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1.
BMC Musculoskelet Disord ; 22(1): 603, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215239

RESUMO

BACKGROUND: Predicting the duration of sickness absence (SA) among sickness absent patients is a task many sickness certifying physicians as well as social insurance officers struggle with. Our aim was to develop a prediction model for prognosticating the duration of SA due to knee osteoarthritis. METHODS: A population-based prospective study of SA spells was conducted using comprehensive microdata linked from five Swedish nationwide registers. All 12,098 new SA spells > 14 days due to knee osteoarthritis in 1/1 2010 through 30/6 2012 were included for individuals 18-64 years. The data was split into a development dataset (70 %, nspells =8468) and a validation data set (nspells =3690) for internal validation. Piecewise-constant hazards regression was performed to prognosticate the duration of SA (overall duration and duration > 90, >180, or > 365 days). Possible predictors were selected based on the log-likelihood loss when excluding them from the model. RESULTS: Of all SA spells, 53 % were > 90 days and 3 % >365 days. Factors included in the final model were age, sex, geographical region, extent of sickness absence, previous sickness absence, history of specialized outpatient healthcare and/or inpatient healthcare, employment status, and educational level. The model was well calibrated. Overall, discrimination was poor (c = 0.53, 95 % confidence interval (CI) 0.52-0.54). For predicting SA > 90 days, discrimination as measured by AUC was 0.63 (95 % CI 0.61-0.65), for > 180 days, 0.69 (95 % CI 0.65-0.71), and for SA > 365 days, AUC was 0.75 (95 % CI 0.72-0.78). CONCLUSION: It was possible to predict patients at risk of long-term SA (> 180 days) with acceptable precision. However, the prediction of duration of SA spells due to knee osteoarthritis has room for improvement.


Assuntos
Osteoartrite do Joelho , Humanos , Prognóstico , Estudos Prospectivos , Licença Médica , Suécia
2.
Anticancer Res ; 41(7): 3511-3517, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34230146

RESUMO

BACKGROUND/AIM: We previously found crypts in symmetric fission (CSF) and in asymmetric fission (CAF) in colectomy-specimens with ulcerative colitis. We now analyzed CSF and CAF (CSAF) in biopsies from 80 patients with inflammatory bowel disease (IBD) without dysplasia or carcinoma. PATIENTS AND METHODS: One unselected double-biopsy from affected endoscopic areas was investigated in the 80 cases. RESULTS: A total of 353 crypts in fission were found. The median number of CAF/biopsy was 3.7 and for CSF/biopsy, 0.7 (p<0.00001). CONCLUSION: CSAF often occur in unselected biopsies from patients with IBD. Whereas the increased frequency of CSF might mirror a compensatory mechanism of crypt production in areas occupied by inflammation, CAF reflects a pathological aberration of cryptogenesis, probably generated by somatic mutations. The biological significance of CAF in IBD without dysplasia or carcinoma, deserves to be further investigated.


Assuntos
Doenças Inflamatórias Intestinais/patologia , Biópsia/métodos , Colite Ulcerativa/patologia , Colo/patologia , Neoplasias do Colo/patologia , Feminino , Humanos , Inflamação/patologia , Mucosa Intestinal/patologia , Masculino , Suécia
3.
BMJ Open ; 11(7): e046738, 2021 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-34226219

