Aim: To report data from the first national pressure ulcer prevalence survey in Sweden on prevalence, pressure ulcer categories, locations and preventive interventions for persons at risk for developing pressure ulcers. Methods: A cross-sectional research design was used in a total sample of 35 058 persons in hospitals and nursing homes. The methodology used was that recommended by the European Pressure Ulcer Advisory Panel. Results: The prevalence of pressure ulcers was 16.6% in hospitals and 14.5% in nursing homes. Many persons at risk for developing pressure ulcers did not receive a pressure-reducing mattress (23.3–27.9%) or planned repositioning in bed (50.2–57.5%). Conclusions: Despite great effort on the national level to encourage the prevention of pressure ulcers, the prevalence is high. Public reporting and benchmarking are now available, evidence-based guidelines have been disseminated and national goals have been set. Strategies for implementing practices outlined in the guidelines, meeting goals and changing attitudes must be further developed.

BACKGROUND: Left ventricular (LV) dysfunction is well documented in the critically ill. We assessed 1-year mortality in relation to cardiac biomarkers and LV function parameters by echocardiography in patients with shock. METHODS: A prospective, observational, cohort study of 49 patients. B-natriuretic peptide (BNP), highsensitive troponin T (hsTNT) and transthoracic echocardiography (TTE) were assessed within 12 h of study inclusion. LV systolic function was measured by ejection fraction (LVEF), mean atrioventricular plane displacement (AVPDm), peak systolic tissue Doppler velocity imaging (TDIs) and velocity time integral in the LV outflow tract (LVOT VTI). LV diastolic function was evaluated by transmitral pulsed Doppler (E, A, E/A, E-deceleration time), tissue Doppler indices (e, a, E/e) and left atrial volume (La volume). APACHE II (Acute Physiology and Chronic Health Evaluation) and SOFA (Sequential Organ Failure Assessment) scores were calculated. RESULTS: hsTNT was significantly higher in non-survivors than in survivors (60 [17.0-99.5] vs 168 [89.8-358] ng/l, p = 0.003). Other univariate predictors of mortality were APACHE II (p = 0.009), E/e (p = 0.023), SOFA (p = 0.024) and age (p = 0.031). Survivors and nonsurvivors did not differ regarding BNP (p = 0.26) or any LV systolic function parameter (LVEF p = 0.87, AVPDm p = 0.087, TDIs p = 0.93, LVOT VTI p = 0.18). Multivariable logistic regression analysis identified hsTNT (p = 0.010) as the only independent predictor of 1-year mortality; adjusted odds ratio 2.0 (95% CI 1.2- 3.5). CONCLUSIONS: hsTNT was the only independent predictor of 1-year mortality in patients with shock. Neither BNP nor echocardiographic parameters had an independent prognostic value. Further studies are needed to establish the clinical significance of elevated hsTNT in patients in shock.

Background: Previous studies have reported conflicting findings on academic achievement in children with type 1 diabetes, and generally lower self-assessed health status among respondents with diabetes. Objective: Thus, in this study, using the theoretical framework of the human-capital model, a population-based survey data set for Sweden, and explanatory variables following predictions from theory and previous empirical human-capital studies, individuals diagnosed with diabetes before the age of 19 were examined whether they differ from the general population at the same age concerning (i) educational level attained and (ii) self-assessed health later in life. Special attention was devoted to the association between education and health. Subjects: A set of pooled cross-sectional population survey data complemented with register data, comprising 20 670 individuals (of whom 106 individuals were diagnosed with diabetes), aged 19–38 yr, from 1988 to 2000, was created from the Swedish Biennial Survey of Living Conditions. Method: The influence of childhood diabetes was analyzed using multiple regression analysis, controlling for educational level, wage, sex, age, marital status, and parental ethnicity. Results: Childhood diabetes was associated with lower levels of attained education and self-assessed health in comparison with the general population. More educated individuals reported better health, though. Conclusions: In terms of the rapid increase in the incidence of diabetes in many countries, it is important to bear in mind that investments made both in education and in health, early in life, may facilitate the capability of the individual to experience healthy time later in life.

This study of 17,443 childbearing women, investigated the relationship between hospital admissions 5 years prior to index birth, type of mental disorders and risk factors for mode of delivery. Hospital based electronic perinatal medical records between 2001 and 2006, were linked with the Swedish National Inpatient Care Registry 1996–2006. Of all the women, 39.3% had had inpatient care prior to index birth (27.3% had had obstetric, 10.1% somatic, and 1.9% psychiatric inpatient care). Diagnoses of mental disorders at psychiatric admission (n = 333) were categorized into five groups: personality/behavioral/unspecified disorder (30.9%), affective disorders and ‘suicide attempt’ (28.9%), neurotic/somatoform disorders (18.9%), substance use (17.1%) and schizophrenia (4.2%). Women with history of psychiatric care were more often smokers, below age 24 and single (p < 0.001, respectively), had more markers of mental ill-health in pregnancy records (p ≤ 0.001), compared to women without such previous care, and fewer were nulliparous (p < 0.001). The results show that women with prior psychiatric inpatient care and those with identified mental ill-health in pregnancy records, were associated with increased adjusted risks of cesarean sections. Identifying a woman’s mental health status in pregnancy may predict and prevent emergency cesarean section.

Interprofessional education (IPE) is an educational strategy attracting increased interest as a method to train future health care professionals. One example of IPE is the clinical training ward, where students from different health care professions practice together. At these wards the students work in teams with the support of facilitators. The professional composition of the team of facilitators usually corresponds to that of the students. However, previous studies have revealed that nurse facilitators are often in the majority, responsible for student nurses’ profession specific facilitation as well as interprofessional team orientated facilitation. The objective of this study was to describe how nurses act when facilitating interprofessional student teams at a clinical training ward. The research design was ethnography and data were collected through participant observations and interviews. The analysis revealed the four strategies used when facilitating teams of interprofessional students to enhance collaborative work and professional understanding. The nurse facilitator as a team builder is a new and exciting role for nurses taking on the responsibility of facilitating interprofessional student teams. Future research needs to explore how facilitating nurses balance profession specific and team oriented facilitating within the environment of an interprofessional learning context.

Abstract Objective: To identify predictors as free-text markers for mental ill-health from an electronic perinatal record (EMR) system and the association for emergency cesarean section (CS) in nulliparous women. Design: Population-based study using an EMR system. Setting: The catchment area of Malmö University Hospital in Sweden. Population: 6 467 women with complete perinatal electronic records (EMR) were selected of 10 662 nulliparous women presenting with a singleton cephalic baby for vaginal delivery between 2001 and 2006. Methods: Free-text search of markers for mental ill-health and multivariate logistic regression. Main Outcome Measures: Eleven markers for mental ill-health were tested with Cohen’s kappa for agreement and used as exposure variables. Odds ratios (OR) with 95% confidence interval (CI) were calculated for emergency CS, and adjusted for maternal age, diabetes, epidural anesthesia, and gestational weeks <37 and >41 by a multivariate logistic regression model with vaginal delivery as the reference. Results: Three markers identified from the EMR system reached statistically significant associations with an increased risk for emergency CS in nulliparous women: stress adjusted OR 1.66 (95% CI 1.34–2.06), sleep adjusted OR 1.57 (1.14–2.16), and worry adjusted OR 1.41 (1.10–1.79). Conclusions: Free-text words in medical records, indicating stress, sleep disturbances, or worry predicted increased adjusted OR for emergency CS in first-time mothers. Recognizing pregnant women’s reporting of their mental health status could have a predictive bearing on delivery outcomes.

