Occupational risk of SARS-CoV-2 infection: a nationwide register-based study of the Danish workforce during the COVID-19 pandemic, 2020-2021.

OBJECTIVE: Most earlier studies on occupational risk of COVID-19 covering the entire workforce are based on relatively rare outcomes such as hospital admission and mortality. This study examines the incidence of SARS-CoV-2 infection by occupational group based on real-time PCR (RT-PCR) tests. METHODS: The cohort includes 2.4 million Danish employees, 20-69 years of age. All data were retrieved from public registries. The incidence rate ratios (IRRs) of first-occurring positive RT-PCR test from week 8 of 2020 to week 50 of 2021 were computed by Poisson regression for each four-digit Danish Version of the International Standard Classification of Occupations job code with more than 100 male and 100 female employees (n=205). Occupational groups with low risk of workplace infection according to a job exposure matrix constituted the reference group. Risk estimates were adjusted by demographic, social and health characteristics including household size, completed COVID-19 vaccination, pandemic wave and occupation-specific frequency of testing. RESULTS: IRRs of SARS-CoV-2 infection were elevated in seven healthcare occupations and 42 occupations in other sectors, mainly social work activities, residential care, education, defence and security, accommodation and transportation. No IRRs exceeded 2.0. The relative risk in healthcare, residential care and defence/security declined across pandemic waves. Decreased IRRs were observed in 12 occupations. DISCUSSION: We observed a modestly increased risk of SARS-CoV-2 infection among employees in numerous occupations, indicating a large potential for preventive actions. Cautious interpretation of observed risk in specific occupations is needed because of methodological issues inherent in analyses of RT-PCR test results and because of multiple statistical tests.

Fecal incontinence and associated pelvic floor dysfunction during and one year after the first pregnancy.

INTRODUCTION: Obstetric anal sphincter injury is an important risk factor for postpartum fecal incontinence but few studies have reported fecal incontinence occurring, even during pregnancy. The first objective of this study was to examine the prevalence of fecal incontinence, obstructed defecation and vaginal bulging early and late in pregnancy and postpartum. The second objective was to assess the association between symptoms in pregnancy, delivery characteristics, and bowel and vaginal bulging symptoms at 1 year postpartum. MATERIAL AND METHODS: This prospective cohort study was conducted between October 2014 and October 2017, including 898 nulliparous women enrolled with the maternity healthcare service in Örebro County, Sweden. The women responded to questionnaires regarding pelvic floor dysfunction in early and late pregnancy and at 8 weeks and 1 year postpartum. The data were analyzed using random effect logistic models estimating odds ratios (ORs) and generalized linear models estimating relative risks, with 95% confidence intervals (CIs). RESULTS: At 1 year postpartum, the prevalence of fecal incontinence, obstructed defecation and vaginal bulging was 6% (40/694), 28% (197/699) and 8% (56/695), respectively. Among women with vaginal delivery, the risk of fecal incontinence and vaginal bulging increased significantly both in late pregnancy, with ORs of 3.4 (95% CI 1.5-7.7) and 3.6 (95% CI 1.6-8.1), respectively, and at 1 year postpartum, with ORs of 5.0 (95% CI 2.1-11.5) and 8.3 (95% CI 3.8-18.1), respectively, compared with early pregnancy. Among all women, factors associated with increased prevalence of fecal incontinence 1 year postpartum were fecal incontinence during pregnancy (adjusted relative risk [aRR] 7.4; 95% CI 4.1-13.3), obstructed defecation during pregnancy (aRR 2.0; 95% CI 1.1-3.9) and concurrent obstructed defecation (aRR 2.4; 95% CI 1.3-4.5). CONCLUSIONS: This prospective study shows an increased risk of fecal incontinence by late pregnancy, suggesting that the pregnancy itself may be involved in the development of postpartum fecal incontinence. Obstructed defecation during pregnancy and postpartum was found to be associated with increased risk of fecal incontinence postpartum, indicating that postpartum fecal incontinence may be a result of incomplete bowel emptying.

Sexual function in primiparous women: a prospective study.

