Staff perspectives on poor mental health in secondary school students: an increasing problem handled with insufficient resources.

Introduction: An increasing number of schools are recognizing the importance of addressing students' mental health based on the association with educational outcomes and long-term health. The school organization and the members of the school staff play important but, in several ways, challenging roles in this work. The purpose of this study was to explore views of staff from schools and school health services on mental ill health among students and their own role in detecting and managing it. Methods: A qualitative study was conducted in a sparsely populated municipality in northern Sweden. In total, 40 participants from three secondary schools and the school health services participated either in focus groups or individual interviews. Participants were teachers, assistants, school nurses, school counselors and psychologists. Data were analyzed using thematic analysis. Results: The analysis revealed the main theme Student mental ill health: an increasing problem handled with insufficient resources and two subthemes, i.e., Uncertainty in interpreting students' signs of mental ill health and the need to clarify roles and establish a supportive organization. Conclusions: It was concluded that school staff were uncertain regarding how to interpret signs of mental ill health among students and required better knowledge and more resources to help students with mental ill health. A clearer organization and consensus regarding support for students with mental ill health were also necessary in light of the division of responsibilities between school staff and the school health services.

Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research.

BACKGROUND: Point-of-care medical information systems (POCMIS) can provide an efficient and effective means of strengthening health systems globally through their encouragement of continued medical education. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, this research provides suggestions for improved implementation of POCMIS in low- and middle-income countries informed by an intervention implemented across public and military hospitals in Lima, Peru. METHODS: Analysis is based on qualitative interviews conducted with 12 Peruvian surgeons across eight public hospitals and one military hospital who received an intervention that provided free access to UpToDate and introduced Google Translate. The post-intervention interviews were transcribed, translated, and analyzed for themes overlapping with CFIR constructs to expose barriers to implementation and suggestions for improved implementation of future interventions. RESULTS: Barriers included a lack of seniority buy-in and engaged leadership, an overabundance of personal preferences for multiple POCMIS, and a culture of assumption that inhibited open communication regarding access to and use of POCMIS. Suggestions for improved implementation focused on the adaptation of the intervention. Namely, surgeons discussed regionally-specific adaptations as well as adaptations specific to their surgical specialty including visual, rather than written, representation of the information available via POCMIS. CONCLUSIONS: Results indicate necessary adaptations for implementing interventions including POCMIS in LMICs, mimicking much of the implementation science literature on intervention adaptation. In addition to explicit suggestions provided by surgeons, we also suggest actionable steps to adapt to barriers identified in our data. Rapid assessment procedures (RAP) are one established methodological technique useful for assessing organization culture prior to implementation, allowing for necessary cultural adaptations. Dynamic adaption process (DAP) is another useful and established method that breaks implementation into four phases allowing for adaptations based on the initial assessment of the intervention site.

Does Access to Point-of-Care Medical Information Improve Trauma and General Surgeons' Clinical Knowledge in a Middle-Income Country? A Mixed-Methods Study with Random Assignment.

BACKGROUND: Investing in continued medical education strengthens surgical systems. This study assessed the effectiveness of an evidence-based practice (EBP) tutorial and access to UpToDate (UTD) to improve EBP and understand how and why providers practice using evidence. STUDY DESIGN: This is a mixed-methods, implementation study at 9 public hospitals in Peru consisting of a didactic session for surgeons on EBP and Google Translate and support of applications for UTD access. Change in clinical knowledge scores (CKS), access and use of UTD, and impact of language pre-and postintervention were measured. Qualitative interviews uncovered reasons for these changes. RESULTS: Intervention participants had lower CKS at follow-up compared with baseline (odds ratio [OR] of higher score 0.41 [0.18,0.98]; p = 0.044), and this effect was modified (p = 0.003) to the extent that the reverse was true for control participants (OR 2.30 [1.13,4.71]; p = 0.022). Participants with 1 to 20 years of experience had significantly improved CKS compared with students/residents (1 to 10 years: OR 4.5 [1.1,18]; 11 to 20 years: OR 4.9 [1.4,17]); there was no evidence of a different CKS between providers with >20 years of experience compared with students/residents (OR 1.3 [0.5,3.7]). Administrative disconnect, usability, motivation, education, time, resources, and age influenced point-of-care medical information systems impact on knowledge and EBP. Participants reporting low English proficiency translated medical literature mostly used Google Translate. Those with low/no English reading proficiency had higher odds of reporting a negative impact on research than those with working (p = 0.007) or professional (p < 0.001) proficiency. CONCLUSIONS: Providing education on EBP, free UTD access, and translation solutions did not correlate with increased CKS due to complex barriers to using point-of-care medical information systems.