AIM: The aim of this study was to investigate to what extent individual-based extended information given to mothers from city parts of low education can improve precautions taken by them to prevent burn and scald injuries involving young children in the home and further to compare the results with a group of mothers who had not received extended information. METHODS: This intervention study, with a comparison group, has a quasi-experimental design. Individual-based information, with an empowerment approach, was given to a group of mothers living in two separate areas of a city in southern Sweden with a low level of education. In total, 99 mothers of children under the age of 7 months participated. The mothers were selected through the local child healthcare authorities. Observations were made and bivariate analyses were established. RESULTS: The results showed that the intervention had a significant impact on improving the precautions the participating mothers introduced to protect their children against burn and scald injuries in the home and further, in relation to a comparison group. CONCLUSIONS: Through empowerment, workshops, and home visits aimed to increase their consciousness and knowledge, the participating mothers' precautions taken against child injuries in the home improved. It is of great importance that a framework for considering the problem of burn and scald injuries to children is presented from a preventive perspective which, in combination with evidence-based interventions, may enable the creation of injury prevention programmes for implementation by the community health care.

Background: Although both labour dystocia and domestic violence during pregnancy are associated with adverse maternal and fetal outcome, evidence in support of a possible association between experiences of domestic violence and labour dystocia is sparse. The aim of this study was to investigate whether self-reported history of violence or experienced violence during pregnancy is associated with increased risk of labour dystocia in nulliparous women at term. Methods: A population-based multi-centre cohort study. A self-administrated questionnaire collected at 37 weeks of gestation from nine obstetric departments in Denmark. The total cohort comprised 2652 nulliparous women, among whom 985 (37.1%) met the protocol criteria for dystocia. Results: Among the total cohort, 940 (35.4%) women reported experience of violence, and among these, 66 (2.5%) women reported exposure to violence during their first pregnancy. Further, 39.5% (n = 26) of those had never been exposed to violence before. Univariate logistic regression analysis showed no association between history of violence or experienced violence during pregnancy and labour dystocia at term, crude OR 0.91, 95% CI (0.77-1.08), OR 0.90, 95% CI (0.54-1.50), respectively. However, violence exposed women consuming alcoholic beverages during late pregnancy had increased odds of labour dystocia, crude OR 1.45, 95% CI (1.07-1.96). Conclusions: Our findings indicate that nulliparous women who have a history of violence or experienced violence during pregnancy do not appear to have a higher risk of labour dystocia at term, according to the definition of labour dystocia in this study. Additional research on this topic would be beneficial, including further evaluation of the criteria for labour dystocia. Background Accumulating knowledge suggests that domestic violence occurring during pregnancy is a serious public health issue due to the risk for adverse maternal and fetal health outcomes [1-3]. Labour dystocia, another serious complication in obstetrics, has also been increasingly highlighted during the past decades [4-9]. Labour dystocia is defined as a slow or difficult labour or childbirth. According to Kjaergaard et al. [10] the term ‘dystocia’ is frequently used in clinical practice, yet there is no consistency in the use of terminology for prolonged labour or labour.

Social and physical environment in a geographic perspective helps to explain health conditions and disease incidence. Health inequalities can be related to places, and to health care accessibility and social spaces. Ill health are related to time and place in timegeography. Personal physical, social and emmotionella relationships to places affect health and wellbeing. The book is intended for students in medical care programs, as well as geographers and social scientists with an interest in health issues, as well as professionals in health care and public health planning.

Information and education are important components in the care of patients before colorectal surgery. In order to optimize a quick recovery after surgery sufficient and evidence based information is essential. The aim was to describe and review scientific articles regarding the importance of the preoperative patient information given before colorectal surgery from a patient perspective. The method was a literature study, with a systematic approach, in order to find evidence concerning patient information before colorectal surgery. The results showed that patients describe experiences of anxiety, insecurity, and the fear of the unknown. They needed healthcare givers which provide a feeling of security and continuity. If the patients receive multidimensional, written and verbal information, they are less anxious and have higher self-control postoperatively. They also experience less pain and can be mobilized earlier. If patients who should receive a stoma met a stoma therapist preoperative expressed less anxiety, fewer stoma complications and better mental well-being. This means that the patients can manage their colostomy earlier. Accurate preoperative information enhances understanding of the postoperative recovery phase and makes patients more involved. This leads to earlier recovery and discharge. The conclusion is that patients undergoing colorectal surgery are in great need of preoperative information. When this is given due to a standard care program, with regard to the individual needs, the patients will be better prepared for their surgery and postoperative care. Patients will participate in their care actively and take responsibility early, reducing complications and accelerate the post-operative recovery. Through good cooperation in the team around the patient, the individual needs of the patient are optimized. If the patient is assigned a patient charge nurse, the individual needs is identified earlier and if necessary followed up postoperatively after discharge.

Rapporten berör ett aktionsforskningsprojekt bland samhällsplanerare i skånska kommuner. Kommunerna har arbetat med olika case/ fall för att påvisa hur de kan skapa en långsiktig hållbarhet som främjar hälsa för kommande generationer. Forskaren har studerat processen i det arbetet. Resultatet visar att kommunernas tjänstemän arbetar med en defintion av hållbar utveckling som bevarar naturvärden, främja social inkludering över generationerna och arbeta hälsofrämjande i relation till att skapa rekreation och minska hälsofarliga miljöer. De fokuserar mer på miljöaspekter än en generell social hållbarhet och är begränsade i att tänka på mer marginaliserade grupper i samhällsplaneringen. I miljöfrågor så har de ett djupare engagemang som försätter dem i en sorts etisk stress när de måste frångå sina principer pågrund utav politiskt fattade beslut. Rapporten kritiserar det politiska besluten om att snabba upp planprocessen och påvisar att en systematiserad reflekterande dialog mellan olika yrkesfunktioner tidigt i planeringsarbete bidrar till en mer långsiktig hållbar utveckling i praktiken.

This report presents the results from a participatory development project that was carried out at the nursing program at Malmö University, Faculty of Health and Society. The project was part of a training-course in leadership and management – an Individual Coaching in Group (ICG) - for leaders/prefects at Malmö University College, which is presented in detail in the introductory part of the report. Furthermore, a subject theory and theoretical elements that are significant for this type of leadership/management in an academic environment is presented as an underlying compass. The overall object of the project was to identify elements pertaining to the development and work of the internationalization process of the nursing program in collaboration with students and colleagues to pursue an educational environment with the level of quality and standards that have been stipulated in the Bologna process (Ds 2004). The operating objective was to develop a program presentation, which would suite an international teaching auditorium within the nursing education. The method used was a project organization that consisted of work teams and various meeting flora. Deming's model (1993) for participatory development work was used to structure the implementation of project processes and the work of making a film about the nursing education. The forming of the project, its structure and processes are rendered in the part of the report where the results are presented. One outcome was a screen adaptation of the nursing education. The film showed that the didactic models of the nursing education contain not only traditional features of the trade but more creative and novel teaching models as well. The project work as such has also visualized how good and prolific collaboration between representa¬tives from the trade, i.e. clinical organizations and prospective employers, and the nursing education, i.e. students and lecturers at Malmö University can be. In conclusion, the project work method of filming the educational work at the nursing program proved encouraging to the people involved to further fuel their discussions and reflections on aims and objectives as well as content of the nursing education per se. An active and prolific participation in the origination and shaping of the educational work by students, the student union, lecturers, instructors/supervisors from the clinics and developers of health care and nursing has lead to their reflecting critically on everyday educational work as much as it has evoked pride in their nursing education. The most successful element of the project management was the nature of its structure, supportive conduct of the involvement of the colleagues as well as its creativity and skills. The project was successful in its amalgamating settings in which the nursing education may be fostered and brought up to date in an academic environment. To purposefully promote a similar integration in the future would provide a powerful investment in terms of improved quality of the nursing education as well as render a positive work environment in which the appointed goals may be achieved. The method of using a project orientated organization is favorable to this direction and will keep the nursing education on track.

