Navigating complexity: healthcare providers' experiences with integrating physical health promotion in psychosis outpatient services in Sweden.

BACKGROUND: Individuals with psychotic disorders face an increased risk of physical health issues, leading to reduced life expectancy. Despite recommendations to integrate physical health promotion into mental healthcare, challenges persist, and mortality from somatic diseases continues to rise. Understanding healthcare providers' perspectives is crucial to overcoming these barriers. This study aims to explore the experiences of healthcare providers working in direct patient care and as unit heads regarding factors influencing health promotion in Swedish psychosis outpatient units. METHODS: A qualitative descriptive study was conducted in two specialized psychosis outpatient units. Thirteen healthcare providers, including clinical case managers and three heads of units, were individually interviewed. Thematic analysis was used to analyze the data. RESULTS: Three main themes were generated: (1) Health care providers' attitudes and competence. The health care provider's values and beliefs influenced the engagement in health promotion. (2) Patient-related aspects. Understanding how different patient life components shaped the physical health and need for measurements (3) Organizational prerequisites. Prioritizing resources and leadership impact the experience of health promotion. Clinical case management appeared as a promising approach to coordinate/integrate physical and mental health care, evident in themes 1 and 3. CONCLUSIONS: Beyond organizational factors, healthcare providers' skills, patient understanding, and ethical reflection influence their motivation to engage in physical health promotion. The study included only 13 participants, representing various professions, including managers who provided specific leadership perspectives. Clinical case managers appear well-suited to address physical health promotion due to their proficiency in shared decision-making and coordination.

Understanding ageism towards older nursing staff and service users: A systematic mapping review from the perspective of clinical leaders and healthcare managers.

INTRODUCTION: Ageist attitudes negatively affect the quality of care for service users and the working conditions of older nursing staff. Clinical leaders' perceptions of older service users and nursing staff are unknown. AIM: To map research evidence on ageist attitudes in healthcare towards service users and older nursing staff, from the leadership perspective. MATERIAL AND METHODS: A systematic mapping review with database searches in March 2021 and May 2023). Nineteen articles (qualitative n = 13, quantitative n = 3, mixed methods n = 3) were analysed and mapped to the Nurse Executive Capability Framework. RESULTS: Future planning, team building, and self-awareness are leadership categories requiring consideration. Guidelines and policies addressing the holistic needs of older service users and older nursing staff are lacking. CONCLUSIONS: Organizational planning, team building, and self-awareness are crucial for the holistic care of older service users and for creating attractive workplaces for older nursing staff.

Clinical and histopathologic predictors of recurrent glomerulonephritis after kidney transplantation.

INTRODUCTION: We evaluated the long-term outcomes of recurrent glomerulonephritis (RGN) using clinical, histopathological, and demographic predictors. METHODS: A retrospective cohort study of kidney transplant recipients (KTR) in two renal centers between 2005 and 2020. Clinical and native kidney histological data were analyzed. The risk factors and outcomes of each primary glomerulonephritis subtype were assessed using Cox methods. RESULT: 336 recipients with primary glomerulonephritis were analyzed. RGN was diagnosed in 17%, 20%, 25%, and 13% of recipients with IgA nephropathy (IgAN), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN) and membranoproliferative glomerulonephritis (MPGN), respectively. Median time to recurrence was shortest in FSGS (.6 years IQR .2-2.9) and longest in MN (6.3 years IQR 3.3-8.0) whereas time to graft loss after diagnosis was shortest in MPGN (.3 years IQR .1-1.7) and longest in IgAN (2.9 year IQR 1.3-4.3). Recipients with recurrent IgAN were likely to be younger, have higher proteinuria at diagnosis, receive living donor allografts, receive cyclosporine treatment, have a history of acute rejection, and have segmental sclerosis in native glomeruli. Younger age of the donors, higher proteinuria at diagnosis, alemtuzumab, proteinuria within the first 12 months, acute rejection, low baseline eGFR, mesangial proliferation, and IgG and IgA deposits were associated with FSGS recurrence. MPGN recurrence was predicted by lower BMI at transplantation, and crescentic native disease. Death-censored graft survival at 5-, 10-, and 15-years was 83%, 51%, and 29% in the RGN group and 95%, 93%, and 84%, respectively in the non-RGN group. Over 15 years, recipients with RGN are nine times more likely than those without RGN to lose their grafts, regardless of donor type, acute rejection, and baseline eGFR. Transplant recipients of related donor allograft were not more likely to have recurrent GN than non-related donors.