Longitudinal Associations Between Energy Drink Consumption, Health, and Norm-Breaking Behavior Among Swedish Adolescents.

Objectives: To describe the intake of energy drinks (EDs) among a sample of Swedish adolescents while considering health-related variables, and to investigate the longitudinal associations between ED consumption, health, and norm-breaking behavior. Longitudinal studies on this topic are scarce. Methods: Questionnaire data were collected in the northern part of Sweden in 2010-2011 from 1,622 adolescents in grades 6-9. Analyses were performed using a chi-squared test and logistic regression. Results: Seventy-four percent of the boys and 54% of the girls had consumed EDs (P < 0.001). ED consumption was associated with variables related to low health, low support levels, and norm-breaking behavior. The associations were generally stronger among the girls and the boys who consumed EDs at least once a week. ED consumption was a predictor of worse health and norm-breaking behavior 1 year later. Adjusted odds ratios ranged from 1.53 (95% CI: 1.07, 2.20; school-related stress) to 4.88 (95% CI: 2.28, 10.43; gaming-related truancy). Conclusions: Health promotion activities benefit from a broad approach but could focus on girls who consume EDs and those boys with the highest consumption levels.

A sense of health and coherence in young rural schoolchildren in Sweden.

Background: Little is known about how younger schoolchildren in a rural setting experience their sense of coherence (SOC), how they think and reason about health and what they perceive as important to achieve health goals. This study aimed to investigate children's SOC and their health perceptions.Method: In this mixed-method study 94 children (8-12 years) from three rural schools answered several questionnaires: The Child-SOC (CSOC), Positive Health Scale (PHS) and Cantril's ladder of life scale. Another 23 children (of 94) participated in four focus group interviews. Thematic analysis was used to identify themes from the interview transcripts.Results: High SOC was reported by 48% of the boys and 22% of the girls. However, no significant gender differences were found. Four themes were generated from the qualitative analysis: Understanding health, Managing health, Doing bodily health and Socialising health. Both younger and older children had a holistic view of health in which health was seen as an individual's living habits in which social contacts mattered.Conclusion: In a rural context children need to adapt to activities that exist in their immediate environment. Thus, activities during school hours can be an important complement in health promotion.

The Nordic perspective on migration and empowerment.

International migration is a complex phenomenon that touches on a multiplicity of economic, social and security aspects affecting our daily lives. In the Nordic countries' migration is a contentious political topic as the number of migrants has significantly increased in recent decades. The aim of this study is to analyse governmental policy documents on migrants in Denmark, Finland, Norway and Sweden and to identify and compare how they are described within an empowerment perspective. A critical discourse analysis was undertaken of each Nordic country. The findings revealed that all four documents placed migrants in a passive position in regard to decision-making and that an empowerment perspective was lacking. Migrants are similarly treated in each Nordic country as a problem to deal with rather than as a possible resource for the society and the approach seeks to protect the welfare state and the culture of the country. The lack of empowerment perspective may be having a negative impact on the health and well-being of migrants and on their integration in the Nordic society. The article concludes by raising several questions in regard to migration and empowerment in the Nordic context.

On Time: A Qualitative Study of Swedish Students', Parents' and Teachers' Views on School Attendance, with a Focus on Tardiness.