RESUMO

INTRODUCTION: COVID-19 may cause severe pneumonitis and trigger a massive inflammatory response that requires ventilatory support. The intensive care unit (ICU)-mortality has been reported to be as high as 62%. Dexamethasone is the only of all anti-inflammatory drugs that have been tested to date that has shown a positive effect on mortality. We aim to explore if treatment with hyperbaric oxygen (HBO) is safe and effective for patients with severe COVID-19. Our hypothesis is that HBO can prevent ICU admission, morbidity and mortality by attenuating the inflammatory response. The primary objective is to evaluate if HBO reduces the number of ICU admissions compared with best practice treatment for COVID-19, main secondary objectives are to evaluate if HBO reduces the load on ICU resources, morbidity and mortality and to evaluate if HBO mitigates the inflammatory reaction in COVID-19. METHODS AND ANALYSIS: A randomised, controlled, phase II, open label, multicentre trial. 200 subjects with severe COVID-19 and at least two risk factors for mortality will be included. Baseline clinical data and blood samples will be collected before randomisation and repeated daily for 7 days, at days 14 and 30. Subjects will be randomised with a computer-based system to HBO, maximum five times during the first 7 days plus best practice treatment or only best practice treatment. The primary endpoint, ICU admission, is defined by criteria for selection for ICU. We will evaluate if HBO mitigates the inflammatory reaction in COVID-19 using molecular analyses. All parameters are recorded in an electronic case report form. An independent Data Safety Monitoring Board will review the safety parameters. ETHICS AND DISSEMINATION: The trial is approved by The National Institutional Review Board in Sweden (2020-01705) and the Swedish Medical Product Agency (5.1-2020-36673). Positive, negative and any inconclusive results will be published in peer-reviewed scientific journals with open access. TRIAL REGISTRATION: NCT04327505. EudraCT number: 2020-001349-37.


Assuntos
COVID-19 , Oxigenação Hiperbárica , Preparações Farmacêuticas , Adulto , Humanos , Unidades de Terapia Intensiva , Morbidade , SARS-CoV-2 , Suécia , Resultado do Tratamento
4.
BMJ Open ; 11(7): e051316, 2021 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-34226237

RESUMO

OBJECTIVE: To investigate the possible connection between cardiorespiratory fitness (CRF) and muscle strength in early adulthood and severity of COVID-19 later in life. DESIGN: Prospective registry-based cohort study. PARTICIPANTS: 1 559 187 Swedish men, undergoing military conscription between 1968 and 2005 at a mean age of 18.3 (SD 0.73) years. MAIN OUTCOME MEASURES: Hospitalisation, intensive care or death due to COVID-19 from March to September 2020, in relation to CRF and muscle strength. RESULTS: High CRF in late adolescence and early adulthood had a protective association with severe COVID-19 later in life with OR (95% CI) 0.76 (0.67 to 0.85) for hospitalisation (n=2 006), 0.61 (0.48 to 0.78) for intensive care (n=445) and 0.56 (0.37 to 0.85) for mortality (n=149), compared with the lowest category of CRF. The association remains unchanged when controlled for body mass index (BMI), blood pressure, chronic diseases and parental education level at baseline, and incident cardiovascular disease before 2020. Moreover, lower muscle strength in late adolescence showed a linear association with a higher risk of all three outcomes when controlled for BMI and height. CONCLUSIONS: Physical fitness at a young age is associated with severity of COVID-19 many years later. This underscores the necessity to increase the general physical fitness of the population to offer protection against future viral pandemics.


Assuntos
COVID-19 , Adolescente , Adulto , Índice de Massa Corporal , Estudos de Coortes , Humanos , Masculino , Força Muscular , Aptidão Física , Fatores de Risco , SARS-CoV-2 , Suécia/epidemiologia
5.
BMC Health Serv Res ; 21(1): 747, 2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34315457

RESUMO

BACKGROUND: Recruiting and retaining staff are standing challenges in eldercare. Low pay, difficult working conditions, and social relations at the workplace impact on turnover intentions. Few studies have used quantitative data for estimating the role of recognition by the wider society for staff instability. This study examines how perceived lack of recognition at the societal level affects Nordic eldercare workers' considerations of leaving their jobs. METHODS: The 2015 Nordcare survey among frontline eldercare workers in Denmark, Finland, Norway, and Sweden (N = 3,677) is analysed. Issues such as working conditions, financial strain, work-life balance, and appreciation by care recipients and colleagues, were covered. Recognition at the societal level was measured by perceptions of being valued by top municipal leaders, mass media, and the general public. Analyses are made with cross-tabulations and multivariate linear probability regression models. RESULTS: In the total sample, 41.1 % had "seriously considered to quit during the last 12 months". About one third felt "not at all valued" by top municipal leaders, while one fourth felt "not at all valued" by mass media. In bivariate analyses, perceptions of recognition were strongly associated with considerations to quit. These associations were reduced, but remained sizeable and highly significant in multivariate analyses adjusted for age, gender, health, working conditions, financial stress, workplace relations, and other known turnover predictors. CONCLUSIONS: Lack of recognition by societal agents such as top municipal leaders, mass media, and the general public, is widely felt by Nordic eldercare workers. Feeling poorly valued by such sources is associated with frequent considerations to leave one's employment. Perceived lack of recognition by the wider society has a significant and independent impact on staff instability in the eldercare sector. Societies' recognition order is embedded in social structures which are resistant to change, but policies which succeed in raising the societal recognition of eldercare work may contribute to reduced retention difficulties in eldercare.


