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  • 1.
    Andersson, Claes
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Criminology (KR).
    Berman, Anne H
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Lindfors, Petra
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Bendtsen, Marcus
    Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden.
    Effects of COVID-19 contagion in cohabitants and family members on mental health and academic self-efficacy among university students in Sweden: a prospective longitudinal study2024In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 3, article id e077396Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study used causal inference to estimate the longitudinal effects of contagion in cohabitants and family members on university students' mental health and academic self-efficacy during the COVID-19 pandemic.

    DESIGN: A prospective longitudinal study including a baseline online measurement in May 2020, and online follow-ups after 5 months and 10 months. Participants were recruited through open-access online advertising.

    SETTING: Public universities and university colleges in Sweden.

    PARTICIPANTS: The analytical sample included 2796 students.

    OUTCOME MEASURES: Contagion in cohabitants and in family members was assessed at baseline and at the 5-month follow-up. Mental health and academic self-efficacy were assessed at the 5-month and 10-month follow-ups.

    RESULTS: Mild symptoms reported in cohabitants at baseline resulted in negative mental health effects at follow-up 5 months later, and mild baseline symptoms in family members resulted in negative effects on academic self-efficacy at follow-ups both 5 and 10 months later.

    CONCLUSIONS: Notwithstanding the lack of precision in estimated effects, the findings emphasise the importance of social relationships and the challenges of providing students with sufficient support in times of crisis.

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  • 2.
    Attauabi, Mohamed
    et al.
    Department of Gastroenterology and Hepatology, Herlev Hospital, Herlev, Denmark.
    Madsen, Gorm Roager
    Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark.
    Bendtsen, Flemming
    Gastrounit, Medical Section, Hvidovre Hospital, Hvidovre, Denmark.
    Wewer, Anne Vibeke
    The Paediatric Department, Hvidovre Hospital, Hvidovre, Denmark.
    Wilkens, Rune
    Gastrounit, Medical Section, Hvidovre Hospital, Hvidovre, Denmark.
    Ilvemark, Johan
    Department of Gastroenterology and Hepatology, Herlev Hospital, Herlev, Denmark.
    Vladimirova, Nora
    Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark.
    Jensen, Annette Bøjer
    Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark.
    Jensen, Frank Krieger
    Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark.
    Hansen, Sanja Bay
    Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark.
    Siebner, Hartwig Roman
    Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark.
    Nielsen, Yousef Jesper Wirenfeldt
    Department of Radiology, Herlev Hospital, Herlev, Denmark.
    Møller, Jakob M
    Department of Radiology, Herlev Hospital, Herlev, Denmark.
    Thomsen, Henrik S
    Department of Radiology, Herlev Hospital, Herlev, Denmark.
    Thomsen, Simon Francis
    Department of Dermatology, Bispebjerg Hospital, Kobenhavn, Denmark.
    Ingels, Helene Andrea Sinclair
    Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Kobenhavn, Denmark.
    Theede, Klaus
    Gastrounit, Medical Section, Hvidovre Hospital, Hvidovre, Denmark.
    Boysen, Trine
    Gastrounit, Medical Section, Hvidovre Hospital, Hvidovre, Denmark.
    Bjerrum, Jacob T
    Department of Gastroenterology and Hepatology, Herlev Hospital, Herlev, Denmark.
    Jakobsen, Christian
    Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark.
    Dorn-Rasmussen, Maria
    Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark.
    Jansson, Sabine
    Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark.
    Yao, Yiqiu
    Department of Dermatology, Bispebjerg Hospital, Kobenhavn, Denmark.
    Burian, Ewa Anna
    Department of Dermatology, Bispebjerg Hospital, Kobenhavn, Denmark.
    Møller, Frederik Trier
    Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Kobenhavn, Denmark.
    Fana, Viktoria
    Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark.
    Wiell, Charlotte
    Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark.
    Terslev, Lene
    Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark.
    Østergaard, Mikkel
    Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark.
    Bertl, Kristina
    Malmö University, Faculty of Odontology (OD).
    Stavropoulos, Andreas
    Malmö University, Faculty of Odontology (OD).
    Seidelin, Jakob B
    Department of Gastroenterology and Hepatology, Herlev Hospital, Herlev, Denmark.
    Burisch, Johan
    Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, Hvidovre, Denmark.
    Influence of Genetics, Immunity and the Microbiome on the Prognosis of Inflammatory Bowel Disease (IBD Prognosis Study): the protocol for a Copenhagen IBD Inception Cohort Study2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 6, p. e055779-e055779Article in journal (Refereed)
    Abstract [en]

    Introduction: Inflammatory bowel diseases (IBD), encompassing Crohn's disease and ulcerative colitis, are chronic, inflammatory diseases of the gastrointestinal tract. We have initiated a Danish population-based inception cohort study aiming to investigate the underlying mechanisms for the heterogeneous course of IBD, including need for, and response to, treatment.

    Methods and analysis: IBD Prognosis Study is a prospective, population-based inception cohort study of unselected, newly diagnosed adult, adolescent and paediatric patients with IBD within the uptake area of Hvidovre University Hospital and Herlev University Hospital, Denmark, which covers approximately 1 050 000 inhabitants (~20% of the Danish population). The diagnosis of IBD will be according to the Porto diagnostic criteria in paediatric and adolescent patients or the Copenhagen diagnostic criteria in adult patients. All patients will be followed prospectively with regular clinical examinations including ileocolonoscopies, MRI of the small intestine, validated patient-reported measures and objective examinations with intestinal ultrasound. In addition, intestinal biopsies from ileocolonoscopies, stool, rectal swabs, saliva samples, swabs of the oral cavity and blood samples will be collected systematically for the analysis of biomarkers, microbiome and genetic profiles. Environmental factors and quality of life will be assessed using questionnaires and, when available, automatic registration of purchase data. The occurrence and course of extraintestinal manifestations will be evaluated by rheumatologists, dermatologists and dentists, and assessed by MR cholangiopancreatography, MR of the spine and sacroiliac joints, ultrasonography of peripheral joints and entheses, clinical oral examination, as well as panoramic radiograph of the jaws. Fibroscans and dual-energy X-ray absorptiometry scans will be performed to monitor occurrence and course of chronic liver diseases, osteopenia and osteoporosis.

    Ethics and dissemination: This study has been approved by Ethics Committee of the Capital Region of Denmark (approval number: H-20065831). Study results will be disseminated through publication in international scientific journals and presentation at (inter)national conferences.