INTRODUCTION AND HYPOTHESIS: The aim of this prospective study was to examine the impact of sociodemographic, pregnancy and obstetric characteristics on sexual function 12 months postpartum in primiparous women. We hypothesized that sexual function would decrease after childbirth. METHODS: Between 1 October 2014 and 1 October 2017, all nulliparous women in early pregnancy registering for maternity health care in Region Örebro County, Sweden, were invited to participate in this prospective study. A total of 958 women were included. Sexual activity and function were measured at early pregnancy, 8 weeks postpartum and 12 months postpartum using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The associations between sociodemographic, pregnancy and obstetric characteristics and sexual activity and function from early pregnancy to 12 months postpartum were examined using linear and logistic models based on generalized estimating equations. RESULTS: We found that the prevalence of sexually active women decreased from 98.0% in early pregnancy to 66.7% at 8 weeks postpartum, but increased to 90.0% at 12 months postpartum. Age ≥ 35 years, second-degree perineal tear and current breastfeeding were statistically significant risk factors for sexual inactivity at 12 months postpartum. Poor self-reported health in early pregnancy was statistically significantly associated with decreased sexual function at 12 months postpartum. CONCLUSIONS: A majority of women resumed sexual activity at 8 weeks postpartum and most women at 12 months postpartum; the decrease in sexual function at 12 months postpartum was small and few risk factors were observed.

Medication dosage calculation among nursing students: does digital technology make a difference? A literature review.

BACKGROUND: Patient safety is a major part of nursing care and following patients' medication orders is considered one of the greatest responsibilities of individual nurses and nursing Failure to make safe drug calculations poses serious risks to patient safety. It is therefore important to strengthen nursing students' numeracy skills and conceptual abilities during their education. Research suggests that digital technologies play an increasingly important role in promoting nursing students' knowledge and medication dosage calculation (MDC) skills. The present review aims to identify and critically evaluate research investigating how the use of digital technologies informs the development of nursing students' MDC skills. METHODS: A systematic literature review was performed within Scopus (Elsevier), Academic Search Elite (Ebsco), Cinahl (Ebsco), ERIC (Ebsco), Web of Science and PubMed. Research papers on MDC using digital technologies were considered for inclusion. Starting from 2843 sources, eighteen research articles met the inclusion criteria. RESULTS: The results show that use of digital technologies can reduce nursing students' medication errors. Interestingly, web-based courses were the most commonly used digital technologies aimed at developing nursing students' MDC skills. However, such courses had limited impacts the development of these skills. CONCLUSION: The present review concludes by mapping the current knowledge gaps and making suggestions for further research.

Stress and urgency urinary incontinence one year after a first birth-prevalence and risk factors. A prospective cohort study.

INTRODUCTION: Few prospective studies have examined the effect of pregnancy and childbirth on stress and urgency urinary incontinence separately. The aim of the present study was to assess the extent to which pregnancy, vaginal delivery, and vaginal delivery characteristics affect the risk of significant stress and urgency incontinence 1 year after delivery. MATERIAL AND METHODS: We conducted a prospective cohort study of 670 nulliparous women from early pregnancy to 1 year partum. The women were recruited at maternity health care service in Region Örebro County, Sweden, between October 1, 2014 and October 1, 2017 and completed questionnaires in early and late pregnancy and at 8 weeks and 1 year postpartum. Primary outcome measures were significant stress and urgency incontinence at 1 year postpartum in women who reported being continent before pregnancy. Generalized linear models were used. RESULTS: Stress and urgency incontinence commencing before pregnancy were reported by 4% and 3% of women, respectively, in the first questionnaire in early pregnancy, and these women were excluded from subsequent analysis. Stress and urgency incontinence were reported by 21% and 8%, respectively, at 1 year postpartum, in women not reporting incontinence before pregnancy. Stress incontinence during pregnancy increased the risk of stress incontinence postpartum (risk ratio [RR] 2.48, 95% CI 1.86-3.3). Urgency incontinence during pregnancy increased the risk of urgency incontinence postpartum (RR 4.07, 95% CI 2.1-7.89). Vaginal delivery increased the risk of stress incontinence postpartum (adjusted RR 2.63, 95% CI 1.39-5.01) but not of urgency incontinence. This effect of vaginal delivery on stress incontinence was similar irrespective of incontinence status during pregnancy. The population-attributable fraction of stress incontinence associated with vaginal delivery was 0.58 (95% CI 0.23-0.77). CONCLUSIONS: This study shows essentially different risk factors for stress and urgency incontinence, supporting stress incontinence as being the subtype mostly associated with pregnancy and childbirth, and urgency incontinence as being more stable over time. At a population level, vaginal delivery was the major risk factor for stress incontinence, followed by reporting stress incontinence during pregnancy.

