The dilemma of the split between theory and reality as experienced by primary healthcare professionals: a mixed methods study of evidence-based practice in a primary care context.

BACKGROUND: Primary care depends upon a good information flow across professional and structural boundaries to provide the best care for patients. Previous research has mainly focused on Evidence-Based Practice (EBP) within specific professions. Mapping of pan-professional experiences of and attitudes to EBP in publicly funded clinical practice is necessary to deepen the understanding of EBP and its implementation. Thus, this study aimed to investigate healthcare professionals' experiences of and attitudes towards working in accordance with EBP in primary care. METHODS: The study used a convergent mixed methods design divided into two strands: a quantitative enquiry tool (Evidence-Based Practice Attitude Scale, EBPAS) and a set of qualitative interviews analysed by means of qualitative content analysis. Both strands included all primary care employees with patient interaction in the studied county (n = 625), including doctors, nurses, physiotherapists, psychologists and assistant nurses. Out of the original 625 healthcare professionals, 191 finished the first strand and 8 volunteered for the second strand (2 nurses, 2 physiotherapists, 1 psychiatrist and 3 doctors). RESULTS: The EBPAS value of 2.8 (max 4) indicated a generally positive attitude towards EBP amongst the population, which was also evident in the interviews. However, there were additional experiences of not having the ability or resources to engage in EBP. This was illustrated by the theme that emerged from the qualitative content analysis: "The dilemma of the split between theory and reality". Due to the organisational and managerial focus on efficiency rather than quality of care, there were few or no incentives for promoting individual educational or research development. CONCLUSIONS: Although the general attitude towards EBP is positive, experiences of practising it differ. There is a need to increase knowledge of EBP concepts, requirements and implementation in the clinical setting. The absence of opportunities to do research and collegial debate about new ways of finding and implementing research-based evidence results might influence the quality of care.

A comparison of small-area deprivation indicators for public-health surveillance in Sweden.

AIMS: The aims of this study were to construct a small-area index of multiple deprivation (IMD) from single deprivation indicators (SDIs) and to compare the explanatory power of the IMD and SDIs with regard to mortality. We considered a small-area division of Sweden consisting of 5985 DeSO (Demografiska statistikområden), each with a population size between 653 and 4243 at the end of 2018. METHODS: Four SDIs were provided by open-source data: (a) the proportion of inhabitants with a low economic standard; (b) the proportion of inhabitants aged 25-64 years with ⩽12 years of schooling; (c) the proportion of inhabitants aged 16-64 years who were not in paid employment; and (d) the proportion of inhabitants who lived in a rented apartment/house. A four-indicator IMD was constructed using factor analysis. As a validation, the IMD and SDIs were compared by exploring their DeSO-level associations with spatially smoothed death rates, with robustness checks of associations across different small-area contexts defined by degree of urbanisation and distribution of immigrants from non-Western countries. RESULTS: The constructed IMD and SDI1 performed essentially equally and outperformed SDI2, SDI3 and SDI4. Associations between IMD/SDI1 and the spatially smoothed death rates were most pronounced within the age range 60-79 years, showing 5-8% lowered rates among those categorised in the least deprived quintiles of IMD and SDI1, respectively, and 7-9% elevated rates among those categorised in the most deprived quintiles. These associations were consistent within each small-area context. CONCLUSIONS: We suggest prioritisation of SDI1, that is, a DeSO-level deprivation indicator based on open-access data on economic standard, for public-health surveillance in Sweden.

The Association Between Sublingual Varices and Cardiovascular Risk Factors.