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  • 3.
    Deprez, Julie
    et al.
    Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Kottner, Jan
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium;Institute of Clinical Nursing Science, Charité Universitätsmedizin, Berlin, Germany.
    Eilegård Wallin, Alexandra
    Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ohde, Nils
    nstitute of Clinical Nursing Science, Charité Universitätsmedizin, Berlin, Germany.
    Bååth, Carina
    Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden; Faculty of Health, Welfare and Organisation, Østfold University College - Campus Frederikstad, Fredrikstad, Norway.
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Hultin, Lisa
    Department of Public Health and Caring Sciences, Upsalla University, Upsalla, Sweden; Upsalla University Hospital, Upsalla, Sweden.
    Josefson, Anna
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Beeckman, Dimitri
    Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    What are the prognostic factors for the development of incontinence-associated dermatitis (IAD): a protocol for a systematic review and meta-analysis2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 7, article id e073115Article in journal (Refereed)
    Abstract [en]

    Introduction: Incontinence-associated dermatitis (IAD) is irritant contact dermatitis and skin damage associated with prolonged skin contact with urine and/or faeces. Identifying prognostic factors for the development of IAD may improve management, facilitate prevention and inform future research.

    Methods and analysis: This protocol follows the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Prospective and retrospective observational studies or clinical trials in which prognostic factors associated with the development of IAD are described are eligible. There are no restrictions on study setting, time, language, participant characteristics or geographical regions. Reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports are excluded. MEDLINE, CINAHL, EMBASE and The Cochrane Library will be searched from inception until May 2023. Two independent reviewers will independently evaluate studies. The Quality in Prognostic Studies tool will be used to assess the risk of bias, and the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies-Prognostic Factors checklist will be used for data extraction of the included studies. Separate analyses will be conducted for each identified prognostic factor, with adjusted and unadjusted estimated measures analysed separately. Evidence will be summarised with a meta-analysis when possible, and narratively otherwise. The Q and I2 statistics will be calculated in order to quantify heterogeneity. The quality of the evidence obtained will be evaluated according to the Grades of Recommendation Assessment, Development and Evaluation guidance.

    Ethics and dissemination: No ethical approval is needed since all data is already publicly accessible. The results of this work will be published in a peer-reviewed scientific journal.

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  • 4. Feldman, Inna
    et al.
    Helgason, Asgeir Runar
    Johansson, Pia
    Tegelberg, Åke
    Malmö University, Faculty of Odontology (OD).
    Nohlert, Eva
    Cost-effectiveness of a high-intensity versus a low-intensity smoking cessation intervention in a dental setting: long-term follow-up2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 8, p. 1-8, article id e030934Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to conduct a cost-effectiveness analysis (CEA) of a high-intensity and a low-intensity smoking cessation treatment programme (HIT and LIT) using long-term follow-up effectiveness data and to validate the cost-effectiveness results based on short-term follow-up. DESIGN AND OUTCOME MEASURES: Intervention effectiveness was estimated in a randomised controlled trial as numbers of abstinent participants after 1 and 5-8 years of follow-up. The economic evaluation was performed from a societal perspective using a Markov model by estimating future disease-related costs (in Euro (euro) 2018) and health effects (in quality-adjusted life-years (QALYs)). Programmes were explicitly compared in an incremental analysis, and the results were presented as an incremental cost-effectiveness ratio. SETTING: The study was conducted in dental clinics in Sweden. PARTICIPANTS: 294 smokers aged 19-71 years were included in the study. INTERVENTIONS: Behaviour therapy, coaching and pharmacological advice (HIT) was compared with one counselling session introducing a conventional self-help programme (LIT). RESULTS: The more costly HIT led to higher number of 6-month continuous abstinent participants after 1 year and higher number of sustained abstinent participants after 5-8 years, which translates into larger societal costs avoided and health gains than LIT. The incremental cost/QALY of HIT compared with LIT amounted to euro918 and euro3786 using short-term and long-term effectiveness, respectively, which is considered very cost-effective in Sweden. CONCLUSION: CEA favours the more costly HIT if decision makers are willing to spend at least euro4000/QALY for tobacco cessation treatment.

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  • 5.
    Gustavsson, Kristoffer
    et al.
    Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
    van Diepen, Cornelia
    Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands..
    Fors, Andreas
    Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden.
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bertilsson, Monica
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hensing, Gunnel
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Healthcare professionals' experiences of job satisfaction when providing person-centred care: a systematic review of qualitative studies2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 6, article id e071178Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVES: This qualitative systematic review aimed to explore and synthesise healthcare professionals' (HCPs) experiences of job satisfaction when providing person-centred care (PCC) in healthcare settings in Europe.

    METHOD: This systematic review of qualitative studies was followed by a thematic synthesis applying an inductive approach. Studies concerning HCPs and different levels of healthcare in Europe were eligible for inclusion. The CINAHL, PubMed and Scopus databases were searched. Study titles, abstracts and full texts were screened for relevance. Included studies were assessed for methodological quality using a quality appraisal checklist. Data were extracted and synthesised via thematic synthesis, generating analytical themes.

    RESULTS: Seventeen studies were included in the final thematic synthesis, and eight analytical themes were derived. Most studies were conducted in Sweden and the UK and were performed in hospitals, nursing homes, elderly care and primary care. Thirteen of these studies were qualitative and four used a mixed-method design in which the qualitative part was used for analysis. HCPs experienced challenges adapting to a new remoulded professional role and felt torn and inadequate due to ambiguities between organisational structures, task-oriented care and PCC. Improved job satisfaction was experienced when providing PCC in line with ethical expectations, patients and colleagues expressed appreciation and team collaboration improved, while learning new skills generated motivation.

    CONCLUSION: This systematic review found varied experiences among HCPs. Notably, the new professional role was experienced to entail disorientation and uncertainty; importantly, it also entailed experiences of job satisfaction such as meaningfulness, an improved relationship between HCPs and patients, appreciation and collaboration. To facilitate PCC implementation, healthcare organisations should focus on supporting HCPs through collaborational structures, and resources such as time, space and staffing.

    PROSPERO REGISTRATION NUMBER: CRD42022304732.