Psychometric and clinical evaluation of schizophrenia remission criteria in outpatients with psychotic disorders.

BACKGROUND: Psychotic disorders such as schizophrenia have debilitating effects on health and functioning. Given symptomatic remission's recent emergence as a viable treatment goal, the Remission in Schizophrenia Working Group's criteria (RSWG-cr), based on eight items from the Positive and Negative Syndrome Scale (PANSS-8), are frequently used in clinical and research settings. Against that background, we sought to evaluate the PANSS-8's psychometric properties and examine the RSWG-cr's clinical validity among outpatients in Sweden. METHODS: Cross-sectional register data were collected from outpatient psychosis clinics in Gothenburg, Sweden. Following confirmatory and exploratory factor analyses of PANSS-8 data (n = 1,744) to assess the PANSS-8's psychometric properties, internal reliability was evaluated using Cronbach's alpha. Next, 649 of the patients were classified according to the RSWG-cr and their clinical and demographic characteristics compared. Binary logistic regression was used to estimate odds ratios (OR) and assess each variable's impact on remission status. RESULTS: The PANSS-8 showed good reliability (α = .85), and the 3D model of psychoticism, disorganization, and negative symptoms presented the best model fit. According to the RSWG-cr, 55% of the 649 patients were in remission; they were also more likely to live independently, be employed, not smoke, not take antipsychotics, and have recently received a health interview and physical examination. Patients living independently (OR = 1.98), who were employed (OR = 1.89), who were obese (OR = 1.61), and who had recently received a physical examination (OR = 1.56) also had an increased likelihood of remission. CONCLUSIONS: The PANSS-8 is internally reliable, and, according to the RSWG-cr, remission is associated with variables of interest for patients' recovery, including living independently and being employed. Although our findings from a large, heterogeneous sample of outpatients reflect everyday clinical practice and reinforce past observations, the directions of those relationships need to be assessed in longitudinal studies.

How a point-of-care dashboard facilitates co-production of health care and health for and with individuals with psychotic disorders: a mixed-methods case study.

BACKGROUND: Individuals with psychotic disorders experience widespread treatment failures and risk early death. Sweden's largest department specializing in psychotic disorders sought to improve patients' health by developing a point-of-care dashboard to support joint planning and co-production of care. The dashboard was tested for 18 months and included more than 400 patients at two outpatient clinics. METHODS: This study evaluates the dashboard by addressing two questions: 1) Can differences in health-related outcome measures be attributed to the use of the dashboard? 2) How did the case managers experience the accessibility, use, and usefulness of the dashboard for co-producing care with individuals with psychotic disorders? This mixed-method case study used both Patient-Reported Outcome Measures (PROM) and data from a focus group interview with case managers. Data collection and analysis were framed by the Clinical Adoption Meta Model (CAMM) phases: i) accessibility, ii) system use, iii) behavior, and iv) clinical outcomes. The PROM used was the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0), which assesses functional impairment and disability. Patients at clinics using the dashboard were matched with patients at clinics not using the dashboard. PROM data were compared using non-parametric statistics due to skewness in distribution. The focus group included five case managers who had experience using the dashboard with patients. RESULTS: Compared to patients from clinics that did not use the dashboard, patients from clinics that did use the dashboard improved significantly overall (p = 0.045) and in the domain self-care (p = 0.041). Focus group participants reported that the dashboard supported data feedback-informed care and a proactive stance related to changes in patients' health. The dashboard helped users identify critical changes and enabled joint planning and evaluation. CONCLUSION: Dashboard use was related to better patient health (WHODAS scores) when compared with matched patients from clinics that did not use the dashboard. In addition, case managers had a positive experience using the dashboard. Dashboard use might have lowered the risk for missing critical changes in patients' health while increasing the ability to proactively address needs. Future studies should investigate how to enhance patient co-production through use of supportive technologies.

Attitudes towards oldest-old adults (age ≥80 years): A survey and international comparison between Swedish and Austrian nursing students.