Assuntos
Reorganização de Recursos Humanos , Finlândia , Humanos , Noruega , Inquéritos e Questionários , Suécia
6.
Nutrients ; 13(7)2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34206639

RESUMO

We have developed a mobile phone application for measuring the intake of dietary fiber and validated the ability of the application to accurately capture this intake against measurements registered by a dietary record. We also investigated what food groups contributed most to the total, soluble, and insoluble dietary fiber intake. Twenty-six randomly selected Swedish women aged 35-85 years were included and randomized to either start to register dietary intake in the application or by a dietary record, during three consecutive days. After a washout period of at least two weeks, the participants used the other method. We found that the difference in measured mean fiber intake between the dietary record and the application was two grams independent of the total intake per day. A statistically significant correlation between fiber intake as measured by the two methods was found (rho = 0.65, p < 0.001). Vegetables and roots were the predominantly contributing foods to total and soluble fiber intake. Bread and crackers contributed most to insoluble fiber intake. In conclusion, the application may be considered as a useful and easy-to-use method to measure dietary fiber intake.


Assuntos
Registros de Dieta , Inquéritos sobre Dietas/estatística & dados numéricos , Fibras na Dieta/análise , Aplicativos Móveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Telefone Celular , Inquéritos sobre Dietas/métodos , Ingestão de Alimentos , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Suécia
7.
J Wound Care ; 30(7): 534-542, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34256595

RESUMO

Objective: The prevalence and economic burden of wounds are growing. Any wound has the potential to become hard-to-heal and require frequent care. Clinicians need to find ways to absorb demand on services without compromising outcomes. Drivers of wound care efficiency-time-to-heal, frequency of dressing change and the incidence of complications-can be evaluated to shape future wound management. A survey of wound care was conducted by clinicians from five centres in Sweden over a one-week period, during which clinicians documented every wound once. At the time of surveying, 49% of wounds were considered to be improving, infection incidence was 11.7% and dressings were changed a mean of 2.2 times per week, with highly exuding wounds changed 6.9 times per week. The data highlighted the importance of diagnosing patient and wound characteristics in selecting treatments and organising care. Recognised gaps in diagnoses potentially identify opportunities to influence healing, complication incidence and intensity of nursing, thus reducing demand on resources. In conclusion, this survey highlights opportunities to reduce the burdens these drivers present. Through improved diagnosis and alignment to recognised care pathways, there is potential to improve patient outcomes and alleviate the strains placed upon wound care providers.


Assuntos
Bandagens , Cicatrização , Humanos , Infecção da Ferida Cirúrgica , Suécia/epidemiologia
8.
BMJ Open ; 11(7): e049302, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233997

RESUMO

OBJECTIVES: There is concern that the COVID-19 pandemic will be associated with an increase in suicides, but evidence supporting a link between pandemics and suicide is limited. Using data from the three influenza pandemics of the 20th century, we aimed to investigate whether an association exists between influenza deaths and suicide deaths. DESIGN: Time series analysis. SETTING: Sweden. PARTICIPANTS: Deaths from influenza and suicides extracted from the Statistical Yearbook of Sweden for 1910-1978, covering three pandemics (the Spanish influenza, the Asian influenza and the Hong Kong influenza). MAIN OUTCOME MEASURES: Annual suicide rates in Sweden among the whole population, men and women. Non-linear autoregressive distributed lag models was implemented to explore if there is a short-term and/or long-term relationship of increases and decreases in influenza death rates with suicide rates during 1910-1978. RESULTS: Between 1910 and 1978, there was no evidence of either short-term or long-term significant associations between influenza death rates and changes in suicides (ß coefficients of 0.00002, p=0.931 and ß=0.00103, p=0.764 for short-term relationship of increases and decreases in influenza death rates, respectively, with suicide rates, and ß=-0.0002, p=0.998 and ß=0.00211, p=0.962 for long-term relationship of increases and decreases in influenza death rates, respectively, with suicide rates). The same pattern emerged in separate analyses for men and women. CONCLUSIONS: We found no evidence of short-term or long-term association between influenza death rates and suicide death rates across three 20th century pandemics.