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  • 6.
    Hofman, Hannelore
    et al.
    Univ Ghent, Univ Ctr Nursing & Midwifery, Fac Med & Hlth Sci, Dept Publ Hlth & Primary Care, Ghent, Belgium..
    Beeckman, Dimitri
    Univ Ghent, Univ Ctr Nursing & Midwifery, Fac Med & Hlth Sci, Dept Publ Hlth & Primary Care, Ghent, Belgium.;Örebro Univ, Fac Med & Hlth, Swedish Ctr Skin & Wound Res SCENTR, Sch Hlth Sci, Örebro, Sweden..
    Duljic, Tanja
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Örebro Univ, Fac Med & Hlth, Swedish Ctr Skin & Wound Res SCENTR, Sch Hlth Sci, Örebro, Sweden..
    Al Gilani, Samal
    Dalarna Univ, Sch Hlth & Welf, Falun, Sweden..
    Johansson, Sara
    Creat Mammals, Gothenburg, Sweden..
    Kottner, Jan
    Univ Ghent, Univ Ctr Nursing & Midwifery, Fac Med & Hlth Sci, Dept Publ Hlth & Primary Care, Ghent, Belgium.;Charite, Inst Clin Nursing Sci, Charite Ctr Hlth & Human Sci, Berlin, Germany..
    Kinnaer, Lise-Marie
    Univ Ghent, Univ Ctr Nursing & Midwifery, Fac Med & Hlth Sci, Dept Publ Hlth & Primary Care, Ghent, Belgium..
    Eriksson, Mats
    Örebro Univ, Fac Med & Hlth, Sch Hlth Sci, Örebro, Sweden..
    Patients' experiences with the application of medical adhesives to the skin: a qualitative systematic review protocol2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 6, article id e073546Article, review/survey (Refereed)
    Abstract [en]

    IntroductionMedical adhesives are adhesives used in medical devices to establish and maintain contact with the body over a period of time (usually by application to the skin) and are widely used in most care settings. Application of medical adhesives to the skin can lead to skin stripping, mild or severe allergic reactions and skin irritation that may manifest as redness, itching or rash. Adhesive-related skin injury can lead to infection, delayed wound healing and an increased risk of scarring. These injuries can cause severe discomfort and pain, and can affect the patient's quality of life. A systematic review summarising patient's experiences on this topic will contribute to informing adhesive producers and policy makers, and guiding further development and improvement of available technologies. Methods and analysisThis systematic review protocol is based on the principles of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline. A systematic search will be conducted in CINAHL, EMBASE, MEDLINE and PsycINFO. In addition, manual searches will be performed, reviewing the reference lists of relevant reviews and articles included for quality assessment. Qualitative studies using various methods will be considered for inclusion. Screening of title, abstract and full text will be done by two reviewers. The methodological quality of studies under consideration will be critically assessed by two reviewers using the Joanna Briggs Institute Critical Appraisal Tool for Qualitative Research. Data extraction will be performed independently by two reviewers using a predefined data extraction form. Meta-aggregation will be used to summarise the evidence. Ethics and disseminationNo ethical approval or consent is required because no participants will be recruited. This systematic review protocol is published in an open access journal to increase transparency of the research methods used. Results will be disseminated at national and international conferences.

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  • 7.
    Ljungbeck, Birgitta
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Finnbogadóttir, Hafrún
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Curricula and learning objectives in nurse practitioner programmes: a scoping review protocol2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 7, article id e028699Article in journal (Refereed)
    Abstract [en]

    Introduction: Globally, nurse practitioner (NP) has become an important nursing role in the pursuit of a more efficient healthcare, possessing the necessary expert skills to work as autonomous practitioners. Nevertheless, there are barriers in the implementation of this role. One barrier concerns the different levels of education required for NPs. Previous studies demonstrate the importance of acting for a uniform international education. The aim of the scoping review was to compile research about education to become an NP, focusing on the content of curricula and learning objectives.

    Methods and analysis: The six-stage methodological framework by Arksey and O'Malley will guide the scoping review through the following stages: identifying the research questions; identifying relevant studies; study selection; charting the data; collating, summarising and reporting the results; and consultation. The research questions are as follows: What is the content of curricula in NP programmes? What are the learning objectives in NP programmes? The literature searches will be conducted between March and June 2019 in the following databases: PubMed, CINAHL and ERIC, followed by hand searching reference lists of key studies. Grey literature will be searched in Google Scholar, Libsearch, existing networks and relevant organisations. Two researchers will screen titles and abstracts. Included full-text articles will be screened by three researchers and assessed for their methodological quality by the use of the Critical Appraisal Skills Programme. The PreferredReporting Items for Systematic Reviews and Meta-Analyses flow diagram will be used to demonstrate included and excluded articles. The findings will be presented through a numerical summary of the included articles, followed by a thematic analysis.

    Ethics and dissemination: Research ethics approval is not required for a scoping review. The scoping review will be submitted to a peer-reviewed journal. Additionally, the findings will be disseminated to stakeholders representing political, educational, professional and union organisations through a Delphi study as part of the consultation stage of the Arksey and O'Malleys framework.

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  • 8. Magneli, Martin
    et al.
    Unbeck, Maria
    Rogmark, Cecilia
    Rolfson, Ola
    Hommel, Ami
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Samuelsson, Bodil
    Schildmeijer, Kristina
    Sjostrand, Desiree
    Gordon, Max
    Skoldenberg, Olof
    Validation of adverse events after hip arthroplasty: a Swedish multi-centre cohort study2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 3, p. 1-9, article id e023773Article in journal (Refereed)
    Abstract [en]

    Objectives Preventing adverse events (AEs) after orthopaedic surgery is a field with great room for improvement. A Swedish instrument for measuring AEs after hip arthroplasty based on administrative data from the national patient register is used by both the Swedish Hip Arthroplasty Register and the Swedish Association of Local Authorities and Regions. It has never been validated and its accuracy is unknown. The aim of this study was to validate the instrument's ability to detect AEs, and to calculate the incidence of AEs following primary hip arthroplasties. Design Retrospective cohort study using retrospective record review with Global Trigger Tool methodology in combination with register data. Setting 24 different hospitals in four major regions of Sweden. Participants 2000 patients with either total or hemi-hip arthroplasty were recruited from the SHAR. We included both acute and elective patients. Primary and secondary outcome measures The sensitivity and specificity of the instrument. Adjusted cumulative incidence and incidence rate. Results The sensitivity for all identified AEs was 5.7% (95% CI: 4.9% to 6.7%) for 30 days and 14.8% (95% CI: 8.2 to 24.3) for 90 days, and the specificity was 95.2% (95% CI: 93.5% to 96.6%) for 30 days and 92.1% (95% CI: 89.9% to 93.8%) for 90 days. The adjusted cumulative incidence for all AEs was 28.4% (95% CI: 25.0% to 32.3%) for 30 days and 29.5% (95% CI: 26.0% to 33.8%) for 90 days. The incidence rate was 0.43 AEs per person-month (95% CI: 0.39 to 0.47). Conclusions The AE incidence was high, and most AEs occurred within the first 30 days. The instrument sensitivity for AEs was very low for both 30 and 90 days, but the specificity was high for both 30 and 90 days. The studied instrument is insufficient for valid measurements of AEs after hip arthroplasty.