Objective: To study the association between sublingual varices (SV) and cardiovascular (CVD) risk factors. Methods: A total of 989 consecutive dental patients aged 55-84 years participated in the study, which applied a survey about risk factors, diseases and medications. Digital photos of the lateral borders of the tongue, height, weight, waist, hip and blood pressure were registered, and blood samples were analyzed. Those with SV were compared with those without SV (nSV). Results: Those with SV had more hypertension 41.8% vs 27.0% (p<0.0001), a higher systolic blood pressure (BP) 139.5 (SD 18.6) mmHg vs 134.3 (SD 18.8) mmHg (95% CI -7.73 ─ -2.72), more diabetes type 2 (DM-2) 7.4% vs 3.8% (p=0.014), a higher fasting plasma glucose 5.9 (SD 1.5) mmol/L vs 5.7 (SD 1.0) mmol/L (95% CI -0.42 ─ -0.05), more dyslipidemia 24.1% vs 17.7% (p=0.018), lower HDL 1.6 vs 1.7 (p=0.003), a greater waist circumference 97.0 cm vs 93.9 cm (95% CI -4.66 ─ -1.46), a greater waist/hip ratio 0.92 cm/cm vs 0.90 cm/cm (95% CI -0.03 ─ -0.01), and a higher BMI 26.6 kg/m2 vs 26.0 kg/m2 (95% CI -1.11 ─ -0.03). The following associations with SV were found in multivariate analysis: hypertension OR=1.6 (95% CI 1.19 ─2.13), a high systolic BP OR =1.5 (95% CI 1.11 ─2.13), a high fP-glucose OR= 1.8 (95% CI 1.03 ─3.21), a low HDL OR= 1.8 (95% CI 1.15 ─2.92), a greater waist circumference OR= 1.68 (95% CI 1.10 ─2.58), a greater waist/hip ratio OR=2.21 (95% CI 1.36 ─3.58), and a higher BMI OR=1.05 (95% CI 1.02 ─1.09). Conclusion: This study shows an association between SV and a high BP, a high fP-glucose, hypertension, diabetes mellitus type 2, dyslipidemia, abdominal obesity, older age and smoking.

Evidence-based practice in primary healthcare from the managerial point of view - a national survey.

BACKGROUND: The vast availability of and demand for evidence in modern primary healthcare force clinical decisions to be made based on condensed evidence in the form of policies and guidelines. Primary healthcare managers play a key role in implementing these governing documents. Thus, the aim of this article is to investigate the use and availability of evidence-based practice resources from the perspective of first-line primary healthcare managers. METHODS: The study is based on a national survey of primary healthcare managers, consisting of 186 respondents, recruited nationally from Sweden. The data was analysed using empirically constructed concepts and validated using factor analysis. A chi-square test was utilized to determine the statistical significance of comparisons. Associations between variables were calculated using Spearman's correlation coefficients. All tests were two-sided, and the significance level was set to 0.05. RESULTS: A majority (97 %) of managers stated that guidelines and policy documents impacted primary healthcare; 84 % of managers observed a direct effect on daily practices. Most of the managers (70 %) stated that some adaptation was needed when new evidence was introduced. The managers emphasized the importance of keeping themselves updated and open to new information about work routines (96 %). CONCLUSIONS: The study illustrates a nearly unanimous response about the influence of clinical evidence on daily practice. The emphasis on the importance of all staff members keeping their professional knowledge up to date is viewed as a direct result of this effect on daily practice. An information-dense organization such as a primary healthcare organization would have much to gain from increased cooperation with regional information resources such as clinical libraries.

Inter-rater reliability among psychiatrists when assessing depression according to the Montgomery-Åsberg Depression Rating Scale.

INTRODUCTION: Montgomery-Åsberg Depression Rating Scale (MADRS) is a validated tool for rating the depth of depression. The structured interview guide for the MADRS (SIGMA) is an interview guide that has been developed in order to increase the inter-rater reliability. Patients often meet more than one psychiatrists during their hospitalization for depression. A divergent rating of depression between psychiatrists could affect both the treatment and the outcome. This makes knowledge of the inter-rater reliability among psychiatrists important. AIM: The primary aim of this study was to measure the inter-rater reliability between psychiatrists when rating depression using the MADRS. METHODS: Ten in-patients, who were diagnosed with depression, were filmed while being interviewed using the SIGMA. The patients were after that instructed to rate themselves using the self-rating version of the MADRS. Ten psychiatrists rated the pre-recorded interviews according to the MADRS. The inter-rater reliability was measured using intra-class correlation (ICC). RESULTS: The mean ICC for the total MADRS score was 0.952 (95% CI 0.891-0.986; p<.001) and Cronbach's alpha 0.961. ICC values for each item ranged between 0.866 and 0.978 (p<.001). Cronbach's alpha ranged between 0.905 and 0.984. The ICC values, when comparing the psychiatrists rating to the patients rating, ranged between 0.307 and 0.809 (p<.001). CONCLUSION: All of the ICC values in the study, except when comparing the psychiatrists rating to the patients self-rating, were considered to be excellent. This study confirms the findings of reliability found in similar studies which involved fewer raters and not exclusively psychiatrists.

