Reports indicate a decrease in youth mental health in Sweden but at the same time research suggests that what is interpreted as mental ill-health could be considered everyday challenges by young people themselves. The distribution of mental health and illness among young people is uneven based on inequities related to factors such as race, gender and socioeconomic status. Sweden in particular is a country with large socioeconomic inequities in youth mental health and in school results, compared to other European countries. The aim of this study was to explore young people's experiences of the role of race, gender and socioeconomic status in relation to everyday challenges. Sixty-five young people aged 13–15 years old were recruited by student health services and participated in focus group discussions at schools in the southernmost part of Sweden. Data were analysed by secondary analysis with deductive qualitative content analysis using Ecosocial theory of disease distribution as theoretical framework. The analysis resulted in one main theme; Navigating inequities to gain and keep social status, with three underlying themes; Guided by social norms, Negative impact in everyday life and Importance of family influence. Participants were aware and critical of norms and expectations related to race, gender and socioeconomic status. Experiences of prejudice and unfairness was both own lived experiences by the participants as well as observed through friends and classmates. Young people spontaneously identify everyday challenges related to race, gender and socioeconomic status, even when not asked directly about these issues. Conforming to sexist, racist and classist, expectations is a way to lose and gain status in a school setting. Many of the inequities discussed related to socioeconomic status and the direct consequences of having or not having money. Young people's everyday experience of inequities is important to consider in youth mental health promotion aiming to tackle health inequities. Further research is needed on those experiences and how this affects mental health.

During the past decades there has been an increase in mental ill-health problems among children. Social-emotional learning (SEL) has shown promise to promote well-being by supporting children in developing abilities to cope with everyday difficulties. Structured SEL programs can be part of the school curriculum from early age. However, teachers' positive perceptions of the values of such programs are essential for program success. The aim of this evidence synthesis was to describe and understand teachers' experiences of providing SEL programs to students and their perceived effect on students' mental well-being. We followed the ENTREQ and PRISMA guidelines. Systematic searches were conducted and we included seven studies with a moderate level of methodological limitations. We conducted a thematic meta-synthesis, and confidence in the evidence was assessed with GRADE-CERQual. Teachers perceived that students developed a higher level of coping with their feelings and created improved relationships as a result of the SEL programs. As they received new tools to support students' well-being, teachers were positive to the programs. They noted, however, that the programs needed adaptation to the local context. To the best of our knowledge, this is the first meta-synthesis on the experiences among teachers on the impact of SEL programs on students' well-being. Notably, the results suggest that SEL programs could help teachers to attend to students' mental health. After conducting extensive searches for data, only studies from high-income countries were found. Therefore, further studies are needed within low-income countries in regard to SEL programs and experiences among teachers on students' mental wellbeing. It would also be beneficial to synthesize research on the students and their experiences on how SEL programs impact their mental well-being.

Collaboration for nursing is a core competence and therefore educational interventions are essentials for collaborative skills. To identify such interventions, we carried out a study to understand nursing students' collaborative process. A narrative inquiry method was used to explore the collaborative process of first-year undergraduate nursing students. The analysis was conducted on field notes from 70 h of observation of 87 nursing students' collaboration during skills lab activities. It also included transcriptions of four focus group discussions with 11 students. The results are presented as a sequential process of (1) navigating in unfamiliar territory, (2) navigating together to cope, and (3) navigating together towards independency and the future nursing profession. We identified a transition from teacher-led assistance and guidance to student interdependency and reciprocal learning, ending with student-led assistance supporting independency. In line with Vygotsky's theory of zone of proximal development, different scaffolding interventions are needed depending on where the students are in the collaborative process. 

INTRODUCTION: Research suggests that participating in after-school leisure activities has been related to promoting health, well-being and safety among children living in disadvantaged neighbourhoods. The United Nations Child Rights Convention emphasises the inclusion of children in decisions that concern them. However, children seldom are involved in designing implementing and evaluating health promotional environments. The aim of this programme is through a participatory process with children, parents/guardians, and peer-activity leaders explore, measure and evaluate the impact on children's overall well-being related to the social context in an already established health promotion environments in Southern Sweden.

METHODS AND ANALYSIS: The project is based on a previously implemented unique community-based participatory research (CBPR) model for equal health in three socially disadvantaged areas in Malmö. All activity house (AAH) is a meeting place for children established in schools but after school time by the culture department of the Malmö municipality. In AAH migrant children participate in need-driven after school activities that they themselves create and develop. To increase participation of the children and ensure that these environments are based on their needs, 30 children (10-12 years), parents/guardians (30), peer-activity leaders (15), and researchers create CBPR teams in the areas and engage in a participatory process. The children reflect, analyse and write about their well-being; identify and discuss key factors in an iterative process, which also includes a strategic group of stakeholders. The children then develop and validate (with 100 other children from AAH) the Socioculturally Aligned Survey Instrument for Children survey inspired by the KIDSSCREEN V.27. The survey tool so developed will further be used to evaluate AAH and will be distributed to all children participating in their activities.

ETHICS AND DISSEMINATION: This programme has been approved by the Swedish Ethical Review Authority. The results from this programme will be published as reports and scientific publication.

Background

The goal of the Swedish child healthcare system is to reach all children with health-promotive actions and to create equal health opportunities for all children. In that context, an extended home-visit program – called Grow Safely – for first-time parents, with an interprofessional collaboration between child healthcare nurses, midwives, social workers, and dental assistants, was initiated. The current study aims at illuminating and evaluating the health, social, and dental professionals’ experiences of working within this program and how such collaboration could benefit the professions.

Methods

A qualitative method was chosen, and 13 interviews were carried out with professionals working within child healthcare centers that participated in an extended home-visit program in the southernmost part of Sweden. The interviews were analyzed via Burnard’s approach to content analysis.

Results

The results showed that it was satisfying for the health, social, and dental professionals to work with the home-visit program and that they encountered positive feelings among the parents receiving it. The creation of deep conversations and parents opening up about feelings that could otherwise be shameful to express, was a positive aspect of the home visits. A negative aspect was the difficulty of handling the (sometimes necessary) interpretation over the phone during the visits, and another one was the fact that the visits were time-consuming and required logistical planning. Overall, the professionals were positive about the home-visit program in that they felt that they were able to give the families what they needed and to have discussions on sensitive issues. They also appreciated the fact that different professions collaborated in order to reach the same goal. 