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  • 9.
    Neziraj, Merita
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Kumlien, Christine
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Skanes universitetssjukhus Malmö, Malmö, Sweden.
    Hellman, Peter
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Andersson, Magdalena
    Health and Social Care, Strategic Development, Unit of Research and Development and Competence Centre, Malmö, Sweden.
    The STAIR OF KNOWLEDGE-a codesigned intervention to prevent pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes in Sweden: development of a complex intervention2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 8, article id e072453Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe the development of a codesigned complex intervention intended to prevent the risks of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes.

    DESIGN: : Nursing homes in the municipality in southern Sweden.

    PARTICIPANTS: End users (n=16) in nursing homes (n=4) codesigned the intervention together with the research group in workshops (n=4) in March-April 2022. Additionally, stakeholders (n=17) who were considered to play an important role in developing the intervention participated throughout this process. Data were analysed using reflexive thematic analysis.

    RESULTS: Four workshops were conducted with end users (n=16) and 13 meetings with stakeholders (n=12) were held during the development process. The intervention aims to bridge the evidence-practice gap regarding the preventive care process of the risks of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes. The intervention is aimed at end users, lasts for 3 weeks and is divided into two parts. First, end users obtain knowledge on their own by following written instructions. Second, they meet, interact and discuss the knowledge acquired during part 1.

    CONCLUSION: The intervention is robustly developed and thoroughly described. The study highlights the extensive process that is necessary for developing tailored complex interventions. The description of the entire development process may enhance the replicability of this intervention. The intervention needs to be tested and evaluated in an upcoming feasibility study.

    TRIAL REGISTRATION NUMBER: NCT05308862.

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  • 10. Nwaru, Bright I
    et al.
    Ekerljung, Linda
    Rådinger, Madeleine
    Bjerg, Anders
    Mincheva, Roxana
    Malmhäll, Carina
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Wennergren, Göran
    Lotvall, Jan
    Lundbäck, Bo
    Cohort profile: the West Sweden Asthma Study (WSAS): a multidisciplinary population-based longitudinal study of asthma, allergy and respiratory conditions in adults.2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 6, article id e027808Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The West Sweden Asthma Study (WSAS) is a population-representative longitudinal study established to: (1) generate data on prevalence trends, incidence and remission of asthma, allergy and respiratory conditions, (2) elucidate on the risk and prognostic factors associated with these diseases, (3) characterise clinically relevant phenotypes of these diseases and (4) catalyse relevant mechanistic, genomic, genetic and translational investigations. PARTICIPANTS: WSAS comprised of randomly selected individuals aged 16 to 75 years who are followed up longitudinally. The first stage involved a questionnaire survey (>42 000 participants) and was undertaken in 2008 and 2016. A random sample (about 8000) of participants in the initial survey undergoes extensive clinical investigations every 8 to 10 years (first investigations in 2009 to 2012, second wave currently ongoing). Measurements undertaken at the clinical investigations involve structured interviews, self-completed questionnaire on personality traits, physical measurements and extensive biological samples. FINDINGS TO DATE: Some of our key findings have shown a 54% increase in the use of asthma medications between the 1990s and 2000s, primarily driven by a five-fold increase in the use of inhaled corticosteroids. About 36% of asthmatics expressed at least one sign of severe asthma indicator, with differential lung performance, inflammation and allergic sensitisation among asthmatics with different signs of severe asthma. Multi-symptom asthmatics were at greater risk of having indicators of severe asthma. In all adults, being raised on a farm was associated with a decreased risk of allergic sensitisation, rhinitis and eczema, but not asthma. However, among adolescents (ie, those 16 to 20 years of age), being raised on a farm decreased the risk of asthma. Personality traits were associated with both beliefs of asthma medication and adherence to treatment. FUTURE PLANS: Follow-up of the cohort is being undertaken every 8 to 10 years. The repeated clinical examinations will take place in 2019 to 2022. The cohort data are currently being linked to routine Swedish healthcare registers for a continuous follow-up. Mechanistic, genomic, genetic and translational investigations are ongoing.

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  • 11.
    Patomella, Ann-Helen
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Guidetti, Susanne
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Mälstam, Emelie
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Univ Gavle, Fac Hlth & Occupat Studies, Gavle, Sweden..
    Eriksson, Christina
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Bergström, Aileen
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Åkesson, Elisabet
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Asaba, Eric
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Primary prevention of stroke: randomised controlled pilot trial protocol on engaging everyday activities promoting health2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 11, article id e031984Article in journal (Refereed)
    Abstract [en]

    Introduction Stroke is a globally common disease that has detrimental effects on the individual and, more broadly, on society. Lifestyle change can contribute to reducing risk factors for stroke. Although a healthy lifestyle has direct benefits, sustaining and incorporating healthy activities into everyday life is a challenge. Engaging everyday activities have the potential to support lifestyle change and to promote sustainable activity patterns. Current healthcare is failing to reduce modifiable risk factors in people at risk, and in addition to current practice, there is a need for systematic and efficient non-pharmacological and non-surgical stroke-prevention strategies. The aim of the pilot study was to increase knowledge about the effects of a prevention programme and its feasibility to promote sustainable and healthy activity patterns among persons at risk of stroke. Methods and analysis The proposed pilot study will be a two-armed randomised, assessor-blinded, parallel pilot trial. The study will include feasibility data, investigating acceptability and delivery of the intervention. Persons at risk of stroke (n=60) will be included in a mobile phone-supported prevention programme. The 10-week programme will be conducted at primary healthcare clinics, combining group meetings and online resources to support self-management of lifestyle change. Main outcomes are stroke risk, lifestyle habits and healthy activity patterns. Assessments will be performed at baseline and at follow-up (immediately following the end of the programme and at 6 and 12 months). Effects of the programme will be analysed using inferential statistics. Feasibility will be analysed using both qualitative and quantitative methods.

