Access to urban green spaces and use of social services and institutional long-term care among older people in Malmö, Sweden: a longitudinal register study.

BACKGROUND: Finding ways to prolong independence in daily life among older people would be beneficial for both individuals and society. Urban green spaces have been found to improve health, but only a few studies have evaluated the association between urban green spaces and independence in daily life. The aim of this study was to assess the long-term effect of urban green spaces on independence in daily life, using social services and support, mobility aids, and relocation to institutional long-term care as proxies, among community dwelling people 65 + years. METHODS: We identified 40 357 people 65 + years living in the city of Malmö, Sweden in 2010. Using geographical information systems (GIS), we determined the amount of urban green spaces (total, public, and quiet) within 300 m of each person's residence. All three measures were categorized based on their respective percentiles, so that the first quartile represented the 25% with the least access and the fourth quartile the 25% with the most access. In 2015 and 2019, we assessed the outcomes minor assistance (non-personal support), major assistance (personal support), and relocation into institutional long-term care. These three outcome measures were used as proxies for independence in daily life. The effect of amount of urban green spaces in 2010 on the three outcomes in 2015 and 2019, respectively, was assessed by pairwise comparing the three highest quartiles to the lowest. RESULTS: Compared to the lowest quartile, those in the highest quartile of quiet green spaces in 2010 were less likely to receive minor assistance in both 2015 and 2019. Besides this, there were no indications that any of the measures of urban green space affected independence in daily life at the five- and nine-year follow-up, respectively. CONCLUSION: Although urban green spaces are known to have positive impact on health, physical activity, and social cohesion among older people, we found no effect of total, public, or quiet green spaces on independence in daily life. This could possibly be a result of the choice of measures of urban green spaces, including spatial and temporal aspects, an inability to capture important qualitative aspects of the green spaces, or the proxy measures used to assess independence in daily life.

'Normality in all the abnormality'-Older adults' experiences of holidays and celebrations from the COVID-19 pandemic.

INTRODUCTION: The importance of holidays, traditions, and family celebrations to human culture and occupational engagement has been neglected. The aim of this study was to explore how older adults experienced holidays and celebrations with social and physical distancing during the COVID-19 pandemic. METHODS: A secondary analysis was made on data from the At-Risk Study. Seventeen community-living adults (11 women and 6 men) aged 71-87 years, from Sweden participated. They were interviewed remotely four times during the first year of the pandemic. Data were analysed with qualitative content analysis. No consumer/community involvement occurred. FINDINGS: Three categories on how the participants hoped for, planned, decided, adapted, avoided, and experienced holidays and celebrations with social and physical distancing included expectations and preparations in unpredictable times; the constant need for re-evaluation; and almost everything turned out differently. CONCLUSIONS: The desire to celebrate despite pandemic restrictions shows the importance and meaning holidays hold for older adults. Celebrations can be disrupted for many reasons, not only as extreme as the ongoing pandemic. For wellbeing in later life health care, social care, and society need to understand the inherent components and acknowledge ways of supporting participation in occasional events such as holidays, traditions, and family celebrations.

The Egress Enabler: Development and psychometric evaluation of an instrument to measure egressibility.

BACKGROUND: Egressibility has been defined as a person-environment fit issue and describes accessibility to means of evacuation. Although egressibility concerns everyone, it has become a useful concept particularly in relation to safety and accessibility for people with functional limitations, commonly highlighted as a vulnerable group in egress scenarios. Egressibility is an important safety factor, but there has been limited efforts trying to quantify it. OBJECTIVE: The aim has been to develop an instrument to measure egressibility in public buildings, as well as conducting initial psychometric testing of the instrument. METHODS: The Egress Enabler is based on the previously developed Housing Enabler instrument. The Egress Enabler was developed in several steps by an interdisciplinary team, incorporating an expert panel and a case study. RESULTS: Evaluation of content validity was in line with previous similar efforts, inter-rater reliability was considered "good" to "excellent" by means of intraclass correlation, and qualitative assessment of construct validity showed theoretically sound results. CONCLUSIONS: It is suggested that an instrument like the Egress Enabler is needed for a systematic evaluation of egressibility during design. construction or operation. This is needed for ensuring equal access to egress for people with functional limitations.

Impact of Sociodemographic Factors on Use of Formal Social Services in an Older Swedish Population.