En portfolio är inte bara en samling alster utan är också en lär-, kommunikationsoch utvärderingsstrategi för att spegla studentens utveckling under utbildningstiden för att säkerställa att lärandemålen uppfylls. Portfoliouppgifter baserade på kursplanens lärandemål skall underlätta för studenten att nå målen med aktuell kurs och utbildning (Biggs & Tang, 1998; Ellmin & Ellmin, 2003). Intentionen med portfoliometodiken är att skapa ett helhetsperspektiv över studentens utveckling och ska vara ett hjälpmedel för både läraren och studenten att på ett strukturerat sätt dokumentera, kommunicera och skapa forum som främjar ett optimalt lärande. Studenten skall se sin utveckling och lärandeprocess under hela utbildningen och inte bara i en enstaka kurs. När utbildningen är klar har studenten en portfolio som visar på den egna utvecklingen och kompetensen som färdig sjuksköterska. Portfoliometodiken ska stimulera till ökat ansvarstagande och genom att formulera egna mål kan studenten öka medvetenheten hos sig själv och belysa de områden som behöver utvecklas (Gannon et al, 2001). Studenter har under sin utbildning behov av olika former av stöd och portfoliometodiken kan möjliggöra att studenten får det stöd som behövs genom att studenten belyser sina speciella behov. I utvecklings- och bedömningssamtalen vars summativa och reflekterande dokumentation kan ingå i portfolion, skall studenten vara en aktiv samtalspartner och genom att leda samtalet får studenten också ett större ansvar för sitt eget lärande (Ellmin & Ellmin, 2003; Van Tartwijk & Driessen, 2009). Portfoliometodiken stimulerar också till reflektion då studenten tittar tillbaka på och analyserar sina tidigare genomförda uppgifter och upplevelser från såväl teoretiska som praktiska moment (Van Tartwijk & Driessen, 2009). På sjuksköterskeutbildningen på Malmö högskolan finns metodiken till viss del implementerad sedan vårterminen 2010. Implementeringen fokuserades initialt på hur portfoliometodiken ska användas i den verksamhetsförlagda utbildningen (VFU) men finns nu även i andra kurser. Denna process har varit komplicerad men utmanande då flera hundra handledare men också många lärare varje termin blir involverade i denna pedagogik (FoU-rapport 2, 2011, http://hdl.handle.net/2043/11938).

BACKGROUND: Palliative care is not a priority in developing countries. Hospice Africa Uganda (HAU), where nurses complete a course in clinical palliative care, is considered a model for other African countries. AIM: To explore the role of the palliative care nurse specialist (PCNS) in Uganda. METHODS: This ethnographic field study uses observations, interviews, and group interviews. PARTICIPANTS: In total, 20 participants are included in this study. RESULT: The role of the palliative care nurse specialist is multifaceted. Beyond prescribing drugs, their role is to deliver holistic care. They encounter numerous challenges in their work, but they also have the possibility to improve the quality of the patient's life.

Background Early hospital arrival and rapid intervention for acute myocardial infarction is essential for a successful outcome. Several studies have been unable to identify explanatory factors that slowed decision time. The present study examines whether personality, psychosocial factors, and coping strategies might explain differences in time delay from onset of symptoms of acute myocardial infarction to arrival at a hospital emergency room. Methods Questionnaires on coping strategies, personality dimensions, and depression were completed by 323 patients ages 26 to 70 who had suffered an acute myocardial infarction. Tests measuring stress adaptation were completed by 180 of them. The patients were then categorised into three groups, based on time from onset of symptoms until arrival at hospital, and compared using logistic regression analysis and general linear models. Results No correlation could be established between personality factors (i.e., extraversion, neuroticism, openness, agreeableness, conscientiousness) or depressive symptoms and time between onset of symptoms and arrival at hospital. Nor was there any significant relationship between self-reported patient coping strategies and time delay. Conclusions We found no significant relationship between personality factors, coping strategies, or depression and time delays in seeking hospital after an acute myocardial infraction.

Objective: The overall aim of this thesis was to investigate whether selfreported history of violence is associated with increased risk of labour dystocia in nulliparous women at term and to elucidate midwives’ awareness of domestic violence during pregnancy in southern Sweden. Design/Method/Setting/Population: Paper I utilised a population-based multi-centre cohort study design. A self-administrated questionnaire was administered at four points in time with start at 37 weeks of gestation, at nine obstetric departments in Denmark. The total cohort comprised 2652 nulliparous women, among whom 985 (37.1%) met the protocol criteria for labour dystocia. In paper II an inductive qualitative design was utilised, based on focus group interviews. Participants were midwives with experience of working in antenatal care units connected to two university hospitals in southern Sweden. Sixteen midwives were recruited by network sampling complemented by purposive sampling, and were divided into four focus groups of 3 to 5 individuals. Results: In paper I cohort of the total, 940 (35.4 %) women reported experience of violence and of these 66 (2.5 %) women reported exposure of violence during their first pregnancy. Further, 39.5% (n = 26) of those had never been exposed to violence before. Univariate logistic regression analysis showed no association between history of violence or experienced violence during pregnancy and labour dystocia at term, crude OR 0.91, 95% CI (0.77-1.08), OR 0.90, 95% CI (0.54-1.50), respectively. However, violence exposed women consuming alcoholic beverages during late pregnancy had increased odds of labour dystocia (crude OR 1.49, CI: 1.07 – 2.07) compared to unexposed to violence women who were alcohol consumers (crude OR 0.89, 95 % CI: 0.69- 1.14). In paper II five categories emerged: 1) ‘Knowledge about ‘the different faces’ of violence’, perpetrator and survivor behaviour, and violence-related consequences. 2) ‘Identified and visible vulnerable groups’, ‘at risk’ groups for exposure to domestic violence during pregnancy, e.g. immigrants and substance users. 3) ‘Barriers towards asking the right questions’, the midwife herself as an obstacle, lack of knowledge among midwives as to how to handle disclosure of violence, and presence of the father-to-be at visits to the midwife. 4) ‘Handling the delicate situation’, e.g. the potential conflict between the midwife’s professional obligation to protect the abused woman and the unborn baby and the survivor’s wish to avoid interference. 5) ‘The crucial role of the midwife’, insufficient or non-existent support, lack of guidelines and/or written plans of action in situations when domestic violence is disclosed. The above five categories were subsumed under the overarching category ‘Failing both mother and the unborn baby’ which highlights the vulnerability of the unborn baby and the need to provide protection for the unborn baby by means of adequate care to the pregnant woman. Conclusions: Our findings indicate that nulliparous women who have a history of violence or experienced violence during pregnancy do not appear to have a higher risk of labour dystocia at term, according to the definition of labour dystocia used in this study. Additional research on this topic would be beneficial, including further evaluation of the criteria for labour dystocia (Paper I). Avoidance of questions concerning the experience of violence during pregnancy may be regarded as a failing not only to the pregnant woman but also to the unprotected and unborn baby. Nevertheless, certain hindrances must be overcome before the implementation of routine enquiry concerning pregnant women’s experiences of violence. It is of importance to develop guidelines and a plan of action for all health care personnel at antenatal clinics as well as continuous education and professional support for midwives in southern Sweden (Paper II).