Prevalence of exhaustion symptoms and associations with school level, length of work experience and gender: a nationwide cross-sectional study of Swedish principals.

BACKGROUND: While poor mental health and psychiatric disorders attributed to stressful work conditions are a public health concern in many countries, the health consequences of the occupational stress experienced by school principals is an understudied issue. Although current data is lacking, some research suggests that principals have a stressful work situation that eventually may lead to burnout and exhaustion disorder, thus negatively affecting the ability of principals to function as leaders. To gauge the situation in Sweden, and as a basis for future preventive actions, we examined to what extent principals displayed signs of exhaustion and whether the prevalence rates of exhaustion differed across school levels, length of work experience as a principal, and gender. METHODS: Principals (N = 2219; mean age 49 years [SD 7 years]; 78% women) working at least 50% in pre-schools, compulsory schools, upper secondary schools or adult education completed a cross-sectional web survey entailing two validated inventories: The Karolinska Exhaustion Disorder Scale (KEDS) and the Lund University Checklist for Incipient Exhaustion (LUCIE). Data was analysed using traditional non-parametric methods. Gender stratification achieved covariate balance when analysing school level and length of work experience. RESULTS: Altogether, 29.0% of the principals met the exhaustion criteria in KEDS. The prevalence rates for the four LUCIE-steps of increasing signs of exhaustion were: no signs of stress, 48.8%; weak signs of stress, 25.6%; clear signs of stress but no exhaustion, 15.4%; possible exhaustion disorder, 10.2%. Compared with male principals, female principals reported more signs of possible exhaustion disorder in both LUCIE and KEDS. School level was not associated with reports of exhaustion symptoms in neither LUCIE nor KEDS. Among male principals, length of work experience was associated with exhaustion symptoms in KEDS. CONCLUSIONS: A large group of Swedish principals working in pre-schools, compulsory schools, upper secondary schools or adult education displayed a symptomatology of signs of exhaustion that if sustained might lead to poor health. This observation suggests that education authorities, or other relevant stakeholders, ought to take some form of preventive action. However, effective combinations of individual, group, organisational, and/or societal preventive activities remain to be identified and tested.

Organizational and social work environment factors, occupational balance and no or negligible stress symptoms among Swedish principals - a cross-sectional study.

BACKGROUND: Few studies have assessed the mental health of principals, or studied associations with both organizational and social work environment factors and occupational balance. The purpose of the present study was therefore to investigate associations between supporting and demanding organizational and social work environment factors, occupational balance and stress symptoms in principals. METHODS: A total of 4309 surveys (2316 from the first round, 1992 from the second round), representing 2781 Swedish principals who had responded to at least one of two surveys, were included in the present study. The surveys include questions about socio-demographic factors, occupational balance, overtime work, and supporting and demanding organizational and social work environment factors, as well as questions about personal stress and exhaustion. Generalized Estimating Equations (GEE) models were used to specify a repeated measures model with a dichotomous outcome (binary logistic regression) and multiple independent factors. Data from two surveys were combined, taking into account dependent observations due to the fact that many study subjects had participated in both surveys. RESULTS: Associations were found between occupational balance (Q1: OR 2.52, 95% CI 2.03-3.15; Q2: OR 4.95, 95% CI 3.86-6.35; Q3: OR 9.29, 95% CI 6.99-12.34), overtime work (Once a week: OR 1.51, 95% CI 1.10-2.08; Sometimes a week: OR 1.31, 95% CI 1.03-1.66), supportive private life (OR 1.50, 95% CI 1.36-1.66), supportive colleagues at the leadership level (OR 1.24, 95% CI 1.14-1.36), supportive management (OR 1.17, 95% CI 1.07-1.28) and no or negligible stress symptoms. In addition, role demands (OR 0.72, 95% CI 0.63-0.83), having a container function (OR 0.72, 95% CI 0.64-0.82), collaboration with employees (OR 0.77, 95% CI 0.66-0.89), role conflicts (OR 0.75, 95% CI 0.66-0.89) and having a buffer function (OR 0.86, 95% CI 0.77-0.97) were associated with lower likelihood to rate no or negligible stress symptoms. CONCLUSIONS: The occupational balance of principals is strongly associated with no or negligible stress symptoms, and thus is a promising venue for promoting well-being. Improvements should be made to several factors in the organizational and social work environments to improve principals' chances of having occupational balance, and therefore better mental health.