BACKGROUND: In Sweden, societal support for older people is the responsibility of the municipalities. However, due to Sweden's current aging-in-place policy for older people, there is a need to assess how the use of such services varies based on sociodemographic factors. The aim of this study was to describe the use of different forms of social services and institutional long-term care (ILTC) in an older population and to evaluate the impact of sociodemographic factors. METHODS: This was a cross-sectional register-based study, including all individuals aged 65 years and older in two Swedish municipalities in 2010, 2015, and 2019. The study analyzed the use of social services and ILTC in relation to sex, place of birth, cohabitation status, and type of housing. RESULTS: Women, those born in Sweden, and those living in an apartment were more likely to receive assistance than men, those born abroad, or living in single family houses, respectively. People living alone were consistently more likely to have assistance, as well as ILTC. CONCLUSIONS: There may be a discrepancy between the individual's need and the assistance provided from the municipality in certain sociodemographic groups in the older population in Sweden.

Sociodemographic Variations in the Availability of Urban Green Spaces in an Older Swedish Population.

Urban green spaces (UGS) can have a positive impact on health and thereby potentially ease the strain on the health care system. However, the availability and benefits seem to vary between different sociodemographic groups. The aim of this study was to investigate associations between sociodemographic factors and availability to UGS among people aged 65 years or older. Data on sociodemographic variables and residential coordinates were obtained for three cross-sectional cohorts in two cities (Malmö and Kristianstad) and three years (2010, 2015, and 2019). Three measures of urban green spaces; total (UGS), public (PGS) and quiet (QGS), within 300 m were used to determine availability. The results indicated higher availability to both total and publicly available urban green spaces for groups with lower socioeconomic status (SES) is positive from a health perspective. However, availability to high qualitative publicly available urban green spaces, from a noise perspective, was lower, indicating the opposite.

Finding an existential place to rest: enabling well-being in young adults.

What enables well-being when experiencing existential concerns as a young adult is an under-explored area of research. In order to address young adults' existential concerns and provide caring support that builds their resilience to meet life challenges, the purpose of the study is to describe the meaning of enabling well-being as experienced by young adults living with existential concerns. This phenomenological study is based on a reflective lifeworld research. Seventeen young adults, aged 17-27 years, were interviewed. The results is presented in an essential meaning and further explored with its variations and individual nuances of the phenomenon; enabling well-being. The essential meaning of enabling well-being, when experiencing existential concerns as a young adult, means finding a place to rest. Finding a place to rest means finding both movement and stillness in life to reflect upon one's life story in order to understand oneself. The results also show that young adults enable their own well-being in many ways when experiencing existential concerns. When their existential concerns feel overwhelming, they need support from healthcare professionals. When young adults seek professional support, the professionals must be open and focus on the young adults' life story to enable well-being.

Changes in daily life and wellbeing in adults, 70 years and older, in the beginning of the COVID-19 pandemic.

BACKGROUND: In the beginning of the COVID-19 pandemic, Swedish authorities enforced specific recommendations on social distancing for adults 70 years and older (70+). Day-to-day life changed for 15% of the Swedish population. The aim of the study was to explore how adults 70+ experienced and managed changes in everyday life due to the COVID-19 pandemic and how those changes affected wellbeing at the beginning of the virus outbreak. METHODS: Eleven women and six men, (mean age 76 years), living in ordinary housing, participated in remote semi-structured interviews in April 2020. The interviews were analysed with qualitative content analysis. FINDINGS: The theme Suddenly at risk - '…but it could have been worse' included four categories My world closed down; Negotiations, adaptations and prioritizations to manage staying at home; Barriers and facilitators to sustain occupational participation; and Considerations of my own and other's health and wellbeing emerged from the data analysis. CONCLUSION: Everyday life changes had implications for health and well-being. The participants questioned previous conceptions of meaning in relation to habitual activities, likely leading to consistent occupational changes. However, these long-term effects remain to be explored, and considered to enable older adult's health during the pandemic and beyond.

'Are they really allowed to treat me like that?' - A qualitative study to explore the nature of formal patient complaints about mental healthcare services in Sweden.

The improvement of mental healthcare services requires patients' experiences to identify problems and possible deficits in care. In this study, we explored the nature and meaning of formal patient complaints about mental healthcare services in one region of Sweden using a descriptive design with a qualitative approach. A systematic random sample of 106 formal patient complaints about mental healthcare services in 1 Swedish county was selected and analysed thematically, based on descriptive phenomenology. Themes identified were: lack of access to mental healthcare services and specialist treatment, problems related to unmet needs and difficulties with healthcare staff, insufficient care and treatment and lack of continuity in care, and experiences of not been taken seriously or feeling abused by staff. The vulnerability of patients already in the system is a greater issue than realized. The human right to health and the healthcare of patients with mental ill health can be strengthened by increased access to care, listening to patients properly, and delivering continuity in care.

