Assessing risk, planning for safety and security, and aiding recovery for children subjected to violence in a family setting is a complex process. The aim of the article is to synthesize the current research literature about risks for children subjected to violence in the family and outline an empirical base for a holistic and practically usable model of risk assessments placing the individual child at the center. Such assessments need to recognize four different areas of risk: (1) child safety, i.e., known risk factors for severe and dangerous violence aimed at both adults and children and how they play out in the individual case; (2) the child’s response in situations with violence; (3) the child’s perspective, especially fear and feelings of powerlessness in situations with violence; (4) developmental risks, e.g., instability in the child’s situation and care arrangements, lack of a carer/parent as a “secure base” and “safe haven”, the child developing difficulties due to the violence (e.g., PTSD), problems in parents’ caring capacities in relation to a child with experiences of, and reactions to, violence, and lack of opportunities for the child to make sense of, and create meaning in relation to, experiences of violence. In addition to the four areas of risk, the article emphasizes the importance of assessing the need for immediate intervention and safety planning in the current situation as regards safety, the child’s responses, the child’s perspectives, and long-term developmental risks.
Extensive research shows nurses’ work environment to be particularly stressful. This study develops, explores, and psychometrically tests a new profession-specific questionnaire identifying generalised and specific resistance resources, that make it possible to measure resources to manage work-related stress. An exploratory study design was employed. The questionnaire development was inspired by the MEASURE approach and the salutogenic theory of health. Building on the results from a literature review of nursing research and salutogenesis, supplemented by twelve interviews with hospital nurses, an item pool was generated. The first version was pilot-tested in a group of nurses who were studying to become specialist nurses. The second version of the questionnaire was psychometrically tested on a sample of registered nurses in close patient care (n = 475), analysed using confirmatory factor analysis to test seven predefined domains of the questionnaire. The analysis revealed a first order seven-domain model of 21 items: job satisfaction, professional role, work motivation, commitment, belonging in the workplace, factors and conditions for remaining in the profession, and workload. The structure of the questionnaire indicates its usefulness in clinical practice for measuring resistance resources.
Common mental health and musculoskeletal disorders (CMDs and MSDs) are two of the most significant causes of non-participation in employment amongst working age adults. Background: This case study fills an important gap in the scientific literature on reintegration back to work after sickness absence due to CMDs and MSDs. It particularly examines the return to work (RTW) experiences of sick-listed employees to understand the facilitators and barriers of sustainable RTW. Methods: Using a realist evaluation approach within a qualitative inquiry, perceptions of employees were explored to provide in-depth understanding of what, how and under what circumstances sustainable RTW can be enabled for employees absent on a short- or long-term basis. Repeat face-to-face semi-structured interviews were conducted with 22 participants (15 women and 7 men, aged 30–50 years and sick-listed with MSDs and CMDs) who were recruited using purposive sampling. Data was thematically analysed. Results: A total of 2 main codes and 5 subcodes were developed and grouped into three theoretical abstractions. As a result of validating the context, mechanism, and outcome configurations with accounts of participants, all three initial theories explaining the most prominent mechanisms that either facilitates or impedes a sustainable RTW for people with CMDs and MSDs were justified.
Conclusions: Our findings reveal the active role of line managers on the RTW outcomes of returning employees. However, line-manager’s competence and ability to effectively support and implement appropriate RTW strategies suited to employees’ hinges on working in alignment with key stakeholders and returning employees.
There is great potential for reducing greenhouse gas emissions (GHGE) from public-sector meals. This paper aimed to develop a strategy for reducing GHGE in the Swedish school food supply while ensuring nutritional adequacy, affordability, and cultural acceptability. Amounts, prices and GHGE-values for all foods and drinks supplied to three schools over one year were gathered. The amounts were optimized by linear programming. Four nutritionally adequate models were developed: Model 1 minimized GHGE while constraining the relative deviation (RD) from the observed food supply, Model 2 minimized total RD while imposing stepwise GHGE reductions, Model 3 additionally constrained RD for individual foods to an upper and lower limit, and Model 4 further controlled how pair-wise ratios of 15 food groups could deviate. Models 1 and 2 reduced GHGE by up to 95% but omitted entire food categories or increased the supply of some individual foods by more than 800% and were deemed unfeasible. Model 3 reduced GHGE by up to 60%, excluded no foods, avoided high RDs of individual foods, but resulted in large changes in food-group ratios. Model 4 limited the changes in food-group ratios but resulted in a higher number of foods deviating from the observed supply and limited the potential of reducing GHGE in one school to 20%. Cost was reduced in almost all solutions. An omnivorous, nutritionally adequate, and affordable school food supply with considerably lower GHGE is achievable with moderate changes to the observed food supply; i.e., with Models 3 and 4. Trade-offs will always have to be made between achieving GHGE reductions and preserving similarity to the current supply.
Healthcare systems worldwide are faced with continuously increasing demand for care, while simultaneously experiencing insufficient capacity and unacceptably long patient waiting times. To improve healthcare access and availability, it is thus necessary to improve capacity utilization and increase the efficiency of existing resource usage. For this, variations in healthcare systems must be managed judiciously, and one solution is to apply a capacity pooling approach. A capacity pool is a general, collaborative capacity that can be allocated to parts of the system where the existing workload and demand for capacity are unusually high. In this study, we investigate how basic mean-variance methodology from portfolio theory can be applied as a capacity pooling approach to healthcare systems. A numerical example based on fictitious data is used to illustrate the theoretical value of using a portfolio approach in a capacity pooling context. The example shows that there are opportunities to use capacity more efficiently and increase service levels, given the same capacity, and that a mean-variance analysis could be performed to theoretically dimension the most efficient pooling organization. The study concludes with a discussion regarding the practical usefulness of this methodology in the healthcare context.