Risk factors for perineal and vaginal tears in primiparous women - the prospective POPRACT-cohort study.

BACKGROUND: The aim of this study was to estimate the incidence of second-degree perineal tears, obstetric anal sphincter injuries (OASI), and high vaginal tears in primiparous women, and to examine how sociodemographic and pregnancy characteristics, hereditary factors, obstetric management and the delivery process are associated with the incidence of these tears. METHODS: All nulliparous women registering at the maternity health care in Region Örebro County, Sweden, in early pregnancy between 1 October 2014 and 1 October 2017 were invited to participate in a prospective cohort study. Data on maternal and obstetric characteristics were extracted from questionnaires completed in early and late pregnancy, from a study-specific delivery protocol, and from the obstetric record system. These data were analyzed using unadjusted and adjusted multinomial and logistic regression models. RESULTS: A total of 644 women were included in the study sample. Fetal weight exceeding 4000 g and vacuum extraction were found to be independent risk factors for both second-degree perineal tears (aOR 2.22 (95% CI: 1.17, 4.22) and 2.41 (95% CI: 1.24, 4.68) respectively) and OASI (aOR 6.02 (95% CI: 2.32, 15.6) and 3.91 (95% CI: 1.32, 11.6) respectively). Post-term delivery significantly increased the risk for second-degree perineal tear (aOR 2.44 (95% CI: 1.03, 5.77), whereas, maternal birth positions with reduced sacrum flexibility significantly decreased the risk of second-degree perineal tear (aOR 0.53 (95% CI 0.32, 0.90)). Heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, vacuum extraction and fetal head circumference exceeding 35 cm were independent risk factors for high vaginal tears (aOR 2.32 (95% CI 1.09, 4.97), 3.16 (95% CI 1.31, 7.62), 2.53 (95% CI: 1.07, 5.98) and 3.07 (95% CI 1.5, 6.3) respectively). CONCLUSION: The present study corroborates previous findings of vacuum extraction and fetal weight exceeding 4000 g as risk factors of OASI. We found that vacuum extraction is a risk factor for second-degree tear, and vacuum extraction, fetal head circumference exceeding 35 cm and heredity of pelvic floor dysfunction and/or connective tissue deficiency were associated with increased risk of high vaginal tears. These findings have not been documented previously and should be confirmed by additional studies.

When is work a cause of early retirement and are there any effective organizational measures to combat this? A population-based study of perceived work environment and work-related disorders among employees in Sweden.

BACKGROUND: The ageing workforce has an impact on public health. The aim of this study was to evaluate work-related disorders, work tasks and measures associated with the possibility of working beyond 65 years of age or not. METHOD: The data comprised two sample surveys based on the Swedish population: the Survey of National Work-Related Health Disorders, and the National Work Environment Survey. RESULTS: A logistic regression analysis showed that an active systematic work environmental management in the workplace was a statistically significant association with whether individuals could work in their current occupation until 65 years of age (OR 1.7). The final multivariate model stated that whether individuals could work until 65 years was associated with bodily exhaustion after work, frequent feeling of the own work effort being insufficient at the end of the day, experience of the work as restricted and with a lack of freedom, working alone and at risk of unsafe or threatening situations, and generally feeling dissatisfied with the work tasks. Women-dominated workplaces were more highly associated with both male and female employees not being able to work until age 65 (OR 1.6). CONCLUSION: Deficiencies in the working environment seems to be a threat to the public health. An active systematic work environmental management in the workplace increases the possibility to extend the working life. Tools for managers, like the swAge-model, to easily perform active systematic work environmental controls could therefore be a possible way to decrease the risk of work injury as well as increase the possibility for a sustainable extended working life.