Balance in life as a prerequisite for community-dwelling older adults' sense of health and well-being after retirement: an interview-based study.

PURPOSE: This study aimed to describe community-dwelling older adults' perceptions of health and well-being in life after retirement. METHODS: This study is part of a larger project using a mixed-methods design to address lifestyles' influence on community-dwelling older adults' health. Individual semi-structured interviews were conducted with 18 older adults in age 70 to 95 years. Data were analysed according to a phenomenographic approach. RESULTS: The results encompass four categories describing variations in community-dwelling older adults' perceptions of health and well-being after retirement: feeling well despite illness and disease, interacting with and being useful for oneself and others, independently embracing opportunities and engaging in life, and maintaining a healthy lifestyle. CONCLUSIONS: The absence of illness and disease is not a clear prerequisite for a sense of health and well-being. To promote and preserve health and well-being after retirement, older adults strived for-and coached themselves to uphold-a balance in life, focusing on not burdening others. This life orientation after retirement must be acknowledged by society at large, especially from an ageist perspective, and in health and social care to preserve and promote health and well-being.

Psychosocial Working Conditions and Social Participation. A 10-Year Follow-Up of Senior Workers.

Social participation is important for health, and it is well known that high strain jobs impact negatively on mental and physical health. However, knowledge about the impact of psychosocial working conditions on social participation from a long-term perspective is lacking. The purpose of this study was to investigate the associations between different job types and social participation from a long-term perspective. A comprehensive public health questionnaire "The Scania Public Health Survey", was used, and psychosocial working conditions were measured with a Swedish translation of the Job Content Questionnaire. Based on data from 1098 working respondents aged 55 at baseline and a 10-year follow-up when the respondents were not working, the analyses revealed that social participation varied by job type. Jobs with high decision latitude, as in active and relaxed jobs, seem to predict high social participation, even after cessation of employment. Besides that, the result suggests that high social participation during working life is a predictor of high social participation from a long-term perspective which promotes healthy aging. Incentives for working longer are strongly related to good working conditions. A supportive work environment with possibilities for employees to participate in decision making, i.e., high control, is vital for a sustainable working life. This may contribute to an extended working life and may also support social participation prior to retirement as well as after retirement and thus to healthy aging.

Barriers and Facilitators for Implementation of Individualized Fire Safety (IFS) in Sweden.

In 2010, the Swedish Civil Contingencies Agency (MSB) announced a "vision zero" of zero fire deaths in Sweden by 2050. Studies into fire deaths have identified that certain risk groups, including but not limited to older people, are overrepresented in fire death statistics in Sweden. The MSB has developed guidelines for how individualised fire safety (IFS) can be implemented in local communities for risk groups, in support of their vision zero for fire deaths. This paper presents the results of an interview study with a selection of Swedish municipalities to further explore how municipalities are working with IFS programs for community dwelling older people. The Consolidated Framework for Implementation Research has been used to analyse data developed through semi-structured interviews, from an analysis of the delegation of authority from MSB to local level and assessment of secondary documentation from national, regional and local organisations. The analysis has identified that IFS has, indeed, been implemented to varying degrees in Sweden, but that there are both facilitators and barriers which can be further leveraged to improve the implementation of IFS in the future.

Structural Analysis of Strigolactone-Related Gene Products.

Structural knowledge of biological macromolecules is essential for understanding their function and for modifying that function by engineering. Protein crystallography is a powerful method for elucidating molecular structures of proteins, but it is essential that the investigator has a basic knowledge of good practices and of the major pitfalls in the technique. Here we describe issues specific for the case of structural studies of strigolactone (SL) receptor structure and function, and in particular the difficulties associated with capturing complexes of SL receptors with the SL hormone ligand in the crystal.

Master student's application of evidence-based knowledge and skills in Swedish healthcare practice.