Despite the general move to support people with learning disabilities in their own homes or in home-like settings, many institutional settings still exist and little research has been carried out on the role of the care workers who work in them. In this study, participant observations over a 16-month period describe care workers’ experiences of working in an institutional care setting in Sweden, and 18 care workers were interviewed. The three main themes to emerge from the thematic analysis were: care workers were engaged in creating a family-like atmosphere; they were engaged in making the everyday ordered and structured; and they were exposed to stress factors. It became evident that care workers need additional support, training and opportunities for reflection to handle their complex work situation.

The purpose of this study was to explore how persons with severe mental illness (SMI) experience oral health problems (especially dry mouth), and weigh the support they received in this regard from professionals and staff at community-based congregate housing through a controlled intervention programme. Oral health problems and dry mouth are found in association with apathy and indifference, cognitive deficits, and long-term medication with psycho-pharmacological drugs. The present study describes the results from one part of a longitudinal intervention programme, which sought effective ways of mitigating dry mouth through increased support with oral health problems. This part consists of 67 informal interviews with ten participants in two community-based urban housing projects between November 2006 and June 2007, with a follow-up session in December 2007. Content analysis of the results yielded five categories: The shame of having poor dental health, history of dental care, experiences of self-care, handling of oral health problems, and experiences of staff support. Poor oral health caused shame and limited participation in social activities. Participants avoided oral health issues by such circumventions as denial of a tooth ache or dental infections, or postponing oral problems with the hope that they would die away. Offers of support were frequently resisted because of unsatisfactory prior encounters with dental professionals and staff. Our findings suggest that self-care needs to be facilitated in an unobtrusive manner with minimal staff involvement, and clients should be referred to dental care providers experienced in treating people with SMI.

Research related to oral health in people with mental health problems may deepen our understanding of the quality of life of such individuals. This study aimed to investigate the relationship between oral status, health perceptions and life satisfaction, and their impacts on oral health-related quality of life (OHQoL). Data were collected from 113 patients in outpatient psychiatric care using a structured interview and an oral examination. Six multivariate models (one comprising the total population, three separate diagnostic groups, and two sex groups) investigated the variance in OHQoL. In the total population, the number of teeth, subjective life satisfaction, perception of physical health, sex, and relying on chance accounted for 40% of the variance. In the group consisting of patients diagnosed with schizophrenia 41% of the variance was explained by the variables 'number of teeth' and 'perception of physical health'. In the group diagnosed with mood disorders, the variable 'number of teeth' accounted for 58% of the variance. The variance in the remaining group of diagnoses was explained, up to 38%, by life satisfaction and reliance on chance. The sex models revealed significant differences: men considered the responsibility of caring for their oral health as a health matter, while women saw oral health as a more subjective issue. The perception of OHQoL was found to be dependent on the particular psychiatric diagnosis and sex. Such findings can be of use in the development of rehabilitation, as well as preventive strategies that could be individually tailored to maintain OHQoL and oral health.

Aim: To describe self-reported mental health indicators and to develop a score for mental health status in pregnant women. Method: Cross-sectional data was used from the Swedish population of a European cohort study conducted in 6 countries (Belgium, Iceland, Denmark, Estonia, Norway and Sweden). A total of 1 025 pregnant women in Malmoe, Sweden, filled in a questionnaire including background information and validated instruments to measure signs of depression during previous week by Edinburgh Depression Scale (EDS-5) and present health status. History of psychosocial care, medication, abuse, post traumatic stress symptoms (PTSS) and life events was reported for the past twelve months. EDS score was calculated by cut off >7 and >8. Ethnicity was defined by mother tongue. Results: Most women had Swedish as their mother tongue but 215 women (21.4%) had another language than Swedish. EDS at >7 (14.1%) and >8 (9.1%) was more common in foreign than in Swedish women (p<0.0001). Signs of PTSS as having physical ailments, feelings of numbness, avoidance, intrusion and anxiety in the past 12 months were also more common in this group (p<0.0001). Conclusion Pregnant women with another mother tongue than Swedish may have a less favourable mental health status than Swedish women. The algorithm for mental health score is under development using PTSS and other relevant indicators for the Swedish data. As such it will be analysed for associations with delivery outcomes in the whole BIDENS dataset.

Den här rapporten presenterar ett aktionsforskningsprojekt i form av en forskningscirkel om poesi med sjuksköterskor som arbetar med svårt sjuka och döende människor. Med hjälp av dikten så bearbetar de sina existentiella tankar och upplevelser, i det som författarna benämner det existentiella rummet. Sjuksköterskor upplever ofta att de saknar ord att beskriva svåra känslor av existentiell karaktär. Men med hjälp av poesin får känslorna ett språk, som personalen sedan kan reflektera över tillsammans i grupp och med sina patienter. I den aktionsinriktade processen ger sjuksköterskorna uttryck för att poesin hjälper dem att få ihop det professionella och det med mänskliga i omvårdnaden om sina patienter såväl som i sitt eget existentiella rum. Vilket lägger grunden för en ett bättre bemötande. Resutatet av forskningen påvisar bland annat att reflekterande samtal i grupp bör föranledas av en känslomässig förankring utöver det erfanhetsbeskrivande för att uppnå en känsla av mening i själva reflektionen. Det påvisar också vikten av gestaltande aktiviteter i palliativ vård.

Rationale: Cross-cultural comparative studies using reliable and valid instruments can increase awareness of the differences and similarities between health worker's ability to respond to patients' individual needs within different health systems. This will enable a better understanding of cultural perspectives in individualized nursing care. Aim: To describe the translation and adaptation process of the Individualized Care Scale (ICS) and examine its reliability and validity in a cross-cultural study. Design: A cross-sectional comparative study. Settings: Twenty-seven orthopaedic and trauma in-patient units at 14 hospitals in 5 countries. Participants: A total of 1126 patients were included in the study: Finland (n = 425), Greece (n = 315), Sweden (n = 218), UK (n = 135) and USA (n = 33). Methods: A systematic forward- and back-translation procedure using bilingual techniques, a committee approach, pretest techniques and pilot testing were used with a convenience sample to produce a valid ICS for each participating group. Psychometric evaluation of the adapted ICS was based on means, SD, missing data analysis, Cronbach's alpha coefficients and average inter-item correlations. Construct validity was examined using sub-scale correlations to total scales and principal components analysis. Results: The use of the range of options and the sub-scale mean scores ranging from 2.72 to 4.30 demonstrated the sensitivity of the scale. Cronbach's alpha coefficients (0.77-0.97) and average inter-item correlations (0.37-0.77) were acceptable. The sub-scale correlations to total scales were high (0.83-0.97). The underlying theoretical construct of the ICS was demonstrated by the explained variances ranging from 58% to 79%. Conclusions: The ICS shows promise as a tool for evaluating individualized care in European cultures. The international expansion of an existing instrument developed for one country facilitates comparative studies across countries. There is a need to further test the construct validity and appropriateness of the ICS in different settings in European and nonwestern cultures.

Ett aktionsforskningprojekt i form av en kunskapsverkstad där personal inom äldreomsorgen samlats i en forskningscirkel för att diskutera sitautioner runt sexualitet och samliv i deras arbete. Rapporten presenterar tidigare forskning inom området samt påvisar hur bristande kunskap och föreställningar om sexualitet och samliv bland de allra äldsta konstruerar ett sexuellt rum - som exkluderar snarare än inkluderar sexualitet och intimitet för äldre i den kommunala äldreomsorgen. Kunskapsbrister och outtalade föreställningar påverkar även personalens arbetsmiljö eftersom de har svårta att hantera dessa situationer.Dialogen i forskningscirkeln påvisar även skillnader mellan att arbeta i de egna hemmen kontra på kommunens särskilda boende, vilket antyder en sorts moralgeografi dör olika förhållningsätt råder till äldre människors integritet beroende på vilken plats omsorgen bedrivs.

