Background: Eating disorders are a growing public health concern which requires more attention and research to increase the understanding and prevention of eating disorders. This paper focuses on eating disorders and its relation to the joy of food. It is very important to find joy for food when suffering from an eating disorder to achieve a healthier life and healthier thinking around food and the body. This paper has examined possible methods that can be used for treating people with eating disorders to enjoy food. The study was conducted at Capio Anorexia Center in Malmö, a daycare clinic for eating disorders, and the study was focused on how the staff works to help patients find joy for food during treatment, and how they work to express food in a positive way to their patients.

Methods: Literature studies were carried out before and after the study at Capio Anorexia Center. Qualitative half structured interviews were also carried out with two of the staff at Capio Anorexia Center, and with a dietitian and an anonymous person who has suffered from an eating disorder and received treatment. Three of the interviews were conducted with sound recording and the other one was conducted via email. Each interview lasted about 45 minutes. The interviews were compiled by first writing of the recorded interviews and then the answers for each interview were categorized to relevant fields. An analysis and comparison of these interviews to various literatures like books, reports, scientific papers and internet sources related to enjoying food and eating disorders were also carried out.

Results: Eleven methods were found that may be useful to find joy for food both in treatment and outside of treatment for those who need support: daring, educational meals, eating regularly, varied and plan meals, cook and serve appealing meals, mindfulness and mindfulness eating, eating environment and social importance when eating, nutritional therapy, the “sapere-method”, eating slow and relaxed, the use of vodcast during meals and to keep out myths, dieting and beauty ideals.

Conclusions: Eleven possible methods that may be useful to find joy for food have been found. This by preliminary studies with literature, a study at Capio Anorexia Center and interviews, and also by analyzing and comparing the interviews with literature related to eating disorders and enjoying food. The eleven methods described may be useful when regaining joy for food and a healthier thinking when it comes to food and meal situations. An important step in recovering from an eating disorder is to find pleasure when eating; therefore these methods can be possible tools to help people with eating disorders to find the joy for food. However, to reach a healthy life free from an eating disorder these methods described in this paper has to be combined with a variety of other therapies, because it is also important to work with self-esteem, self-confidence, and other symptoms and problems of the eating disorder.

Syftet med studien var att få en djupare förståelse om på vilket sätt läshunden kan bidra till att förbättra barns läsförmåga. Studien använder sig av en metainspirerad innehållsanalys. Metaanalys användes för att samla in information till studien samt att kunna dra slutsatser om tidigare forskning. Innehållsanalys användes för att skapa teman och kodning, med hjälp av innehållsanalys kan man skapa en djupare mening med textens innehåll. Artiklarna från resultatdelen samlades in från vetenskapliga databaser där alla artiklar är peer-reviewe.

Studien undersöker på vilket sätt kan en läshund bidra till att positivt påverka barns läsförmåga? Är det hunden i sig som påverkar barnets läsförmåga eller är det miljön? Resultat visar på att läshunden påverkar barn positivt både psykiskt, fysiskt och socialt. Resultatet visar även på att det är läshunden som påverkar barnen positivt och inte miljön de vistas i under lästiden. Slutsatsen man kan dra av denna studie är att läshunden visar på en positiv påverkan på barn och har givit oss förståelse om på vilket sätt läshunden påverkar barnen.

Quality of life (QoL) studies in heart transplant recipients (HTRs) using validated, quantitative, self-report questionnaires have reported poor QoL in approximately 20% of patients. This consecutive mixed methods study compared self-report questionnaires, the Medical Outcomes Study 36-item Short Form Health Survey (MOS SF-36) and the Atkinson Life Satisfaction Scale, with phenomenologically informed audiovisual (AV) qualitative interview data in 27 medically stable HTRs (70% male; age 53 ± 13.77 years; time since transplant 4.06 ± 2.42 years). Self-report questionnaire data reported poor QoL and more distress compared with previous studies and normative population samples; in contrast, 52% of HTRs displayed pervasive distress according to visual methodology. Using qualitative methods to assess QoL yields information that would otherwise remain unobserved by the exclusive use of quantitative QOL questionnaires.

Background: Cosmesis has been found to have an impact on prosthesis users' body image. Therefore the satisfaction of the cosmesis plays an essential role in a prosthesis user perception of themselves. Most cosmeses on the market are natural-looking, although more futuristic options are coming to the market. Most of the previous evidence has been conducted using quantitative methods. There is a lack of research investigating the experiences of cosmesis in transtibial prosthesis users through qualitative methods. This is expected to elucidate potentially undiscovered areas and factors surrounding patient satisfaction. 

Purpose: The aim of this thesis is to explore transtibial prosthesis user's satisfaction with the appearance of their cosmesis and gain a deeper understanding of their experiences regarding cosmeses. 

