BFamHC. Thematic analysis was used to analyze the data. Families reported the BFamHC as positive and as a unique kind of family health conversation, one that afforded them the opportunity to communicate and share their experiences as a family group. A family conversation, even one as time-limited as BFamHC, offered a sense of relational sharing and togetherness, thus preventing feelings of isolation and vulnerability. Therapeutic family-focused conversations, such as BFamHC, hold promise as a useful family nursing intervention following the diagnosis of breast cancer.

BACKGROUND: Implementation of person-centred care (PCC) is a challenging undertaking. Thus, a call has been issued for a robust and generic instrument to measure and enable evaluation of PCC across settings and patient groups. This study aimed to develop a generic questionnaire measuring patients' perceptions of PCC. Further aims were to evaluate its content and measurement properties using a mixed-methods approach entailing Rasch and qualitative content analyses.

METHODS: The study was conducted in three iterative phases. Phase one included six key informants to gain a broad view of the concept. Phase two entailed a Delphi study involving two rounds with eight experts who generated ratings on relevance, readability, comprehensiveness and suggestions for revision. Data were analysed using the Item Content Validity Index in conjunction with qualitative comments to improve the questionnaire. Phase three was performed using a mixed-methods design. Quantitative data were collected from patients (n = 553) responding to the questionnaire who were recruited from six in- and outpatient care units in a health care region in Sweden. Data was analysed using the Rasch measurement model. Qualitative data were based on the respondents' free-text comments, cognitive interviews (n = 10) and field notes, and then analysed with deductive content analysis.

RESULTS: A questionnaire was developed and operationalised based on the information given by key informants in phase one and then validated for its content by experts in phase two. In phase three Rasch analyses revealed problems with targeting, thresholds and two misfitting items. These problems were corroborated by data from the qualitative analyses, which also revealed some issues of wording and interpretation of items. When thresholds were resolved and two items removed, the questionnaire met the assumptions of the Rasch model.

CONCLUSIONS: Experts gave the questionnaire content high ratings and it met measurement requirements assumed by the Rasch model after revisions. Those problems on targeting that remain need to be addressed in future studies. Meanwhile, we regard the questionnaire as of sufficient quality to be useful in benchmarking PCC.

Refugees are already a vulnerable group in society and are in a stressful situation due to their often uncertain legal status in seeking asylum and integration in the new society after migration. Refugees are, in general, at greater risk of poor health outcomes when contracting Covid-19, exacerbated by poor living conditions and difficulties in accessing healthcare. The longer-term social consequences of the pandemic also disproportionately impact refugees, including social isolation, unemployment and difficulties to obtain correct health information. The aim of this paper is to review the social and health consequences that Covid-19 has brought to the refugees residing in Sweden. This needs to be emphasized in order to mitigate against these likely consequences and improve the overall well-being among such a highly vulnerable group in society. As Covid-19 demonstrates, human health needs to be understood holistically, meaning that the vulnerability of any individuals, or even nations, is a vulnerability for the whole population requiring urgent action. 

Keywords: Covid-19, refugees, social situation, health information

Importance: Occupational therapy can play a role in primary care management of chronic diseases among older adults. Objective: To assess the feasibility of delivering a primary care occupation-focused intervention (Integrated PRimary care and Occupational therapy for Aging and Chronic disease Treatment to preserve Independence and Functioning, or i-PROACTIF) for older adults with chronic disease. Design: Feasibility study comparing i-PROACTIF with complex care management using a two-group randomized controlled trial design with data gathered at baseline and during and after the 8-wk intervention. Setting: Family medicine clinic serving an urban, low-income, working-class community. Outcomes and Measures: Feasibility indicators were recruitment, retention, utility of clinical assessments, and acceptability of interventions assessed through feedback surveys completed by patients and primary care providers (PCPs). Patient outcomes, including perspectives on chronic illness care, occupational performance, and overall well-being, were collected using standardized, validated measures and analyzed descriptively. Participants: Eighteen adult volunteers, ages X50 yr, with heart disease, arthritis, and uncontrolled diabetes completed the study. Ten PCPs completed feedback surveys. Intervention: i-PROACTIF focuses on preserving functional independence, is based on the Person-Environment-Occupation framework, and consists of two assessment sessions and six weekly treatment sessions. Results: Recruitment goals were achieved, with an 86% retention rate. Clinical measures unearthed deficits in areas that were unreported or underreported by patients. Participants reported being extremely satisfied with the intervention. Physicians and nurses also supported the intervention. Both groups showed improved scores on most outcomes. Conclusion and Relevance: Delivering and evaluating i-PROACTIF was feasible and acceptable. Future efficacy trials are needed before it can be used in clinical settings. What This Article Adds: The results of this study can inform future occupational therapy interventions and clinical trials in primary care for older adults with chronic conditions.

Syftet var att avtäcka innebörden av patienters återhämtning från psykisk ohälsa utifrån en psykiatrisk professionell omvårdnadskontext. Forskningsdesignen som användes var fenomenologisk kvalitativ metod med djupintervjuer. Resultatet presenteras i en struktur sammansatt av tre konstituenter: 1) Förståelsen att återhämtning tar tid och är en del av patientens hela liv och berättelse, 2) fokus på att stödja patienten i riktning mot återhämtning samt 3) målet att först och främst arbeta med patientens självuppfattning och identitet. Resultatet är förenligt med det som i forskning anses främja återhämtningen för patienter inom den psykiatriska vården. Resultatet överensstämmer även med den personcentrerade vården och omvårdnadsmodellen The Tidal Model. Resultaten pekar således på arbetssätt som kan ingå i sjuksköterskans återhämtningsinriktade arbete i den psykiatriska vården.