Boken är den första i en serie om närsjukvård i samverkan. Forskningen tar utgångspunkt i den kommunala verksamheten och de vårdteam som består av biståndshandläggare, distriktssköterskor, sjukgymnaster och arbetsterapeuter. Syftet är att genom aktionsforskning bidra till en kunskapsöverföring som skapar förutsättningar för bättre relationer mellan olika professio­ner i närsjukvården. Avsikten är att stärka samspelet i hela det kommunala teamet, så att det förbättrar vården för den enskilde vårdtagaren, oavsett personalens professionstillhörighet. Aktionen i projektet utgörs utav casemetoden samt dialog samtal i fokusgrupper. Teoretiskt tar studien utgångspunkt i Bourdieus begrepp habitus och sociala rum. Resultatet visar att de olika professionerna angriper de situa­tioner och vårdbehov de ska ta ställning till utifrån sina professionella habitus på ett sådant sätt att det innebär att det kan uppstå intressekonflikter i vårdteamen. Samtidigt söker de konsensus mellan sig i vårdteamet som ofta bygger på för givet tagande i tolk­ningen av olika vårdsituationer. Genom aktionen så belyses deras habitus och ger dem möljighet att beakta vårdsituationerna från andra aspekter som förstärker samarbetet och som ger en bättre omvårdnad. En viktig sak att ta i beaktande i det sammanhanget är att det råder olika kulturella före­ställningar, som färgar vårdsammanhangen utifrån profesionella habitus beroende på i vilken plats omsorgen bedrivs.

En portfolio är inte bara en samling alster utan är också en lär-, kommunikationsoch utvärderingsstrategi för att spegla studentens utveckling under utbildningstiden för att säkerställa att lärandemålen uppfylls. Portfoliouppgifter baserade på kursplanens lärandemål skall underlätta för studenten att nå målen med aktuell kurs och utbildning (Biggs & Tang, 1998; Ellmin & Ellmin, 2003). Intentionen med portfoliometodiken är att skapa ett helhetsperspektiv över studentens utveckling och ska vara ett hjälpmedel för både läraren och studenten att på ett strukturerat sätt dokumentera, kommunicera och skapa forum som främjar ett optimalt lärande. Studenten skall se sin utveckling och lärandeprocess under hela utbildningen och inte bara i en enstaka kurs. När utbildningen är klar har studenten en portfolio som visar på den egna utvecklingen och kompetensen som färdig sjuksköterska. Portfoliometodiken ska stimulera till ökat ansvarstagande och genom att formulera egna mål kan studenten öka medvetenheten hos sig själv och belysa de områden som behöver utvecklas (Gannon et al, 2001). Studenter har under sin utbildning behov av olika former av stöd och portfoliometodiken kan möjliggöra att studenten får det stöd som behövs genom att studenten belyser sina speciella behov. I utvecklings- och bedömningssamtalen vars summativa och reflekterande dokumentation kan ingå i portfolion, skall studenten vara en aktiv samtalspartner och genom att leda samtalet får studenten också ett större ansvar för sitt eget lärande (Ellmin & Ellmin, 2003; Van Tartwijk & Driessen, 2009). Portfoliometodiken stimulerar också till reflektion då studenten tittar tillbaka på och analyserar sina tidigare genomförda uppgifter och upplevelser från såväl teoretiska som praktiska moment (Van Tartwijk & Driessen, 2009). På sjuksköterskeutbildningen på Malmö högskolan finns metodiken till viss del implementerad sedan vårterminen 2010. Implementeringen fokuserades initialt på hur portfoliometodiken ska användas i den verksamhetsförlagda utbildningen (VFU) men finns nu även i andra kurser. Denna process har varit komplicerad men utmanande då flera hundra handledare men också många lärare varje termin blir involverade i denna pedagogik (FoU-rapport 2, 2011, http://hdl.handle.net/2043/11938).

The essential principles of the Swedish health care structures are that the public sector is responsible for providing and financing health services for all citizens. Local health centers, which employ several categories of medical professionals, provide primary health and community care services. For patients requiring hospital treatment, medical services are available at county, regional and municipality levels. Since last decades the resources allocated to health care have been constantly reduced, a trend that is expected to continue along with the increased service costs. Initially, the discussion about medical services was restrained to structural matters. Examples of implemented changes are the closing of hospitals, separating of emergency care as well as caring responsibilities, supporting collaboration between and among various hospitals, and increasing cooperation between hospitals and other parts of the health care system. With the help of economic directives and mandatory referrals, patients are guided to primary and community based health care providers instead of the more expensive hospital care providers. This presentation introduces the students to the distinctive qualities of Swedish community care service organizations and the dilemmas and possibilities that follow.

Bakgrund: Under den verksamhetsförlagda utbildningen (VFU) i sjuksköterskeprogrammet används ofta reflektion som ett sätt att träna studenten i att vara en reflekterande praktiker dvs. en sjuksköterska som kan binda samman teori och praktik. Det är dock inte en självklarhet att kunna reflektera utan det är snarare en förmåga som måste utvecklas. Dessutom varierar såväl omfattning som vilka modeller som används för reflektion och oftast sker ingen form av dokumentation av de reflektioner som gjorts. En portfolio är egentligen en samling av alster men kan också fungera som ett redskap för att förtydliga progression i lärandeprocessen och löpa som en ”röd tråd” genom utbildningen. Att använda sig av portfoliometodiken skulle kunna vara ett sätt att följa studenternas lärandeprocess och ge möjlighet till att arbeta mer strukturerat med skriftlig reflektion. Syfte: Denna studie avser att utifrån studenters, handledares och lärares perspektiv beskriva hur reflektion används i lärandeprocessen under VFU i sjuksköterskeprogrammet samt deras inställning till att arbeta med reflektion kopplat till portfolios. Metod: Studien har en kvalitativ design där 5 fokusgruppsintervjuer har genomförts med studenter (7 st), handledare (2 st), kliniska lärare (3) och universitetsadjunkter (3). Intervjuerna har transkriberats ordagrant och kommer att analyseras med hjälp av innehållsanalys Resultat: Den första preliminära analysen visar på betydelsen av reflektion för både studenter, handledare och lärare. Det framkom också att det finns olika former av reflektion såsom (1) här och nu, (2) avslutande, sammanfattande, eller (3) en speciell reflektionsstund ex då ett speciellt tema tas upp. Det fanns till övervägande del en positiv inställning till portfoliometodiken som sågs som ett tänkbart pedagogiskt verktyg för reflektion i VFU. Portfolion ansågs också möjliggöra en visualisering av lärandeprocessen för alla parter. Det fanns dock även en del farhågor i grupperna såsom att arbetet med portfolion inte fick bli en belastning och att det var bra om portfolion utgick från de befintliga dokument som används idag. Likaså upplevdes det som viktigt att reflektionerna som var kopplade till portfolion gavs en tyngd, kändes betydelsefulla och efterfrågades av handledare och lärare. Det fanns annars en risk att ingen skulle bry sig om att använda den och skriva i den och det hela skulle rinna ut i sanden. Sammanfattningsvis gav dock alla grupper uttryck för att användande av reflektion kopplat till portfolio kändes mer modernt och att det kändes angeläget att något sådant infördes i VFU:n.