BACKGROUND AND RATIONALE: Ageism in nursing, particularly regarding oldest-old adults (age ≥80 years), adversely affects patient safety and care quality. Nurse education can reduce ageist attitudes. Swedish and Austrian nursing students' attitudes towards adults age ≥80 years have not been assessed. AIMS: To analyse attitudes towards adults age ≥80 years among nursing students from universities in Sweden and Austria. DESIGN: A prospective cross-sectional survey including the four-factor, 26-item validated Ageing Semantic Differential scale and demographic questions. METHODS: A pen-and-paper survey was administered to nursing students at the Medical University of Graz, Austria (May-June 2019); an online survey was conducted at the University of Gothenburg, Sweden (January-June 2020). Demographic data were analysed descriptively; means and individual item ratings were calculated for each country. Multiple logistic regression was performed for each factor of the instrument: (1) Instrumentality, (2) Autonomy, (3) Acceptability and (4) Integrity. Six independent variables were included in the regression analysis. RESULTS: In total, 136 Austrian and 222 Swedish students responded (88% women). Compared with Austrian students, Swedish students were older and had more positive attitudes about oldest-old adults. Swedish students' median factor ratings (7-point scale) were 3.62 (Factor 1), 3.50 (Factor 2), 2.71 (Factor 3) and 3.80 (Factor 4). Austrian students' median ratings were 4.25 (Factor 1), 3.83 (Factor 2), 3.28 (Factor 3) and 4.00 (Factor 4). Regression analyses showed that the variables country, older family member/acquaintance, and age were associated with the different factors. DISCUSSION: Compared with Austrian students, Swedish students' attitudes towards oldest-old adults were more favourable. We discussed the findings at individual, interpersonal/intergroup and societal/cultural levels and present implications for education and research. CONCLUSIONS: Nurse education should address ageism as a multilevel phenomenon, and include the person-centred care perspective. Further research comparing nursing students' attitudes from different cultures is needed.

Clinical validity of the 12-item WHODAS-2.0 in a naturalistic sample of outpatients with psychotic disorders.

BACKGROUND: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) is a self-administered instrument to assess functional impairment. It is used in the general population as well as different patient groups. However, its application to patients with psychotic disorders may be hampered by disease-specific difficulties of self-estimation. This study aimed to examine the psychometric properties of the short (12-item) WHODAS-2.0 in a naturalistic sample of outpatients attending a psychosis clinic in Gothenburg, Sweden. METHODS: Annual data from two outpatient clinics registered 2016-2019 were analyzed retrospectively. The assessment of the short WHODAS-2.0 was based on the first questionnaire completed by 881 patients. Confirmatory factor analysis evaluated previously validated models. Item convergent and discriminant validity as well as internal reliability were computed. Construct validity was assessed by comparing mean differences in accord with previous research regarding patients' characteristics associated with functioning such as advanced age, diagnosed comorbidities, antipsychotic treatment status, and symptom severity measured with PANSS-8 remission items. RESULTS: A heterogeneous sample was obtained in terms of age (range: 20-92), various living situations, and different geographic areas of birth. Most patients (75%) had been diagnosed with psychotic disorders more than 10 years ago and the majority (89%) were on antipsychotic medication. We confirmed an adjusted two-level factor model with a single second-order disability factor and six first-order factors representing the six IFC dimensions. The WHODAS-2.0 sum score measuring general disability showed good reliability (Cronbach's alpha = 0.89). Construct validity was confirmed as older patients, patients with comorbidities, and patients in assisted living had higher WHODAS-2.0 scores. Patients with no or mild psychotic symptoms had significantly lower WHODAS-2.0 sum scores than patients with more severe symptoms. CONCLUSIONS: The findings further validate the 12-item WHODAS-2.0 in a naturalistic sample of outpatients with psychotic disorders. This study corroborates the clinical significance of the short, 12-item WHODAS-2.0 by demonstrating consistent associations between patients' age, medical comorbidities, living situation, antipsychotic treatment status, and psychotic symptom severity.

A comparison of three interactive examination designs in active learning classrooms for nursing students.