AIM: To investigate the application of evidence-based knowledge and skills in everyday healthcare practice among healthcare personnel attending a course in evidence-based practice (EBP) at the master's level. METHODS: In this cross-sectional study, an evaluation of the use of instrumental, conceptual and persuasive research was performed among students attending a master's course in EBP at Lund University. Seven questions from the validated questionnaire in the Longitudinal Analysis of Nursing Education project were used. The questionnaire was distributed among 21 students at the first lecture in the course (the group before the course). Students who had participated in the course 1 (n = 15) and 2 (n = 13) years earlier received the questionnaire by ordinary mail (the group after the course). RESULTS: The current study revealed that the majority of the students used research in their daily healthcare practice. However, the extent and type of use varied. There were differences in research use between the 'before' and 'after' groups. More specifically, the students in the group responding after the course were significantly more prone to use research in practice than the students responding before the course (P = 0.01 and 0.04). CONCLUSION: An EBP course offered to master's degree students provides enhancement of evidence-based knowledge and skills, and stimulates research use in healthcare practice.

Assessing environmental barriers by means of the swedish craig hospital inventory of environmental factors among people post-stroke.

BACKGROUND: When occupational therapists address environmental barriers to occupational engagement, some barriers might not be possible to reduce for single individuals, because decisions have to be taken at community or societal level, for example changes in public transport. Investigating environmental barriers by means of the Swedish Craig Hospital Inventory of Environmental Factors (CHIEF-S) may increase our understanding of the environmental impact on occupation engagement and the methodological challenges to assess environmental barriers. AIMS: To investigate and describe the magnitude of encountered environmental barriers in a group of people post-stroke and to assess psychometric properties of the CHIEF-S. MATERIAL AND METHODS: In total, 34 participants, who had sustained a stroke in Sweden were recruited. RESULTS: The participants reported in average 2,7 barriers and the total frequency-magnitude score of barriers (CHIEF-S score) was 0.45. The Cronbach's α for the total CHIEF-S was 0.80 and the analysis of test-retest reliability revealed ICC = 0.86. The entire instrument demonstrated better psychometric properties than the single sub-scales. CONCLUSION: In this study, the frequency-magnitude of environmental barriers encountered by people post-stroke are reported at a group level and adds information to the cumulative knowledge generation on perceived environmental barriers in the society. However, to inform which interventions are needed at a more detailed level, other data collection methods have to be added.

The intertwining of reconciliation and displacement: a lifeworld hermeneutic study of older adults' perceptions of the finality of life.

PURPOSE: This study aimed to explain and understand the existential meaning of the finality of life from the perspective of healthy older adults. METHOD: Participants were recruited from a major project on older adults' life situations. They were interviewed about their thoughts on the end of life, and their responses were interpreted using a lifeworld hermeneutic approach. RESULTS: The findings showed that thinking about the inevitable finality of life involves feelings of liberation, frightening thoughts, a comforting promise of something beyond death, acceptance of the concept of death as a companion in life and a desire to live. Philosopher Simone de Beauvoir's existential ideas about ageing and death were then used to further explain and understand the meaning of the finality of life and to support a comprehensive understanding. de Beauvoir suggests that when the temporal horizon of existence shrinks, one lives closer to the finality of life. For a comprehensive understanding, attributing meaning to the finality of life required the intertwining of reconciliation and displacement. The interpretations were further discussed using ideas from the fields of existential philosophy and caring science in order to develop a basis for caring practice. CONCLUSIONS: The conclusions suggested that professional health care for older adults would benefit from a lifeworld-led caring science approach that includes readiness for a caring dialogue that focuses on existential issues.

Young men's experiences of living with existential concerns: "living close to a bottomless darkness".

INTRODUCTION: Young men may struggle in life with challenges of various concerns about their identity and who they want to be in life. Many health issues arise from social norms and wider societal determinations and for today's young men, following such norms poses a risk of losing oneself. An essential part of health are connected to the existential dimensions in life and concerns who you are, and how well you know and understand yourself. However; little is known about what it means for young men to live a life with existential concerns. PURPOSE AND METHOD: The purpose of this phenomenological study, based on reflective lifeworld research (RLR), is to describe young men's experiences of living with existential concerns for which they have sought support. Eight lifeworld interviews were conducted. RESULTS: The results essentially show that young men living with existential concerns describe their situations as living close to a bottomless darkness. This is further described according to four constituents: enduring everyday life, striving for a solution, hearing an inner self-critical voice, and wearing a hard shell. CONCLUSION: We conclude that strengthening young men's health processes requires healthcare professionals to create an atmosphere where young men feel safe talking about existential concerns without feeling exposed and vulnerable.

Nurses' Experiences of Promoting Healthy Aging in the Municipality: A Qualitative Study.