Irritable bowel syndrome (IBS) is a common disease, and constitutes a large portion of patients admitted to gastroenterology units. We wanted to examine whether there is a need for patients with suspected IBS to have a thorough examination by a gastroenterologist to establish the diagnosis, or whether other specialist or subspecialist physicians could better or equally identify the problems. From April 2003 to April 2005, females admitted with presumed IBS and consequently scrutinized by a gastroenterologist in our department were included. They were examined by a physician to establish a diagnosis. Four years later, the medical records were again scrutinized including abdominal symptoms, laboratory analyses and X-ray findings, to check if the findings were identical to the original diagnoses. Fifty admissions were identified. Nine of the patients did not want to participate, and 2 patients did not keep the appointment. The diagnosis of IBS was confirmed in only 20 (51%) and the other 19 (49%) had another diagnosis other than IBS. At follow up, 3 patients included with the IBS diagnosis had organic diseases, and 4 with another diagnosis also had IBS. Thus, 46% of the examined women with expected IBS had another diagnosis. A thorough examination of the patient and confirmation of the symptoms by a gastroenterologist is necessary before diagnosis of IBS is confirmed. For this purpose, patients need to meet a specialist when diagnosis is uncertain

The aims of this study were to determine whether a registered nurse can collect information and plan a holistic and individual strategy for the treatment of patients with irritable bowel syndrome (IBS) and whether this approach can reduce these patients' health aspects. The referrals of 50 Swedish-speaking female patients aged between 18 and 65 years with the preliminary diagnosis of IBS were collected and scrutinized by a gastroenterologist at a university hospital. Of these, 41 patients agreed to participate but 2 did not show up. The 39 patients were randomized into one of two groups: (1) the intervention group (n = 19) where the subjects were interviewed on the basis of the theory of culture care by a nurse before visiting a gastroenterologist and (2) the control group (n = 20) where the subjects first met a gastroenterologist. After the medical examination, 19 subjects were found to have diseases other than IBS. The interview gave a holistic view of the subjects' problems, which could be of use when planning further care. Because subjects sometimes did not receive an accurate diagnosis by their primary care physician, however, the clinic nurse could not give these subjects IBS-specific information because the subjects' diagnosis had not been established. The initial medical assessments based on the primary care doctors' care of many subjects with IBS symptoms were a noted weak point.

A present-day universitys faces the demands of growing globalization. In consequence the graduating and post-graduating educations are forming more mobile and globalised students exchange programmes. The Malmö University, Department of Nursing offers students and teachers a continuous exchange programme within international exchange networks. The programmes contain lectures, seminars, debates and social events focusing on improvements of patient care. However, after many years of this exchange programmes there is still lack of knowledge about its efficiency and its benefits to the students’ professional role development. Through a qualitative methodology, the study explores how students´ experience of international exchange as a professional learning environment influence their nursing skills. The preliminary results show that students during their exchange programmes perceived a broader view of nursing and the nature of care. The students reported some memorable aspects during their international exchange period that facilitated them widen insights to nursing in various social contexts and health care systems. Some of these experiences were reported as challenging their attitudes and influential on their selection of further career direction.

Offentliga institutioner och verksamheter består av en mängd aktörer vilka skall kunna samarbeta för att gemensamt lösa uppgifter och uppkomna problem. I kapitlet belyses synvinklar och utvecklingstendenser inom den offentliga sektorns tjänster relevanta för samarbetet

OBJECTIVES: The relationship between oral health and various aspects of quality of life has gone uninvestigated in psychiatric populations. The aim of this study was to investigate the correlation between the Oral Health Impact Profile-14 and subjective quality of life, perceptions about general health, and self-related variables. METHODS: A structured interview constructed from validated instruments was administered to 113 consumers attending outpatient psychiatric care. RESULTS: A lower perceived oral health-related quality of life had a correlation with decreased ratings of subjective quality of life, general health disabilities, and chance and internal locus of control. CONCLUSIONS: Correlations between subjective and general health-related quality of life and oral health-related quality of life had not been detected in this group before. In order to improve mental health consumers' total perceived quality of life, oral health problems should be regularly addressed in the course of psychiatric care.

ARTICLE IN FRENCH. Foot problems in people with diabetes are common,expensive and life-threatening. Eightyfive per cent of all amputations in diabetic patients are preceded by an ulcer, deteriorated to a severe infection or gangrene. The complexity of diabetes foot ulcers necesitates an intrinsic knowledge of underlying pathophysiology and a multi-factorial approach to achieve an effective strategy with regard to prevention and treatment. The most important factors related to development of foot ulcers are peripheral neuropathy, minor foot trauma, foot deformity and decreased tissue perfusion. The International Working Group for the Diabetic Foot Consensus Group has suggested a simple risk classification with regard to prevention of diabetes related amputations and foot ulcers. Identification of the high risk patient can only be detected from a history and clinical examination of the feet, as many foot ulcers in diabetes can potentially be prevented by regular foot inspections, access to foot care for non ulcer pathology and use of adequate foot wear. The feet of diabetic patients should be inspected at every visit to primary health care and specialist care providers and also at every visit from home care service. Assessment of the feet, education to the patient to eprform daily inspections, washing the feet daily, use of foot cream, and use of appropriate shoes requires a multidisciplinary approach including appropriate education of involved health care professionals and patients.

Background: Few studies evaluate patients' perspectives when a new drug is introduced to treat chronic diseases such as diabetes mellitus. The clinical role of a new insulin treatment, in terms of the relationship between higher cost and better treatment outcomes (as defined from the patient perspective) has been discussed. We sought to explore patient satisfaction with a new insulin treatment (insulin glargine). At its launch in 2002/3 it was purported to provide constant, peakless insulin release following once- or twice-daily administration, thus leading to fewer hypoglycaemic episodes while providing metabolic control equivalent to that achieved with NPH human basal insulin. Aims: To investigate the indications used for prescription of a new drug and its clinical effects on glycosylated haemoglobin (HbA1c) levels, perceived hypoglycaemic events and patient satisfaction. Methods: The Diabetes Treatment Satisfaction Questionnaire (Status Version, DTSQ-s), which measures satisfaction with treatment regimen, and perceived frequency of hyperglycaemia and hypoglycemia, was circulated to all living patients who had ever started treatment with insulin glargine at the Department of Endocrinology at Malmö University Hospital. Medical records of 913 patients were assessed for HbA1c levels at 0 and 12 months after starting insulin glargine therapy. Results: Completed questionnaires were returned by 615 of 960 patients (64%) who had ever started insulin glargine. The main indications for starting treatment were physicians' or nurses' initiatives, desire for fewer fluctuations and improved metabolic control. HbA1c levels fell by 0.41% for patients with type 1 diabetes and by 0.68% for those with type 2 diabetes. The mean DTSQ-s score was 28.45 for satisfaction, whereas the mean perceived hypoglycaemic/hyperglycaemic events score was 3. Conclusion: Treatment satisfaction was very high and perceived frequency of hypoglycaemia/hyperglycaemia was very low. The indications for treatment of insulin glargine are being followed in accordance with national recommendations..

Impaired mental health has been associated with an increased need for dental care. Population surveys have indicated that people with enduring mental health problems make less frequent planned visits to the dentist and report a greater number of missing teeth than the general population. The study aims to examine oral health status, attendance to dental care, and medication in an outpatient psychiatric sample. A descriptive study combining a structured interview with a visual oral examination carried out in 113 outpatients under psychiatric care. Dental health was described in terms of sound, missing and/or filled teeth, and showed a relation between these categories and types of psychiatric diagnosis, age and numbers of antidepressant and neuroleptic drugs. Oral hygiene was found to be more neglected among men and in patients with the diagnosis of schizophrenia. The need of dental treatment was widespread, although regular dental visits were commonly reported. In order to maintain good oral health, regular dental check-ups should be encouraged for patients under psychiatric care. Further studies are required to reveal contributory causes for/to decreased oral health. The difficulty such individuals have in maintaining additional self-efficacy raises questions about the necessity for oral health interventions in outpatient psychiatric services.