It is well-known that unpredictable variations in supply and demand of capacity inhealthcare systems create the need for flexibility. The main tools used to create short-term volume flexibility in the healthcare system include overtime, temporary staff from internal calling lists, moving staff across units, internal staffing pools, external staffing agencies, queuing patients, and purchasing care from external providers. We study the creation of short-term volume flexibility in healthcare systems to manage short-term capacity losses and demand fluctuations. A questionnaire was developed and distributed among healthcare managers in the Region Västra Götaland healthcare system. Respondents were asked to what extent they used each tool to create short-term flexibility in capacity. Data were analyzed using multiple regression analysis. Several significant tendencies were found, including that acute units use overtime and internal staffing pools to a larger extent, and queuing patients and external providers to a lesser extent than planned units. The prerequisites and required managerial approaches used to efficiently manage aggregate capacity in the system differ substantially between different parts of the system. These differences must be addressed when, for example, capacity pools are considered. These results serve as a stepping stone towards a more thorough understanding of efficient capacity management in healthcare systems.
The aim of this study was to analyze the influence of some personal characteristics, health variables, and social support on the self-rated health of people in housing exclusion in Spain. For that purpose, we used the FOESSA Survey of Social Integration and Needs database, with a final sample of 1574 households. Being more educated and reporting a good life satisfaction stood out as the main factors preventing worse health status. Furthermore, results showed that being female, experiencing poverty-related food insecurity, not having health insurance, experiencing widowhood or partner bereavement, and having caring responsibilities for others or having a disabled person in the household are associated with increased reporting of regular or poor health. On the other hand, being young, having a diagnosed/long-term illness, and a big household size are preventive factors for good health. These results allowed identifying risk and prevention factors to inform interventions to improve the health of those living in housing exclusion. Promoting better education levels, social support, and overall life satisfaction could be important to improve health in this population. Developing social support policies for caring responsibilities and food insecurity must be a priority to improve the health of people living in housing exclusion.
As we age there are natural physiological deteriorations that decrease the accuracy and flexibility of the postural control system, which increases the risk of falling. Studies have found that there are individual differences in the ability to learn to manage repeated postural threats. The aim of this study was to investigate which factors explain why some individuals are less proficient at adapting to recurrent postural perturbations. Thirty-five community dwelling older adults performed substantial sensory and motor testing and answered surveys regarding fall-related concerns and cognitive function. They were also subjected to three identical surface perturbations where both kinematics and electromyography was captured. Those that were able to adapt to the third perturbation were assigned to the group “Non-fallers” whereas those that fell during all perturbations were assigned to the group “Fallers”. The group designation dichotomized the sample in a hierarchical orthogonal projection of latent structures— the discriminant analysis model. We found that those who fell were older, had poorer physical performance, poorer strength and longer reaction times. The Fallers’ postural control strategies were more reliant on the stiffening strategy along with a more extended posture and they were less skillful at making appropriate feedforward adaptations prior to the third perturbation.
(1) Background: Spouse carers of persons with dementia (PwD) are particularly vulnerable to negative outcomes of care, yet research rarely focuses on their caregiving situation. This study explores factors associated with the positive value and negative impact of caregiving in spouse carers of PwD in Sweden. (2) Methods: The study was a cross-sectional questionnaire-based survey, with a convenience sample of spouse carers of PwD (n = 163). The questionnaire addressed: care situation, carer stress, health and social well-being, relationship quality and quality of support, and contained measures of positive value and negative impact of caregiving. (3) Results: Hierarchical regression models explained 63.4% variance in positive value and 63.2% variance in negative impact of caregiving. Three variables were significant in the model of positive value: mutuality, change in emotional closeness following dementia and quality of support. Six variables were significant in the model of negative impact: years in relationship, years as carer, behavioural stress, self-rated health, emotional loneliness and change in physical intimacy following dementia. (4) Conclusions: Support to spouse carers of PwD should address the carer–care-recipient relationship quality, although different aspects of the relationship should be addressed if both the positive value of caregiving is to be enhanced and the negative impact reduced.
Informal caregivers play a crucial role in the care of individuals with dementia, and their caregiving may significantly impact their own health and well-being. This cross-sectional survey study focuses on the perceived importance of various types and characteristics of formal support in a convenience sample of caregivers aged 65 years or older (N = 175) caring for a spouse with dementia. Participants completed a questionnaire containing 17 items describing different types of support and 12 items describing different characteristics of support, rating their importance. The questionnaire also contained questions on various caregiving-related factors. Principle components analysis (PCA) was carried out on the importance ratings, separately, on the types of support items and the characteristics of support items. Each PCA produced three components. For types of support, they were Proficiency and Opportunity, Supportive Structures, Flexible Counselling. For characteristics of support, they included Respectful and Competent, Timely Support, and Accessible and Acceptable. The three characteristics of the support components all had higher mean importance ratings than the three types of support components. The content of some components indicated that while spouse caregivers rate support for their caregiving needs as important, they may not always differentiate their own needs from those of their partner with dementia. The negative impact of caregiving was the factor most strongly and consistently associated with the components' importance ratings. This study emphasizes the need for health and social care providers to address the unique needs of spouse caregivers while simultaneously ensuring the delivery of quality care for individuals with dementia.
Chronic pain is a major public health issue. Mounting evidence suggests that interdisciplinary multimodal pain rehabilitation programs (IMMRPs) performed in specialist pain care are an effective treatment for patients with chronic pain, but the effects of such treatment if performed in primary care settings have been less studied. The aims of this pragmatic study were to (1) describe characteristics of patients participating in IMMRPs in primary care; (2) examine whether IMMRPs in primary care improve pain, disability, quality of life, and sick leave 1-year post discharge in patients with chronic pain; and (3) investigate if outcomes differ between women and men. Data from 744 (645 women and 99 men, age range 18-65 years) patients with non-malignant chronic pain included in the Swedish Quality Registry for Pain Rehabilitation Primary Care were used to describe patient characteristics and changes in health and sick leave. At 1-year follow-up, the patients had improved significantly (p < 0.01) in all health outcome measures and had reduced sick leave except in men, where no significant change was shown in physical activity level. This study indicates that MMRPs in primary care improved pain and physical and emotional health and reduced sick leave, which was maintained at the 1-year follow-up.