Conclusions

This study showed that the health, social, and dental professionals enjoyed working with the home-visit program and that they encountered positive feelings among the parents regarding the collaborative visits being conducted within the home, where the families felt safe and relaxed. Despite the extended time required and the logistical challenges involved, the professionals expressed that the home visits created a deeper collaboration amongst them. 

Objectives 

Health inequalities exist among children in Sweden, and one effort that the Swedish government has focused on to promote health among small children and their parents is an extended home-visiting program during the child’s first 15 months. This study aimed to illuminate healthcare professionals’ experiences of meeting parents in different social situations during the home visits within Grow safely. 

Methods

The chosen method was qualitative, and 13 interviews were carried out with healthcare, social, and dental professionals working with the extended home-visiting program within the child healthcare in the south of Sweden. 

Results

The results revealed that the parents raised differing needs in the meetings with the healthcare professionals in the program. The needs included advice on children with special needs, support with problematic breastfeeding, and more psychosocial support. The professionals met different groups of parents, such as young parents or newly arrived migrant parents, that in different ways needed the team to reach out to them. The professionals also met families who came from better-off areas and who were not initially considered to really need the program. As the program progressed, these parents could see that diverse, unpredictable needs could be met by the intervention. For example, the program provided access to and advice from social workers, which in turn created contacts that lasted longer than the program itself.

Conclusions

The professionals encountered various family situations and needs within the extended home-visiting program. This highlights the need for a close collaboration between child healthcare nurses and social workers, in order to be able to support the families and work towards the aim of reaching equal health among all children in Sweden. 

Migration management policies in many states have marginalized significant numbers of individuals on the basis of their precarious residency status, negatively impacting their health. This article looks at how three European states with high levels of contagion - France, Sweden, and the United Kingdom - adapted their migration management policies to the changed circumstances during the Covid 19 pandemic in which there was new pressure for prioritizing population health over other concerns. The analysis compares globally-recognized 'best practices' for migrant health during the pandemic with policies adopted by France, Sweden, and the UK - selected as prominent migrant-hosting states and that experienced high rates of Covid-19. The article draws on supplementary evidence through interviews with civil society organizations working directly with migrants living on the margins of society - what are termed here 'marginalized migrants' (MMs). As the article concludes, the national policies often fell below international 'best practices' such that migration management was often prioritized over population health despite the crisis. The perspective developed in this paper is important for understanding where migration control policies have been prioritized over public health.

Under åren 2019–2022 genomfördes en satsning på ett utökat hembesöks-program för förstagångsföräldrar inom barnhälsovården i Skåne. Satsningen hade namnet Växa tryggt och baserades på erfarenheter av ett liknande program i Rinkeby. I Växa tryggt erbjöds förstagångsföräldrar sammanlagt sex hembesök under barnets första 15 månader. Besöken genomfördes i ett sam-arbete mellan barnmorskor, barnhälsovårdssjuksköterskor, föräldrastödjare och tandsköterskor/tandhygienister.En tvärvetenskaplig forskargrupp från Malmö universitet har på uppdrag av Region Skåne forskat om Växa tryggts genomförande och effekter. Forsk-ningen har inkluderat intervjuer och enkäter riktade till deltagande familjer, de professioner som genomförde hembesöken, verksamhetschefer och politiska beslutsfattare.I denna rapport redovisas forskargruppens övergripande resultat. Resultaten visar genomgående att både professioner och deltagande familjer var mycket nöjda med de utökade hembesöken. För professionerna, främst familjestöd-jaren och tandsköterskan/tandhygienisten, har Växa tryggt inneburit möj-ligheter att tidigt komma i kontakt med barnfamiljer i upptagningsområdet. Utöver stöd och support i enskilda frågor har professionerna även kunnat informera om ytterligare stöd som barnhälsovården, socialtjänsten och tand-vården kan erbjuda. För familjerna har de utökade hembesöken varit ett stöd i den intiala osäkerhet som ofta präglar ett nyblivet föräldraskap. Samtidigt har Växa tryggt främjat möjligheten att bygga tillitsfulla relationer med välfärds-professioner som utifrån sina skilda kompetenser är experter på barn- och familjeliv. Hemmet har i det föreliggande projektet visat sig vara en bra arena för att kunna individanpassa råd och stöd. Ytterligare en positiv effekt av Växa tryggt har varit att fera professioner samverkat i hembesöken och därmed kunnat komplettera och stärka varandra i dialoger med familjerna.

AIM: The aim was to explore collaboration between first year undergraduate nursing students in a three-year bachelor program during clinical skills lab practices.

BACKGROUND: The ability to collaborate is important in the nursing profession to ensure patient safety. Thus, efforts supporting nursing students with learning activities emphasizing this ability is crucial in nurse education as a preparation for the requirements of the nursing profession. Collaborative learning models are described as ways that support the students' interaction during education. However, collaboration between students has shown to have challenges such as negative competition and confrontations. This stresses the need to explore the collaboration between students to find ways to support the interaction.

DESIGN: The study was conducted with a focused ethnographic approach.

METHOD: Data were generated by participant observations during one semester, involving 70 h observation of 87 first year nursing students for 6 months and 24 training sessions in clinical skills lab practices. Two focus group discussions were used to elaborate students' views of collaboration and to provide an opportunity for follow up questions and interpretations from the observations. Field notes and focus group discussions were interpreted as one unit of analysis conducted with thematic network analysis. A global theme were synthesized from organizational and additional basic themes presenting the overall metaphor of the students' collaboration.

RESULT: The global theme, Between adaptation and non-conformity, revealed a field of tension in the nursing students' collaboration. One the one hand, the global theme involved the students' ability to adopt to new knowledge and to being a nursing student in a clinical skills lab and to others' perspective. On the other hand, non-conformity creates a collaboration with less reflection between the students and non-synchronized and time-consuming laboratory work.