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  • 12.
    Ramji, Rathi
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Brogårdh-Roth, Susanne
    Malmö University, Faculty of Odontology (OD).
    Olofsson, Anna Nilvéus
    Kottorp, Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Understanding behavioural changes through community-based participatory research to promote oral health in socially disadvantaged neighbourhoods in Southern Sweden.2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 4, article id e035732Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Inequalities in oral health have been on the rise globally. In Sweden, these differences exist not between regions, but among subgroups living in vulnerable situations. This study aims at understanding behavioural change after taking part in participatory oral health promotional activity among families living in socially disadvantaged neighbourhoods in Southern Sweden.

    SETTING: The current study involved citizens from a socially disadvantaged neighbourhood in Malmö, together with actors from the academic, public and private sectors. These neighbourhoods were characterised by high rates of unemployment, crime, low education levels and, most importantly, poor health.

    PARTICIPANTS: Families with children aged 7-14 years from the neighbourhood were invited to participate in the health promotional activities by a community representative, known as a health promoter, using snowball sampling. Between 8 and 12 families participated in the multistage focus groups over 6 months. Data were analysed using qualitative content analysis.

    RESULTS: Three main themes emerged from the analysis, providing an understanding of the determinants for behavioural change, including meaningful social interactions, family dynamics and health trajectories. The mothers in the study valued the social aspects of their participation; however, they believed that gaining knowledge in combination with social interaction made their presence also meaningful. Further, the participants recognised the role of family dynamics primarily the interactions within the family, family structure and traditional practices as influencing oral health-related behaviour among children. Participants reported having experienced a change in general health owing to changed behaviour. They started to understand the association between general health and oral health that further motivated them to follow healthier behavioural routines.

    CONCLUSIONS: The results from this study show that oral health promotion through reflection and dialogue with the communities, together with other stakeholders, may have the potential to influence behavioural change and empower participants to be future ambassadors for change.

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  • 13. Richards, David A
    et al.
    Bazeley, Patricia
    Borglin, Gunilla
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Craig, Peter
    Emsley, Richard
    Frost, Julia
    Hill, Jacqueline
    Horwood, Jeremy
    Hutchings, Hayley Anne
    Jinks, Clare
    Montgomery, Alan
    Moore, Graham
    Plano Clark, Vicki L
    Tonkin-Crine, Sarah
    Wade, Julia
    Warren, Fiona C
    Wyke, Sally
    Young, Bridget
    O'Cathain, Alicia
    Integrating quantitative and qualitative data and findings when undertaking randomised controlled trials.2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 11, article id e032081Article in journal (Refereed)
    Abstract [en]

    It is common to undertake qualitative research alongside randomised controlled trials (RCTs) when evaluating complex interventions. Researchers tend to analyse these datasets one by one and then consider their findings separately within the discussion section of the final report, rarely integrating quantitative and qualitative data or findings, and missing opportunities to combine data in order to add rigour, enabling thorough and more complete analysis, provide credibility to results, and generate further important insights about the intervention under evaluation. This paper reports on a 2 day expert meeting funded by the United Kingdom Medical Research Council Hubs for Trials Methodology Research with the aims to identify current strengths and weaknesses in the integration of quantitative and qualitative methods in clinical trials, establish the next steps required to provide the trials community with guidance on the integration of mixed methods in RCTs and set-up a network of individuals, groups and organisations willing to collaborate on related methodological activity. We summarise integration techniques and go beyond previous publications by highlighting the potential value of integration using three examples that are specific to RCTs. We suggest that applying mixed methods integration techniques to data or findings from studies involving both RCTs and qualitative research can yield insights that might be useful for understanding variation in outcomes, the mechanism by which interventions have an impact, and identifying ways of tailoring therapy to patient preference and type. Given a general lack of examples and knowledge of these techniques, researchers and funders will need future guidance on how to undertake and appraise them.

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  • 14.
    Ross, Michael W.
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Berg, Rigmor C.
    Schmidt, Axel J.
    Hospers, Harm J.
    Breveglieri, Michele
    Furegato, Martina
    Weatherburn, Peter
    The European MSM Internet Survey (EMIS) Network,
    Internalised homonegativity predicts HIV-associated risk behavior in European men who have sex with men in a 38-country cross-sectional study: some public health implications of homophobia2013In: BMJ Open, E-ISSN 2044-6055, Vol. 3, no 2, article id e001928Article in journal (Refereed)
    Abstract [en]

    Objectives Internalised homonegativity (IH) is hypothesised to be associated with HIV risk behaviour and HIV testing in men who have sex with men (MSM). We sought to determine the social and individual variables associated with IH and the associations between IH and HIV-related behaviours. Design and setting We examined IH and its predictors as part of a larger Internet-delivered, cross-sectional study on HIV and health in MSM in 38 European countries. Participants 181 495 MSM, IH data analysis subsample 144 177. All participants were male, over the age of consent for homosexual activity in their country of domicile, and have had at least one homosexual contact in the past 6 months. Methodology An anonymous Internet-based questionnaire was disseminated in 25 languages through MSM social media, websites and organisations and responses saved to a UK-based server. IH was measured using a standardised, cross-culturally appropriate scale. Results Three clusters of European countries based on the level of experienced discrimination emerged. IH was predicted by country LGB (lesbian, gay and bisexual) legal climate, Gini coefficient and size of place of settlement. Lower IH was associated with degree the respondent was ‘out’ as gay to others and older age. ‘Outness’ was associated with ever having an HIV test and age, education and number of gay friends, while IH (controlling for the number of non-steady unprotected sex partners and perceived lack of control over safe sex) was associated with condom use for anal intercourse. Conclusions IH is associated with LGB legal climate, economic development indices and urbanisation. It is also associated with ‘outness’ and with HIV risk and preventive behaviours including HIV testing, perceived control over sexual risk and condom use. Homonegative climate is associated with IH and higher levels of HIV-associated risk in MSM. Reducing IH through attention to LGB human rights may be appropriate HIV reduction intervention for MSM.