Self-stigma is prevalent in individuals with psychiatric disorders and can profoundly affect people. A unified assessment with sound psychometric properties is needed for evaluating self-stigma across psychiatric conditions. The aim of this study was to examine the psychometric properties of the Self-Stigma Scale-Short version (SSS-S) using Rasch modeling. Six-hundred and twelve participants with substance use disorders (n = 319), attention-deficit/hyperactivity disorder (n = 100), and schizophrenia (n = 193) completed the SSS-S. Rasch results confirmed the unidimensionality of the nine items of the SSS-S. The four-point Likert scale of the SSS-S reflected monotonical increases along the self-stigma continuum. No ceiling or floor effects were detected. Among the three subdomains of the SSS-S, cognitive items appeared to be the most robustly endorsed, and behavioral items were the least endorsed. Two items in the SSS-S displayed differential item functioning across the three diagnoses. Additionally, SSS-S scores showed weak to moderate correlation with depression, anxiety, and stress scale scores. The SSS-S had overall satisfactory psychometric properties. Healthcare professionals may use this assessment to assess self-stigma in multiple psychiatric groups, and information gained may facilitate improved care.
Background: Fine particulate matters with aerodynamic diameters smaller than 2.5 micrometers (PM2.5) have been a critical environmental problem in China due to the rapid road vehicle growth in recent years. To date, most methods available to estimate traffic contributions to ambient PM2.5 concentration are often hampered by the need for collecting data on traffic volume, vehicle type and emission profile.
Objective: To develop a simplified and indirect method to estimate the contribution of traffic to PM2.5 concentration in Beijing, China.
Methods: Hourly PM2.5 concentration data, daily meteorological data and geographic information were collected at 35 air quality monitoring (AQM) stations in Beijing between 2013 and 2014. Based on the PM2.5 concentrations of different AQM station types, a two-stage method comprising a dispersion model and generalized additive mixed model (GAMM) was developed to estimate separately the traffic and non-traffic contributions to daily PM2.5 concentration. The geographical trend of PM2.5 concentrations was investigated using generalized linear mixed model. The temporal trend of PM2.5 and non-linear relationship between PM2.5 and meteorological conditions were assessed using GAMM.
Results: The medians of daily PM2.5 concentrations during 2013-2014 at 35 AQM stations in Beijing ranged from 40 to 92 mug/m(3). There was a significant increasing trend of PM2.5 concentration from north to south. The contributions of road traffic to daily PM2.5 concentrations ranged from 17.2% to 37.3% with an average 30%. The greatest contribution was found at AQM stations near busy roads. On average, the contribution of road traffic at urban stations was 14% higher than that at rural stations.
Conclusions: Traffic emissions account for a substantial share of daily total PM2.5 concentrations in Beijing. Our two-stage method is a useful and convenient tool in ecological and epidemiological studies to estimate the traffic contribution to PM2.5 concentrations when there is limited information on vehicle number and types and emission profile.
Objective: To compare the performance of frequentist and Bayesian generalized additive models (GAMs) in terms of accuracy and precision for assessing the association between daily exposure to fine particles and respiratory mortality using simulated data based on a real time-series study.
Methods: In our study, we examined the estimates from a fully Bayesian GAM using simulated data based on a genuine time-series study on fine particles with a diameter of 2.5 m or less (PM2.5) and respiratory deaths conducted in Shanghai, China. The simulation was performed by multiplying the observed daily death with a random error. The underlying priors for Bayesian analysis are estimated using the real world time-series data. We also examined the sensitivity of Bayesian GAM to the choice of priors and to true parameter.
Results: The frequentist GAM and Bayesian GAM show similar means and variances of the estimates of the parameters of interest. However, the estimates from Bayesian GAM show relatively more fluctuation, which to some extent reflects the uncertainty inherent in Bayesian estimation.
Conclusions: Although computationally intensive, Bayesian GAM would be a better solution to avoid potentially over-confident inferences. With the increasing computing power of computers and statistical packages available, fully Bayesian methods for decision making may become more widely applied in the future.
Background: Chronic pain and mental disorders are common reasons for long term sick leave. The study objective was to evaluate the efficacy of a multidisciplinary assessment and treatment program including acceptance and commitment therapy (TEAM) and stand-alone acceptance and commitment therapy (ACT), compared with treatment as usual (Control) on health outcomes in women on long-term sick leave.
Method: Participants (n = 308), women of working age on long term sick leave due to musculoskeletal pain and/or common mental disorders, were randomized to TEAM (n = 102), ACT (n = 102) or Control (n = 104). Participants in the multidisciplinary assessment treatment program received ACT, but also medical assessment, occupational therapy and social counselling. The second intervention included ACT only. Health outcomes were assessed over 12 months using adjusted linear mixed models. The results showed significant interaction effects for both ACT and TEAM compared with Control in anxiety (ACT [p < 0.05]; TEAM [p < 0.001]), depression (ACT [p < 0.001]; TEAM [p < 0.001]) and general well-being (ACT [p < 0.05]; TEAM [p < 0.001]). For self-rated pain, there was a significant interaction effect in favour of ACT (p < 0.05), and for satisfaction with life in favour of TEAM (p < 0.001).
Conclusion: Both ACT alone and multidisciplinary assessment and treatment including ACT were superior to treatment as usual in clinical outcomes.