Complexity of best-evidenced practice in periodontal therapy: Views of Swedish Dental Hygienists.

OBJECTIVES: Dental hygienists (DHs) have an important role in the treatment of patients with periodontitis. The objective of the current qualitative interview study was to gain understanding about personal and organizational factors that influence best-evidenced DH practice in the treatment of periodontitis. METHODS: Data were obtained by interviewing Swedish DHs, who had been engaged in a preceding clinical field study on evidence-based periodontal therapy. Qualitative content analysis was used for analysis. Data sampling was terminated after 18 interviews, when deemed that sufficient amount of information had been gained. RESULTS: In the analysis of the interview data, a main theme was identified as "I know what to do, but I do as I usually do; DHs' ambivalence between theory and practice in the treatment of patients with periodontitis." The results elucidated that the DHs were well aware of "what to do" in order to offer their patients adequate periodontal care, but this knowledge was not congruent with how they usually worked. Established routines and culture at the clinic, DHs' predetermined beliefs about lack of motivation and ability to cooperate among patients, lack of time and reflection, economic demands in care and lack of interest and support by co-working dentists were barriers to best-evidenced DH practice in periodontal care. CONCLUSIONS: The results elucidate the complexity of best-evidenced DH practice in the treatment of periodontal patients and indicate needs for quality improvement of the periodontal care provided in general dental practice, by actions taken on both individual/professional and organizational levels.

Development and validation of a protocol for documentation of obstetric perineal lacerations.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to develop a new protocol for documentation of perineal lacerations and to validate the latter against the most common obstetric record system in Sweden. The hypothesis was that the new protocol would render more complete data on perineal lacerations than the current documentation method. METHODS: A protocol for documentation of perineal lacerations was developed to be sufficiently comprehensive to serve research purposes. All women delivering their first child vaginally from 13 October 2015 to 1 February 2016 at Örebro University Hospital were eligible for the validation study. Perineal lacerations were documented using the protocol in parallel with the regular obstetric record system (ObstetriX). Cross tabulations were used to compare the coverage regarding perineal lacerations between the two documentation methods. McNemar's test was used to evaluate systematic differences between the methods. RESULTS: A total of 187 women were included. The coverage of documentation regarding perineal laceration was significantly higher (p < 0.001) in the new protocol (89%) compared with ObstetriX (18%). Incidence of second-degree perineal tears was 26% according to the new protocol and 11% according to ObstetriX. The incidence of third-degree perineal tears A, B, and C was 2.7%, 2.1%, and 2.1%, respectively, according to the new protocol, and 3.2%, 2.7%, and 1.1% according to ObstetriX. CONCLUSIONS: This validation study of a new documentation protocol showed that it delivered significantly more comprehensive information regarding perineal lacerations than the most common obstetric record system in Sweden.

Expression of genes involved in inflammation and growth - does sampling site in human full-term placenta matter?

Objective To investigate the placental gene expression of substances in the inflammatory cascade and growth factors at nine different well-defined sampling sites in full-term placentas from 12 normal weight healthy non-smoking women with an uncomplicated singleton pregnancy. Methods All placentas (six girls and six boys) were delivered vaginally. Quantitative real-time polymerase chain reaction was used to analyze toll receptor-2 and -4, interleukin-6 and -8, tumor necrosis factor-α, leptin, ghrelin, insulin-like growth factor-1 and -2, hepatocyte growth factor, hepatocyte growth factor receptor and insulin receptor (IR). Results The leptin gene and the IR gene showed higher expression in lateral regions near the chorionic plate compared to central regions near the basal plate (P = 0.028 and P = 0.041, respectively). Conclusion Our results suggest that the sampling site may influence the gene expression for leptin and IR in placental tissue obtained from full-term normal pregnancies. We speculate that this may be due to differences in placental structure and perfusion and may be important when future studies are designed.

Social inequality in working life expectancy in Sweden.