Methods: The method in this thesis is a qualitative phenomenology approach with an interpretivist view. The experiences of 5 male transtibial users regarding their cosmesis and satisfaction towards it were explored. This was done by having in-depth semi-structured interviews that were analyzed with thematic analysis. 

Results: The results five main themes arrived: Satisfaction, Natural-looking cosmesis, Function, Difficulties with the material, and Awareness. The results of these themes showed that the participants have different experiences regarding cosmesis. 

Conclusion: This thesis found a variation regarding satisfaction of the appearance among unilateral transtibial prosthesis users. Similarities in satisfaction and experience were found in the respective age groups of the participants. However, due to saturation not being fully reached, there should be further investigations. 

Bakgrund: Även om kaströrelsen i detalj skiljer sig mellan olika idrotter så är den biomekaniska funktionen i grunden densamma. Inom alla kastrelaterade idrotter återkommer den så kallade accelerationsfasen, här har det visat sig att inåtrotationen i axelleden har en hög korrelation med bollhastighet i kaströrelsen. Axelledens inåtrotatorer har alltså en viktig funktion för ett effektivt kast. En funktionell uppvärmning av dessa strukturer optimerar prestationsförmågan och minskar skaderisken. Kan träningsredskapet Activation Grip (AG) effektivisera uppvärmningen av den övre extremiteten hos kastidrottare?

Syfte: Att undersöka och jämföra hur muskelaktiviteten i m. pectoralis major (PM), m. deltoideus anterior (DA), m. flexor carpi raidalis (FCR) och m. extensor digitoris communis (EDC) påverkas vid inåtrotation i axelleden med och utan träningsredskapet AG. Studien syftar även till att utvärdera AG som produkt.

Metod: Muskelaktiviteten i PM, DA, FCR och EDC registrerades med hjälp av elektromyografi (sEMG) hos 18 aktiva idrottare inom överarmskastrelaterade idrotter (ålder 23,7 ± 5,7) vid inåtrotation i axelleden med maximal hastighet, jämfört med samma rörelse med AG och 30% belastning.

Resultat: Resultatet visade på en signifikant högre muskelaktivering (p < 0.05) i DA, FCR, EDC under inåtrotationen med maximal hastighet. Hos PM sågs ingen signifikant skillnad i muskelaktivitet. AG fick över lag positiv respons från testdeltagarna. 

Konklusion: Med resultatet i beaktande så skulle AG kunna kombineras tillsammans med andra uppvärmningsövningar för att få specifik aktivering i önskad muskulatur. Vidare studier gällande rörelse, motstånd och hastighet för att effektivisera användningen av AG bör göras. Även om AG fick positiv respons så bör produkten utvecklas ytterligare.

Bakgrund: Under ungdomsåren förändras ungdomar fysiskt, emotionellt och kognitivt. De går in i en ny fas i livet och utvecklas från att vara barn till att bli vuxna. Under ungdomsåren etablerara och experimenterar ungdomar med vanor, attityder, tro samt livsstil. Vid ogynnsamma förhållanden kan olika riskbeteende öka. Bland ungdopmar idag ses en ökning av sexuellexponering på sociala medier. Etfersom internet idag är mer lättillgängligt än tidigare kan det medföra att ungdomar i högre utsträckning exponerar sig sexuellt, vilket kan leda till sexuella övergrepp och missbruk.

Syfte: Är att beskriva vad ungdomar kommunicerar om i bloggar, angående sex och relationer.

Metod: En kvalitativ innehållsanalys enligt Graneheim och Lundman användes där fem ungdomsbloggar i åldrarna 17-25 år användes och analyserades

Resultat: Utifrån de analyserade ungdomsbloggarna framkom det två huvudkategorier; Samhällets trender påverkar ungdomars sexuella hälsa och Tillit har betydelse för relationen. Under kategorierna bildades sex underkategorier. I resultatet framkom det att ungdomar kommunicerar i stor utsträckning om sex och relationer på sociala forum. De ansåg att det idag är mer accepterat med olika sexuella läggningar och familjekonstellationer samt diskuterades dagens könsideal. Det uttrycktes en negativ syn på hormonella preventivmedel. Bloggarna uttryckte att det var viktigt med bekräftelse i en relation.

Konklusion: Ungdomar kommunicerar brett om sex och relationer på nätet, där de har en possitiv inställning till alternativa familjekontellationer. Synen på preventivmedel var negativ bland annat på grund av dess biverkningar och de förespråkade istället hormonfria alternativ. Relationer kan påverkas av olika förändringar i livet och att vara offentlig på internet kan upplevas som ansträngande för relationen.