When addressing child and youth mental health, policy makers around the world call for collaboration between welfare providers. Research shows, however, that cross-sector collaboration is challenging. This article aims to scrutinize the issue of sustainability in the collaborative work undertaken between welfare providers to jointly support and promote child and youth mental health. In a qualitative interview study, 19 key officials involved in collaborative mental health work in three Swedish municipalities were interviewed, 13 individually and 6 in three small groups. Data were analyzed through content analysis and the application of practice-oriented collaboration theories. The results show that informants feel collaboration is beneficial for child and youth mental health. The results also show that five aspects of this collaborative work can affect its sustainability: (1) how the collaborative work was set up: if it was a special project or part of existing organizational structures; (2) what model of funding was used; (3) how many organizational levels were involved; (4) if goals were common, concurrent or contradictive; and (5) if important stakeholders were seen to be 'missing'. Collaboration members felt their collaborative work had caused them to drift away from important non-participant stakeholders. This article concludes that to develop long-term sustainable collaborations addressing child and youth mental health, key features of collaborative work need to be taken into consideration.
Environmental injustice, characterized by lower socioeconomic status (SES) persons being subjected to higher air pollution concentrations, was explored among pregnant women in Scania, Sweden. Understanding if the general reduction of air pollution recorded is enjoyed by all SES groups could illuminate existing inequalities and inform policy development. "Maternal Air Pollution in Southern Sweden", an epidemiological database, contains data for 48,777 pregnancies in Scanian hospital catchment areas and includes births from 1999-2009. SES predictors considered included education level, household disposable income, and birth country. A Gaussian dispersion model was used to model women's average NOX and PM2.5 exposure at home residence over the pregnancy period. Total concentrations were dichotomized into emission levels below/above respective Swedish Environmental Protection Agency (EPA) Clean Air objectives. The data were analyzed using binary logistic regression. A sensitivity analysis facilitated the investigation of associations' variation over time. Lower-SES women born outside Sweden were disproportionately exposed to higher pollutant concentrations. Odds of exposure to NOX above Swedish EPA objectives reduced over time, especially for low-SES persons. Environmental injustice exists in Scania, but it lessened with declining overall air pollution levels, implying that continued air quality improvement could help protect vulnerable populations and further reduce environmental inequalities.
Much is known about the adverse health impact of high and low temperatures. The Spatial Synoptic Classification is a useful tool for assessing weather effects on health because it considers the combined effect of meteorological factors rather than temperature only. The aim of this study was to assess the association between oppressive weather types and daily total mortality in Sweden. Time-series Poisson regression with distributed lags was used to assess the relationship between oppressive weather (Dry Polar, Dry Tropical, Moist Polar, and Moist Tropical) and daily deaths over 14 days in the extended summer (May to September), and 28 days during the extended winter (November to March), from 1991 to 2014. Days not classified as oppressive weather served as the reference category. We computed relative risks with 95% confidence intervals, adjusting for trends and seasonality. Results of the southern (Skåne and Stockholm) and northern (Jämtland and Västerbotten) locations were pooled using meta-analysis for regional-level estimates. Analyses were performed using the dlnm and mvmeta packages in R. During summer, in the South, the Moist Tropical and Dry Tropical weather types increased the mortality at lag 0 through lag 3 and lag 6, respectively. Moist Polar weather was associated with mortality at longer lags. In the North, Dry Tropical weather increased the mortality at shorter lags. During winter, in the South, Dry Polar and Moist Polar weather increased mortality from lag 6 to lag 10 and from lag 19 to lag 26, respectively. No effect of oppressive weather was found in the North. The effect of oppressive weather types in Sweden varies across seasons and regions. In the North, a small study sample reduces precision of estimates, while in the South, the effect of oppressive weather types is more evident in both seasons.
Children generally do not meet the recommendation of 60 min of daily physical activity (PA); therefore, active school transportation (AST) is an opportunity to increase PA. To promote AST, the involvement of parents seems essential. Using the theory of planned behavior (TPB), the aim was to develop and validate the PILCAST questionnaire to understand parents' intentions to let their child cycle or walk to school. Cross-sectional sampling was performed, where 1024 responses were collected from parents. Confirmatory factor analysis indicated acceptable fit indices for the factorial structure according to the TPB, comprising 32 items grouped in 11 latent constructs. All constructs showed satisfying reliability. The regression analysis showed that the TPB explained 55.3% of parents' intentions to let the child cycle to school and 20.6% regarding walking, increasing by a further 18.3% and 16.6%, respectively, when past behavior was added. The most influential factors regarding cycling were facilitating perceived behavioral control, positive attitudes, subjective and descriptive norms, and for walking, subjective and descriptive norms. The PILCAST questionnaire contributes to a better understanding of the psychological antecedents involving parents' decisions to let their child cycle or walk to school, and may therefore provide guidance when designing, implementing and evaluating interventions aiming to promote AST.
Children generally do not meet the recommendation of 60 min of daily physical activity (PA); therefore, active school transportation (AST) is an opportunity to increase PA. To promote AST, the involvement of parents seems essential. Using the theory of planned behavior (TPB), the aim was to develop and validate the PILCAST questionnaire to understand parents’ intentions to let their child cycle or walk to school. Cross-sectional sampling was performed, where 1024 responses were collected from parents. Confirmatory factor analysis indicated acceptable fit indices for the factorial structure according to the TPB, comprising 32 items grouped in 11 latent constructs. All constructs showed satisfying reliability. The regression analysis showed that the TPB explained 55.3% of parents’ intentions to let the child cycle to school and 20.6% regarding walking, increasing by a further 18.3% and 16.6%, respectively, when past behavior was added. The most influential factors regarding cycling were facilitating perceived behavioral control, positive attitudes, subjective and descriptive norms, and for walking, subjective and descriptive norms. The PILCAST questionnaire contributes to a better understanding of the psychological antecedents involving parents’ decisions to let their child cycle or walk to school, and may therefore provide guidance when designing, implementing and evaluating interventions aiming to promote AST.