BACKGROUND: Despite the advantages of using active learning strategies in nursing education, researchers have rarely investigated how such pedagogic approaches can be used to assess students or how interactive examinations can be modified depending on circumstances of practice (e.g., in online education). AIMS: The aim was to compare three interactive examination designs, all based on active learning pedagogy, in terms of nursing students' engagement and preparedness, their learning achievement, and instructional aspects. METHODS: A comparative research design was used including final-year undergraduate nursing students. All students were enrolled in a quality improvement course at a metropolitan university in Sweden. In this comparative study to evaluate three course layouts, participants (Cohort 1, n = 89; Cohort 2, n = 97; Cohort 3, n = 60) completed different examinations assessing the same course content and learning objectives, after which they evaluated the examinations on a questionnaire in numerical and free-text responses. Chi-squared tests were conducted to compare background variables between the cohorts and Kruskal-Wallis H tests to assess numerical differences in experiences between cohorts. Following the guidelines of the Good Reporting of a Mixed Methods Study (GRAMMS), a sequential mixed-methods analysis was performed on the quantitative findings, and the qualitative findings were used complementary to support the interpretation of the quantitative results. RESULTS: The 246 students who completed the questionnaire generally appreciated the interactive examination in active learning classrooms. Among significant differences in the results, Cohort 2 (e.g., conducted the examination on campus) scored highest for overall positive experience and engagement, whereas Cohort 3 (e.g., conducted the examination online) scored the lowest. Students in Cohort 3 generally commended the online examination's chat function available for use during the examination. CONCLUSIONS: Interactive examinations for nursing students succeed when they are campus-based, focus on student preparation, and provide the necessary time to be completed.

Registered nurses' perspectives on medically safe practices and sound ethical standards in aesthetic nursing: An interview study.

AIMS AND OBJECTIVES: To explore the views of registered nurses experienced in aesthetic nursing regarding medically safe practices and sound ethical standards. BACKGROUND: Aesthetic nursing is an emerging field of modern-day healthcare encompassed within aesthetic medicine. There is a distinct lack of research regarding how registered nurses who specialise in this area of care view medically safe practices and sound ethical standards. This is important to explore, because, in the absence of mandatory regulations within the sector, and it is the aesthetic nurse's own obligation to uphold professional, medical and ethical standards. DESIGN: Qualitative study. METHODS: Individual semi-structured interviews were conducted with 13 registered nurses who had worked in aesthetic nursing for at least two years. The interview transcripts were categorised using qualitative content analysis. The COREQ checklist was used to report the study. RESULTS: A main theme was generated during the analysis: Considering my professional, the clinic's and the patient's needs. The participants described that they considered medical and ethical aspects pertinent to their professional roles as registered nurses but also undertook practices in addition to what they already did as registered nurses, such as creating professional networks using social media. They also described the importance of establishing local medical and ethical guidelines for their clinics, and that they considered patients' individual needs such as using individual information relating to their patients' previous experiences. CONCLUSIONS: The study points to the positive tendencies of registered nurses in aesthetics to develop their own professional networks and create local medical and ethical guidelines until more robust mandatory regulations are in place. RELEVANCE TO CLINICAL PRACTICE: Considering that aesthetic nursing is a young industry, registered nurses are in an excellent position to utilise their professional networks and work with professional bodies to develop standards of professional nursing practice and education for this field.

Adolescents' presentation of food in social media: An explorative study.

The study aimed to explore how adolescents communicate food images in a widely used social media image-sharing application. We examined how and in what context food was presented and the type of food items that were frequently portrayed by following a youth related hashtag on Instagram. The hashtag #14år ("14 years") was used to find adolescent users on Instagram: these users public photo streams were then searched for food items they had shared with others. Food items were identified and categorized based on type of food and how the food items were presented. Most of the adolescent users (85%) shared images containing food items. A majority of the images (67.7%) depicted foods high in calories but low in nutrients. Almost half of these images were arranged as a still life with food brand names clearly exposed. Many of these images were influenced by major food marketing campaigns. Fruits and vegetables occurred in 21.8% of all images. This food group was frequently portrayed zoomed in with focus solely on the food, with a hashtag or caption expressing palatability. These images were often presented in the style of a cook book. Food was thus presented in varied ways. Adolescents themselves produced images copying food advertisements. This has clear health promotion implications since it becomes more challenging to monitor and tackle young people's exposure to marketing of unhealthy foods in these popular online networks because images are part of a lifestyle that the young people want to promote. Shared images contain personal recommendations, which mean that they may have a more powerful effect than commercial advertising.

The search for meaning in health care inquiries: introducing qualitative meaning analysis.