Markers for mental unhealth during pregnancy - predictors for delivery outcome Background: Population based studies report increasing mental ill-health levels of women in reproductive ages. Routine ante- and perinatal data is registered by the Nurse Midwife, and forwarded to the Medical Birth Registry of Sweden. No standard variables exist for identifying mental health status. An electronic medical registry (EMR) as a perinatal record system is in use since 1997, at Malmö University Hospital, Sweden. It holds variables possible for follow-up studies and is searchable for free-text. The EMR is used by all clinical staff involved with the pregnant woman. Objectives: To identify markers for mental unhealth in pregnancy in registry data to predict delivery outcome. Description: Patient records from 2001 to 2006 with 22,053 pregnancies were selected. Theoretical markers of mental unhealth related words were identified and tested in a sub-sample. A free-text-search among all 22,053 patient records was performed to identify the occurrence of each of the selected markers. Results: Ten words relating to mental health instruments were chosen for the free-text database search. Occurrence of reported words as "panic", “anxiety” and “stress” showed an increase OR for instrumental delivery and acute Caesarean section. The phrase "anti-depressive" seems to lower the OR for these outcomes. Preliminary data indicate an increased risk of obstetric complications at delivery associated with some of the markers for mental unhealth for nulliparous women. Ethical approval, no. 350/2007.

Projektet har genomförts i tre kommunla boende för dementa och berör platsers betydelse för dementa boendes sociala välbefinnande. Några av frågeställningarna i projektet är: Kan socialt välmående för de dementa boende relateras till specifika platser? Har förändringar i den fysiska miljön någon påverkan på de dementa boende? Materialet består av fokusgrupper tillsammans med personalen i de tre särskilda boendena, djupintervjuer med anhöriga samt dagböcker som följer trettio dementa boende under tre månader. Förutom de spatiala frågorna tar rapporten upp behovet av kontinuitet i arbetet med de dementa boende och hur det kan minska oro och därmed reducera medicinförbrukningen. Den pekar även på att om de dementa boende skall uppleva mening i boendet så måste de utveckla sociala aktiviteter i mindre grupper, olika konstellationer och miljöer som de känner igen sedan tidigare. Rapporten visar att när dementa boende får komma till platser där de utövat sociala aktiviteter (och som är förknippade med stark positiva känsloupplevelser) förstärks deras kognition och minnesfunktion.

Beskrivning av projektet Självförtroende och fysisk aktivitet med projektledare Ingegerd Ericsson, Idrottsvetenskap, Lärarutbildningen, Malmö högskola.

Background: Alcohol consumption in Europe and North America is greatest in 18-25-year-olds. This behaviour can be seen as a transitional stage from childhood to adulthood, where consuming alcohol is perceived as a typical feature of adult behaviour. Youths often start to consume alcohol when they are 14-15 years of age, and one in five youngsters around 15 years of age report binge drinking. Studies of alcohol consumption among youths with type 1 diabetes have not been undertaken but it is well known that, in these people, alcohol drinking can cause hypoglycaemia and worsen the capacity to feel and interpret the symptoms of hypoglycaemia. Aim: The overall aim was to explore experiences of alcohol consumption among youths with type 1 diabetes. Another objective was to identify strategies as to how they deal with situations when they drink alcohol. Methods: Semistructured interviews with ten 18-year-old youths with type 1 diabetes, using Burnard's content analysis method. Results: This study illustrates that informants strive for security, independence and control. Frequency of binge drinking did not seem to differ from rates in other teenagers. Informants exposed themselves to considerable risks and many had met with serious incidents. Moreover, the result exemplifies how symptoms of diabetic ketoacidosis (such as nausea and vomiting) can easily be misinterpreted as a hangover or gastroenteritis. Informants lacked age-appropriate knowledge about diabetes and the effects of alcohol, but had tested things out themselves; some involved their friends in their diabetes treatment. Moreover, three strategies occurred with the aim of normalisation and security: the 'low-consumption' strategy, the 'ambitious' strategy and the 'rather-high-than-dead' strategy. Fear of hypoglycaemia was a significant concern and the consequence was poor diabetes control. Conclusion: To increase youths' independence and security, the diabetes care team should provide adequate and relevant information about alcohol. Treatment plans might contain practical steps such as advice about responsible alcohol intake and adjustments of insulin and meals, and could also encourage young people with diabetes to carry diabetes ID and inform friends about hypoglycaemia (and how to handle situations involving alcohol)..

Intag av mat och dryck liksom elimination av kroppens avfallsprodukter tillhör månniskans grundläggande fysiologiska behov.Att drabbas av urin- och avföringsproblem av skiftande slag kan upplevas integritets-kränkande för den drabbade. Att prata om det kan vara svårt och ännu mer besvärande att vara i behov av hjälp med sina toalettbestyr. den friska individen har dåliga kunskaper om sina kroppsliga funktionerså länge han/hon är frisk. Först när något kroppsligt fel tillstöter söker individen kunskap. detta gäller i ännu högre grad normal urin och tarmfunktion eftersom detta område är omgärdat av tabu.Sjuksköterskans viktigaste uppgift är att dela med sig av sin kunskap.

Risk factors for suicidal behaviour include adverse life events as well as biochemical parameters acting, e.g. within the hypothalamic–pituitary– adrenal axis and/or monoaminergic systems. The aim of the present investigation was to study stressful life events and biological stress markers among former psychiatric inpatients, who were followed up 12 years after an index suicide attempt. At the time of the index suicide attempt, and before treatment, cerebrospinal fluid (CSF) samples were taken, and 24 h (h) urine (U) was collected. 3-Methoxy-4-hydroxyphenylglycole (MHPG) in CSF and 24 h urinary samples of cortisol and noradrenaline/adrenaline (NA/A) were analysed. Data concerning stressful life events were collected retrospectively from all participants in the study through semi-structured interviews at follow-up. We found that patients who reported sexual abuse during childhood and adolescence had significantly higher levels of CSF-MHPG and U-NA/A, than those who had not. Low 24 h U-cortisol was associated with feelings of neglect during childhood and adolescence. In conclusion, this study has shown significant and discrepant biological stress-system findings in relation to some adverse life events.

Rationale and aims: This study focuses on the development of an instrument for the evaluation of clinical practice guidelines and is one part of a research project about the implementation and use of such guidelines among hospitals in the southern region of Sweden. The aim of the present paper was to investigate the test-retest reliability of a questionnaire. Method: A questionnaire was designed to gather data about guidelines that have been implemented as well as information about factors, which, according to the Promoting Action on Research Implementation in Health Service (PARIHS)-model, influence the success of implementation. Thirty-nine professionals at one of the hospitals included in the survey completed the questionnaire on two occations within a mean time of 5.5 weeks. The test-retest reliability was analyzed by means of Cohen's Kapps and percentage concordance. Results: Eight items had good agreement in terms of strength and high percentage concordance. With regard to the Kappa values 13 items show moderate and two fair agreement. Conclusions: The test-retest reliability scores show mainly acceptable results indicating a reasonable stability, thus suggesting the possibility of further developing the instrument. The factors described in the PARIHS-model seem relevant for use in evaluating implementation and use of guidelines. The instrument could benefit from a revision of the language in order to enhance clarity and make it less abstract.