The aim of this paper is to describe frail older persons' experiences of hospital care of information and participation when being an inpatient at a hospital. A qualitative method was used. Data were collected at the hospital from 20 interviews with frail older patients, together with observations in the environment at the hospital ward. A content analysis was performed. Patients experienced not receiving information about their care and rehabilitation, or receiving such information in noisy surroundings. They experienced situations of misunderstanding related to their medication, which indicates the need for appropriate discharge calls for frail older patients. They expressed feelings of distress concerning the future, caused by hasty admissions or relatives' problems to handle the situation. The results highlight the need to receive appropriate information and to participate in decision-making. The level of health literacy should be taken notice of when giving information, using peaceful and quiet environments when informing frail older persons. Person-centered care should be recognized to a greater extent in order for healthcare professionals to give information to frail older people in a health literacy-friendly way. This might make it easier for frail older persons to participate in a partnership in care.
GamTest is a self-rating scale of negative consequences of gambling, included in the popular responsible gambling tool Playscan as part of an overall risk assessment and feedback feature. Two previous psychometric evaluations of this instrument yielded contradictory results: in an online high-gambling population, a five-factor model was supported and the instrument had overall good psychometric properties, but in a low-gambling population, the same factor structure was not supported. Because GamTest is used with both low- and high-gambling populations, more psychometric research is needed to fully understand how the instrument works. The current study examined, for the first time, psychometric performance among a sample of low-gambling respondents using a Rasch analysis. Results indicated that the instrument could be improved by decreasing the scale-steps and removing several problematic items demonstrating misfit. Furthermore, the findings indicated that some items functioned differently depending on gender, and that a shortened, improved nine-item version could not differentiate between different levels of risk. Our findings suggest that the instrument would arguably benefit from being adapted for use in a low-gambling population.
Excessive alcohol use and gambling can have negative consequences. Across countries, the risk of excessive alcohol use is more common in university populations than in the general population. However, few studies have investigated the prevalence of both alcohol use and gambling in this group. This study explores these behaviours in a Swedish university setting. In addition, this study investigates how impulsivity affects alcohol use and gambling. In total, 794 Swedish students answered an online survey. Data were analysed using descriptive statistics to determine prevalence, and multinomial logistic regression was used to determine the contribution of impulsivity, age, and sex to alcohol use and gambling. Compared to the Swedish national prevalence, the prevalence was higher for excessive alcohol use, but the prevalence of gambling was at the same level or lower. High levels of impulsivity and male sex increased the risk of excessive alcohol use, while older age lowered the risk of excessive alcohol use and gambling. The results indicate that primarily young men could benefit from primary prevention in a university setting. Also, screening for impulsivity in men might be one way to identify risk groups in a university population.
When the primary goal of exercise is to compensate for food intake and to alter body shape and weight, it is considered compulsive and may be harmful. Compulsive exercise (CE) is important in the pathogenesis of eating disorders (EDs). Many healthy adolescents engage in CE too, and this may indicate a risk for EDs. Our aim was to learn more about ED risk factors tied to CE and to try to isolate questions to ask in order to probe for high ED risk in adolescents engaging in CE. Using two well-established instruments (the Structural Analysis of Social Behavior and the Eating Disorders Examination Questionnaire), we studied associations between ED variables and CE in healthy adolescent boys and girls. We examined gender-specific items to generate the best possible fit for each gender. Individuals with CE displayed significantly greater ED pathology and more self-criticism, and this pattern was stronger in girls than in boys. Risk factors for ED among individuals with CE differed slightly for boys and girls. We put forward a set of gender-specific questions that may be helpful when probing for ED risk among adolescents engaging in CE.
While the COVID-19 pandemic is ongoing, early outcome studies indicate severe and pervasive global effects of the pandemic and associated measures to prevent the spread of the virus. General population studies, as well as insight into the outcomes for particular groups, will be necessary in order to mitigate potentially long-term effects as well as to prepare for future epidemics or pandemics. The pandemic conditions have been marked by rapid and abrupt changes and unpredictability which are circumstances that leave the autistic population particularly vulnerable to adverse outcomes following the distinctive features of the diagnosis. Studies are only beginning to delineate the outcomes of the global autism community and the present study adds to these findings by providing a local, multi-perspective, qualitative analysis of the lived experiences of the Swedish autism community. In this study, autistic youth and adults, caregivers of autistic individuals, as well as representatives of Swedish interest organizations were interviewed. Thematic analysis was performed on the population as a whole and patterns of results were formalized according to the International Classification of Function, Disability and Health (ICF-CY). Participants report wide-ranging adverse outcomes of the pandemic relating to mental health and access to support, participation in daily activities and socialization, education, and work as well as parental resources. However, participants also report positive outcomes relating to a reduction in specific social and everyday demands, and normalization of lived experiences. Additionally, interviews outlined some strategies used to cope during pandemic conditions. Implications of these findings are discussed.
This study aims to identify the relevant empirical work, to synthesize its findings, and to thus attain a general understanding of the application of the Transtheoretical Model (TTM) in transport behavior research. An integrative literature review was used to determine whether or not the implemented interventions impact the stages and processes of travel behavior change. Data was collected from different databases. English language articles published between 2002 and 2017 were included. After sequentially narrowing the search and removing duplicates, 53 relevant papers remained, 13 of which fulfilled the stated criteria of constituting a transport intervention study using the TTM as a reference frame. The final 13 studies were classified and categorized according to stages and processes in the TTM. Findings showed that none of the interventions met the method requirements for a proper evaluation of design and outcome measurement. Reporting did not follow a standardized structure desirable when enabling comparative analyses. Allowing for these shortcomings, it is inferred that positive travel behavior changes have been obtained during some interventions. Importantly, although it was stated that the empirical studies were based on the TTM, the included interventions were implemented irrespective of the individual’s stage of change. For future research, it will be necessary to conduct evaluations of higher quality.