Assuntos
COVID-19 , Influenza Humana , Suicídio , Feminino , Hong Kong , Humanos , Masculino , Pandemias , SARS-CoV-2 , Suécia/epidemiologia
9.
BMC Palliat Care ; 20(1): 102, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210312

RESUMO

BACKGROUND: At the time of the first wave of the COVID-19 pandemic in Sweden, little was known about how effective our regular end-of-life care strategies would be for patients dying from COVID-19 in hospitals. The aim of the study was to describe and evaluate end-of-life care for patients dying from COVID-19 in hospitals in Sweden up until up until 12 November 2020. METHODS: Data were collected from the Swedish Register of Palliative Care. Hospital deaths during 2020 for patients with COVID-19 were included and compared to a reference cohort of hospital patients who died during 2019. Logistic regression was used to compare the groups and to control for impact of sex, age and a diagnosis of dementia. RESULTS: The COVID-19 group (1476 individuals) had a lower proportion of women and was older compared to the reference cohort (13,158 individuals), 81.8 versus 80.6 years (p < .001). Breathlessness was more commonly reported in the COVID-19 group compared to the reference cohort (72% vs 43%, p < .001). Furthermore, anxiety and delirium were more commonly and respiratory secretions, nausea and pain were less commonly reported during the last week in life in the COVID-19 group (p < .001 for all five symptoms). When present, complete relief of anxiety (p = .021), pain (p = .025) and respiratory secretions (p = .037) was more often achieved in the COVID-19 group. In the COVID-19 group, 57% had someone present at the time of death compared to 77% in the reference cohort (p < .001). CONCLUSIONS: The standard medical strategies for symptom relief and end-of-life care in hospitals seemed to be acceptable. Symptoms in COVID-19 deaths in hospitals were relieved as much as or even to a higher degree than in hospitals in 2019. Importantly, though, as a result of closing the hospitals to relatives and visitors, patients dying from COVID-19 more frequently died alone, and healthcare providers were not able to substitute for absent relatives.


Assuntos
COVID-19/complicações , COVID-19/epidemiologia , Cuidados Paliativos , Assistência Terminal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/virologia , COVID-19/psicologia , Estudos de Coortes , Delírio/epidemiologia , Delírio/virologia , Dispneia/epidemiologia , Dispneia/virologia , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/epidemiologia , Náusea/virologia , Dor/epidemiologia , Dor/virologia , Sistema de Registros , Suécia/epidemiologia , Avaliação de Sintomas , Adulto Jovem
10.
PLoS One ; 16(7): e0253371, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34197498

RESUMO

BACKGROUND: The Covid-19 pandemic has had unprecedented effects on individual lives and livelihoods as well as on social, health, economic and political systems and structures across the world. This article derives from a unique collaboration between researchers and museums using rapid response crowdsourcing to document contemporary life among the general public during the pandemic crisis in Sweden. METHODS AND FINDINGS: We use qualitative analysis to explore the narrative crowdsourced submissions of the same 88 individuals at two timepoints, during the 1st and 2nd pandemic waves, about what they most fear in relation to the Covid-19 pandemic, and how their descriptions changed over time. In this self-selected group, we found that aspects they most feared generally concerned responses to the pandemic on a societal level, rather than to the Covid-19 disease itself or other health-related issues. The most salient fears included a broad array of societal issues, including general societal collapse and fears about effects on social and political interactions among people with resulting impact on political order. Notably strong support for the Swedish pandemic response was expressed, despite both national and international criticism. CONCLUSIONS: This analysis fills a notable gap in research literature that lacks subjective and detailed investigation of experiences of the general public, despite recognition of the widespread effects of Covid-19 and its' management strategies. Findings address controversy about the role of experts in formulating and communicating strategy, as well as implications of human responses to existential threats. Based on this analysis, we call for broader focus on societal issues related to this existential threat and the responses to it.