CONCLUSION: Collaborative activities in nurse education fosters and challenges nursing students' collaboration required for clinical practices and later in the nursing profession. By the presented scaffolding efforts, nurse educators can arrange a learning environment that can support the collaboration between students and facilitate the transition into the profession.

Background: To achieve the requisites for a child’s healthy development and to reducehealth inequalities, it is important to promote health initiatives at an early stage in a child’slife and to include the parents. Home visits by healthcare professionals have been foundto have positive health effects for both the baby and the parents. From an extended homevisit programme in Sweden, our aim was to illuminate first-time parents’ experience of ahome visit conducted by a midwife and a child health care nurse 1–2 weeks postnatal.Methods: Data was collected by interviews (n = 13) with first-time parents. Thetranscribed texts were analyzed using inductive content analysis.Results: The participants’ experiences could be understood from the two themes, Atrust in the professionals and Feeling safe as a new parent. The participants experiencedthat the midwives and the child health care nurses complemented each other andappreciated to get knowledge and information from both professions. In their own home,they felt secured and relaxed, and the professionals could help them provide a safe homeenvironment for the child.Conclusion: By meeting both professionals at the same time and in their own home,the participants experienced that the needs of the baby and their needs and concernsas new parents were included and supported.

Den här rapporten ger en sammanfattning av de seminarier som organiserades under våren 2021 av PHEDKommissionen för framtiden för hälso- och sjukvården efter covid-19, som bjöd in till vittnesmål från hälso- och sjukvårdspersonal, tjänstemän, tankesmedjor, forskare, civilsamhället och andra intresserade parter baserat på de erfarenheter de fått och lärt sig av under pandemin. De vittnesmål som framfördes kom från många olika geografska platser och många olika nivåer, vilket gjorde dem relevanta både för Sverige och globalt. De fastställer fera centrala rekommendationer för att skydda och förbättra folkhälsan. Dessa rekommendationer både kompletterar och i hög grad utökar de rekommendationer som togs fram i den första rapporten, som var mer fokuserad på Sverige (”Ojämlikhet i samhället gör oss sårbara för pandemier”) och baserad på vittnesmål från hösten 2020, och som kan nås via: https://phed.uni.mau.se/. Den stora mängd erfarenheter som sammanfattas här går långt utöver pandemiperioden och tillhandahåller idéer och praktisk vägledning för att skydda och stärka människors hälsa så att den blir mer motståndskraftig inför framtida kriser. 

This report summarises the Spring 2021 sessions of the PHED Commission on the Future of Healthcare Post Covid-19, which invited testimony from healthcare practitioners, civil servants, thinktanks, researchers, civil society, and other interested parties based on their experiences learnt during the pandemic. The evidence presented came from multiple geographies and levels, making it relevant both to Sweden and globally. It identifes several key recommendations for protecting and improving public health. These recommendations supplement and greatly expand upon those identifed in the report (‘Societal inequity makes us vulnerable to pandemics’) based on testimony from Fall/Autumn 2020, which can be accessed via: https://phed.uni.mau.se/. The wealth of experience summarized here goes well beyond the pandemic period, providing ideas and practical guidance for protecting and strengthening human health to be more resilient in the face of future crises.

Objective: There is an association between pre-migration exposure to threats and violence, and the risk for mental illness among newly arrived refugees (NAR). The aim of this study is therefore to investigate the effect of pre-migration violent and threatening experiences on the mental health of NAR in Sweden. The participants were recruited between February 2015 and February 2016, undergoing the naturalisation process in Sweden. In total, 681 questionnaires were returned (response rate of 39.5%).

Results: The results showed that almost 50% of the sample were at risk for mental illness. Analysis of pre-migration exposure to violence or threats, and risk for mental illness, showed a significant odds ratio for violence as well as for threats. Analysing men and women separately resulted in a significant odds ratio for women for pre-migration threats. For men, pre-migration violence and threats were significantly associated with the risk for mental illness. The host society receiving NAR must screen for mental illness and be prepared to provide support and care for refugees who were exposed to violence or threats, and who are subsequently at risk for mental illness. This must be considered in order to improve health and subsequently the social integration of refugees.

This chapter compares health communication towards migrants living at the margins of society – undocumented migrants, asylum seekers, and refugees – within the different Scandinavian countries (Denmark, Norway, and Sweden), to understand the present state of health communication and its role in both strengthening and, where being unequal, segregating societal inclusion within the Nordic region. We know that such migrants often experience health challenges related not only to their migratory journey, but often caused by the precarious situation in which they are placed upon arrival in host countries. Past studies show significant challenges in obtaining care, and difficulties with communication, including cultural awareness. Where health communication fails to meet the needs of a diverse population, we see growing societal segregation that often follows racialized structures with long-term consequences for society.

Background: Previous research indicates that social relations have an impact on the well-being of refugees and that well-being is important for effective integration into the host country. Few studies in Sweden have, to the best of our knowledge, looked at the association between social relations and mental ill-health among newly arrived refugees. The aim is to investigate what effect social relations have on the mental health of newly arrived refugees in the south of Sweden. Methods: A cross-sectional study was conducted in Scania, the southernmost county of Sweden, between February 2015 and February 2016. The study population consisted of newly arrived adult refugees speaking Dari or Arabic, who received the civic and health information that is part of an introduction course for all newly arrived refugees. Results: Individuals who rarely met with friends had higher odds of experiencing mental ill-health (OR=1.70, 95% CI, 1.03-2.82) than individuals who frequently spent time with friends. Furthermore, individuals who seldom attended social/community meetings or activities in an organisation or group, such as a sports association or another kind of association, a church, a mosque, or women’s or men’s meetings, had higher odds of mental ill-health (OR=1.58, 1.1-2.28), compared to those who frequently did so. Conclusions: The study suggests a link between spending time with friends, as well as engaging in social/community activities, and the mental health of newly arrived refugees in the southernmost county of Sweden, which is one of the counties in Sweden that received the highest number of refugees. The results are in line with a previous study on the same subject in Sweden.