Physical activity (PA) decreases with age, and interventions are needed to promote PA during adolescence, especially, among those in low-socioeconomic status (SES) areas. The aim of this study was to investigate whether a two-year, empowerment-based health-promotion school intervention had any effects on changes in (a) moderate-to-vigorous PA (MVPA), (b) sedentary time (SED), (c) exercise training (ET) frequency, and (d) ET duration, among adolescents. Participants (aged 12-13 years at baseline) from one intervention school and two control schools, were recruited from a multicultural area of Sweden, characterized by low-SES. During the course of the two-year intervention, a total of 135 participants (43% boys) were included in the study. The intervention was developed and implemented as a result of cooperation and shared decision-making among the researchers and the participants. MVPA and SED were measured with accelerometers, and ET frequency and duration was self-reported at the beginning of the seventh, eighth, and ninth grade, respectively. There were no significant effects of the two-year, empowerment-based health-promotion school intervention on changes in the accelerometer-measured MVPA and SED, or the self-reported ET frequency and duration, among the adolescents. Overall, the intervention was unsuccessful at promoting PA and reducing SED. Several possible explanations for the intervention's lack of effects are discussed.
Physical activity (PA) decreases with age, and interventions are needed to promote PA during adolescence, especially, among those in low-socioeconomic status (SES) areas. The aim of this study was to investigate whether a two-year, empowerment-based health-promotion school intervention had any effects on changes in (a) moderate-to-vigorous PA (MVPA), (b) sedentary time (SED), (c) exercise training (ET) frequency, and (d) ET duration, among adolescents. Participants (aged 12⁻13 years at baseline) from one intervention school and two control schools, were recruited from a multicultural area of Sweden, characterized by low-SES. During the course of the two-year intervention, a total of 135 participants (43% boys) were included in the study. The intervention was developed and implemented as a result of cooperation and shared decision-making among the researchers and the participants. MVPA and SED were measured with accelerometers, and ET frequency and duration was self-reported at the beginning of the seventh, eighth, and ninth grade, respectively. There were no significant effects of the two-year, empowerment-based health-promotion school intervention on changes in the accelerometer-measured MVPA and SED, or the self-reported ET frequency and duration, among the adolescents. Overall, the intervention was unsuccessful at promoting PA and reducing SED. Several possible explanations for the intervention's lack of effects are discussed.
Burnout was originally conceptualized based on experiences of new professionals. Role clarity, task mastery, and social acceptance are recognized as key resources enabling new professionals’ management of the challenges of the new profession. However, relations between these resources and stress, strain, and burnout have not yet been thoroughly investigated at professional entry. Increased understanding of these relations could have implications for strategies to prevent burnout. The aim of the study was to investigate within- and between-individual effects over the first months and relations to burnout at one-year post-entry. Data (n = 322) was collected weekly over the first 13 weeks and again 9 months later. Relationships were modelled using a multilevel regression model and correlation analysis. Results showed that on weeks when participants experienced higher role clarity, task mastery, and social acceptance, they reported significantly less stress, and that participants who experienced higher levels of the resources in general, reported significantly less strain. Levels of the resources at three months were related to symptoms of burnout at 12 months. The study findings provide support of the role of task mastery, role clarity, and social acceptance as resources buffering the impact of demands at professional entry on experiences of stress, strain, and burnout.
Burnout was originally conceptualized based on experiences of new professionals. Role clarity, task mastery, and social acceptance are recognized as key resources enabling new professionals' management of the challenges of the new profession. However, relations between these resources and stress, strain, and burnout have not yet been thoroughly investigated at professional entry. Increased understanding of these relations could have implications for strategies to prevent burnout. The aim of the study was to investigate within- and between-individual effects over the first months and relations to burnout at one-year post-entry. Data (n = 322) was collected weekly over the first 13 weeks and again 9 months later. Relationships were modelled using a multilevel regression model and correlation analysis. Results showed that on weeks when participants experienced higher role clarity, task mastery, and social acceptance, they reported significantly less stress, and that participants who experienced higher levels of the resources in general, reported significantly less strain. Levels of the resources at three months were related to symptoms of burnout at 12 months. The study findings provide support of the role of task mastery, role clarity, and social acceptance as resources buffering the impact of demands at professional entry on experiences of stress, strain, and burnout.
A healthy lifestyle with sufficient physical activity (PA) can contribute to weight management. Yet, many people do not maintain a healthy lifestyle. To explain PA, we propose a model that incorporates the Theory of Planned Behavior (TPB) with weight-related self-stigma. We recruited 325 young adults to complete questionnaires regarding their physical activities, weight-related self-stigma, and TPB factors. We used structural equation modeling to examine the model fit and the path invariance across weight groups. The model showed excellent model fit, but path invariance was not supported. Weight-related self-stigma significantly explained the perceived behavioral control, behavioral intention, and engagement of PA. People without overweight and people with overweight have different considerations for PA. Weight-related self-stigma is important for PA as well. To promote a healthy lifestyle, healthcare providers should provide different suggestions or interventions that suit their patients' weight-related concerns.