The need for interpreters in health care has increased as the number of multilingual individuals increases in today´s society. This entails greater demands on healthcare services to maintain a high quality of healthcare for all. Speech therapists often encounter multilingual people and are then in many cases in need of interpreters during assessments or interventions. Currently, there are only a few studies available that describe challenges that may occur in collaborationsbetween interpreters and speech and language therapist, viewed from the interpreters’perspective. The purpose of this study is thus to investigate the role of interpreters and emphasise their perspective on speech and language therapy activities (e.g. assessment and intervention) for multilingual people. Increased knowledge of the interpreters’ perspective may reveal challenges, as well as identify well-functioning working methods that exist. Results of the study may contribute to strengthening the collaboration between interpreters and speech and language therapists.The material for the study consists of questionnaire responses from 209 interpreters from different parts of Sweden. To provide a comprehensive overview of their answers,information about the interpreters was compiled in tables. Free text answers were an accompanying option to many of the fixed questions. The interpreters' free text answers were analysed using thematic analysis. Overall, the results showed that many of the interpreters perceived the collaboration with the speech therapists as positive, but that there are areas for improvement. The most commonly addressed area was that the interpreters felt that the speech therapists did not have sufficient knowledge of how interpreters are required to perform their profession (by oath of conduct). An improved understanding of each other's professions might increase the degree of satisfaction in the collaboration between interpreter and speech and language pathologist. Getting access to the materials that are to be used for assessment or intervention, before the appointment to be interpreted, would provide the interpreter with a fair chance to prepare appropriately. This is something that a majority of the interpreters in the present study pressed would improve their own performance and thus also increase patient safety.

AimWe aimed to identify measures used to assess the participation of disabled children and to map the measures' content to the family of participation-related constructs (fPRC) to inform future research and practice. MethodSix databases were searched to identify measures used to assess participation in health, psychology, and education research. Included studies involved children aged 0 to 18 years with a permanent impairment or developmental disability and reported use of a quantitative measure of participation. A second search sought relevant literature about each identified measure (including published manuals) to allow a comprehensive understanding of the measure. Measurement constructs of frequently reported measures were then mapped to the fPRC. ResultsFrom an initial yield of 32 767 articles, 578 reported one or more of 118 participation measures. Of these, 51 measures were reported in more than one article (our criterion) and were therefore eligible for mapping to the fPRC. Twenty-one measures quantified aspects of participation attendance, 10 quantified aspects of involvement as discrete scales, and four quantified attendance and involvement in a manner that could not be separated. InterpretationImproved understanding of participation and its related constructs is developing rapidly; thoughtful selection of measures in research is critical to further our knowledge base.

The risk of violence in close relationships is higher for people with cognitive disabilities than in the general population. This is due to social isolation, and physical or financial dependence on others in everyday activities. To enable adequate protection for these victims, social workers need to take decisions and provide support that is based on knowledge about both violence and disability-related needs. By contrast, people with cognitive disabilities are de facto less likely to be provided with support adapted to their needs. Therefore, this study explores how social workers navigate barriers and facilitating aspects to support victims of violence with cognitive disabilities.Data were collected in individual interviews with 18 social workers, and analysed using content analysis. The inclusion criteria were 3 years or more experience in identifying and/or assessing exposure to violence in close relationships among people with cognitive disabilities.

The emerging categories illustrate how social workers face dilemmas when navigating the balance between individuals’ rights for self-determination and complex needs for protection and support. The policies that frame social workers' practice in Sweden are discussed in relation to the need for flexible interventions and accessible support based on interprofessional collaboration related to violence and cognitive disability. The categories also problematize the power dynamics involved and how different actors’ experiences, values, and power influence the support process. The different actors involved add to the complexity that social workers need to navigate.

This presentation focus on how social workers' practice is governed and hindered by policy, a focus on individuals' rights for self-determination, and the need to support and protect a group that may have difficulties to identify both violence and their needs for support.

I dagens samhälle är ständig utveckling och förnyelse viktiga överlevnadsvillkor för företag inte minst inom branschen företagshälsovård. Konkurrensen ökar och företagen måste ständigt se till att ligga i framkant och det har allt oftare konstaterats att den viktigaste tillgången är att utveckla de anställdas kompetens. Syftet med studien är att studera personals uppfattningar kring kompetensutvecklingen inom företagshälsans olika yrkesgrupper samt att genom den identifiera hur gynnsamma förhållanden för lärande kan skapas. För att få svar på syftet har vi använt oss av kvalitativa intervjuer som datainsamlingsmetod. Sammanlagt genomfördes sex intervjuer där fem olika yrkesgrupper representerades och företagets Vd. Studien har en fenemenografisk ansats som medför dataanalysmetod som består av sju steg. Eftersom vi var ute efter variationer av yrkesgruppernas olika uppfattningar var den fenemenografiska ansatsen mest optimal.