Assuntos
COVID-19 , Crowdsourcing , Medo , COVID-19/epidemiologia , COVID-19/psicologia , Humanos , Estudos Longitudinais , Pandemias , Suécia/epidemiologia , Fatores de Tempo
11.
Artigo em Inglês | MEDLINE | ID: mdl-34208784

RESUMO

The aim of the study was to estimate the level of the human resources index (HRI) measure among Swedish municipal employees, and to investigate the association between human resources index (HRI) and relational justice, short-term recovery, work environment-related production loss, and health-related production loss. A cross-sectional design was used with one sample of municipal employees (n = 6402). The results showed a positive association (r = 0.31) between human resources index (HRI) and relational justice; a positive (r = 0.27) association between HRI and short-term recovery; a negative association between HRI and work environment-related production loss (r = -0.37); and a negative association between HRI and health-related production loss (r = -0.23). The findings implicate that HRI captures important aspects of the work environment such as productivity, relational justice, and short-term recovery. The HRI measure is part of a support model used in workplaces to systematically address work environment-related issues. Monitoring changes in the HRI measure, it is possible to determine whether the measures taken effect production loss, perceived leadership, and short-term recovery in a work group. The support model using HRI may thus be used to complement traditional work environment surveys conducted in Swedish organizations as obliged by legal provisions.


Assuntos
Conservação dos Recursos Naturais , Local de Trabalho , Estudos Transversais , Retroalimentação , Humanos , Suécia , Recursos Humanos
12.
Scand J Trauma Resusc Emerg Med ; 29(1): 89, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217351

RESUMO

BACKGROUND: Triage and triage related work has been performed in Swedish Emergency Departments (EDs) since the mid-1990s. According to two national surveys from 2005 to 2011, triage was carried out with different triage scales and without guidelines or formal education. Furthermore, a review from 2010 questioned the scientific evidence for both triage as a method as well as the Swedish five level triage scale Medical Emergency Triage and Treatment System (METTS); nevertheless, METTS was applied in 65% of the EDs in 2011. Subsequently, METTS was renamed to Rapid Emergency Triage and Treatment System (RETTS©). The hypothesis for this study is that the method of triage is still applied nationally and that the use of METTS/RETTS© has increased. Hence, the aim is to describe the occurrence and application of triage and triage related work at Swedish Emergency Departments, in comparison with previous national surveys. METHODS: In this cross-sectional study with a descriptive and comparative design, an electronic questionnaire was developed, based on questionnaire from previous studies. The survey was distributed to all hospital affiliated EDs from late March to the middle of July in 2019. The data was analysed with descriptive statistics, by IBM SPSS Statistics, version 26. RESULTS: Of the 51 (75%) EDs partaking in the study, all (100%) applied triage, and 92% used the Swedish triage scale RETTS©. Even so, there was low concordance in how RETTS© was applied regarding time frames i.e., how long a patient in respective triage level could wait for assessment by a physician. Additionally, the results show a major diversion in how the EDs performed education in triage. CONCLUSION: This study confirms that triage method is nationally implemented across Swedish EDs. RETTS© is the dominating triage scale but cannot be considered as one triage scale due to the variation with regard to time frames per triage level. Further, a diversion in introduction and education in the pivotal role of triage has been shown. This can be counteracted by national guidelines in what triage scale to use and how to perform triage education.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Triagem/organização & administração , Estudos Transversais , Humanos , Suécia , Triagem/normas
13.
Front Public Health ; 9: 642983, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34277534

RESUMO

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.