Tardiness is a common problem in many schools. It can be understood as an individual risk for future problematic behavior leading to absenteeism, school dropout, exclusion and later health problems. Tardiness can also be examined in relation to a broader social-ecological perspective on health. The aim of this study was to analyze students', school staff's and parents' views on students' tardiness in two Swedish schools. A focus group interview design was used with 21 school personnel, 21 students in grade nine and two parents. The data were analyzed by using thematic content analysis. The results illustrated the main theme-It depends on…-regarding what will happen if a student arrives late to school lessons. This finding is further explained by the subthemes about teachers' signals and reactions and the responses from teachers and students. The conclusion showed the importance of organizing the school day more predictably for the students. Late arrival is a sign of shortcomings in a school organization. It is necessary to develop guidelines related to how to handle students' late arrival based on predictable viewpoints but even more so on how to promote students' sense of belonging and their interest in and motivation for going to school.

Rethinking the definition of major trauma: The need for trauma intervention outperforms Injury Severity Score and Revised Trauma Score in 38 adult and pediatric trauma centers.

BACKGROUND: Patients' trauma burdens are a combination of anatomic damage, physiologic derangement, and the resultant depletion of reserve. Typically, Injury Severity Score (ISS) >15 defines major anatomic injury and Revised Trauma Score (RTS) <7.84 defines major physiologic derangement, but there is no standard definition for reserve. The Need For Trauma Intervention (NFTI) identifies severely depleted reserves (NFTI+) with emergent interventions and/or early mortality. We hypothesized NFTI would have stronger associations with outcomes and better model fit than ISS and RTS. METHODS: Thirty-eight adult and pediatric U.S. trauma centers submitted data for 88,488 encounters. Mixed models tested ISS greater than 15, RTS less than 7.84, and NFTI's associations with complications, survivors' discharge to continuing care, and survivors' length of stay (LOS). RESULTS: The NFTI had stronger associations with complications and LOS than ISS and RTS (odds ratios [99.5% confidence interval]: NFTI = 9.44 [8.46-10.53]; ISS = 5.94 [5.36-6.60], RTS = 4.79 [4.29-5.34]; LOS incidence rate ratios (99.5% confidence interval): NFTI = 3.15 [3.08-3.22], ISS = 2.87 [2.80-2.94], RTS = 2.37 [2.30-2.45]). NFTI was more strongly associated with continuing care discharge but not significantly more than ISS (relative risk [99.5% confidence interval]: NFTI = 2.59 [2.52-2.66], ISS = 2.51 [2.44-2.59], RTS = 2.37 [2.28-2.46]). Cross-validation revealed that in all cases NFTI's model provided a much better fit than ISS greater than 15 or RTS less than 7.84. CONCLUSION: In this multicenter study, NFTI had better model fit and stronger associations with the outcomes than ISS and RTS. By determining depletion of reserve via resource consumption, NFTI+ may be a better definition of major trauma than the standard definitions of ISS greater than 15 and RTS less than 7.84. Using NFTI may improve retrospective triage monitoring and statistical risk adjustments. LEVEL OF EVIDENCE: Prognostic, level IV.

A photovoice study of school belongingness among high school students in Norway.

Although high school graduation is important for living conditions and health throughout life, many students do not complete. In Norway's northern most county, Finnmark, up to 45% of students do not complete high school. Contrary to prior research that has primarily focused on causes for dropout, this study's aim was to deepen understanding of factors that support high school attendance. A strengths-based participatory approach using photovoice addressed attendance factors as perceived by seven participating students from one high school in Finnmark. Qualitative content analysis of data generated through group dialogue about participant-generated photos and individual interviews identified six factors important for students' school attendance: a supportive school environment, a good learning environment, recuperation and recreation, family and friends, goals and ambitions, and place attachment. Related aspects of a supportive environment and belongingness, where school staff made important contributions to promoting a positive environment, were essential.

Participation and support - associations with Swedish pupils' positive health.