PURPOSE: To describe how Qualitative Meaning Analysis (QMA), based on a lifeworld theoretical approach, can be made accessible to students and researchers not well-versed in the philosophy of science or qualitative research. Additionally, to demonstrate that it is a more rigorous approach than qualitative content analysis in guiding healthcare inquiries. METHOD: In recent years, qualitative approaches in nurse education and research have increasingly relied on various content analytical procedures. Liberated from clear philosophical underpinnings, they offer a seemingly pragmatic stance to nursing inquiries. However, by prioritizing 'sorting content' over the exploration of meaning, there's a risk of adopting a mechanistic approach to qualitative analysis. This is problematic because we contend that the search for meaning lies at the heart of qualitative inquiry in nursing and healthcare research, dealing with existential phenomena surrounding health, illness, and care. RESULT: This paper explores the search for meaning in health care research, particularly in nursing, and introduces key epistemological aspects. It also discusses practical considerations to further familiarize and encourage the use of QMA in graduate nursing education and research. CONCLUSION: Qualitative inquiry with a focus on meaning is a powerful means when the intention is to develop person-centered care, and the relationship between the professionals and patients is in focus. Such an approach has the potential to illuminate existential suffering as well as innate health capacities in patients.

Mapping proteolytic processing in the secretome of gastric cancer-associated myofibroblasts reveals activation of MMP-1, MMP-2, and MMP-3.

Cancer progression involves changes in extracellular proteolysis, but the contribution of stromal cell secretomes to the cancer degradome remains uncertain. We have now defined the secretome of a specific stromal cell type, the myofibroblast, in gastric cancer and its modification by proteolysis. SILAC labeling and COFRADIC isolation of methionine containing peptides allowed us to quantify differences in gastric cancer-derived myofibroblasts compared with myofibroblasts from adjacent tissue, revealing increased abundance of several proteases in cancer myofibroblasts including matrix metalloproteinases (MMP)-1 and -3. Moreover, N-terminal COFRADIC analysis identified cancer-restricted proteolytic cleavages, including liberation of the active forms of MMP-1, -2, and -3 from their inactive precursors. In vivo imaging confirmed increased MMP activity when gastric cancer cells were xenografted in mice together with gastric cancer myofibroblasts. Western blot and enzyme activity assays confirmed increased MMP-1, -2, and -3 activity in cancer myofibroblasts, and cancer cell migration assays indicated stimulation by MMP-1, -2, and -3 in cancer-associated myofibroblast media. Thus, cancer-derived myofibroblasts differ from their normal counterparts by increased production and activation of MMP-1, -2, and -3, and this may contribute to the remodelling of the cancer cell microenvironment.

Schizophrenia in Print, Digital, and Audiovisual Media: Trends, Topics, and Results From an Anti-Stigma Intervention Targeting Media Professionals.

Background: Negative portrayals of schizophrenia in media can prompt the condition's stigmatization. However, because research on language stigmatizing schizophrenia has focused on paper-based media, its results have limited generalizability to contemporary media. Also, research on interventions to guide media professionals in accurately depicting schizophrenia has been scarce. The present study had two aims: (1) to assess how print, web, and radio/TV news media in Sweden portray schizophrenia and (2) to evaluate a campaign targeting media professionals' responses to information about schizophrenia and the consequences of stigmatizing language. Study Design: Using data from Retriever's database, considering media types and topics, the terms "schizophrenia" and "schizophrenic" were examined in the past 20 years, whereas analyses of stigmatizing reporting of these terms used media from the past 10 years. Media professionals' responses and actions in the anti-stigma information campaign StigmaWatch were also evaluated. Study Results: Between 2002 and 2022, "schizophrenia" was mentioned 34 141 times in the dataset and "schizophrenic" 10 058 times. However, no trends were statistically significant. All media topics and most types of media contained stigmatizing reporting. Of the 230 media professionals who received informative emails from StigmaWatch, 77 (33%) responded. Most responses were supportive, and 14% of the professionals reported taking corrective measures (eg, revising erroneous descriptions of schizophrenia) following the email. Conclusions: No media topic was free of language stigmatizing schizophrenia. The anti-stigma information campaign seemed to have been effective, for most media professionals who responded were supportive, and a sizable proportion reported taking corrective measures.

A systematic mapping review identifying key features of restraint research in inpatient pediatric psychiatry: A human rights perspective.