The purpose of this study was to describe nurses' experiences of promoting healthy aging in municipalities. A descriptive qualitative research design based on semi-structured interviews with 13 nurses was employed. The nurses described the importance of giving older adults the possibility to live as individuals, but also that the organization matters as too does the nurses' own desire to work professionally and with passion. Nurses in the municipality noticed that in today's world, there is a changing perspective of older adults. They more often want to continue their previous life and care greatly about quality of life and because of this, they also expect more service from their health care. Our study suggests that nurses should be supported to specialize in elderly care and measures should be taken to reduce the gap between vision and reality when it comes to team work.

Using sensor-based technology for safety and independence - the experiences of people with dementia and their families.

BACKGROUND: The majority of people with dementia prefer to live independently and safely in their own home cared for by their family members. Much effort has been invested in the development of technology, such as sensor-based networks. Many challenges remain, in particular gaining more knowledge about their experiences and perceived benefits. This study aimed to explore experiences, needs and benefits with using sensor-based technology for safety and independence in the homes of people with dementia and their family members. METHODS: This study is part of the TECH@HOME project, aiming to evaluate the effects of sensor-based technology on independence among people with dementia and caregiver stress among their family members. This study applied an inductive, qualitative approach with semi-structured interviews of people with dementia (n = 9) and family members (n = 21). The participants were interviewed between June and September 2018 after using the technology for at least 6 months. The interviews were analysed with manifest content analysis. RESULTS: Our findings highlighted that technology was considered as a precaution and a safety measure that could provide a sense of having control of the everyday life of the person with dementia. Understanding and acceptance of the technology were as important, together with the reliability of the technology. Ethical dilemmas related to the monitoring of the person with dementia in the home were also raised. CONCLUSION: This study provides insights into how people with dementia and family members experience and benefit from using sensor-based technology in their own homes. The knowledge generated is essential for healthcare professionals and policymakers developing and implementing care and service systems including technology, as well as for the industry.

Structure and mechanism of piperideine-6-carboxylate dehydrogenase from Streptomyces clavuligerus.

The core of ß-lactam antibiotics originates from amino acids of primary metabolism in certain microorganisms. ß-Lactam-producing bacteria, including Streptomyces clavuligerus, synthesize the precursor of the amino acid α-aminoadipic acid by the catabolism of lysine in two steps. The second reaction, the oxidation of piperideine-6-carboxylate (or its open-chain form α-aminoadipate semialdehyde) to α-aminoadipic acid, is catalysed by the NAD+-dependent enzyme piperideine-6-carboxylate dehydrogenase (P6CDH). This structural study, focused on ligand binding and catalysis, presents structures of P6CDH from S. clavuligerus in its apo form and in complexes with the cofactor NAD+, the product α-aminoadipic acid and a substrate analogue, picolinic acid. P6CDH adopts the common aldehyde dehydrogenase fold, consisting of NAD-binding, catalytic and oligomerization domains. The product binds in the oxyanion hole, close to the catalytic residue Cys299. Clear density is observed for the entire cofactor, including the nicotinamide riboside, in the binary complex. NAD+ binds in an extended conformation with its nicotinamide ring overlapping with the binding site of the carboxylate group of the product, implying that the conformation of the cofactor may change during catalysis. The binding site of the substrate analogue overlaps with that of the product, suggesting that the cyclic form of the substrate, piperideine-6-carboxylate, may be accepted as a substrate by the enzyme. The catalytic mechanism and the roles of individual residues are discussed in light of these results.

Lost in an unknown terrain: a phenomenological contribution to the understanding of existential concerns as experienced by young women in Sweden.

Purpose: The aim of this study is to describe young women's (16-25 years old) experiences of living with existential concerns for which they have sought support from healthcare professionals, teachers, family, or friends, among others. Methods: This phenomenological study is based on a reflective lifeworld research (RLR) approach. Nine young women were interviewed about their experience of living with existential concerns. Results: The results show the essential meaning of the phenomenon of "existential concerns" that can be described as living a life that is marked in a profound way by a feeling of being lost in an unknown terrain. To further understand the essential meaning, four constituents are described: the unpredictable body, longing for comprehension, playing a game, and longing to share one's vulnerability. Conclusions: Young women with existential concerns are vulnerable, as they are profoundly influenced by these concerns. They have to navigate through daily life while trying to fit in and to make their situation comprehensible. These young women have a longing to share their existential concerns with a trustworthy person, while at the same time they fear revealing their existential concerns and risking being rejected by others. A lifeworld-led, caring science approach, intertwined with the results of the present study, has the potential to direct caring practice.