I resultatet framkommer det ett flertal uppfattningar kring kompetensutveckling, lärandestrategier och hur gynnsamma förhållanden för lärande kan skapas. Vidare finns det gemensamma uppfattningar om att yrkesgrupperna har ett stort handlingsutrymme och att det är nödvändigt för att arbetet ska fungera. En av studiens slutsatser är att tid för reflektion är viktigt för gynnsamma förhållanden. Genom att få mer tid att kunna reflektera över det som har skett tror vi medför ett mer kreativt tänkande och en utveckling av kompetens. En annan intressant slutsats som framkom är att varje yrkesgrupp är i behov av den konsultativa kompetensen och att den aldrig är färdigutvecklad.

The quality of meal-oriented support for people with intellectual disabilities is important for their health. The aim of the present study was to explore the experiences of meal-oriented support and diet counselling for adults with intellectual disabilities living in supported housing, from the perspective of housing staff and mothers. Five focus group interviews, including nine supporting staff members and nine mothers, were conducted. The interviews were analyzed using systematic text condensation. Five themes appeared; Extensive needs of the individual, Staff skills determine the food intake, Informal caregivers make up for shortage of support, Effective collaboration with a registered dietitian is needed and Responsibility of the organization state that professionalization of staff is needed. Lacking resources, such as time and nutritional knowledge, insufficient considerations of individual needs, and high staff turnover influence the meal-orientated services negatively. This study brings to the fore, staff working practices and the complexity of providing meal-oriented support for people with intellectual disabilities. Staff need skills to perform individually tailored support. This is best accomplished through effective collaboration between housing staff and relatives underpinned by knowledge from a registered dietitian. The working practices must be structured at the organizational level of the services.

Background: The childhood vaccination program is the most successful medical response to public health. Despite this, there have always been negative voices about vaccination. Information about childhood vaccinations is spread quickly and easily through media and information channels, such as Facebook and YouTube. This information is not always critically reviewed and suspected sideeffects may then be overestimated. Evidence shows that there is a variety of reasons why some parents have doubt about childhood vaccination. Child Health nurse's task is to meet all parents with respect and give correct information so the parents have a decision basis for vaccination.

A lack of communication between the Child Health nurse and the parents can contribute to increased concern, which may lead to the parents choosing to abstain from vaccination.

Aim: The aim was to describe Child Health nurse's experiences of communicating with parents before childhood vaccinations.

Method: Semi-structured interviews with nine Child Health nurses. The study has been analyzed using a qualitative content analysis.

Results: The result showed that all participants in the study felt that most parents had a positive attitude towards childhood vaccination. The study showed that the Child Health nurses felt that they provided a good and distinct information to the parents. At the same time, participants believed that the dissemination of information could be improved. It showed that there are differences in when Child Health nurses present information to the parents. The participants in the study felt safe in the meeting with parents and about communication of information prior to vaccination.

Conclusion: The study showed that Child Health nurses felt secure about communication, both with information before vaccination and in meeting hesitent parents. Child Health nurses described that they had good and distinct information within the organization.

Africa is currently home to some 78 million people with disabilities. Meanwhile, recent years have seen the size and populations of the continent’s major cities increasing at a startling rate. As a result, there is a pressing need to consider issues of urban design and accessibility, and how they affect people with disabilities.

Background: Patients who receive palliative care experience that they lose their independence through the disease and are frustrated that their body is not functioning as before. They also experience that their situation make them change their attitudes towards life. Several patients appreciate when healthcare professionals show genuine interest and the same patients have confidence in the healthcare system. Some patients experience that the healthcare professionals have no time and that their knowledge regarding their psychosocial problems is inadequate. Aim: The purpose is to describe nurses experience of nursing in palliative care. Method: Qualitative literature study with descriptive synthesis. Ten qualitative articles have been analyzed and is presented in the result. Results: After analysis, two themes were disclosed; Becoming enriched and Being challenged who described nurse’s experiences presented under five subthemes. Conclusion: Nurses perceived, among other things, that they were strengthened as a person and that they learned to re-prioritize and appreciate life. They also experienced grief over the fate of patients and it was common to take work home. Several of the nurses perceived that doctors did not give them support, others felt that their lack of experience contributed to the care worsening.