INTRODUCTION: Restraints, a highly regulated and contentious measure in pediatric psychiatry, have significant negative impacts on children. The application of international human rights standards, such as the Convention of the Rights of the Child (CRC) and the Convention of the Rights of Persons with Disabilities (CRPD), has spurred global efforts to reduce or eliminate the use of restraints. However, a lack of consensus on definitions and terminology, as well as quality indicators in this field, hinders the ability to compare studies and evaluate interventions consistently. AIM: To systematically map existing literature on restraints imposed upon children in inpatient pediatric psychiatry against a human rights perspective. Specifically, to identify and clarify gaps in literature in terms of publication trends, research approaches, study contexts, study participants, definitions and concepts being used, and legal aspects. These aspects are central to assess whether published research is contributing to achieve the CRPD and the CRC in terms of interpersonal, contextual, operational, and legal requirements of restraints. METHODS: A systematic mapping review based on PRISMA guidelines was conducted, adopting a descriptive-configurative approach to map the distribution of available research and gaps in the literature about restraints in inpatient pediatric psychiatry. Six databases were searched for literature reviews and empirical studies of all study designs published between each database's inception and March 24, 2021, manually updated on November 25, 2022. RESULTS: The search yielded 114 English-language publications, with a majority (76%) comprising quantitative studies that relied primarily on institutional records. Contextual information about the research setting was provided in less than half of the studies, and there was an unequal representation of the three main stakeholder groups: patients, family, and professionals. The studies also exhibited inconsistencies in the terms, definitions, and measurements used to examine restraints, with a general lack of attention given to human rights considerations. Additionally, all studies were conducted in high-income countries and mainly focused on intrinsic factors such as age and psychiatric diagnosis of the children, while contextual factors and the impact of restraints were not adequately explored. Legal and ethical aspects were largely absent, with only one study (0.9%) explicitly referencing human rights values. CONCLUSIONS: Research on restraints of children in psychiatric units is increasing; however, inconsistent reporting practices hinder the understanding of the meaning and frequency of restraints. The exclusion of crucial features, such as the physical and social environment, facility type, and family involvement, indicates inadequate incorporation of the CRPD. Additionally, the lack of references to parents suggests insufficient consideration of the CRC. The shortage of quantitative studies focusing on factors beyond patient-related aspects, and the general absence of qualitative studies exploring the perspectives of children and adolescents regarding restraints, suggest that the social model of disability proposed by the CRPD has not yet fully penetrated the scientific research on this topic.

Elevated pulse pressure and its associations with demographic and clinical parameters in a clinically representative sample of outpatients with psychotic disorders.

Elevated pulse pressure is associated with metabolic and neurocognitive diseases. Preliminary small-scale studies among patients with psychotic disorders have indicated that these patients had an increased pulse pressure compared with controls. However, it is unclear whether and how these associations are manifested among larger heterogenous samples of patients with psychotic disorders. We examined elevated pulse pressure and its associations with demographic and clinical characteristics in a clinically representative sample of outpatients with psychotic disorders (n = 1289). In a subsample (n = 343), we also examined associations with six domains of functioning. Controlling for age and cardiovascular disease, body mass index (BMI) and employment status independently predicted the odds ratio of having elevated pulse pressure. Elevated pulse pressure was also primarily associated with the physical domains of functioning. Outpatients with psychotic disorders that have high BMI and are unemployed thus seem to be at increased risk for elevated pulse pressure and should therefore be particularly considered for blood pressure screenings.

Nurses' general attitudes and caregiving-specific perceptions toward the oldest-old: A nationwide survey.