Migration is a stressful experience and research shows that newly arrived migrants in Sweden suffer from different challenges and struggle to relate to parenting in a new culture that is different from their own. The Swedish Child Health Services (CHS) focuses on promoting health among children, as well as supporting parents in parenting. Although this is a goal, migrant parents participate at lower rates in parental support groups. This paper aims to discuss how the Swedish CHS can support these families and address the need for improvement in the parental support offered to migrant parents during transition into their host country. In addition, this paper also aims to review and discuss the advantages of using a community-based participatory research approach together with the Swedish CHS to identify and apply culturally appropriate support programs to increase health literacy among migrant parents.  

The Swedish government decided to place greater emphasis and resources on supporting parents and promoting equal health among families in Sweden, with special emphasis on migrants and other vulnerable groups. This report from the Swedish government indicates the importance of creating knowledge about new ways, methods, and actions that may be needed to increase this support. One suggestion of this paper is to provide culturally appropriate healthcare work using a community-based participatory research approach, where migrant parents themselves are actively involved in the development of support programs. This approach will not only provide migrant families knowledge and support, it will also build on their needs and the challenges they can share, and receive support to overcome.

International guidance set forth recommendations to protect marginalized migrant populations during Covid-19 given the significant inequalities in terms of social and economic well-being reported in the literature. However, a cross-country study of three European countries with high rates of Covid-19 infections and deaths has shown that migrant well-being has significantly decreased since the outbreak of Covid-19 in Europe from March 2020 and that policy measures to help those marginalized populations have been insufficient. The conclusions on migrant well-being during Covid-19 draw on interviews with prominent civil society organizations in all three countries that work specifically on migrant health and welfare. All interviews were semi-structured and conducted between October and November 2020. The analysis mainly focuses on objective/material measures of well-being related to access to health care, information on prevention of infection, housing and exclusion by host population.

Introduction

In Sweden, often seen as one of the most egalitarian countries, the COVID-19 pandemic exposed high levels of health inequality, especially harming people with a refugee background. This is also despite Sweden’s image as a refugee-friendly country. In this context, the aim of this paper is to better understand how Swedish health- and social workers have reacted to the health- and social needs of refugees during the pandemic. The Swedish case is particularly interesting because, as seen in the paper, health- and social workers had the task of communicating health guidance to refugees who were sometimes more reliant on information from abroad where the consensus on COVID-19 restrictions ran contrary to the approach recommended by the Swedish public health authority.

Method

The study utilizes a qualitative content analysis of 13 in-depth interviews with health- and social workers in Sweden, active in the care of refugees within different kinds of health- and social care settings. 

Results

The analysis showed that healthcare services have remained open during the pandemic but with new precautions at reception areas impacting how refugees access healthcare. As discussed in the article, the shift to digital tools has particularly impacted refugees, worsening already existing barriers to healthcare services faced by those with refugee status. Public health recommendations were poorly designed to the needs of refugees whose living conditions often prevented them from self-isolation and social distancing. Furthermore, Sweden’s initially non-restrictive approach to the pandemic instructed health- and social-workers to encourage refugees to take far fewer precautions (e.g. self-isolation, home-schooling, pregnant women to avoid virus hotspots) compared both with European neighbours and the international media typically used by refugees. When Sweden shifted towards a more restrictive approach, health- and social-workers had to revise their guidance in relation to the new recommendations around precautions.

Conclusion

Refugees have faced increased barriers to maintaining their health and well-being during the pandemic that exceed those experienced by the rest of the Swedish population. Refugees have, in general, taken precautions in regard to social distancing and followed recommendations but faced challenges with social distancing due to isolation and crowded living. Public health authorities have often failed to acknowledge that individuals use increasingly diverse sources of knowledge when trying to protect their health, and that not everyone has access to the knowledge needed to access healthcare and social systems. At the same time, there is a need to acknowledge that refugees are sometimes a source of expertise that was ignored by the Swedish health and social system during the pandemic. There is a need for urgent efforts to halt the worsening health conditions for this specific group, but also to counter knock-on societal effects and rising health inequity.

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

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

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

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

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.

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

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

Under hösten 2020 organiserade PHED-projektet i ett samarbete mellan Malmö och Lunds universitet en kommission och bjöd in till muntliga och skriftliga vittnesmål om framtiden för hälso- och sjukvården efter covid-19. Efter att initialt ha fokuserat på Region Skåne, utvidgades diskussionerna till att omfatta ett bredare nationellt fokus liksom internationella jämförelser med Frankrike och Storbritannien. Undersökningen omfattade vittnesmål från såväl yrkesverksamma inom hälso- och sjukvård som tjänstemän, civilsamhället och forskare. Överlag framställde vittnesmålen covid-19 som både en tragedi och ett lärotillfälle som skulle kunna stärka samhället. Flera centrala rekommendationer för att skydda och förbättra folkhälsan togs fram.

During Fall/Autumn 2020, the PHED project between Malmö and Lund Universities organised a Commission inviting oral and written testimony on the future of healthcare post Covid-19. Focused initially on the Scania region, the discussions expanded to include a wider Swedish national focus, and international comparison with France and the United Kingdom. The inquiry included testimony from healthcare practitioners, civil servants, civil society, as well as researchers. Overall, the testimony pointed to Covid-19 as both a tragedy and a learning moment by which to strengthen society. It identifies several key recommendations for protecting and improving public health.

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

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

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

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

Bakgrund

Att tvingas fly är en påfrestande och svår process att genomleva. Att efter flykten etablera sig i mottagarlandet medför ytterligare utmaningar. Vägen till att etablera sig i det nya samhället är ofta lång och kantad av svårigheter. Att lära sig språket, att förstå det svenska samhället samt utmaningar med svårigheter att validera diplom och kompetens är några av de svårigheter nyanlända upplever under den första tiden i landet. En ytterligare vanligt förekommande utmaning är att finna ett stabilt och tryggt boende. En förutsättning för att överhuvudtaget kunna bemöta dessa svårigheter är det egna hälsokapitalet. Hur ser hälsokapitalet ut bland dem som varit på flykt från krig och oroligheter och är det tillräckligt starkt för att hantera allt som möter individen under etableringen? I hälsokapitalet bör alla hälsorelaterade faktorer innefattas, vilka på ett eller annat sätt berör det mänskliga livet. För att främja etablering och inkludering av nyanlända individer är det viktigt att ha en grundläggande förståelse för den situation som denna grupp av nytillkomna invånare befinner sig i vad gäller hälsa och dess olika riskfaktorer.