Assuntos
COVID-19 , Migrantes , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Humanos , Pandemias , Saúde Pública , Política Pública , Fatores de Risco , SARS-CoV-2 , Condições Sociais , Suécia/epidemiologia
14.
Health Qual Life Outcomes ; 19(1): 174, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217326

RESUMO

BACKGROUND: The main aim of post-mastectomy breast reconstruction is to improve the patient's quality of life, which makes high-quality and validated patient-reported outcome measurements essential. None of the established instruments include evaluation of donor-site morbidity, such as impact on upper extremity and back function, when a latissimus dorsi (LD) muscle is used; and BREAST-Q LD questionnaire was therefore recently developed for this purpose. The aim of this study was to translate into Swedish and culturally adapt the BREAST-Q LD questionnaire's two subscales, appearance and function, and perform a psychometric evaluation of the subscales in a Swedish population of patients. METHODS: This was a cross-sectional study. The questionnaire was translated according to established guidelines. The questionnaires were sent to all patients operated using an LD flap between 2007 and 2017. Internal consistency was assessed using Cronbach's α. Inter-item correlations and corrected item-total correlations were calculated using the Pearson's correlation coefficient. Convergent validity was evaluated by comparing the BREAST-Q LD questionnaire to the Western Ontario Osteoarthritis of the Shoulder Index, using the Spearman correlation coefficient. Test-retest reliability was tested with intraclass correlation coefficients (ICCs), and the coefficient of variation and Bland-Altman plots were drawn. Floor and ceiling effects were calculated. Known-group validation was tested by comparing scores from the patients and from normal controls using the Mann-Whitney U-test and by calculating eta squared effect size. RESULTS: The questionnaires were sent to 176 eligible patients and 125 responded (71%). The patients had been operated a mean of 6.6 years ago, and most (92%) had previous radiation. Internal consistency was satisfactory for both subscales. The correlation coefficients between questions were r > 0.30 for all items of both scales. The corrected item-total correlation coefficient ranged from 0.62 to 0.90. As hypothesised, the function scale was correlated with the WOOS "Physical symptoms" subscale. Reliability was adequate according to the ICCs. The ceiling effect threshold for the appearance scale was reached and that for the back scale was almost reached. There were significant differences between patients and controls, in the hypothesised direction. CONCLUSIONS: The results of this study support a good internal consistency, convergent validity, test-retest reliability and known-group validation for the Swedish BREAST-Q LD questionnaire. However, it may be difficult to discriminate between patients with very mild and those with no symptoms using the appearance scale. TRIAL REGISTRATION: ClinicalTrials.Gov identifier NCT04526561.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia , Mastectomia , Satisfação do Paciente , Psicometria , Músculos Superficiais do Dorso/transplante , Retalhos Cirúrgicos , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Mastectomia/métodos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Psicometria/métodos , Qualidade de Vida , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Suécia , Traduções
15.
BMC Med Educ ; 21(1): 373, 2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34238267

RESUMO

BACKGROUND: Academic reading and writing are seen as self-evident literacy competences in most contemporary higher educations, however, whether students also are introduced to professional literacy of relevance for dentistry during their education is a question. The purpose of this study is to analyze one of the Swedish dental programmes, with respect to its design, in relation to possible content of relevance for academic and professional literacy. Secondarily, to identify and analyze Swedish dental students' writing in an academic setting, i.e. what these students are expected to read and write, and how they write. METHODS: Data, for this ethnographically inspired case-study, was produced by observations and audio-recordings of lectures, copies of teachers' handouts and of volunteering students' notes, and a multiple-choice-test. Data-analysis was made in five steps, starting with macro-level data, i.e. curriculum and syllabuses, followed by the syllabuses for the two observed modules, the teacher-provided material, analysis of the students' notes, while in the fifth and final step, the results from the previous steps were compared, to find patterns of what students were expected to read and write, and what in the teacher-provided multimodal material that was emphasized in teachers' talk. RESULTS: This study showed that students were engaged in several types of literacy events, such as reading, finding and watching videos on their learning platform, writing, and following instructions. The study also showed that there is a recurrent academic content comprised of anatomy, physiology and pathology, while the professional content comprised of patient communication and anamnesis. Further, an integrated content was found and was initiated in teacher-constructed PowerPoints and by student-questions. Note-taking patterns varied between individual students, but the general pattern for this group of students were the use of complementary notes. This type of note-taking was used to make available further descriptions of the teacher-constructed text in PowerPoints, but also an independent text describing pictures shown on teachers' PowerPoints or the blackboard. CONCLUSION: Findings from the present study reveal that students either copy text from teachers' PowerPoint-slides, re-formulate text from teachers' PowerPoint-slides, or write complementing text to teachers' PowerPoint-slides. Further, the students individually choses type of note-taking based on situation. The study also revealed that the academic literacy - in the two modules during the fifth and sixth semesters of a dental education analyzed - mainly has a professional basis for reading, writing, and communication purposes. The study also showed that academic and professional literacy are closely connected through recurrent integration.