Background: There appears little consensus concerning protein requirements in phenylketonuria (PKU). Methods: A questionnaire completed by 63 European and Turkish IMD centres from 18 countries collected data on prescribed total protein intake (natural/intact protein and phenylalanine-free protein substitute [PS]) by age, administration frequency and method, monitoring, and type of protein substitute. Data were analysed by European region using descriptive statistics. Results: The amount of total protein (from PS and natural/intact protein) varied according to the European region. Higher median amounts of total protein were prescribed in infants and children in Northern Europe (n = 24 centres) (infants <1 year, >2-3 g/kg/day; 1-3 years of age, >2-3 g/kg/day; 4-10 years of age, >1.5-2.5 g/kg/day) and Southern Europe (n = 10 centres) (infants <1 year, 2.5 g/kg/day, 1-3 years of age, 2 g/kg/day; 4-10 years of age, 1.5-2 g/kg/day), than by Eastern Europe (n = 4 centres) (infants <1 year, 2.5 g/kg/day, 1-3 years of age, >2-2.5 g/kg/day; 4-10 years of age, >1.5-2 g/kg/day) and with Western Europe (n = 25 centres) giving the least (infants <1 year, >2-2.5 g/kg/day, 1-3 years of age, 1.5-2 g/kg/day; 4-10 years of age, 1-1.5 g/kg/day). Total protein prescription was similar in patients aged >10 years (1-1.5 g/kg/day) and maternal patients (1-1.5 g/kg/day). Conclusions: The amounts of total protein prescribed varied between European countries and appeared to be influenced by geographical region. In PKU, all gave higher than the recommended 2007 WHO/FAO/UNU safe levels of protein intake for the general population.

The increased focus on patient safety in hospitals has yielded a flood of new technologies and tools seeking to improve the quality of patient care at the point-of-care. Hospitals are complex institutions by nature, and are constantly challenged to improve the quality of healthcare delivered to patients while trying to reduce the rate of medical errors and improve patient safety. Here a simple mistake such as patient misidentification, specimen misidentification, wrong medication, or wrong blood transfusion can cause the loss of a patient's life. The focus of this paper is the implementation and evaluation of a handheld-based patient identification system that uses radio frequency identification (RFID) and 802.11b wireless networks to identify patients. In this approach, each patient is given a RFID wristband which contains demographic information (patient ID number, patient summary, hospital code) of the patient. A handheld device equipped with 802.11b wireless connectivity and a RFID reader is then used by the medical staff to read the patient's wristband and identify the patient. This work was carried out at the Department of Medical Physics and Bioengineering at the University College Hospital Galway, Ireland and in co-operation with the National University of Ireland, Galway.

The objective of this study was to describe measures and outcomes of vocational rehabilitation at six local national insurance offices in the same county in Sweden. Data were collected from mainframe registers and other records at each office. There were great differences in sickness allowance, incapacity rate, selected rehabilitation measures and resuming work. The percentage of sick-listed people who received any rehabilitation measure differed from 1.2 to 8.7%. The gender distribution for the study population was 36% men and 64% women and the predominant diagnosis was musculoskeletal pain conditions, which was followed by psychiatric disorders. Outcomes varied from office B, which reported 58% fully fit after completed planned rehabilitation, to office C, which reported only 24% fully fit. The clear differences in outcome between the offices indicate that various rehabilitation measures differ in effectiveness. The rehabilitation measure 'investigation of working ability' was not linked to any great proportion of people resuming work, but showed a greater correspondence to full disability pension. There were also large differences in social and demographic factors in the different municipalities. The effect of these on the rehabilitation process requires further investigation.

We propose a tentative research plan to increase students’ mental health in elementary schools by implementing Internet of Things (IoT) technology. The research plan should answer how to support students’ mental health using IoT solutions and the critical factors influencing testbeds for IoT solutions with the previously mentioned purpose. Our intended research method is Design Science, which we plan to use stepwise.

During the pandemic, physical meetings were supposed to decrease as much as possible to avoid the virus to spread. Before the pandemic, the physical meeting favoured social care and home health care in Sweden. One solution was to digitize as many of these meetings as possible. Therefore, we investigated this transition in a web survey, including questions with predetermined and open-ended answers. The web-survey was sent to co-workers in home health care and social care in a middle-seized municipality in Sweden. The results showed that not all meetings could be transformed, like meetings with citizens with hearing or cognitive impairments. Challenges related to the transformation were instability in technical equipment, the professionals’ and citizens’ knowledge of handling technical equipment, and access to technical equipment support. Despite this did the co-workers digitize meetings whenever possible, adding operational and problem-solving attitude to the transformation. Due to this study’s limitation, like respondents from one municipality and the pandemic’s length, we intend to investigate further and understand the development of the transformation and how knowledge in the area increases.