Likelihood of admission to hospital from the emergency department is not universally associated with hospital bed occupancy at the time of admission.

BACKGROUND: The decision to admit into the hospital from the emergency department (ED) is considered to be important and challenging. The aim was to assess whether previously published results suggesting an association between hospital bed occupancy and likelihood of hospital admission from the ED can be reproduced in a different study population. METHODS: A retrospective cohort study of attendances at two Swedish EDs in 2015 was performed. Admission to hospital was assessed in relation to hospital bed occupancy together with other clinically relevant variables. Hospital bed occupancy was categorized and univariate and multivariate logistic regression were performed. RESULTS: In total 89,503 patient attendances were included in the final analysis. Of those, 29.1% resulted in admission within 24 h. The mean hospital bed occupancy by the hour of the two hospitals was 87.1% (SD 7.6). In both the univariate and multivariate analysis, odds ratio for admission within 24 h from the ED did not decrease significantly with an increasing hospital bed occupancy. CONCLUSIONS: A negative association between admission to hospital and occupancy level, as reported elsewhere, was not replicated. This suggests that the previously shown association might not be universal but may vary across sites due to setting specific circumstances.

Two-year weight, risk and health factor outcomes of a weight-reduction intervention programme: Primary prevention for overweight in a multicentre primary healthcare setting.

Objective: To study the long-term effects of weight reduction, quality of life and sense of coherence in a primary health care (PHC)-based programme with two different intensities.Design: Prospective two-armed randomised intervention.Setting: Three PHC centres in south west of Sweden.Subjects: In total, 289 women and men aged 40-65 years with a BMI of 28-35 were recruited for a two-year weight-reduction programme. Participants were randomized to high-intensity or low-intensity groups. Blood samples, physical measurements and questionnaires were analysed. Participants received cookbooks and dietary lectures. The high-intensity group also received Motivational interviewing (MI), dietary advice on prescription (DAP- advice), a grocery store lecture, a website and weekly e-mails.Main outcome measures: Weight, quality of life, risks and health factors.Results: In total, 182 (64%) participants completed the 2-year follow-up. The total sample reduced their weight by 1 kg (p = 0.006). No significant differences regarding weight were found between the groups. Anxiety/depression decreased in EQ5-D (p = 0.021), EQ5-D VAS (p = 0.002) and SOC (p = 0.042). Between the groups, there were significant differences in EQ5-D usual activities (p = 0.004), anxiety/depression (p = 0.013), pain/discomfort (p = 0.041), fruit and vegetables (p = 0.005), HLV anxiety (p = 0.005), and visits to nurses (p = 0.012).Conclusion: The total population lost weight, and the high-intensity and low-intensity programmes did not result in significant differences in terms of weight. The high-intensity programme reported health benefits linked to lower levels of anxiety and depression, increased activity and intake of greens and reduced visits to physicians and nurses.Key pointsBoth groups had a consisting weight- reduction after two years.High intensity did not lead to a significant difference in weight reduction between the groups.The high-intensity group reported more health effects, such as better quality of life, reduced anxiety, and increased greenery intake. It is unknown how much support patients in a weight- reduction programme in PHC require to succeed with weight loss and a healthy lifestyle.

Disease mapping of early- and late-stage cancer to monitor inequalities in early detection: a study of cutaneous malignant melanoma.

We consider disease mapping of early- and late-stage cancer, in order to identify and monitor inequalities in early detection. Our method is demonstrated by mapping cancer incidence at high geographical resolution using data on 10,302 cutaneous malignant melanoma (CMM) cases within the 3.7 million population of South-West Sweden. The cases were geocoded into small-areas, each with a population size between 600 and 2600 and accessible socio-demographic data. Using the disease mapping application Rapid Inquiry Facility (RIF) 4.0, we produced regional maps to visualise spatial variations in stage I, II and III-IV CMM incidences, complemented by local maps to explore the variations within two urban areas. Pronounced spatial disparities in stage I CMM incidence were revealed by the regional and local maps. Stage I CMM incidence was markedly higher in wealthier small-areas, in particular within each urban area. A twofold higher stage I incidence was observed, on average, in the wealthiest small-areas (upper quintile) than in the poorest small-areas (lower quintile). We identified in the regional map of stage III-IV CMM two clusters of higher or lower than expected late-stage incidences which were quite distinct from those identified for stage I. In conclusion, our analysis of CMM incidences supported the use of this method of cancer stage incidence mapping for revealing geographical and socio-demographic disparities in cancer detection.