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  • 15.
    Samuelsson, Maria
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Wennick, Anne
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Jakobsson, Jenny
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bengtsson, Mariette
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Models of support to family members during the trajectory of cancer: a scoping review protocol.2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 9, article id e037633Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: A cancer diagnose, for example, colorectal cancer, not only affects the cancer-person stricken, but also the surrounding family. Thus, this scoping review intends to identify appropriate models of support that will guide the development of a model of support to family members during the trajectory of colorectal cancer.

    METHODS AND ANALYSIS: , and described by the Joanna Briggs Institute. All the stages will be conducted iteratively and reflexively. First, a search strategy will be developed with a librarian and applied in the following peer-reviewed databases: PubMed, Cumulative Index to Nursing and Allied Health Literature and PsycINFO. Additional searches will be performed in Google Scholar and SwePub for identification of grey literature and hand searched in the reference lists. Searches will be conducted from December 2019 to February 2020. A draft of the preliminary search strategy was performed in PubMed in November 2019. Subsequently, three members of the research team will independently screen all abstracts for relevance, as well as the full-text articles. Studies meeting the inclusion criteria will be critically evaluated using the Joanna Brigg Institute Critical Appraisal Tools. A descriptive summary of study characteristics and of the scoping review process will be presented, including a visual flow diagram. Lastly, a thematic analysis as presented by Braun and Clarke will be conducted. To enhance validity, contact nurses of persons with colorectal cancer will be provided an overview of the preliminary results.

    ETHICS AND DISSEMINATION: Being a secondary analysis, ethical approval is not needed for this study. The findings of the analysis will be used to inform the design of a future study aiming to develop a model of support and an upcoming scoping review, which will be published in a scientific journal and presented at relevant conferences.

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  • 16.
    Stenberg, Marie
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Mangrio, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bengtsson, Mariette
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Formative peer assessment in healthcare education programmes: protocol for a scoping review.2018In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no 11, article id e025055Article in journal (Refereed)
    Abstract [en]

    Introduction: In formative peer assessment, the students give and receive feedback from each other and expand their knowledge in a social context of interaction and collaboration. The ability to collaborate and communicate are essential parts of the healthcare professionals’ competence and delivery of safe patient care. Thereby, it is of utmost importance to support students with activities fostering these competences during their healthcare education. The aim of the scoping review is to compile research on peer assessment presented in healthcare education programmes, focusing formative assessment. The result of the scoping review will form the basis for developing and conducting an intervention focusing collaborative learning and peer assessment in a healthcare education programme. Methods and analysis: The scoping review will be conducted by using the framework presented by Arksey & O’Malley and Levac et al. The primary research question is: How are formative peer assessment interventions delivered in healthcare education? The literature search will be conducted in the peer-reviewed databases PubMed, Cumulative Index to Nursing and Allied Health Literature, Education Research Complete and Education Research Centre between September and December 2018. Additional search will be performed in Google Scholar, hand-searching of reference lists of included studies and Libsearch for identification of grey literature. Two researchers will independently screen title and abstract. Full-text articles will be screened by three researchers using a charting form. Studies meeting the inclusion criteria will be critically evaluated using the Critical Appraisal Skills Programme. A flow diagram will present the included and excluded studies. A narrative synthesis will be conducted by using thematic analysis as presented by Braun and Clarke. The findings will be presented under thematic headings using a summary table. To enhance validity, stakeholders from healthcare education programmes and healthcare institutions will be provided with an overview of the preliminary results. Ethics and dissemination: Research ethics approval is not required for the scoping review.

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  • 17.
    Stenberg, Marie
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Mangrio, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bengtsson, Mariette
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Formative peer assessment in higher healthcare education programmes: a scoping review2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 2, article id e045345Article, review/survey (Refereed)
    Abstract [en]

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

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  • 18. Strid, Catharina
    et al.
    Andersson, Claes
    Malmö University, Faculty of Health and Society (HS), Department of Criminology (KR).
    Ojehagen, Agneta
    The influence of hazardous drinking on psychological functioning, stress and sleep during and after treatment in patients with mental health problems: a secondary analysis of a randomised controlled intervention study2018In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no 3Article in journal (Refereed)
    Abstract [en]

    Objectives Hazardous drinking could negatively affect health and lead to alcohol use disorders, but it is unclear how hazardous drinking affects treatment outcomes of depression and anxiety and stress related mental health problems. The aim of this study was to examine whether hazardous drinking, measured by Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), influences the outcomes of repeated assessments of psychological functioning (Outcome Questionnaire-45), stress (Perceived Stress Scale) and sleep (Karolinska Sleep Questionnaire), during and after treatment in patients with mental ill health. Methods The study was conducted within REGASSA, a randomised controlled trial aimed at comparing Internet-based cognitive behaviour therapy and physical exercise with treatment as usual on primary care patients with mental ill health. The study involved 871 participants who completed the AUDIT at baseline and who were assessed repeatedly during and after treatment on psychological functioning, stress and sleep by interactive voice response, a computerised, automated telephone technology. Results At baseline, hazardous drinkers were more depressed and had lower scores on psychological functioning than non-hazardous drinkers, while there were no differences on stress and sleep. During the follow-ups, hazardous drinking negatively influenced perceived stress, that is, hazardous drinkers seemed to have less treatment effect on stress, and the results remained after controlling for depression. There were no differences during the follow-ups regarding psychological functioning and sleep. Conclusions Hazardous drinking negatively influenced perceived stress. The findings of the study emphasise the importance of screening for alcohol habits in mental ill-health patients, since risky drinking may affect the outcomes of treatment.