BACKGROUND: In Sweden there is a socioeconomic divide between white and blue collar workers with respect to the risk for premature exit from working life. Disability pension has long represented a major reason behind early exits. OBJECTIVE: The present investigation aimed at studying the effect on socioeconomic groups of new guidelines issued by the Swedish government in 2006, limiting the possibilities for applicants to be granted pension on medical grounds. MATERIAL AND METHOD: The study was based on register data comprising the prevalence of disability pension and premature age pension in different occupations in the age group 55-64 years, comparing the years 2006 and 2011. RESULTS: It was found that in 2011 under the new guidelines, newly approved disability pensions had dropped by 70%. Women were affected more than men. The drop in disability pensions affected applicants within the two most prevalent diagnosis groups, mental disorders (a drop by 58%) and musculoskeletal disorders (a drop by 87%). In the same time period, the percentage in the age range 55-64 years choosing premature age pension more than doubled. An increase in the number of premature age pensions was more common in blue collar occupational groups than in white collar workers. Occupation had a higher impact on working life expectancy than country of birth. CONCLUSION: There are strong indications that many applicants, particularly blue collar workers, who had been unable to be granted disability pension under the new operational guidelines, instead choose premature retirement, a costly alternative for many individuals with already low pension benefits. The results indicate a tendency of passing on the societal costs of early labor market exits to various economic compensation arrangements, as well as to the individuals themselves.

Cost-effectiveness of antibiotic prophylaxis in elective cesarean section.

BACKGROUND: The proportion of pregnant women delivered by cesarean section has increased steadily during the past three decades. The risk of infection is 10-fold augmented after elective cesarean section compared to vaginal delivery. Antibiotic prophylaxis may reduce endometritis by 62% and superficial wound infection by 38% after elective cesarean section. International guidelines recommend antibiotic prophylaxis in elective cesarean section, but this procedure is not routinely followed in Sweden. Studies of costs of antibiotic prophylaxis in cesarean section show conflicting results and are based on substantially different incidence of postoperative infections. No study of costs of antibiotic prophylaxis in elective cesarean section in a Swedish or Nordic context has been pursued. The aim of this study was to investigate if antibiotic prophylaxis is cost-reducing in elective cesarean section in Örebro County, Sweden. METHODS: All women undergoing elective cesarean in the Region Örebro County health care system during 2011-2012 were eligible for inclusion. Postoperative infections and risk factors for infections were registered. A hypothetical situation in which all participants had received antibiotic prophylaxis was compared to the actual situation, in which none of them had received antibiotic prophylaxis. The reduction in the risk of postoperative infections resulting from antibiotic prophylaxis was based on a meta-analysis. Costs for in-patient care of postoperative infections were extracted from the accounting system, and costs for out-patient care were calculated according to standard costs. Costs for antibiotic prophylaxis were calculated and compared with the cost reduction that would be implied by the introduction of such prophylaxis. RESULTS: The incidences of deep and superficial surgical site infection were 3.5% and 1.3% respectively. Introduction of antibiotic prophylaxis would reduce health care costs by 31 Euro per cesarean section performed (95% credible interval 4-58 Euro). The probability of cost-saving was 99%. CONCLUSIONS: Antibiotic prophylaxis in elective cesarean section is cost-reducing in this health care setting. Our results indicate that the introduction of antibiotic prophylaxis in elective cesarean section can also be cost-saving in low infection rate settings.Trial registration Ethical approval was given by the Regional Ethical Review Board in Uppsala (registration number 2013/484).

Translation and cultural adaption of the decisions module for colorectal cancer screening into a Swedish version - the SCREESCO questionnaire.

OBJECTIVES: Colorectal cancer (CRC) is suitable for population screening due to its high incidence and the recognizable and treatable prephase, and the present study is part of the larger study; Screening for Swedish Colons (SCREESCO). In Sweden, there is, to our knowledge, no questionnaire assessing shared decision making (SDM) with regard to CRC screening and, therefore, the aim of the study was to translate and culturally adapt the CRC screening module of the National Survey of Medical Decisions (DECISIONS) into a Swedish context. MATERIAL AND METHODS: A qualitative design inspired by guidelines based on methods for cross-cultural adaptation of questionnaires was used. In addition, focus group discussions, individual interviews and think-aloud (TA) sessions were performed. RESULTS: Of the 54 items included in the original DECISION survey, 32 were excluded, 22 were modified, and three were added as a result of the qualitative study. How the health care organization communicated and CRC screening knowledge was communicated were found to be the most important cultural differences between Sweden and the USA. The final questionnaire consists of 24 items. CONCLUSION: The process of translation and cultural adaptation of the CRC screening module of the DECISIONS survey resulted in the removal and modifying of a considerable number of items. The major rationale for the removal and modifying of items can be explained by the different cultural traditions between Sweden and the USA when communicating with the health care system regarding screening participation and how CRC screening information and knowledge is communicated.