Assuntos
Alfabetização , Estudantes , Educação em Odontologia , Humanos , Suécia , Redação
16.
BMC Med Educ ; 21(1): 363, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193137

RESUMO

BACKGROUND: There is an increasing global interest in selection processes for candidates to surgical training. The aim of the present study is to compare selection processes to specialist surgeon training in the European Union (EU). A secondary goal is to provide guidance for evidence-based methods by a proposed minimum standard that would align countries within the EU. METHODS: Publications and grey literature describing selection strategies were sought. Correspondence with Union Européenne des Médecins Specialists (UEMS) Section of Surgery delegates was undertaken to solicit current information on national selection processes. Content analysis of 13 semi-structured interviews with experienced Swedish surgeons on the selection process. Two field trips to Ireland, a country with a centralized selection process were conducted. Based on collated information typical cases of selection in a centralized and decentralized setting, Ireland and Sweden, are described and compared. RESULTS: A multitude of methods for selection to surgical training programs were documented in the 27 investigated countries, ranging from locally run processes with unstructured interviews to national systems for selection of trainees with elaborate structured interviews, and non-technical and technical skills assessments. Associated with the difference between centralized and decentralized selection systems is whether surgical training is primarily governed by an employment or educational logic. Ireland had the most centralized and elaborate system, conducting a double selection process using evidence-based methods along an educational logic. On the opposite end of the scale Sweden has a decentralized, local selection process with a paucity of evidence-based methods, no national guidelines and operates along an employment logic, and Spain that rely solely on examination tests to rank candidates. CONCLUSION: The studied European countries all have different processes for selection of surgical trainees and the use of evidence-based methods for selection is variable despite similar educational systems. Selection in decentralized systems is currently often conducted non-transparent and subjectively. A suggested improvement towards an evidence-based framework for selection applicable in centralized and decentralized systems as well as educational and employer logics is suggested.


Assuntos
Competência Clínica , Europa (Continente) , União Europeia , Humanos , Irlanda , Espanha , Suécia
17.
Nutrients ; 13(6)2021 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-34204127

RESUMO

Risk factors for ischemic stroke is suggested to differ by etiologic subtypes. The purpose of this study was to examine the associations between modifiable and non-modifiable risk factors and atherothrombotic stroke (i.e., excluding cardioembolic stroke), and to examine if the potential benefit of modifiable lifestyle factors differs among subjects with and without predisposing comorbidities. After a median follow-up of 21.2 years, 2339 individuals were diagnosed with atherothrombotic stroke out of 26,547 study participants from the Malmö Diet and Cancer study. Using multivariable Cox regression, we examined non-modifiable (demographics and family history of stroke), semi-modifiable comorbidities (hypertension, dyslipidemia, diabetes mellitus and atherosclerotic disease), and modifiable (smoking, body mass index, diet quality, physical activity, and alcohol intake) risk factors in relation to atherothrombotic stroke. Higher age, male gender, family history of stroke, and low educational level increased the risk of atherothrombotic stroke as did predisposing comorbidities. Non-smoking (hazard ratio (HR) = 0.62, 95% confidence interval (CI) 0.56-0.68), high diet quality (HR = 0.83, 95% CI 0.72-0.97) and high leisure-time physical activity (HR = 0.89, 95% CI 0.80-0.98) decreased the risk of atherothrombotic ischemic stroke independent of established risk factors, with non-significant associations with body mass index and alcohol intake. The effect of the lifestyle factors was independent of predisposing comorbidities at baseline. The adverse effects of several cardiovascular risk factors were confirmed in this study of atherothrombotic stroke. Smoking cessation, improving diet quality and increasing physical activity level is likely to lower risk of atherothrombotic stroke in the general population as well as in patient groups at high risk.