BACKGROUND: Despite the growing population of older adults worldwide, nurses may harbor negative attitudes toward older patients that might risk patient safety. Most studies have investigated general attitudes toward older adults. Only a few have focused on nurses' perceptions of caring for older patients, and there has been little focus on the oldest-old (aged ≥80 years), an age group that is particularly affected by negative attitudes. Emerging models to combat this issue suggest that education about aging and interaction with older adults are key factors. These models have primarily been evaluated using students, not healthcare professionals. OBJECTIVE: To examine if and to what extent education (training and education about working with older people) and interaction (professional and personal contact with older adults) are associated with nurses' general attitudes toward older persons and their perceptions of caring for older patients (aged ≥80 years). DESIGN: A cross-sectional survey study. PARTICIPANTS: A nationwide sample of 2294 Swedish registered nurses with background characteristics reflective of the national nursing population. METHODS: Emails with study information and survey links were distributed via the Swedish Association of Health Professionals' registry. The survey contained one instrument that measures general attitudes toward older adults and one that measures perceptions of caring for older patients. Following the Positive Education about Aging and Contact Experiences model, items about participants' education and their professional and personal interaction with the oldest-old adults were also included. Descriptive and comparative analyses were conducted. Multiple regression models used general attitudes and caregiving-specific perceptions as dependent variables in each model. RESULTS: Nurses' general attitudes and caregiving-specific perceptions were correlated. Regression analyses revealed that the education and interaction variables were independently associated with general attitudes and caregiving-specific perceptions, but these associations followed different directions. An older family member/close friend, extensive work experience, and working primarily in administration were independently associated with more positive general attitudes toward the oldest-old adults. Working in home care or assisted living, having education in geriatrics/gerontology, and frequent interaction with older patients were associated with less favorable general attitudes but more positive perceptions of caring for the oldest-old patients. CONCLUSIONS: Our results highlight the complex relationship between nurses' general attitudes and their caregiving-specific perceptions toward the oldest-old persons. Education in geriatrics/gerontology and interaction with older adults are warranted to improve nurses' caregiving-specific perceptions. Appropriate scales that consider this complexity beyond general attitudes are needed to capture caregiving-specific and contextual perceptions.

The food diary as a pedagogical strategy in undergraduate nursing nutrition education: A student evaluation.

BACKGROUND: Few studies have evaluated educational nutrition activities in undergraduate nursing, and none have published how the established food assessment method, the food diary, can be used as a pedagogical method in this context. OBJECTIVE: To describe undergraduate nursing students' learning outcomes of basic nutrition and important elements for their learning after conducting a one-day food record with a subsequent seminar (henceforth: "the food diary method"). DESIGN: Cross-sectional. SETTING: Undergraduate nursing program in Sweden. PARTICIPANTS: 161 students. METHODS: Participants conducted a one-day food record by documenting their food intake and calculating the nutritional values. After completion, students participated in a seminar, and an evaluative questionnaire was distributed at the end. The questionnaires contained both numerical and free-text questions. RESULTS: Of 162 students attending the seminar, all but one completed the questionnaire (response rate: 99%). The highest rated learning outcome, on the 5-point Likert scale, was an increased understanding for the nutritional recommendations (Median, M = 5). The highest rated educational aspects were that they compared their records with the nutritional recommendations (M = 5), and the calculations of nutritional values of their records (M = 5). Participants also indicated that they gained information that would be useful for them as practicing nurses (M = 5). CONCLUSIONS: Overall, the food diary method appeared to be a feasible method in educating and engaging undergraduate nursing students in the field of basic nutrition. These findings support results from previous studies in this area, such that educational nutrition activities that utilize active, experiential, and social learning strategies were appreciated by the students.

Classic Tool, New Opportunities: A Psychometric Analysis of a Swedish Online Version of the Aging Semantic Differential Scale.

This study validated a Swedish translation of the Aging Semantic Differential Scale (ASD, 32-items) distributed online. Translation and back-translation were conducted. A convenience sample of nursing students completed the online questionnaire (N = 292) in spring 2020. Confirmatory factor analysis tested a validated four-factor structure consisting of 26 items, and the reliability and validity of the scale were tested. The Swedish version of the ASD was found to be reliable and valid. Model fit indices, internal reliability, and scale validity were acceptable. Construct validity was verified, and mean differences were observed, in accord with previous research regarding participants' age, sex, clinical experience, and personal relationships with older individuals. The findings provide cross-cultural validation of the ASD by extending its international use. The validation of an online version expands data collection flexibility. As this modified instrument required only 26 items, it may be beneficial for use in future studies and practical settings.

Weight Status and BMI-Related Traits in Adolescent Friendship Groups and Role of Sociodemographic Factors: The European IDEFICS/I.Family Cohort.