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  • 19. Tistad, Malin
    et al.
    Flink, Maria
    Ytterberg, Charlotte
    Eriksson, Gunilla
    Guidetti, Susanne
    Tham, Kerstin
    Malmö University, Joint University Administration and Services.
    von Koch, Lena
    Resource use of healthcare services 1 year after stroke: a secondary analysis of a cluster-randomised controlled trial of a client-centred activities of daily living intervention2018In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no 8, article id e022222Article in journal (Refereed)
    Abstract [en]

    Objective: The objective of the study was to compare the total use of healthcare services in the course of the first year after a stroke between participants who, after the acute care, had received occupational therapy as a client-centred activities of daily living (ADL) intervention (CADL) and participants who had received usual ADL intervention (UADL). Design: A secondary analysis of a multicentre cluster-randomised controlled trial (RCT). Setting: Primary and secondary care in Sweden. Participants: Participants were included if they: (1) had received CADL or UADL in the RCT, either as inpatients in geriatric rehabilitation units or in their own homes, and (2) data could be retrieved about their use of healthcare services provided by the county council from computerised registers. Interventions: CADL or UADL. Outcome measures: Inpatient and outpatient healthcare in the course of the first year after stroke. Results: Participants from 7 of the 16 units included in the RCT met the criteria. Participants in the CADL group (n=26) who received geriatric inpatient rehabilitation had a shorter length of hospital stay (p=0.03) than participants in the UADL group (n=46), and the CADL group with home rehabilitation (n=13) had fewer outpatient contacts (p=0.01) compared with the UADL group (n=25). Multiple regression analyses showed that in four of the models, a higher age was associated with a lower use of healthcare services. The use of healthcare services was also associated (some of the models) with dependence in ADL, stroke severity and type of rehabilitation received, CADL or UADL. Conclusions: The provision of client-centred occupational therapy after stroke did not appear to increase the use of healthcare services during the first year after stroke.rrrrr

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  • 20.
    Tsang, Kevin Cheuk Him
    et al.
    Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK; Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
    Pinnock, Hilary
    Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK.
    Wilson, Andrew M
    Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK; Norwich Medical School, University of East Anglia, Norwich, UK; Norwich University Hospital Foundation Trust, Colney Lane, Norwich, UK.
    Salvi, Dario
    Malmö University, Internet of Things and People (IOTAP). Malmö University, Faculty of Technology and Society (TS), Department of Computer Science and Media Technology (DVMT).
    Shah, Syed Ahmar
    Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK; Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
    Predicting asthma attacks using connected mobile devices and machine learning: the AAMOS-00 observational study protocol2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 10, article id e064166Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Supported self-management empowering people with asthma to detect early deterioration and take timely action reduces the risk of asthma attacks. Smartphones and smart monitoring devices coupled with machine learning could enhance self-management by predicting asthma attacks and providing tailored feedback.We aim to develop and assess the feasibility of an asthma attack predictor system based on data collected from a range of smart devices.

    METHODS AND ANALYSIS: A two-phase, 7-month observational study to collect data about asthma status using three smart monitoring devices, and daily symptom questionnaires. We will recruit up to 100 people via social media and from a severe asthma clinic, who are at risk of attacks and who use a pressurised metered dose relief inhaler (that fits the smart inhaler device).Following a preliminary month of daily symptom questionnaires, 30 participants able to comply with regular monitoring will complete 6 months of using smart devices (smart peak flow meter, smart inhaler and smartwatch) and daily questionnaires to monitor asthma status. The feasibility of this monitoring will be measured by the percentage of task completion. The occurrence of asthma attacks (definition: American Thoracic Society/European Respiratory Society Task Force 2009) will be detected by self-reported use (or increased use) of oral corticosteroids. Monitoring data will be analysed to identify predictors of asthma attacks. At the end of the monitoring, we will assess users' perspectives on acceptability and utility of the system with an exit questionnaire.

    ETHICS AND DISSEMINATION: Ethics approval was provided by the East of England - Cambridge Central Research Ethics Committee. IRAS project ID: 285 505 with governance approval from ACCORD (Academic and Clinical Central Office for Research and Development), project number: AC20145. The study sponsor is ACCORD, the University of Edinburgh.Results will be reported through peer-reviewed publications, abstracts and conference posters. Public dissemination will be centred around blogs and social media from the Asthma UK network and shared with study participants.

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  • 21. Wahlberg, Anna
    et al.
    Johnsdotter, Sara
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö högskola, Centre for Sexology and Sexuality Studies (CSS).
    Ekholm Selling, Katarina
    Källestål, Carina
    Essén, Birgitta
    Baseline data from a planned RCT on attitudes to female genital cutting after migration: when are interventions justified?2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7Article in journal (Refereed)
    Abstract [en]

    Objectives: To present the primary outcomes from a baseline study on attitudes towards female genital cutting (FGC) after migration. Design: Baseline data from a planned cluster randomised, controlled trial. Face-to-face interviews were used to collect questionnaire data in 2015. Based on our hypothesis that established Somalis could be used as facilitators of change among those newly arrived, data were stratified into years of residency in Sweden. Setting: Sweden. Participants: 372 Somali men and women, 206 newly arrived (0–4 years), 166 established (>4 years). Primary outcome measures: Whether FGC is acceptable, preferred for daughter and should continue, specified on anatomical extent. Results: The support for anatomical change of girls and women’s genitals ranged from 0% to 2% among established and from 4% to 8% among newly arrived. Among those supporting no anatomical change, 75%–83% among established and 53%–67% among newly arrived opposed all forms of FGC, with the remaining supporting pricking of the skin with no removal of tissue. Among newly arrived, 37% stated that pricking was acceptable, 39% said they wanted their daughter to be pricked and 26% reported they wanted pricking to continue being practised. Those who had lived in Sweden ≤ 2 years had highest odds of supporting FGC; thereafter, the opposition towards FGC increased over time after migration. Conclusion: A majority of Somali immigrants, including those newly arrived, opposed all forms of FGC with increased opposition over time after migration. The majority of proponents of FGC supported pricking. We argue that it would have been unethical to proceed with the intervention as it, with this baseline, would have been difficult to detect a change in attitudes given that a majority opposed all forms of FGC together with the evidence that a strong attitude change is already happening. Therefore, we decided not to implement the planned intervention. Trial registration number NCT02335697; Pre-results.

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  • 22.
    Westerdahl, Frida
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Wennick, Anne
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Borglin, Gunilla
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Teaching strategies and outcome assessments targeting critical thinking in bachelor nursing students: a scoping review protocol.2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 1, article id e033214Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Applying critical thinking is essential for nursing students both in an academic and clinical context. Particularly, as critical thinking is a vital part of nurses' everyday problem-solving and decision-making processes. Therefore, regardless of the topic taught or the setting in which it is taught, it requires teaching strategies especially targeting students' critical thinking skills and abilities. One challenge with the latter is the difficulties to assess and evaluate the impact of such teaching strategies on the students' critical thinking disposition. Hence, our objective will be to review published literature on; existing teaching strategies and outcomes assessments targeting nursing students' critical thinking skills and abilities.