Effects of an antenatal lifestyle intervention on offspring obesity - a 5-year follow-up of a randomized controlled trial.

INTRODUCTION: Strategies to limit excessive maternal gestational weight gain could also have positive health effects for the offspring. This study informs us on the effect of an antenatal lifestyle intervention on offspring body mass index (BMI) trajectory until age five. MATERIAL AND METHODS: A secondary analysis of a randomized controlled trial aimed at reducing gestational weight gain, set in Ørebro, Sweden (Clinical Trials.gov Id NCT00451425). Offspring were followed with standardized measures of weight and height until age five. Mean BMI z-score and proportion (%) of over- and undernutrition (BMI z-score > ± 2 standard deviations) was compared between groups. Risk estimates for obesity at age five were analyzed in relation to maternal gestational weight gain and prepregnancy BMI as a secondary outcome. RESULTS: We analyzed 374 children at birth and 300 at age five. No significant difference in mean BMI z-score was seen at birth (0.68 (I) vs 0.56 (C), p = 0.242) or at age five (0.34 (I) vs 0.26 (C), p = 0.510) and no significant difference in proportion of over- or undernutrition was seen. Excessive maternal gestational weight gain was an independent risk factor for offspring obesity at birth (OR = 4.51, p < 0.001) but not at age five. Maternal obesity was an independent risk factor for offspring obesity at age five (OR = 4.81, p = 0.006). CONCLUSIONS: Our composite antenatal lifestyle intervention did not significantly reduce the risk of obesity in offspring up until age five.

The importance of people's values and preferences for colorectal cancer screening participation.

Background: To explore how individuals reason when they make decisions about participating in colorectal cancer (CRC) screening. Methods: Individuals randomized to FIT or colonoscopy included in the Screening of Swedish Colons (SCREESCO) program was invited to focus group discussions and individual telephone interviews. The concept of shared decision-making (SDM: information; values/preferences; involvement) was used as a matrix for the analyses. To validate findings, additional focus group discussions using the nominal group technique were performed. Results: Lack of knowledge of CRC and CRC screening was prominent for participants and non-participants, while the results differed between the groups in relation to their values and preferences. The influence of significant others promoted participation while it prevented it among non-participants. Those who participated and those who did not made it clear that there was no need to involve health care professionals when making the decision. Conclusions: Based on the results, a display of different ways to spread knowledge and communicate about CRC and CRC-screening could be applied such as, community-based information campaigns, decisions aids, interactive questionnaires, chat-functions and telephone support. The disparity in values and preferences between participants and non-participants may be the key to understand why non-participants make their decisions not to participate and warrant further exploration.

Experiences from implementing value-based healthcare at a Swedish University Hospital - an longitudinal interview study.

BACKGROUND: Implementing the value-based healthcare concept (VBHC) is a growing management trend in Swedish healthcare organizations. The aim of this study is to explore how representatives of four pilot project teams experienced implementing VBHC in a large Swedish University Hospital over a period of 2 years. The project teams started their work in October 2013. METHODS: An explorative and qualitative design was used, with interviews as the data collection method. All the participants in the four pilot project teams were individually interviewed three times, with interviews starting in March 2014 and ending in November 2015. All the interviews were transcribed and analyzed using qualitative analysis. RESULTS: Value for the patients was experienced as the fundamental drive for implementing VBHC. However, multiple understandings of what value for patients' means existed in parallel. The teams received guidance from consultants during the first 3 months. There were pros and cons to the consultant's guidance. This period included intensive work identifying outcome measurements based on patients' and professionals' perspectives, with less interest devoted to measuring costs. The implementation process, which both gave and took energy, developed over time and included interventions. In due course it provided insights to the teams about the complexity of healthcare. The necessity of coordination, cooperation and working together inter-departmentally was critical. CONCLUSIONS: Healthcare organizations implementing VBHC will benefit from emphasizing value for patients, in line with the intrinsic drive in healthcare, as well as managing the process of implementation on the basis of understanding the complexities of healthcare. Paying attention to the patients' voice is a most important concern and is also a key towards increased engagement from physicians and care providers for improvement work.