Studded tires are used in a number of countries during winter in order to prevent accidents. The use of tire studs is controversial and debated because of human health impacts from increased road particle emissions. The aims of this study are to assess whether the use of tire studs in a Scandinavian studded passenger car actually avoids or causes health impacts from a broader life cycle perspective, and to assess the distribution of these impacts over the life cycle. Life cycle assessment is applied and the disability-adjusted life years indicator is used to quantify the following five types of health impacts: (1) impacts saved in the use phase, (2) particle emissions in the use phase, (3) production system emissions, (4) occupational accidents in the production system, and (5) conflict casualties from revenues of cobalt mining. The results show that the health benefits in the use phase in general are outweighed by the negative impacts during the life cycle. The largest contribution to these negative human health impacts are from use phase particle emissions (67-77%) and occupational accidents during artisanal cobalt mining (8-18%). About 23-33% of the negative impacts occur outside Scandinavia, where the benefits occur. The results inform the current debate and highlight the need for research on alternatives to tire studs with a positive net health balance.
Social participation is a modifiable determinant for health and wellbeing among older people; however, social participation is increasingly dependent on technology use. This study investigated social participation in relation to Everyday Technology use and social deprivation of the living environment, among older people with and without dementia in the United Kingdom. Sixty-four people with dementia and sixty-four people without dementia were interviewed using standardized questionnaires: The Participation in ACTivities and Places OUTside Home Questionnaire and Everyday Technology Use Questionnaire. A mixed methods approach integrated statistical analyses and content analysis of free-text responses, through data visualizations. Small, statistically significant associations were found between social participation and Everyday Technology use outside home, for participants with dementia (Rs = 0.247; p = 0.049) and without dementia (Rs = 0.343; p = 0.006). A small, statistically significant association was identified between social participation and social deprivation in the living environment, among only participants with dementia (Rs = 0.267, p = 0.033). The content analysis and graphical joint display revealed motivators, considerations that require extra attention, and strategies for managing social participation. The results underline how Everyday Technology use can be assistive to social participation but also the need to consider social deprivation of the living environment, especially among people with dementia.
Social participation is a modifiable determinant for health and wellbeing among older people; however, social participation is increasingly dependent on technology use. This study investigated social participation in relation to Everyday Technology use and social deprivation of the living environment, among older people with and without dementia in the United Kingdom. Sixty-four people with dementia and sixty-four people without dementia were interviewed using standardized questionnaires: The Participation in ACTivities and Places OUTside Home Questionnaire and Everyday Technology Use Questionnaire. A mixed methods approach integrated statistical analyses and content analysis of free-text responses, through data visualizations. Small, statistically significant associations were found between social participation and Everyday Technology use outside home, for participants with dementia (Rs = 0.247; p = 0.049) and without dementia (Rs = 0.343; p = 0.006). A small, statistically significant association was identified between social participation and social deprivation in the living environment, among only participants with dementia (Rs = 0.267, p = 0.033). The content analysis and graphical joint display revealed motivators, considerations that require extra attention, and strategies for managing social participation. The results underline how Everyday Technology use can be assistive to social participation but also the need to consider social deprivation of the living environment, especially among people with dementia. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.
= 0.033). The content analysis and graphical joint display revealed motivators, considerations that require extra attention, and strategies for managing social participation. The results underline how Everyday Technology use can be assistive to social participation but also the need to consider social deprivation of the living environment, especially among people with dementia.
The time required to reach a correct diagnosis is a key concern for rare disease (RD) patients. Diagnostic delay can be intolerably long, often described as an odyssey and, for some, a diagnosis may remain frustratingly elusive. The International Rare Disease Research Consortium proposed, as ultimate goal for 2017-2027, to enable all people with a suspected RD to be diagnosed within one year of presentation, if the disorder is known. Subsequently, unsolved cases would enter a globally coordinated diagnostic and research pipeline. In-depth analysis of the genotype through next generation sequencing, together with a standardized in-depth phenotype description and sophisticated high-throughput approaches, have been applied as diagnostic tools to increase the chance of a timely and accurate diagnosis. The success of this approach is evident in the Orphanet database. From 2010 to March 2017 over 600 new RDs and roughly 3600 linked genes have been described and identified. However, combination of -omics and phenotype data, as well as international sharing of this information, has raised ethical concerns. Values to be assessed include not only patient autonomy but also family implications, beneficence, non-maleficence, justice, solidarity and reciprocity, which must be respected and promoted and, at the same time, balanced among each other. In this work we suggest that, to maximize patients' involvement in the search for a diagnosis and identification of new causative genes, undiagnosed patients should have the possibility to: (1) actively participate in the description of their phenotype; (2) choose the level of visibility of their profile in matchmaking databases; (3) express their preferences regarding return of new findings, in particular which level of Variant of Unknown Significance (VUS) significance should be considered relevant to them. The quality of the relationship between individual patients and physicians, and between the patient community and the scientific community, is critically important for optimizing the use of available data and enabling international collaboration in order to provide a diagnosis, and the attached support, to unsolved cases. The contribution of patients to collecting and coding data comprehensively is critical for efficient use of data downstream of data collection.
The aim of this study was to examine the convergent validity of self-reported diary times for commuting to and from school with device-measured positional data (Global Positioning System; GPS) in Spanish adolescents. Methods: Cross-sectional data were obtained from four Spanish public secondary schools in 2021, comprising 47 adolescents and 141 home-school and school-home trips. Participants self-reported the time they left and arrived at home and school through a commuting diary. They wore a GPS device recording the objective time during three trips (i.e., one home-school trip and two school-home trips). Agreement between commuting diary and GPS data regarding home-school trips and school-home trips was evaluated using Bland-Altman plots. Results: Total commuting time differed by 1 min (95% limits of agreement were 16.1 min and -18.1 min) between subjective and objective measures (adolescents reported 0.8 more minutes in home-school trips and 1 more minute in school-home trips compared to objective data). Passive commuters reported 0.7 more minutes and active commuters reported 1.2 more minutes in the total commuting time compared to objective data. Conclusions: Self-reported commuting diaries may be a useful tool to obtain commuting times of adolescents in epidemiological research or when tools to measure objective times are not feasible.