Background: Registered nurses' work-related stress, dissatisfaction and burnout are some of the problems in the healthcare and that negatively affect healthcare quality and patient care. A prerequisite for sustained high quality at work is that the registered nurses are motivated. High motivation has been proved to lead to better working results. The theory of inner work life describes the dynamic interplay between a person's perceptions, emotions and motivation and the three key factors for a good working life: nourishment, progress and catalysts. Objectives: The aim of the study was to explore registered nurses' workday events in relation to inner work life theory, to better understand what influences registered nurses to remain in work. Design: A qualitative explorative study with an ethnographic approach. Methods: Participant observation over four months; in total 56 h with 479 events and 58 informal interviews during observation; all registered nurses employed at the unit (n = 10) were included. In addition, individual interviews were conducted after the observation period (n = 9). The dataset was analysed using thematic analysis and in the final step of the analysis the categories were reflected in relation to the three key factors in theory of inner work life. Results: Nourishment in a registered nurse context describes the work motivation created by the interpersonal support between colleagues. It was important to registered nurses that physicians and colleagues respected and trusted their knowledge in the daily work, and that they felt comfortable asking questions and supporting each other. Progress in the context of registered nurses' work motivation was the feeling of moving forward with a mix of small wins and the perception of solving more complex challenges in daily work. It was also fundamental to the registered nurses' development through new knowledge and learning during daily work. Catalysts, actions that directly facilitate the work, were highlighted as the possibility to work independently along with the opportunity to work together with other registered nurses. Conclusion: This study has a number of implications for future work and research on creating an attractive workplace for registered nurses. Working independently, with colleagues from the same profession, integrated with learning, visible progress, and receiving feedback from the work itself, contribute to work motivation.

BACKGROUND: Children in need of special support often display delays in time processing ability, affecting everyday functioning. MyTime is an intervention programme for systematic training of time processing ability. To support preschool children's development of time processing ability and everyday functioning, it is necessary to include their perspectives of the MyTime intervention programme. A previous study shows that MyTime is feasible with children in the preschool setting and shows positive effects on time processing ability for older children in special schools. Yet, there is a lack of knowledge regarding how preschool children experience the intervention programme and how they understand its meaning. The aim of this study was to explore the experiences and the meaning of using MyTime from the perspective of children with informal needs of special support (INS) 5-6 years of age in the preschool context.

METHODS: To explore the children's perspectives, video-recorded interviews with 21 children were analysed hermeneutically. To facilitate the interview situation with the children in need of special support, the Talking Mats© was used. Both body and spoken languages were analysed.

RESULTS: The results reveal children as active participants, willing to share their experiences of using the MyTime intervention in the preschool context. The conceptualization of the children's experiences and expressions uncovers their meaning of using the MyTime intervention as to know and to understand time by doing.

CONCLUSIONS: When children are given the opportunity to use concrete tools to understand and measure time, they experience themselves as active participants involved and engaged in the intervention. They reveal meaningful experiences to be able to manage time that facilitate their everyday functioning and participation in the preschool context.

Syfte och frågeställningar

Studien undersöker samband mellan kroppsliga attribut och fysisk aktivitet, med kognition. Detta för att se ifall en persons grad av fysisk aktivitet och välmående har någon verkan på vår mentala förmåga, samt vilka typer av aktiviteter/attribut som har störst effekt.

• Visar personer med hög självrapporterad grad av fysisk aktivitet en tendens till bättre resultat på kognitionstest?
• Påverkar socioekonomiska faktorer som utbildning, ålder och kön en persons resultat på kognitionstest i förhållande till deras fysiska aktivitet?

Metod

Studiens population valdes primärt genom ett bekvämlighetsurval för att underlätta insamlingen av data från så många individer som möjligt på kort tid. Kraven på deltagarna var att de skulle vara helt friska och mellan 25–70 år samt ha ett arbete. I studien användes en enkät baserad på Hälsoenkäten från Gymnastik- och Idrottshögskolan för att se hur fysiskt aktiva deltagarna var. Deltagarna fick även göra ett TMT-test (A+B del) där deras förmåga att se och uppfatta samt deras förmåga att hålla koll på saker i nuet och fokusera på flera saker samtidigt testades, vilket kopplades till deras kognitiva förmåga.

Resultat

Resultatet från TMT A visade en medeltid (sekunder) på 24,43±6,85 och från TMT B med en medeltid (sekunder) på 56,84±23,38. De som hade svarat högre på hur ofta de är fysiskt aktiva i minst 30 minuter och/eller styrketränade längre tider per vecka klarade av TMT-A och TMT-B på kortare tid.

Slutsats

Vardagsmotion och MVPA (Moderate to Vigorous Physical Activity) ses ha positiv effekt på resultaten från TMT. En ökning i den totala träningsmängden ses vara kopplad till förbättrade resultat. Övriga faktorer som ålder, socioekonomi och utbildning har inte någon effekt på den population som har undersökts.

Informal caregivers (ICs), including the patient's spouse, close relatives, or friends, play an important role in caregiving individuals with head and neck cancer (HNC). AI-based chatbots might offer information and assistance related to caregiving. This study presents the viewpoints of ICs and healthcare professionals (HCPs) on using AI-based chatbots in caring for individuals with HNC. A total of six focus groups were conducted with 15 ICs and 13 HCPs from three Swedish university hospitals. The study uncovers a widespread hesitancy toward the intention to use AI-based chatbots among ICs and HCPs. Factors contributing to this reluctance include their distrust in chatbot-provided information, negative past experiences of using chatbots, and lack of human connection in chatbot interactions. Embracing a holistic approach is crucial when designing chatbots, ensuring active user engagement and incorporating their perspectives into the design process.