Exposure to surgery is associated with better long-term outcomes in patients admitted to Swedish intensive care units.

BACKGROUND: Long-term outcomes of patients admitted to intensive care units (ICUs) after surgery are unknown. We investigated the long-term effects of surgical exposure prior to ICU admission. METHODS: Registry-based cohort study. The adjusted effect of surgical exposure for mortality was examined using Cox regression. Secondary analysis with conditional logistic regression in a case-control subpopulation matched for age, gender, and Simplified Acute Physiology Score III (SAPS3) was also conducted. RESULTS: 72 242 adult patients (56.9% males, median age 66 years [IQR 50-76]), admitted to Swedish ICUs in 3-year (2012-2014) were followed for a median of 2026 days (IQR 1745-2293). Cardiovascular diseases (17.5%), respiratory diseases (15.8%), trauma (11.2%), and infections (11.4%) were the leading causes for ICU admission. Mortality at longest follow-up was 49.4%. Age; SAPS3; admissions due to malignancies, respiratory, cardiovascular and renal diseases; and transfer to another ICU were associated with increased mortality. Surgical exposure prior to ICU admission (adjusted hazard ratio [aHR] 0.90; 95% CI 0.87-0.94; P < .001), admissions from the operation theatre (aHR 0.94; CI 0.90-0.99; P = .022) or post-anaesthesia care unit (aHR 0.92; CI 0.87-0.97; P = .003) were associated with decreased mortality. Conditional logistic regression confirmed the association between surgical exposure and decreased mortality (adjusted odds ratio 0.82; CI 0.75-0.91; P < .001). CONCLUSIONS: Long-term ICU mortality was associated with known risk factors such as age and SAPS3. Transfer to other ICUs also appeared to be a risk factor and requires further investigation. Prior surgical exposure was associated with better outcomes, a noteworthy observation given limited ICU admissions after surgery in Sweden.

A randomized study comparing regular care with a nurse-led clinic based on tight disease activity control and person-centred care in patients with rheumatoid arthritis with moderate/high disease activity: A 6-month evaluation.

INTRODUCTION: A recent survey showed that 27% of rheumatoid arthritis (RA) patients had inadequately controlled disease activity. Hence, there is a need for new strategies aiming at improving patient outcomes. The aim of the present study was to evaluate the effect of a nurse-led clinic with frequent visits, treat-to-target and person-centred care of patients with established RA and moderate-to-high disease activity compared with patients receiving regular care. METHODS: The study was a randomized, controlled trial over 26 weeks, with a nonrandomized extension to week 50. Patients were randomized to an intervention group (IG; nurse-led clinic) based on person-centred care, frequent visits and "treat to target", or to a control group (CG) which visited the clinic according to care as usual. The primary outcome was the difference in the DAS28 change between the IG and the CG groups. RESULTS: A total of 332 patients were screened for eligibility, of which 70 were randomly assigned to either the IG (n = 36) or the CG (n = 34) group. The primary outcome was not met, although patients in the IG group tended to improve more than those in the CG group (difference: 0.43 (95% confidence interval [CI] -0.27, 1.13). In both the IG and CG groups, delta-DAS28 improved significantly. The European League Against Rheumatology moderate or good response was achieved by 76% (95% CI 58, 89) in the IG and 49% (95% CI 32, 65) in the CG group. CONCLUSIONS: Disease activity tended to improve more with the nurse-led intervention compared with regular care, although the difference was not significant, probably partly due to the lack of statistical power.

Characteristics of patients seeking a health promotion and weight reduction program in primary care.