Assuntos
Aterosclerose/prevenção & controle , Dieta/métodos , AVC Isquêmico/prevenção & controle , Neoplasias/dietoterapia , Trombose/prevenção & controle , Idoso , Aterosclerose/etiologia , Dieta Saudável , Exercício Físico , Feminino , Seguimentos , Fatores de Risco de Doenças Cardíacas , Humanos , AVC Isquêmico/etiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Modelos de Riscos Proporcionais , Sistema de Registros , Suécia , Trombose/etiologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-34206396

RESUMO

The COVID-19 pandemic has had a vast influence on Swedish society. Related recommendations and political decisions have greatly affected schools. This study aimed to describe school nurses' experience working in Sweden during the pandemic in 2020. The study used a qualitative method with an inductive approach. Interviews with 17 school nurses in five focus groups and one individual interview were conducted. Qualitative content analysis was used. The impact of the pandemic on school nurses can be described through three categories: "Changes in working methods in relation to the students/guardians", "Impact on cooperation with school staff", and "The school nurse's prerequisites for major changes." Overall, school nurses experienced a transition to a digital way of working. Policies and decisions on global and local levels affected the work situations of school nurses as well as the school nurses' social, cultural, and professional experience. The highest priority for school nurses is students, and school nurses adapted their working methods to give support to students during the changing circumstances. School nurses are both pragmatic and highly creative. Cooperation with other school professions is critical, as is support and guidance during crisis situations.


Assuntos
COVID-19 , Enfermeiras e Enfermeiros , Atitude do Pessoal de Saúde , Humanos , Papel do Profissional de Enfermagem , Pandemias , Pesquisa Qualitativa , SARS-CoV-2 , Serviços de Saúde Escolar , Instituições Acadêmicas , Suécia/epidemiologia
19.
Artigo em Inglês | MEDLINE | ID: mdl-34207621

RESUMO

Currently, there is limited knowledge on how the Swedish strategy with more lenient public health restrictions during the COVID-19 pandemic has influenced people's life satisfaction. Here, we investigated self-reported life satisfaction during the first wave of the pandemic in Sweden, and perceived changes in life satisfaction in relation to various sociodemographic factors. A total of 1082 people (mean age 48 (SD 12.2); 82% women) responded to an online survey during autumn 2020 including the "Life Satisfaction Questionnaire-11". A majority (69%) were satisfied with life as a whole, and with other important life domains, with the exception of contact with friends and sexual life. An equal share reported that life as a whole had either deteriorated (28%) or improved (29%). Of those that perceived a deterioration, 95% considered it to be due to the pandemic. Regarding deteriorated satisfaction with life as a whole, higher odds were found in the following groups: having no children living at home; being middle aged; having other sources of income than being employed; and having a chronic disease. The Swedish strategy might have contributed to the high proportion of satisfied people. Those who perceived a deterioration in life satisfaction may, however, need attention from Swedish Welfare Authorities.


Assuntos
COVID-19 , Pandemias , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , SARS-CoV-2 , Suécia/epidemiologia
20.
Artigo em Inglês | MEDLINE | ID: mdl-34207704

RESUMO

Today, there is a shift towards care being given closer to the patient, with more children receiving care in their homes. Care at home has proven to be a viable alternative to hospital care, as shown by a project for hospital-based home care conducted in West Sweden. The aim of this study was to describe how children with cancer and parents experienced receiving care at home. After purposive sampling, six children with cancer aged 6-16 and eight parents participated. Semistructured interviews were performed, and the data were analysed using qualitative content analysis. Four main categories emerged: save time and energy in the family; maintain everyday life; feel trust in the healthcare professionals; mixed feelings about getting treatment at home. This hospital-based home care project created good conditions for both children with cancer and their parents to feel secure. In addition, home care can be very child-centric, whereby the caregivers involve the children by taking their thoughts and utterances into account.


Assuntos
Serviços Hospitalares de Assistência Domiciliar , Serviços de Assistência Domiciliar , Neoplasias , Cuidadores , Criança , Humanos , Neoplasias/terapia , Pesquisa Qualitativa , Suécia
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