Oral tablets are convenient and widely administered drugdosage forms.The mechanical properties of a drug substance such as plasticity, ability to cohere into compacts and friction/adhesion are important in the development of a tablet formulation. Crystal engineering is an interesting and viabletool for improving or optimizing these technical properties of a drug substance.The creation of a lternative polymorphic forms, cocrystals, salts or hydrates of a drug substance can result in structural variations in the molecular packing of the crystals and, thereby, can alter the deformation behavior of the materials.Knowledge of the relationships between crystal modifications and the technical properties in multicomponent systems is limited, but represents a possibility to predict mechanical properties based on crystalstructure that facilitates engineering particles for the optimal processing performance. The overall objective of this thesis is thus to gain better understanding of the relationships between the crystal structure features and the mechanical properties of cocrystals and salts. Paracetamol form I, its cocrystals with oxalic acid and 4,4´-bipyridine, and its hydrochloride salt were selected as model systems in the study.The materials were scaled-up using rational crystallization methods and the physical purity was confirmed. The relevant properties of these powders were determined.Tablets were then made at applied pressures of50-250 MPa under controlled conditions.The tabletability and compactability of the powders were determined. The compression mechanics of the powders were the investigated according to a material classification protocol.Slip planes were identified by visually observing the crystal structures and based on the attachment energies calculated using different force fields in the materialsstudio.The tensile strengths of the powders increased with increasing pressure and the tabletability decreased in the order oxalic acid>paracetamol-hydrochloride salt≈paracetamol-oxalic acid>4,4´-bipyridine>paracetamol-4,4´-bipyridine.The tensile strength of the tablets decreased exponentially with increasing porosity,with some exceptions.Ingeneral, the cocrystals and the salt displayed intermediate compression characteristics as compared to the reference substances.The elastic recovery of the cocrystal and salt forms of paracetamol was not markedly different from that of paracetamol.It was found that slip plane prediction based on the attachment energies was not reliable. While it was possible to explain the improved tableting properties of powders based on the crystal features (i.e. the presence of slip planes and flat layers), no clear relationship was found with yield pressure. This may be attributed to possible brittle material characteristics and the surface energies of the crystals,which need to be further studied.Thus, cocrystallization and salt formation introduced structural features that were responsible for changes in the compaction and compression properties of drug substances. In future work, we intend to extend these studies to provide a clear picture of structure-mechanical property relationships in organic molecular crystals over multiple length scales;molecules to crystals to bulk powder.Key words Crystal engineering, solid forms, cocrystals, salts, tableting, crystal structure, mechanical properties, compression analysis

Objectives were to study mechanical properties of various solid forms of paracetamol and relate to their crystal structures. Paracetamol Form I (PRA), its cocrystals with oxalic acid (PRA-OXA) and 4,4-bipyridine (PRA-BPY) and hydrochloride salt (PRA-HCL) were selected. Cocrystals and salt were scaled-up using rational crystallization methods. The resulting materials were subjected to differential scanning solid-state characterization. The powders were sieved and 90-360 µm sieve fraction was considered. These powders were examined by scanning electron microscopy (SEM) and densities were determined. Tablets were made at applied pressures of 35-180 MPa under controlled conditions and the tablet height, diameter and hardness were measured. Tensile strength and porosity of the tablets were estimated using well known models. Crystal structures of these systems were visualized and slips planed were identified. Cocrystal and salt of PRA were physically pure. Sieved powders had comparable morphologies and particle size. The apparent and theoretical densities of powders were similar but no clear trends were observed. The tensile strengths of these compacts were increased with increasing pressure whereas tabletability decreased in the order oxalic acid > PRA-HCL ≈ PRA-OXA > BPY > PRA-BPY. Tablet tensile strength decreases exponentially with increasing porosity with the exception of PRY-BPY and BPY. Slip plane prediction based on attachment energies may not be independently considered. However, it was possible to explain the improved mechanical properties of powders based on the crystal structure. Cocrystallization and salt formation have introduced structural features that are responsible for improved tableting properties of PRA.

This study is based on observations of the design process of a virtual patient (VP), which aimed to facilitate interprofessional learning. By following the design process of this particular VP, this study aimed to trace how different practices and the knowledge within these practices were enacted as a VP and to understand the design team's difficulties and challenges. Drawing upon actor-network theory (ANT), the study demonstrates how technology and various practices in healthcare and education were enrolled to build the VP and the different translations that took place during the process. We discuss the results by reflecting on the intertwined relationship among the different enactments of a patient in the different professional practices, the enactment of pedagogical intentions and the role of technology in the design process.