PURPOSE: An important task in primary health care (PHC) is to address lifestyle-related diseases. Overweight (OW) individuals make up a large proportion of PHC patients, and they increasingly have lifestyle-related illnesses that influence their quality of life. Structured health promotion and weight reduction programs could help these patients. The objective of this study was to explore the characteristics, lifestyle habits, and health conditions of individuals seeking a health promotion and weight reduction program in PHC. PATIENTS AND METHODS: The study involved a comparative cross-sectional design performed in PHC in southwestern Sweden. The study population comprised 286 participants (231 women, aged 40-65 years, body mass index [BMI] 28-35 kg/m2) who were recruited between March 2011 and April 2014 to the 2-year program by adverts in local newspapers and recruitment from three PHC centers. Two reference populations were used: a general population group and an OW group. The study population data were collected using a questionnaire, with validated questions regarding health, lifestyle, illnesses, and health care utilization. RESULTS: People seeking a health promotion and weight reduction program were mostly women. They had a higher education level and experienced worse general health than the OW population, and they visited PHC more frequently than both reference groups. They also felt more stressed, humiliated, had more body pain, and smoked less compared to the general population. However, they did not exercise less or had a lower intake of fruits and vegetables than either reference population. CONCLUSION: Individuals seeking a weight reduction program were mostly women with a higher education level and a worse general health than the OW population. They used more health care services compared to the reference groups.

Promoting the creation of R&D intentions in primary healthcare measured by a validated instrument.

BACKGROUND: Primary healthcare has a long and successful patient care history in Sweden. Nevertheless, a research-oriented attitude has been more or less absent in this context. In society today, access to information has significantly influenced the nature of patients' demand for up-to-date healthcare. A prerequisite for this new demand is health professionals who are interested in novel ways of thinking and view a change of work practices as necessary. One way to achieve this goal is by means of strategic communication, which is a relatively new interdisciplinary field. The aim of this study was to analyse the role of strategic communication in the creation of intentions in Research and Development (R&D) among primary healthcare staff as measured by a validated instrument. METHODS: An intervention study on staff was performed. A 15-item questionnaire was validated and implemented. All primary healthcare staff from the southwestern Swedish province of Halland were included. In total, 846 employees (70%) agreed to participate in the measurements. After 12 years, 352 individuals who had participated in the intervention and remained in the organisation were identified and followed up. The intervention comprised established communication channels. The measurements were performed after 7 and 12 years. A questionnaire was designed for this purpose. The questions were validated by a factor analysis, and the degree of reliability was measured with Cronbach's alpha coefficient. χ2 and Fisher's exact tests were used as statistical tests in comparisons. RESULTS: Factor analysis identified five pure factors (most Cronbach's alpha > 0.70). Strategic communication contributed to a significant improvement in the staff members' interest in R&D and willingness to change in both the short (P < 0.05) and long (P < 0.05) term. The positive attitude was stable over time. CONCLUSIONS: Strategic communication seems to be a significant tool for creating a stable positive attitude towards R&D in the primary healthcare context. The creation of a positive attitude towards a scientific approach is a relevant finding that deserves special attention in a context as complex as healthcare. Using a validated instrument seems to contribute to pure results in this case.

Determination of PD-L1 expression in effusions from mesothelioma by immuno-cytochemical staining.

BACKGROUND: Malignant mesothelioma (MM) is an aggressive, fatal tumor. Current therapeutic options only marginally improve survival. Programmed cell death ligand 1 (PD-L1) is a dominant mediator of immunosuppression, binding to programmed cell death 1 (PD-1). PD-L1 is up-regulated in cancer cells, and the PD-1/PD-L1 pathway plays a critical role in tumor immune evasion, thus providing a target for antitumor therapy. Further, a correlation between PD-L1 expression and prognosis has been reported. Studies performed on histological material have revealed expression of PD-L1 in MM, but no study has been performed on MM effusions thus far. METHODS: PD-L1 expression was determined by a commercially available antibody (clone 28-8) in 74 formalin-fixed, paraffin-embedded cell blocks from body effusions obtained at diagnosis from patients with MM. The presence of MM cells was confirmed with CK5/6, calretinin, and EMA and the admixture of macrophages was assessed with CD68. Only cases containing more than 100 tumor cells were assessed. Membranous staining in tumor cells was considered positive. Survival time was calculated from the appearance of the first malignant effusion until death. RESULTS: Reactivity was observed in 23 of 61 (38%) of cases and was classified as ≥1%-5% (n = 9 cases), >5%-10% (n = 4 cases), >10%-50% (n = 4 cases), and >50% (n = 6 cases) positive cells. Survival times did not differ significantly between patients with PD-L1-positive and PD-L1-negative tumors. CONCLUSION: MM effusions are suitable for immune-cytochemical assessment of PD-L1 expression in malignant cells and the results are similar to those reported for histological specimens. Cancer Cytopathol 2017;125:908-17. © 2017 American Cancer Society.