Syfte

Syftet med undersökningen har varit att studera hälsa och hälsorelaterade faktorer bland vuxna nyanlända i Skåne som befinner sig inom etableringen i Skåne.

Material och metod

Alla vuxna nyanlända arabisktalande individer som deltagit i samhällsorientering genom Partnerskap Skåne har bjudits in till att delta i undersökningen. Insamlingsperioden har varit mellan maj månad 2018 till och med mars månad 2019. Mätinstrumentet har utvecklats på svenska för att sedan översättas till arabiska. Enkäten baserades på frågor som fokuserar på bland annat olika sjukdomar, vårdbehov, migrationsspecifika frågor, boende, sociala relationer, våld, levnadsvanor samt sexuell hälsa. Frågeformuläret delades ut i form av pappersenkät inom ramen för samhällsorienteringen av samhälls- och hälsokommunikatörer. Totalt antal svarande blev 315 vilket innebär en svarsfrekvens på 25,3 %.9

Slutsats

Resultatet visade att en stor andel migranter led av antingen övervikt eller fetma och en ganska stor andel av dessa ansåg att deras vikt ökat sedan flykten till Sverige. Drygt var tionde nyanländ upplevde sitt hälsotillstånd vara dåligt eller mycket dåligt och var tredje person ansåg det vara någorlunda. Det var nära hälften som upplevde en förbättring i självupplevd hälsa efter att de fått uppehållstillstånd medan nästan var femte person upplevde en försämring. Nästan varannan nyanländ hade varit i behov av läkarvård under de senaste tre månaderna innan undersökningen genomfördes men inte sökt vård. Drygt var tredje nyanländ hade en risk för psykisk ohälsa och det var en högre andel män än kvinnor som hade denna risk. Mer än hälften av de nyanlända utförde antingen ingen fysisk aktivitet alls eller under mindre än 30 minuter per vecka. Majoriteten av de tillfrågade ansåg inte att det går att lita på människor runtomkring. En betydande del saknade ett socialt nätverk när det gällde att kunna skaffa ett arbete och hälften saknade kontakt med arbetsgivare och nästan var tredje hade svårt att få sin utbildning validerad.

Bakgrund

Att som flykting etablera sig i ett nytt samhälle är ofta en långvarig process. Den börjar med att ansöka om asyl, orientera sig i och förstå det nya samhället, lära sig språket och komplettera tidigare utbildning eller utbilda sig på nytt i strävan efter etablering på arbetsmarknaden. Det svenska samhället har sedan 2010 ett strukturerat och individbaserat etableringsstöd som pågår under en period på cirka 24 månader efter beviljat uppehållstillstånd. Frågan vi genom studien ställt oss är hur väl rustade nyanlända efter genomgången etablering är för att ta sig an alla de utmaningar som väntar under den första tiden efter etableringsprocessen. Hur har situationen utvecklats, hur ser den fysiska och psykiska hälsan ut, vilken uppfattning har de av etableringen samt vidare om de fått ett arbete eller hur de ser på sina möjligheter att få ett. Dessa frågor är viktiga att få kunskap om i syfte att fortsatt kunna erbjuda ett behovsanpassat stöd i processen att etablera sig i Sverige.

Syfte

Syftet med undersökningen har varit att studera hälsa och hälsorelaterade faktorer bland vuxna nyanlända i Skåne som nyligen genomgått etableringsprocessen men även att undersöka om etableringsinsatserna bidragit till ökad delaktighet i samhället och ett närmande till arbetsmarknaden.

Material och metod

Tillvägagångssättet för undersökningen har varit att utveckla ett övergripande frågeformulär på arabiska med fokus på olika frågor gällande hälsa, vårdbehov, boende, sociala relationer, våld, levnadsvanor, migrationsspecifika frågor, arbete och delaktighet samt sexuell hälsa. Urvalet som baseras på ett obundet slumpmässigt urval bestod av 10 000 individer boende i Skåne med födelseland Syrien eller Irak och beviljat uppehållstillstånd mellan 2012.09.01 och 2016.08.31. Vid beviljat uppehållstillstånd var de i åldern 20 till 64 år och bosatta i Skåne. Undersökningen utfördes under hösten 2018. Frågeformuläret skickades ut till respondenterna i form av pappersenkät med möjlighet att fylla i enkäten digitalt. Totalt antal svarande blev 3208, vilket innebär en svarsfrekvens på 33%.11

Slutsats

Uppehållstillstånd är mestadels beviljat under det första året. Kunskaper i det svenska språket är bristfälliga för många. Den självrapporterade hälsan är i linje med den övriga befolkningen i länet och den egna insatsen för att bevara god hälsa bedöms vara betydelsefull. En väsentlig andel upplever otillfredsställda läkar-eller tandläkarvårdbehov. Hälsorelaterade levnadsvanor som rökning och fysisk inaktivitet samt brist på tillit ligger högre än genomsnittet i den övriga befolkningen. Bristande förtroende förekommer för olika samhällsinstanser. Störst förtroende upplevs för barnavårdscentralen. Nästintill alla har haft en etableringsplan inklusive samhälls- och hälsokommunikation. Vad gäller etableringsplanen generellt höll majoriteten med eller delvis med om att planen innehöll relevanta aktiviteter. De utmaningar som observerades var aktiviteternas kvalitet och att dessa inte är utformade med hänsyn till respondenternas situation samt att aktiviteterna krockar med varandra. Avsaknad av socialt nätverk och bristande språkkunskaper ansågs av många som hinder för att komma in på arbetsmarknaden. Att komma in på den svenska arbetsmarknaden är en fortsatt utmaning för många.