    METHODS AND ANALYSIS: Our scoping review will be conducted in accordance with Arksey and O'Malley's framework for scoping studies. Search strategies will be developed in cooperation with an experienced librarian, and adjusted to each individual database for example, CINAHL, PubMed, PsycINFO, ERIC and ERC. A preliminary search in CINAHL was conducted on the 17th of July 2019. Peer-reviewed published studies conducted with a qualitative, quantitative or mixed method design and focussing our objectives, will be eligible for inclusion. Included studies will be quality assessed in accordance with their study design. Data will be charted using a standardised extraction form. The qualitative data will be presented through a thematic analyses, and the quantitative data by descriptive numerical analysis. Lastly, nurse educators and nursing students will be consulted for validation of the findings from the scoping review.

    ETHICS AND DISSEMINATION: Under the Swedish Ethical Review Act (2003:460) this study does not need ethical clearance by a Regional Ethical Review Authority as it not includes any primary empirical data on biological material or sensitive information. The findings will be used to inform the design of a future study aiming to develop an, and subsequently evaluate it, educational intervention targeting teaching strategies focussing on nursing students' critical thinking skills and abilities.

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  • 23.
    Ymeri, Gent
    et al.
    Malmö University, Internet of Things and People (IOTAP). Malmö University, Faculty of Technology and Society (TS), Department of Computer Science and Media Technology (DVMT).
    Salvi, Dario
    Malmö University, Internet of Things and People (IOTAP). Malmö University, Faculty of Technology and Society (TS), Department of Computer Science and Media Technology (DVMT).
    Olsson, Carl Magnus
    Malmö University, Faculty of Technology and Society (TS), Department of Computer Science and Media Technology (DVMT). Malmö University, Internet of Things and People (IOTAP).
    Wassenburg, Myrthe Vivianne
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Center for Neurology, Academic Specialist Center Torsplan, Region Stockholm, Sweden.
    Tsanas, Athanasios
    Usher Institute, Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK; Alan Turing Institute, London, UK.
    Svenningsson, Per
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Center for Neurology, Academic Specialist Center Torsplan, Region Stockholm, Sweden.
    Quantifying Parkinson's disease severity using mobile wearable devices and machine learning: the ParkApp pilot study protocol2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 12, article id e077766Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The clinical assessment of Parkinson's disease (PD) symptoms can present reliability issues and, with visits typically spaced apart 6 months, can hardly capture their frequent variability. Smartphones and smartwatches along with signal processing and machine learning can facilitate frequent, remote, reliable and objective assessments of PD from patients' homes.

    AIM: To investigate the feasibility, compliance and user experience of passively and actively measuring symptoms from home environments using data from sensors embedded in smartphones and a wrist-wearable device.

    METHODS AND ANALYSIS: In an ongoing clinical feasibility study, participants with a confirmed PD diagnosis are being recruited. Participants perform activity tests, including Timed Up and Go (TUG), tremor, finger tapping, drawing and vocalisation, once a week for 2 months using the Mobistudy smartphone app in their homes. Concurrently, participants wear the GENEActiv wrist device for 28 days to measure actigraphy continuously. In addition to using sensors, participants complete the Beck's Depression Inventory, Non-Motor Symptoms Questionnaire (NMSQuest) and Parkinson's Disease Questionnaire (PDQ-8) questionnaires at baseline, at 1 month and at the end of the study. Sleep disorders are assessed through the Parkinson's Disease Sleep Scale-2 questionnaire (weekly) and a custom sleep quality daily questionnaire. User experience questionnaires, Technology Acceptance Model and User Version of the Mobile Application Rating Scale, are delivered at 1 month. Clinical assessment (Movement Disorder Society-Unified Parkinson Disease Rating Scale (MDS-UPDRS)) is performed at enrollment and the 2-month follow-up visit. During visits, a TUG test is performed using the smartphone and the G-Walk motion sensor as reference device. Signal processing and machine learning techniques will be employed to analyse the data collected from Mobistudy app and the GENEActiv and correlate them with the MDS-UPDRS. Compliance and user aspects will be informing the long-term feasibility.

    ETHICS AND DISSEMINATION: The study received ethical approval by the Swedish Ethical Review Authority (Etikprövningsmyndigheten), with application number 2022-02885-01. Results will be reported in peer-reviewed journals and conferences. Results will be shared with the study participants.

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  • 24.
    Åkeflo, Linda
    et al.
    University of Gothenburg.
    Dunberger, Gail
    Ersta Sköndal Bräcke University College.
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Skokic, Viktor
    University of Gothenburg.
    Steineck, Gunnar
    University of Gothenburg.
    Bergmark, Karin
    University of Gothenburg.
    Cohort profile: an observational longitudinal data collection of health aspects in a cohort of female cancer survivors with a history of pelvic radiotherapy-a population-based cohort in the western region of Sweden.2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 7, article id e049479Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The study 'Health among women after pelvic radiotherapy' was conducted in response to the need for more advanced and longitudinal data concerning long-term radiotherapy-induced late effects and chronic states among female cancer survivors. The objective of this paper is to detail the cohort profile and the study procedure in order to provide a sound basis for future analyses of the study cohort.

    PARTICIPANTS: Since 2011, and still currently ongoing, participants have been recruited from a population-based study cohort including all female patients with cancer, over 18 years of age, treated with pelvic radiotherapy with curative intent at Sahlgrenska University Hospital in Gothenburg, in the western region of Sweden, which covers 1.7 million of the Swedish population. The dataset presented here consists of baseline data provided by 605 female cancer survivors and 3-month follow-up data from 260 individuals with gynaecological, rectal or anal cancer, collected over a 6-year period.

    FINDINGS TO DATE: Data have been collected from 2011 onwards. To date, three studies have been published using the dataset reporting long-term radiation-induced intestinal syndromes and late adverse effects affecting sexuality, the urinary tract, the lymphatic system and physical activity. These projects include the evaluation of interventions developed by and provided in a nurse-led clinic.

    FUTURE PLANS: This large prospective cohort offers the possibility to study health outcomes in female pelvic cancer survivors undergoing a rehabilitation intervention in a nurse-led clinic, and to study associations between demographics, clinical aspects and long-term late effects. Analysis focusing on the effect of the interventions on sexual health aspects, preinterventions and postinterventions, is currently ongoing. The cohort will be expanded to comprise the entire data collection from 2011 to 2020, including baseline data and data from 3-month and 1-year follow-ups after interventions. The data will be used to study conditions and treatment-induced late effects preintervention and postintervention.

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