Alkalosis in Critically Ill Patients with Severe Sepsis and Septic Shock.

INTRODUCTION: Although metabolic alkalosis is a common occurrence in intensive care units (ICUs), no study has evaluated its prevalence or outcomes in patients with severe sepsis or septic shock. METHODS: This is a retrospective cohort study of critically ill patients suffering from severe sepsis and septic shock admitted to the ICUs of Halmstad and Varberg County hospitals. From 910 patient records, 627 patients met the inclusion criteria. We investigated the relationship between metabolic alkalosis and mortality. Further, we studied the relationship between metabolic alkalosis and ICU length of stay (LOS). RESULTS: Metabolic alkalosis was associated with decreased 30-day and 12-month mortalities. This effect was however lost when a multivariate analysis was conducted, correcting for age, gender, pH on admission, base excess (BE) on admission, Simplified Acute Physiology Score III (SAPS III) and acute kidney injury (AKI). We then analyzed for any dose-response effect between the severity of metabolic alkalosis and mortality and found no relationship. Bivariate analysis showed that metabolic alkalosis had a significant effect on the length of ICU stay. When adjusting for age, sex, pH at admission, BE at admission, SAPS III and AKI in a multivariate analysis, metabolic alkalosis significantly contributed to prolonged ICU length of stay. In two separate sensitivity analyses pure metabolic alkalosis and late metabolic alkalosis (time of onset >48 hours) were the only significant predictor of increased ICU length of stay. CONCLUSION: Metabolic alkalosis did not have any effect on 30-day and 12-month mortalities after adjusting for age, sex, SAPS III-score, pH and BE on admission and AKI in a multivariate analysis. The presence of metabolic alkalosis was independently associated with an increased ICU length of stay.

Swedish surgical outcomes study (SweSOS): An observational study on 30-day and 1-year mortality after surgery.

BACKGROUND: The European Surgical Outcomes Study (EuSOS) revealed large variations in outcomes among countries. In-hospital mortality and ICU admission rates in Sweden were low, going against the assumption that access to ICU improves outcome. Long-term mortality was not reported in EuSOS and is generally poorly described in the current literature. OBJECTIVE: To describe the characteristics of the Swedish subset of EuSOS and identify predictors of short and long-term mortality after surgery. DESIGN: An observational cohort study. SETTING: Six universities and two regional hospitals in Sweden. PATIENTS: A cohort of 1314 adult patients scheduled for surgery between 4 April and 11 April 2011. MAIN OUTCOME MEASURES: 30-day and 1-year mortality. RESULTS: A total of 303 patients were lost to follow-up, leaving 1011 for analysis; 69% of patients were classified as American Society of Anesthesiologists' physical status 1 or 2, and 68% of surgical procedures were elective. The median length of stay in postanaesthesia care units (PACUs) was 175 min (interquartile range 110-270); 6.6% of patients had PACU length of stay of more than 12 h and 3.6% of patients were admitted to the ICU postoperatively. Thirty-day mortality rate was 1.8% [95% confidence interval (CI) 1.0-2.6] and 8.5% (CI 6.8-10.2) at 1 year (n = 18 and 86). The risk of death was higher than in an age and sex-matched population after 30 days (standardised mortality ratio 10.0, CI 5.9-15.8), and remained high after 1 year (standardised mortality ratio 3.9, CI 3.1-4.8). Factors predictive of 30-day mortality were age, American Society of Anesthesiologists' physical status, number of comorbidities, urgency of surgery and ICU admission. For 1-year mortality, age, number of comorbidities and urgency of surgery were independently predictive. ICU admission and long stay in PACU were not significant predictors of long-term mortality. CONCLUSION: Mortality rate increased almost five-fold at 1 year compared with 30-day mortality after surgery, demonstrating a significantly sustained long-term risk of death in this surgical population. In Sweden, factors associated with long-term postoperative mortality were age, number of comorbidities and surgical urgency.

Comparison Between the Montgomery-Asberg Depression Rating Scale-Self and the Beck Depression Inventory II in Primary Care.