Aims: The Swedish public support system for integration and establishment of newly arrived refugees includes an individualized introduction plan, containing language, civic and health information classes. As the plan requires active involvement, the simultaneous establishment of childcare and school start for children risks creating additional challenges and frustrations. The aim of the study was to explore the experience of adjustment among newly arrived refuge parents in the resettlement process, so as to understand how this risk may be mitigated. Methods: A qualitative study conducted with 24 Syrian refugee parents participating in the resettlement process and having received asylum status. Results: Parents experienced stress due to long waiting times for residence permits and the struggle to find stable housing. The parents established themselves by enrolling in language studies and looking for employment. They also faced challenges adjusting socially since they were mainly meeting people from their own country and therefore felt excluded from the Swedish society. Conclusions: The parents describe the experiences of having escaped from a war-torn country and arrived in new surroundings as mainly challenging for their current situation. Feelings of uncertainty arise as families struggle with daily life while waiting for residence permits, finding stable housing, learning a language and adjusting to new social circumstances. Having this in mind, we conclude that this group of refugees is exposed to health risks in the near future and as such is in need of additional support.

Bakgrund

Migration överlag är en faktor som kan leda till ökade stressnivåer bland migranter vilket ofta kan bero på de omständigheter som förekommit kring själva flykten. Efter att de nyanlända anlänt till värdlandet väntar ofta en period av osäker väntan på uppehållstillstånd vilket har tydligt visat sig korrelera negativt med den psykiska hälsan. I samband med beviljat uppehållstillstånd påbörjas en rad stödinsatser för etablering i samhället. I Sverige erbjuds alla nyanlända att delta i etableringsprocessen vilken innebär ett individanpassat stöd för den nyanländes etablering i samhället. En grundförutsättning för ett aktivt deltagande i etableringsprocessen är en god hälsa samt en stabil tillvaro i form av en trygg boendesituation. En särskilt utsatt grupp bland de nyanlända är familjer med barn där utmaningarna med etableringen är betydligt mer skiftande jämfört med de ensamstående. Dessutom utgör nyanlända kvinnor av olika anledningar en särskilt utsatt grupp. Det är därmed av vikt att närmare belysa hur de nyanlända familjerna och särskilt de nyanlända kvinnorna ser på sin hälsa och sin situation under etableringsprocessen i Sverige.

Syfte

Syftet med studien var att belysa nyanlända familjers upplevelse av hälsa under det att de deltar i etableringsprocessen samt att särskilt belysa nyanlända kvinnors situation under etableringen.

Material och metod

Föreliggande rapport utgörs av två delstudier genomförda med kvalitativ forskningsmetod. Båda delstudierna har baserats på insamlat material genom kvalitativa intervjuer. Intervjuerna har baserats på semi-strukturerade frågescheman som innebär att ett antal övergripande frågor eller teman använts som utgångspunkt vid intervjuerna. Totalt genomfördes 26 intervjuer varav 15 med fokus på familjer och 11 med fokus på kvinnornas situation. Det insamlade materialet har i den första delstudien bearbetats med Attride-Stirlings metod i form av ett tematiskt nätverk och i den andra delstudien med Burnards metod för innehållsanalys. Eftersom det förekommer svårigheter med språket så tidigt inpå flykten till Sverige genomfördes intervjuerna med hjälp av auktoriserade tolkar. Alla intervjuer utfördes i Skåne län.

Slutsats

Nyanlända familjer i etableringen kämpade med väntan på ett erhålla uppehållstillstånd och utmanades även av att hitta ett stabilt boende för sina familjer. Barnen trivdes bra i skolan och föräldrarna drevs av att lära sig det svenska språket samt att komma in på arbetsmarknaden. Detta upplevdes dock10som en utmaning. En del av föräldrarna led även av att ha familjemedlemmar kvar i hemlandet och utmanades av den nya sociala situationen i Sverige. Vad gäller kvinnornas situation specifikt framkom det att återföreningen med familjemedlemmar var viktig eftersom saknaden efter dem ansågs kunna påverka den psykiska hälsan negativt. Kvinnorna i studien verkade vara ivriga till att lära sig språket och att komma in på arbetsmarknaden.Sammanfattningsvis är det viktigt att påpeka att föreliggande undersökning avsåg att studera upplevelsen av hälsa men att detta tema av respondenterna besvarades i relation till hälsans bestämningsfaktorer såsom arbetslöshet, delaktighet och svenskt socialt nätverk samt trygg boendesituation.

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

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

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

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

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

The clinical environment is a vital component of nurse education, constantly changing due to constraints of the current health care systems such as increasing number of students and a limited number of preceptors. Peer learning, is gaining momentum as an educational model highly suitable for clinical placements. The peer learning model incorporates structured learning activities that support student activity, but little is reported of the actual structure and content of those activities. Thereby, the aim of this study was to explore precepting nurses’ experience of using structured learning activities as part of the peer learning model during clinical placement. We used a qualitative research approach, using two open self-administered global questions. The result is based on the analysis of the written responses from 62 preceptors. Four categories followed the analysis: An opportunity for collaboration, An occasion for reflection, A new educational structure, and Recommendations for development. The preceptors perceived the structured learning activities as beneficial for increased collaboration and reflection among students. Moreover, utilizing the structured learning activities was perceived to be time saving for the preceptors, however this is an area where further research is needed.

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

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

Previous research findings suggest that insomnia could be related to decreased health status and that it could also be affected by traumatic life experiences, such as war. Good health is important for newly arrived refugees for an effective integration process. The aim of the present study is, therefore, to investigate the association between self-perceived health and sleep quality among newly arrived refugees in Sweden. The results are based on 681 migrants who participated in a survey between 2015 and 2016. There was a significant odds ratio (OR) after adjustment for confounders for newly arrived refugees that were experiencing bad self-perceived health to also experience bad sleep: OR 8.07 (4.34-15.00). Furthermore, the OR remained significant but lower after adjustments for confounders for newly arrived refugees that had bad self-perceived health to be suffering from anxiety during sleep, with OR 3.83 (2.11-6.94).