BACKGROUND: During adolescence, health behaviors and weight status are increasingly influenced by friendship and peer networks. This paper examines resemblances in weight-related characteristics and how they differ by sociodemographic factors. METHODS: Over 3,000 friendships were reported by 1,603 adolescents, aged 11-16 years, who participated in the school-based I.Family study in 6 European countries. Each "source child" named 1-10 friends for whom standardized weight-related traits were available in the same survey. The mean value of the friends' traits weighted by time spent together was calculated, and related to the source child's trait. Country, age and sex of the source child, parental education, and immigrant background were considered for confounding and moderation. RESULTS: Source children's z-scores of body fat percent and BMI were positively associated with their friends' characteristics, in particular if they had highly educated parents. Positive associations were also found regarding the frequency of fast-food consumption, impulsivity, screen time, preference for sugar-sweetened foods, and hours spent in sports clubs, in increasing order of effect size. Additionally, correlations were observed between friends' cognitive and school functioning and being bullied. No associations were seen for a preference for high-fat foods, weight concerns, and health-related quality of life. Finally, parental education and immigrant background were associated between friends in all countries except Sweden, where no associations were observed. CONCLUSION: Adolescent friends shared a number of weight-related characteristics. For weight measures per se, positive associations with friends' characteristics were only observed in adolescents with high parental education. Associations regarding energy-balance behaviors and indicators of school-related well-being did not differ by parental education. Parental education and immigrant background correlated positively in friends in most countries showing that social aggregation is already occurring in adolescence. The wide spectrum of friendship associations in weight-related traits and behaviors suggests that health promotion initiatives in adolescents should be directed towards peer groups in both school-related and leisure-time environments. ISRCTN Registry: Pan-European IDEFICS/I.Family children cohort (ID ISRCTN62310987; https://doi.org/10.1186/ISRCTN62310987).

Experiences of involuntary psychiatric admission decision-making: a systematic review and meta-synthesis of the perspectives of service users, informal carers, and professionals.

BACKGROUND: In involuntary psychiatric admission, used globally, professionals or caretakers decide upon hospitalization regardless of what the person with psychosocial disabilities decides. This raises clinical, ethical, legal, and human rights concerns, and it goes against Convention on the Rights of Persons with Disabilities (CRPD). CRPD mandates that member states respect the autonomy of people with disabilities. Through Article 12, it recognizes full enjoyment of legal capacity for persons with disabilities. Implementation of Article 12 is challenging in every country, and exploring all the stakeholders' experiences at admission decision-making will help us to understand the challenges that the current psychiatry system poses for service users to exercise their autonomy and identify the areas where service users need support to have their rights, will, and preferences respected. AIM: To describe the experiences of service users, informal carers, and professionals in involuntary psychiatric admission decision-making and throughout the subsequent involuntary admission. We explored the support that the service users need to have their rights, will, and preferences respected. METHOD: A search of twelve databases in medicine, sociology, and law in Danish, English, Japanese, Norwegian, Portuguese, Spanish, and Swedish was conducted in 2017 and 2018, limited to the past 10 years, using terms such as "involuntary," "admission," "mental illness," and "experience". The search identified 682 articles. Four researchers independently reviewed the articles to find those that completed original qualitative or mixed method studies exploring experiences of involuntary psychiatric admission among adults. We added seven publications from the articles' references, contacted experts in the field (no publications were added), and excluded two articles that were in German. Three researchers analyzed the articles' results using Thematic Analysis (PROSPERO registration number CRD42019072874). RESULTS: Overall, 37 articles were included from 11 countries; they involved 731 service users, 100 informal carers, and 291 mental health professionals. We identified a lack of communication and a power imbalance among the stakeholders, which was exacerbated by the professionals' attitudes. At admission decision-making, the service users wanted to be heard and wanted to understand the situation. The families felt responsibility for the service users, they were careful not to ruin relationships, and they struggled to obtain support from the mental health system. Professionals believed that threats or harming others should lead to admission regardless of what the service users or their families felt. Professionals sometimes felt that it was not necessary to explain the information to the service users because they would not understand. Professionals were concerned and frustrated with difficulties in coordinating among themselves. During admission, service users struggled with the ward environment and relationship with staff; they most objected to coercion, such as forced medication. Families were frustrated that they were not involved in the treatment planning, especially as the service users moved toward discharge. The professionals often rationalized that coercion was necessary, and they believed that they knew what was best for the service users. CONCLUSIONS: A lack of communication and a power imbalance among the stakeholders hindered respect for the service users' rights, will, and preferences. This was exacerbated by professionals rationalizing coercion and assuming that service users were incapable of understanding information. Services that encourage communication and overcome power imbalances (e.g. Crisis Plans, Family Group Conferencing) combined with stronger community mental health support will respect service users' rights, will, and preferences and avoid substituted decision-making on issues such as involuntary admission and forced medication.