OBJECTIVE: The Montgomery-Asberg Depression Rating Scale-Self (MADRS-S) and the Beck Depression Inventory II (BDI-II) are commonly used self-assessment instruments for screening and diagnosis of depression. The BDI-II has 21 items and the MADRS-S has 9 items. These instruments have been tested with psychiatric inpatients but not in outpatient primary care, where most patients with symptoms of depression initially seek treatment. The purpose of this study was to compare these 2 instruments in the primary care setting. METHOD: Data were collected from 2 primary care randomized controlled trials that were performed from 2010 to 2013 in Sweden: the Primary Care Self-Assessment MADRS-S Study and Primary Care Internet-Based Cognitive Behavioral Therapy Study. There were 146 patients (73 patients each from both trials) who had newly diagnosed mild or moderate depression (per DSM-IV recommendations) and who had assessment with both the MADRS-S and BDI-II at primary care centers. Comparability and reliability of the instruments were estimated by Pearson product moment correlation and Cronbach α. RESULTS: A good correlation was observed between the 2 instruments: 0.66 and 0.62 in the 2 study cohorts. The reliability within the 2 study cohorts was good for both MADRS-S (Cronbach α: 0.76 for both cohorts) and BDI-II items (Cronbach α: 0.88 and 0.85). CONCLUSIONS: The 2 instruments showed good comparability and reliability for low, middle, and high total depression scores. The MADRS-S may be used as a rapid, easily administered, and inexpensive tool in primary care and has results comparable to the BDI-II in all domains.

Impact of the organisational culture on primary care staff members' intention to engage in research and development.

PURPOSE: The purpose of this paper is to understand how organisational culture influences the intentions of primary care staff members (PCSM) to engage in research and development (R&D). DESIGN/METHODOLOGY/APPROACH: The participants (n=30) were PCSM employed in a care centre in south-western Sweden. The study had an observational design with an ethnographic approach. The data were collected by means of observations, interviews and analysis of documents. FINDINGS: The results revealed the perceptions of PCSM in two domains, research and clinical practice, both of which existed at three different cultural levels: visible (structures and policy), semi-visible (norms and values) and invisible (taken-for-granted attitudes). RESEARCH LIMITATIONS/IMPLICATIONS: It is difficult to conduct a purely objective ethnographic study because the investigation is controlled by its context. However, it is necessary to highlight and discuss the invisible level to improve understanding of negative attitudes and preconceptions related to the implementation of R&D in the clinical setting. PRACTICAL IMPLICATIONS: By highlighting the invisible level of culture, the management of an organisation has the opportunity to initiate discussion of issues related to concealed norms and values as well as attitudes towards new thinking and change in the primary health context. ORIGINALITY/VALUE: This paper is one of the very few studies to investigate the influence of organisational culture on the intentions of PCSM to engage in R&D.

Establishing the Psychometric Properties of the Comprehensive Ethos Towards Wellness Questionnaire in a Norwegian Population.

AIM: to replicate and establish the psychometric properties of the 74-item comprehensive Ethos Towards Wellness Questionnaire in a healthy Norwegian population in terms of content and construct validity as well as homogeneity and stability reliability. METHOD: A questionnaire with a methodological and developmental design was sent on two occasions to 214 healthy middle-aged participants and processed in two phases. RESULTS: The three life context and the ethos indexes at ordinal scale level showed an overall satisfactory construct validity (communalities > 0.30, factor loadings > 0.30, and factor total variance > 50%). On two occasions 4 weeks apart, reliability in terms of homogeneity (Cronbach's α > .70) and stability (intraclass correlation coefficient > 0.70) were also considered satisfactory for the same four indexes. CONCLUSIONS: This newly developed and possibly only questionnaire that focuses on "grasping the big human picture," based on both philosophical reasoning and empirical recommendations of wellness, was found to be valid and reliable in the screening and follow-up of wellness and ethos in a healthy Norwegian population.

Satisfaction with housing and housing support for people with psychiatric disabilities.

The aim of this study was to investigate the degree of satisfaction with housing and housing support for people with psychiatric disabilities in Sweden. A total of 370 residents, in supported housing and in ordinary housing with housing support, completed a new questionnaire and reported a high degree of overall satisfaction, but many of them wanted to move somewhere else. Differences were found between the two different types of housing concerning satisfaction with housing support, social life and available choices. Security and privacy, as well as other's influence on the choice of residential area and dwelling proved to be important predictors for satisfaction.