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

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

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

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

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

BACKGROUND: Resettlement can be particularly challenging for women as having a lower socioeconomic status and language barriers, may impede women's access to education, employment opportunities, health-care services, as well as the cultural, social, material and resilience factors that facilitate adjustment and adaption. Thus, the aim of this study is to further explore the perception of refugee women in Sweden concerning their situation during active participation in the resettlement process in the country. METHODS: Qualitative interview study with 11 recently arrived refugee women who had received their residence permits and were enrolled in the resettlement process. The interviews were conducted in Swedish with the support of an authorized Arabic translator present by telephone. RESULTS: Refugee women suffered from being separated from their loved ones and felt compelled to achieve something of value in the host country. All experienced both physical and mental anguish. CONCLUSIONS: Stakeholders in societies that receive refugee women should stress the importance of finding opportunities for and fast entrance into employment in the host countries. This would be beneficial for the integration and well-being of refugee women after migration.

Objective: Research shows that, depending on the route of travel during the escape, the journey presents the refugees with different health risks. Traumatic events during flight may have long-lasting physical and psychological effects on the refugee children. Therefore, it is important to illuminate the experiences that refugee families arriving in Sweden have endured during their flight. A qualitative study was conducted through interviews with fifteen recently arrived Syrian refugee families. Results: The parents described different reasons as to why they as families had to escape the war. Some families had lost jobs and loved ones in the war and did not want their children to die as well. They mentioned that the journeys varied between 10 and 40 days and were usually filled with struggles and threats. The escape to Sweden was expressed as an emotionally trying journey. Many parents talked about the fear and terror the children felt. Traumatic events during the escape, such as separation from family, death of family members, sexual violence, kidnapping or extortion may have long-lasting physical and psychological effects on the refugee children and their families. Therefore, health care workers meeting and caring for these families after arrival must pay close attention to that.

Background: During recent years, Europe has faced increased immigration. The growing number of refugees presents huge challenges to the healthcare systems of host countries. However, healthcare professionals are generally unprepared to understand and address the health and care needs of refugees. More information about refugees’ experiences of the healthcare system is urgently needed to improve the quality of healthcare delivered and provide opportunities for better access. The aim of this study was to learn more about refugees’ experience of the healthcare system in their host country. Methods: The study was conducted as a scoping review. A systematic search of articles was done in Medline, Cinahl and Psychinfo. 619 articles were found in the searches. Twenty-six articles were included in the study. Results: The results showed that the communication between the health professionals and the refugees was important but poor language skills were perceived as a barrier for good communication. There was a need for both increased oral and written information about the health care system and the right to health care in the host countries. Supportive health professionals were of great importance for a good interaction between the refugee and the health care system. In some of the studies included, some refugees had felt discrimination due to their low proficiency in the national language, or because of race or accent. There was a perceived need for more culturally appropriate health care for the refugees. Conclusions: Since refugees may be at greater risk of poor mental and physical health compared to the rest of the population, there is an urgent need for improvement in communication, interpretation, support and delivery of a culturally appropriate care.

Background: Solid health is a prerequisite for successful inclusion and participation in support systems for recently arrived migrants’ (RAM) i.e. refugees. The society support system may vary depending on the age of RAM but is equally important for an effective start of the establishing process. Understanding health needs of RAM in different phases of establishing is essential as such knowledge is central for the supporting system. Methods: MILSA 2.0 consists of five studies targeting various health aspects. The focus is depicted into an early phase of establishment as well as following the period after the mandatory process. The platform addresses health issues of families with children as well as various health aspects of Arabic speaking adult RAM soon after arrival to Sweden. Also, it focuses on RAM adolescents in relation to risk behavior, social capital and confidence as well as on health issues in adult RAM after the formal establishment process. The platform also illuminates an extended support system of civic and health communication both in time as well as lecturing environment primarily targeting social capital, coherence and self-efficacy. Results: MILSA 2.0 addresses different phases of an establishing process in Sweden. Several health and health related factors are addressed such as self-rated health, social capital, trust, physical activity, sexual and reproductive health and living conditions. The extended civic and health communication addresses increased program hours as well as new program environments such as libraries, museums, and workplaces. Conclusions: These five studies reveals health related knowledge in different aspects of the establishing process as well as it develops several questionnaires and reveals methodological aspects. The platform focuses on both adolescent and adult RAM during and after the mandatory public support system including both the recipients of the support as well as the supporting actors. Key messages: - MILSA 2.0 develops questionnaires and determines health related concerns both during and after the mandatory establishing process. - MILSA 2.0 evaluates the effect of a policy change regarding standard procedures of civic and health communication.

Objective Housing and neighbourhood conditions are widely acknowledged important social determinants of health and health inequalities that persist in developed countries despite general improvements in health outcomes across populations. Previous research has investigated what effect crowded living conditions have on mental health and concluded that women living in crowded conditions were more likely to suffer from depression. In contrast, men living in the same conditions responded with withdrawal or aggression. To the best of our knowledge, only a few studies have examined the association between recently-arrived migrants living in crowded conditions and poor mental health. The aim of this study was to investigate the association between crowded living conditions among recently-arrived migrants in Sweden and mental ill-health. The result is based on 681 migrants who completed and returned questionnaires in 2015-2016. Results The analyses, independent of gender, resulted in a significant unadjusted odds ratio of 1.46 (95% CI 1.05-2.03); even after adjustments were made, the association remained significant OR 1.47 (1.05-2.07). When adding stability in housing into the adjustment-model, the OR did not remain significant OR 1.40 (0.99-1.99), p-value 0.061.

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.

Despite the high rates of HIV infections in Tanzania, significant gaps in the depth and comprehensiveness of HIV knowledge persist among the population in Tanzania. The aim of our study was to explore nurses’ experiences of providing information about HIV prevention in Tanzania. Semi-structured interviews with open-ended questions were conducted with eight nurses in health care centers. The interviews were transcribed and analyzed using qualitative content analysis as described by Burnard. The results showed that the nurses carried out the preventive HIV work by giving information, offering counselling, and teaching precautions. The nurses faced many challenges: for example, misconceptions about condom use, people’s lack of information about HIV, dealing with the stigma attached to HIV, and the lack of resources in the country. The preventive work affected the nurses emotionally, as they felt a sense of social responsibility to help prevent HIV. Key words: experiences, HIV prevention, information, nursing, qualitative study, Tanzania.