Effects on postpartum weight retention after antenatal lifestyle intervention - a secondary analysis of a randomized controlled trial.

INTRODUCTION: High weight retention after pregnancy is related to an increased risk of future obesity. The objective was to evaluate whether an antenatal intervention, compared with standard care, could reduce postpartum weight retention (PPWR). MATERIAL AND METHODS: Women with body mass index >19, age ≥18 years, knowledge of Swedish, and pregnancy ≤16 weeks' gestation were randomized. Standard care was compared with a composite intervention including a personalized weight graph, education on recommended weight gain, prescription of exercise, and monitoring of weight until 1 year after delivery. Mean (kg) PPWR was compared between the groups and risk estimates (odds ratio) for excessive weight retention were calculated. RESULTS: Of 445 women randomized, 267 remained for analysis at ≤16 weeks postpartum and 168 at 1 year postpartum. The intervention group had a significantly lower mean PPWR at ≤16 weeks [1.81 kg (standard deviation, SD, 4.52) vs. 3.19 kg (SD 4.77), p = 0.016]. At one year postpartum, mean retention was still 0.7 kg lower in the intervention group [0.30 kg (SD 5.52) vs. 1.00 kg (SD 5.46)]; the difference was not statistically significant (p = 0.414). Gestational weight gain above Institute of Medicine recommendations was a significant risk factor for excessive weight retention (>5 kg) one year after delivery (OR 2.44; 95% CI 1.08-5.52, p = 0.029). CONCLUSIONS: A composite lifestyle intervention during pregnancy reduced short-term weight retention, but the effect of the intervention did not remain at 1 year postpartum. A gestational weight gain above Institute of Medicine recommendations increases the risk of excessive long-term weight retention.

Conceptualisation of ageing in relation to factors of importance for extending working life - a review.

AIM: The aim of this study was to explore and understand the complexity of ageing in relation to factors of importance for extending working life. METHOD: Discourse analysis of documents was used in an integrative review including 128 articles. RESULT: Four different conceptualisation of ageing are shown to affect older workers' ability to extend their working life: (a) biological ageing people's health in relation to their physical and mental work environment, their pace of work and recuperation needs; (b) chronological ageing statutory retirement age and policies and economic incentives devised for older workers by society, unions and organisations/enterprises; (c) social ageing inclusion in different social groups, the attitude of managers, organisations and family members, the leisure activities and surrounding environment; and (d) mental/cognitive ageing self-crediting, motivating and meaningful activities, competence and skills in working life. CONCLUSIONS SOCIETIES TODAY FOCUS MOSTLY ON CHRONOLOGICAL AGEING AND ARE LOOKING TO INCREASE THE RETIREMENT AGE WITH REGARD TO STATUTORY PENSION SYSTEMS, EG BEYOND 65 YEARS OF AGE THE INTER-RELATIONSHIPS BETWEEN CHRONOLOGICAL, MENTAL, BIOLOGICAL AND SOCIAL AGEING AND THE NINE AREAS IDENTIFIED AS BEING IMPORTANT TO OLDER WORKERS IN THESE RESPECTS NEED TO BE CONSIDERED WHEN AIMING TO PROVIDE A SUSTAINABLE WORKING LIFE FOR THE INCREASING NUMBERS OF OLDER WORKERS IN MODERN SOCIETY THE THEORETICAL MODEL DEVELOPED IS A CONTRIBUTION TO THE CRITICAL DEBATE THAT CAN BE APPLIED BY SOCIETIES, EMPLOYERS AND MANAGERS IN ORDER TO PROVIDE OLDER WORKERS WITH AN INCLUSIVE AND SUSTAINABLE EXTENDED WORKING LIFE.