Solastalgia is a relatively new concept for understanding the links between human and ecosystem health, specifically, the cumulative impacts of climatic and environmental change on mental, emotional, and spiritual health. Given the speed and scale of climate change alongside biodiversity loss, pollution, deforestation, unbridled resource extraction, and other environmental challenges, more and more people will experience solastalgia. This study reviewed 15 years of scholarly literature on solastalgia using a scoping review process. Our goal was to advance conceptual clarity, synthesize the literature, and identify priorities for future research. Four specific questions guided the review process: (1) How is solastalgia conceptualized and applied in the literature?; (2) How is solastalgia experienced and measured in the literature?; (3) How is 'place' understood in the solastalgia literature?; and (4) Does the current body of literature on solastalgia engage with Indigenous worldviews and experiences? Overall, we find there is a need for additional research employing diverse methodologies, across a greater diversity of people and places, and conducted in collaboration with affected populations and potential knowledge, alongside greater attention to the practical implications and applications of solastalgia research. We also call for continued efforts to advance conceptual clarity and theoretical foundations. Key outcomes of this study include our use of the landscape construct in relation to solastalgia and a call to better understand Indigenous peoples' lived experiences of landscape transformation and degradation in the context of historical traumas.
The repercussions of the COVID-19 pandemic on children's lives deserve attention. This study aimed to assess the prevalence of anxiety among Brazilian children and its associated factors during social distancing during COVID-19. We used a cross-sectional design with an online survey from April to May 2020 in Brazil. We included children aged 6-12 years and their guardians. The Children's Anxiety Questionnaire (CAQ; scores 4-12) and the Numerical Rating Scale (NRS; scores 0-10) were used to measure anxiety. We enrolled 157 girls and 132 boys, with a mean age of 8.84 (±2.05) years; 88.9% of respondents were mothers. Based on CAQ ≥ 9, the prevalence of anxiety was 19.4% (n = 56), and higher among children with parents with essential jobs and those who were social distancing without parents. In logistic regression, the following variables were associated with higher CAQ scores: social distancing without parents; more persons living together in home; and education level of guardians. Based on NRS > 7, the prevalence of anxiety was 21.8% (n = 63); however, no associations with NRS scores were found with the investigated variables. These findings suggest the necessity of implementing public health actions targeting these parents and their children at the population level.
Usability is key to achieve quality in software products. The client applications with a high score in usability might impact on the power consumption when they are run in a PC. For this reason, energy savings turn to be critical in green software systems. In this paper the relationship between the usability evaluations of the GUIs and the power consumption measurements of the main components of a PC were analysed. A set of 5 web-based personal health records (PHRs) were selected as a case study. The usability assessment was performed by an expert, employing the 14 principles of design by Alan Dix as heuristics. They were scored on a Likert scale after performing a collection of common tasks in the PHRs. At the same time, an equipment to measure the energy consumption of hard disk drive, graphics card, processor, monitor and power supply was used. Spearman's index was studied for the correlations between the usability assessments and the power consumption measurements. As a results, some weak relationships were found. A total of 5 usability heuristics were observed to may influence energy consumption when they were considered in the implementation of the PHRs. These heuristics were the following ones: consistency, task migratability, observability, recoverability and responsiveness. Based on the results, the usability principles of design cannot always be related to lower energy consumption. Future research should focus on the tradeoffs between usability and power consumption of client applications when they are used in a computer.
Due to population ageing and medical advances, people with advanced chronic diseases (ACD) live longer. Such patients are even more likely to face either temporary or permanent reduced functional reserve, which typically further increases their healthcare resource use and the burden of care on their caregiver(s). Accordingly, these patients and their caregiver(s) may benefit from integrated supportive care provided via digitally supported interventions. This approach may either maintain or improve their quality of life, increase their independence, and optimize the healthcare resource use from early stages. ADLIFE is an EU-funded project, aiming to improve the quality of life of older people with ACD by providing integrated personalized care via a digitally enabled toolbox. Indeed, the ADLIFE toolbox is a digital solution which provides patients, caregivers, and health professionals with digitally enabled, integrated, and personalized care, supporting clinical decisions, and encouraging independence and self-management. Here we present the protocol of the ADLIFE study, which is designed to provide robust scientific evidence on the assessment of the effectiveness, socio-economic, implementation, and technology acceptance aspects of the ADLIFE intervention compared to the current standard of care (SoC) when applied in real-life settings of seven different pilot sites across six countries. A quasi-experimental trial following a multicenter, non-randomized, non-concurrent, unblinded, and controlled design will be implemented. Patients in the intervention group will receive the ADLIFE intervention, while patients in the control group will receive SoC. The assessment of the ADLIFE intervention will be conducted using a mixed-methods approach.
Health complaints are increasing among adolescents and are recognized as a global public health issue. Health complaints are an indicator for subjective ill-being, but little is known about the relationship between sadness and other health complaints. The aim of this study was to investigate sadness and other health complaints among Swedish adolescents. A survey with a cross-sectional design was completed by adolescents (n = 1489, 15–17 years old) in the south of Sweden. A logistic regression analysis was used to analyze the relationship between sadness and other health complaints. The result show that sadness and other health complaints were common among adolescents, and sadness was related to health complaints (headache (OR: 1.58), sleeping difficulties (OR: 2.00), reduced appetite (OR: 1.43), tension (OR: 2.44), and concentration difficulties (OR: 2.75)). When adolescents express sadness or other health complaints it is important to reflect on what these complaints are an expression of, and take into account the body as physical and psychological intertwined. This might entail person-centered support that hopefully leads to an improvement in adolescents’ well-being. Future research that profoundly highlights adolescents’ existential health is needed.