Background: Population based studies report increasing mental ill- health levels of women in reproductive ages. The antenatal routine care program in Sweden consists of 8-10 visits with a nurse midwife. Data from these visits, delivery and postnatal care has been collected with the National Delivery Register since 1973. No variables however exist for identifying mental health. A computerized perinatal patient record system has been in use for12 years at the University Hospital in Malmö, Sweden. It consists of some 2,500 variables possible to use for follow-up studies, as well as searchable free-text. The record system is used by all clinical staff involved with the pregnant woman. Aim: To identify markers for mental ill-health in pregnancy in registry data to predict delivery outcome. Method: Patient records from six consecutive years with 22,000 pregnancies were selected. Theoretical markers of mental ill-health related words were identified and tested in a sub-sample. A free-text-search among all patient records was performed to identify the occurrence of each of the selected markers. Results: Twenty words relating to mental ill-health instruments were chosen for the free-text database search. Presence of reported words as "panic", “anxiety” and “stress” showed an increase OR for instrumental delivery, ruptured sphincter and caesarian section. The phrase "anti-depressive" seem to lower the OR for these outcomes. Conclusion: Preliminary data seems to indicate an increased risk of obstetric complications at delivery associated with some of the markers for ill-health. Further analyses could assist in developing variables for the identification of words predicting mental ill-health and increased obstetric risks. Ethical approval 350/2007. PhD-studies by faculty funding

Background: To study sexual and reproductive health issues, an understanding of cultural and language bound concepts is needed. Scandinavian studies of native speaking women show a relation between history of partner violence, sexual abuse and fear of delivery. In Malmo the third largest city of Sweden, 36% of the population has a foreign background. The proportion of Arabic speaking women within maternity care is increasing in Sweden. Islamic concepts are often based in the Arabic language and are of importance for non-Arabic speaking Muslim women as well. To enable participation in a prospective study on history of abuse and fear and delivery outcome, the validated instruments needed translation into Arabic language. Aim: To describe challenges in translating instruments, on fear and abuse, developed for westernized societies into an Arabic questionnaire. Method: Interviews and face validity testing of translated instruments from Western language to develop an Arabic questionnaire were conducted. Results: In order to validate translated instruments of concepts related to sexual and reproductive health, an understanding of cultural and religious ideas, meaning of words for sexuality, violence, abuse, fear and “destiny” needs to be addressed and considered. Examples of international approaches to these issues will be presented. Conclusion: Translation of cultural concepts for questionnaire development requires more than understanding and interpretation. Ethical approval 2006/354-31; 2007/1360-32. PhD-studies by faculty funding

BAKGRUND Idag sker den vetenskapliga metodskolningen i huvudämnet omvårdnad i kurserna 1, 4, 8 och 9 på sjuksköterskeprogrammet på Malmö Högskola. Studenter har visat i utvärderingar att det inte fanns någon kontinuitet och progression mellan de vetenskapliga metodkurserna på sjuksköterskeprogrammet, vilket också uppmärksammats av undervisarna. Enligt förvaltningslagen är det en myndighetsutövning gentemot en enskild person när en examinator sätter ett betyg. Därför måste betygssättning hanteras rättsäkert och konsekvent vilket kräver väl förankrade betygskriterier (Ekecrantz, 2007). För att säkra kvalitet och kontinuitet mellan kurserna 1, 4, 8 och 9 på sjuksköterskeprogrammet på Malmö Högskola och för att EU-anpassa betygsgraderingen enligt ECTS-skalan (ECTS USERS`GUIDE) behövdes nya bedömningskriterier baserade på nya lärandemål enligt Bologna processen utarbetas. För att successivt öka kunskapsstegringen mellan de vetenskapliga metodkurserna har i ett tidigare projekt nya lärandemål enligt Bologna modellen för respektive kurs utarbetats. SYFTE Syftet med projektet är att identifiera och formulera bedömningskriterier baserade på en successiv kunskapsstegring inom forskningsområdet omvårdnad både avseende metod och ett kritiskt förhållningssätt. GENOMFÖRANDE Arbetet påbörjades i augusti 2007 och projektgruppen består av sex undervisande och examinerande lärare i de berörda kurserna. Litteratur i ämnet studerades och gruppen samlade in information om hur andra universitet och högskolor tillämpat ECTS-skalan. Arbetsgrupper för respektive kurs bildades som utarbetade förslag för bedömningskriterier A till F för respektive kurs. Därefter strålade arbetsgrupperna samman för att gemensamt fastställa samstämmighet samt progression mellan kurserna. Gruppen har också diskuterat examinationsformer, undervisningsmetoder, litteratur och begreppsdefinitioner relaterade till betygskriterier. Arbetet har också lett till att lärandemålen för respektive kurs har fått korrigeras och anpassat för att kunna vara utvärderingsbara. För att få studenternas synpunkter kommer de utarbetade förslagen att presenteras för studenter i respektive kurs för att få deras syn på bedömningskriterierna. Studenter i kurs 4 och 8/9 kommer under läsåret 08/09 att få vara delaktiga i utvecklingsprocessen av bedömningskriterierna. Implementering av resultatet kan tidigast ske VT09 och kommer därefter att utvärderas. Betygskriterierna kan ses i bilaga 1-5. DISKUSSION Dessa kriterier skall vara ett stöd för betygsättning av examensarbete såväl som seminarier och enskilda uppgifter dock utan att minska examinatorns ansvar för bedömningen. Bedömningskriterierna bör också ge utrymme för examinatorns egen bedömning (Boij m.fl., 2007). Betygskriterierna skall fungera som ett stöd för examinatorn så väl som för studenten, som kan inspireras att sträva efter ett högre betyg. Eftersom ECTS-graderingen är målrelaterad så finns det inget krav på att en viss del av studenterna skall få ett visst betyg. Det är dock viktigt att kraven för E skall vara likvärdiga med betyget GODKÄND. Det finns både fördelar och nackdelar med betyg i många grader. Enligt Ekecrantz (2007) ger det större precision och rättvisa samt en bättre feedback till studenterna på deras prestationer. Ekecrantz menar dock att många grader kan leda till ökad stress för studenten och ge en ökad arbetsbelastning för läraren samt att examinationsformerna kan försämras. Arbetsgruppen håller inte riktigt med om detta. Visserligen kan examinationsformerna behöva förändras men det behöver nödvändigtvis inte leda till en försämring. En intressant aspekt som Boij m.fl. (2007) tar upp i sin rapport från Kungliga Tekniska Högskolan är att bedömning av t.ex. examensarbete kan göras utifrån flera perspektiv såsom process, vetenskapligt innehåll och prestation för att examinatorn skall kunna skaffa ett bra underlag för att sätta betyg. Studentinflytande är viktigt och det är en utmaning att få studenterna delaktiga i processen, vilket inte har varit så lätt inom alla verksamheter (Åkesson 2006).

Aims and objectives: To describe and analyse to what extent the goals of the education in promoting culturally competent nursing care have been achieved from a student perspective. Background: As Sweden has transformed into a multicultural society over the past 50 years, there is a need to specify, at all levels of the nursing programme, transcultural concepts for the success of integration. A research-based didactic model was designed for the nursing programme at Malmö University and this was followed by investigations of its outcome. Design and methods: The study is a prospective cohort study with an outcome analysis. A descriptive research study with a longitudinal design was performed, with the focus on Swedish nursing students' experiences of transcultural nursing knowledge and their attitudes before and after implementation of the didactic model. The students evaluate highly their competence to meet demands of multicultural health and medical service. Additionally, their ability to recognise and understand the consequences of international migration on health also received a high mean. Conclusions: The study revealed the knowledge and experience acquired by Swedish students in transcultural nursing. The assumption was that a visible development of knowledge should occur during the three years of education. Interpreting the findings, such effectiveness can be found and hopefully the students will be able to give holistic nursing care based on a person's individual culture.