Bakgrund: WHO rekommenderar exklusiv amning som enda näring under spädbarnets första sex månader. Trots denna rekommendation, ammar inte alla kvinnor, varken helt eller delvis under denna period. Syfte: Syftet med denna systematiska litteraturstudie var att sammanställa evidens gällande sociodemografiska, fysiska, psykiska och sociala faktorers påverkan på att ammande mammor slutar att amma innan barnet är 6 månader. Sökmetod: En systematisk sökning utfördes i fyra olika databaser. Inkluderingskriterier: Studier med kvantitativ forskning inkluderades. Data kollektion och analys: Totalt lästes 186 abstrakt och utav dessa ansågs 83 vara relevanta och 18 var dubbletter. Slutligen inkluderades 27 artiklar eftersom de svarade mot syftet. Kvalitetsgranskning utfördes med hjälp av en granskningsmall från SBU och evidensgradering utfördes med hjälp utav GRADE. Resultat: Det visade sig finnas ett samband mellan avslut av amning och unga mammor, låg utbildningsnivå, återgång till arbetet inom 12 veckor efter barnets födsel, kejsarsnitt och otillräcklig mjölkproduktion och detta samband hade låg evidens. Sambandet mellan depression hos mamman och avslut av amning hade mycket låg evidens. Slutsats: Sociodemografiska faktorer verkade ha samband med avslut av amning i flertalet av dem inkluderade artiklarna. Det preventiva arbetet borde fokusera på hur kunskapen hos hälso-sjukvårdspersonal kan förbättras och hur riktade interventioner kan fokusera på mammor som riskerar att avsluta sin amning innan 6 månader Nyckelord: amning, litteraturstudie, riskfaktorer, avslut av amning

Objective Refugees seek medical advice for a variety of reasons. Previous research suggests that understanding the refugees´ experiences of and access to healthcare are important factors for improving their health as access to healthcare has been found to be a leading health indicator. Therefore, the aim of this study was to illuminate experiences of the Swedish health care system from the perspective of newly arrived refugees. Results More than 70 % of newly arrived refugees in the county of Scania were in need of health care during the last 3 months of 2015-2016. They did not seek care to the same extent as the general population. The main reasons were explained as too high costs, long waiting times and language difficulties. Some disclosed being denied access to health care for reasons, such as being denied care when seeking emergency room for stomach problems and being denied follow-up care for diabetes.

Background: Immigration, particularly when it is involuntary, is known to be an emotional stressor, regardless of the reason behind it. It is always a challenge to be removed from the habitual and cultural action pattern of the person or family. This can make children more vulnerable, because they often arrive with an increased risk of poor physical health. Because of that, it is crucial that immigrant children have access to ongoing health care. The aim of this study is to shed light on the experience of non-European immigrants with Sweden’s Child Health Care system. Methods: Qualitative semi-structured interviews were conducted, with parents of children who were patients of one of the four child health care centres. The centres were in four areas in a town in southern Sweden in which there are substantial immigrant populations. The interviews were conducted, transcribed and then analyzed with content analysis. Results: The results were divided into two main categories: The first is “the sense of being cared for in another way,” which was divided into the following four subcategories: compare with the home country, getting a home visit, engagement and contentment and unfamiliarity with the language. The second main category. “The feeling of getting all the practical needs met through the child health care system” had the following four subcategories: The importance of advice and guidance, getting oral and written information, getting help when needed and getting support when needed. Conclusions: The parents expressed contentment regarding the Swedish child health care and they were thankful for how it was organized, the engagement of the nurses, the information and advices given as well as for the opportunities of getting a home visit after birth. However, more research is needed in order to find out the extent to which the Swedish child health care system is culturally appropriate in the whole country. KEYWORDS Migration, qualitative research, child health care, support

Background: During the last years, Europe experienced an increase in immigration due to a variety of worldwide wars and conflicts, which in turn resulted in a greater number of physical and mental health issues present among the refugees. These factors place high demands not only on the refugees, but also on healthcare professionals who meet the refugees in different situations. Information about the refugees’ experiences of the healthcare systems in their host countries is urgently needed to improve the quality of healthcare delivered, as well as to provide opportunities for better access. The aim of this scoping review is to compile research about the experiences that the refugees have with the healthcare systems in their host countries. Methods: This study was conducted as a scoping review and the methodology is derived from Levac et al. and with inspiration from the framework of Arksey & O’Malley. A systematic article search was done in Medline, Cinahl and Psychinfo. A total of 619 articles were found in the search and finally 26 articles met the inclusion criteria and were included. Results: The results show that communication between healthcare professionals and refugees is important, however, insufficient language knowledge acts as an effective communication barrier. There is a need for more information to be given to the refugees about the reception country’s healthcare system in both oral and written formats, as well as the right to healthcare. Support from healthcare professionals is also important for refugees to have a positive experience with healthcare. In some of the studies included, refugees experienced discrimination due to low proficiency in the language of the host country, and/or because of their race or accent, which shows that culturally appropriate healthcare is needed for them. Conclusions: Since refugees are suffering from poor mental and physical health and could therefore be at a greater risk of morbidity and mortality in comparison to the rest of the population of the host country, there is an urgent need for improvements in communication, interpretation, support, and deliverance of culturally appropriate healthcare.

Purpose: To illuminate the experience of nurses providing healthcare to undocumented migrants in a voluntary network. Methods and sample: In a qualitative study, semi-structured interviews were conducted with RNs regarding their experience of providing healthcare to undocumented migrants within a voluntary network. The interview transcripts were analysed using the inductive method of content analysis. Findings: Three main categories emerged – structural inadequacy, ethical dilemmas and challenges, and personal impact and insights. The informants were driven by a strong ethical approach and a great sense of responsibility as human beings and as nurses. Conclusion: Engaging with the voluntary network allowed the informants to cope with their frustration and feelings of inadequacy which emerged when confronted with institutionalized injustice in the conventional healthcare system.