From the perspective of salutogenesis, schools have opportunities to create supportive environments for health and well-being, but there is a need for more knowledge about positive health determinants in the school setting. The aim of this study was to analyse adolescents' self-reported positive health and its association with supportive factors in the school environment. Data was derived from a cross-sectional study in which pupils were aged 12-16 (n=1527). A positive health scale was used to examine the association of positive health with the following determinants: classroom participation; teacher support; peer support; parental support; and personal relative affluence. Data was analysed with multiple logistic regression. The results showed that positive health was associated with classroom participation and support from teachers and parents more commonly among boys than girls. All determinants were significantly associated with pupils' positive health. The conclusion is that students' positive health is strongly associated with support from the school. Classroom participation and support are major concerns for the health of pupils, and it is essential to develop these aspects of the school environment.

Risky consumption of alcohol and drugs among employees at ski resorts.

AIM: To evaluate risky consumption of alcohol and drugs among Swedish men and women who are employed at ski resorts. METHODS: A cross-sectional sample of 611 employees in 48 small and medium-sized enterprises responded to a questionnaire covering alcohol and drug use, social aspects around work and working conditions. Consumption of alcohol and drugs in the study sample was compared to population data. Data were analysed using Mann-Whitney U-tests and logistic regression analyses. RESULTS: Compared to the general population, the study group of ski resort employees had higher scores on the Alcohol Use Disorders Identification Test (AUDIT) in all age groups except 35+ for men. Regarding the Drug Use Disorders Identification Test (DUDIT) scores, only men in the 18-24 age group had higher scores compared to the general population. The prevalence of risky alcohol and drug use was higher among seasonally employed individuals; 82.9%, compared to 58.0% among other employees for alcohol; 8.3% compared to 2.8% for drugs. The regression analysis indicated that social aspects such as living together with colleagues and having co-workers/friends who are frequently inebriated were the most significant explanatory variables for explaining risk consumption of alcohol (OR 16.82 and OR 4.33). Risky use of drugs was associated with being younger (OR 0.15) and male (OR 0.86), as well as with having co-workers/friends who are frequently inebriated (OR 4.25). CONCLUSIONS: The study showed a high prevalence of risky alcohol consumption among ski resort employees compared to the general population, with higher risky drug consumption found only among younger men. Social aspects such as living with colleagues and having co-workers or friends who are often inebriated, were identified as important explanatory factors. Preventive measures should be introduced, targeting norms and work culture surrounding alcohol and drug use among ski resort employees.

Promoting an equal and healthy environment: Swedish students' views of daily life at school.

Education is an important factor in health equity, but many students still do not complete high school. A focus on the school context rather than on individual problems might help to create a supportive environment for health and learning. In this study we explored factors that promote health and learning from the perspective of vocational and low-achieving high school students in Sweden. We used grounded theory with a constructivist orientation, informed and sensitized by the concept of salutogenesis. Students from a school in a mid-sized municipality in Sweden participated, and we collected data using the photovoice method and interviews. Students identified general factors as significant to their well-being and success in school. The main theme, "promoting driving forces for health and learning," emerged from the categories "longing to be seen by teachers," "longing for support," and "longing for recuperation."

Photovoice: an opportunity and challenge for students' genuine participation.

It has been highlighted that youth empowerment and participation are important principles for school health promotion. Despite this fact, children and youth are rarely given instruments to participate or to influence their situations and the environments in their schools. Photovoice is a method to increased empowerment and participation. Originally it was created as a community action research method based on Freire's critical pedagogy and feminist theory. The purpose of this study was to explore challenges and opportunities for applying photovoice in a school setting to support genuine participation. Together with teachers and students in an upper secondary school in Östersund's municipality in the north of Sweden, the photovoice method was field tested and modified to a classroom situation. The teachers and the students were interviewed about their experiences with the method. The results were interpreted by content analysis and showed that the teachers' capability to be facilitators and the students' possibility to make a difference for the school or the municipality were the most important factors to succeed with photovoice. The conclusions were that photovoice challenges schools and society to have a better structure for genuine participation if youth participation is seen as valuable.