The present cross-sectional study examined the actor-partner interdependence effect of fear of COVID-19 among Iranian pregnant women and their husbands and its association with their mental health and preventive behaviours during the first wave of the COVID-19 pandemic in 2020. A total of 290 pregnant women and their husbands (N = 580) were randomly selected from a list of pregnant women in the Iranian Integrated Health System and were invited to respond to psychometric scales assessing fear of COVID-19, depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. The findings demonstrated significant dyadic relationships between husbands and their pregnant wives' fear of COVID-19, mental health, and preventive behaviours. Pregnant wives' actor effect of fear of COVID-19 was significantly associated with depression, suicidal intention, mental quality of life, and COVID-19 preventive behaviours but not anxiety. Moreover, a husband actor effect of fear of COVID-19 was significantly associated with depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. Additionally, there were significant partner effects observed for both the pregnant wives and their husbands concerning all outcomes. The present study used a cross-sectional design and so is unable to determine the mechanism or causal ordering of the effects. Also, the data are mainly based on self-reported measures which have some limitations due to its potential for social desirability and recall biases. Based on the findings, couples may benefit from psychoeducation that focuses on the effect of mental health problems on pregnant women and the foetus.

Syftet med studien var att ta reda på vad patrullerande poliser upplever som stressande och hur de hanterar stress i sitt arbete. För att kunna besvara syftet användes en metod i form av semistrukturerade intervjuer där fem aktivt patrullerande poliser deltog. Analysen av de insamlade intervjuerna genomfördes en kvalitativ innehållsanalys där det insamlade materialet kategoriserades och olika teman identifierades, de viktigaste meningarna valdes sedan ut som var direkt kopplade till syftet med studien. Resultatet visade att de främsta stressfaktorerna som de patrullerande poliserna upplevde var: Tidspress och personalbrist, vapenhantering samt hemarbete. Vidare var de viktigaste copingstrategierna för att hantera dessa: Socialt stöd från familj och kollegor, vägledning från chefer samt andningsövningar från yogaträning. Cheferna skulle kunna försöka vara mer närvarande i de patrullerande polisernas ärenden för att lättare ge dem det stöd de behöver. Slutsatsen var att det finns olika sätt att hantera stress och det är viktigt att ta lärdom av kollegor, hur de på bästa sätt hanterar stressiga situationer. Det är också viktigt att fortsätta vidare med forskningen, för att ta reda på vilka copingstrategier som är effektivast för att hjälpa patrullerande poliser med att hantera sin stress. 

The current deliverable aims at presenting the results of the analysis of stakeholder needs, in order to have support for selecting the most relevant use cases. For the identification of user requirements of all stakeholders relevant to school transportation different methods were used:

- Focus groups with representatives of one user or stakeholder group

- Workshops with different stakeholders

- 2 questionnaire surveys (Questionaire A: Road Experts, Questionaire B: children, parents and bus drivers)

Problems and needs in the following areas were subject of discussions, interviews and questionnaires:

- Behaviour of road users counteracting with school buses

- Behaviour of pupils on the school bus and while entering and exiting the same

- Design of bus stops

- Protection of pupils on the school bus

- Condition of school buses

- Education of school bus drivers

- Education of pupils concerning school transportation

- Information flow

- Route to/from school

- Special needs of children with disabilities

Results show that the organisation of school transport varies between countries and even within a country. Stakeholders underline the importance of consistent regulations and clear responsibilities as a basis for a safe way to school by bus.

BACKGROUND: The improvement in treatment of pediatric acute lymphatic leukemia (ALL) has introduced new challenges for pediatric oncology care in understanding and handling long-term treatment-related complications later in adult life. The aim of this study was to describe health related quality of life (HRQoL) and the relation to buffering factors among young adult (YA) pediatric ALL survivors and their siblings.

METHODS: This cross-sectional study was performed among 227 adults, treated for pediatric ALL in Sweden between 1985 and 1997 and their siblings (n = 70). Group means of HRQoL (SF-36) were compared between YA ALL survivors and the siblings, as well as to normative values from the general population. Self-efficacy (GSES) and social support (SS-13 subscale AVSI) was considering potential buffering factors for HRQoL and mental health. Associations between HRQoL and mental health respectively and self-efficacy and social support was analyzed.

RESULTS: The YA ALL survivors scored significantly lower on the HRQoL parameters general health (69.6 vs. 78.4, p = 0.004) and role emotional (77.1 vs. 88.1, p = 0.014), than the siblings. Further, they reported significantly lower general health (69.6 vs. 75.8), vitality (56.9 vs. 68.8), social functioning (84.5 vs. 88.6), role emotional (77.1 vs. 85.7) and mental health (71.3 vs. 80.9) compared with Swedish norms. Both YA ALL survivors and the siblings reported lower vitality and worse mental health than the general population. The HRQoL parameters, depression, stress and anxiety were all associated with both self-efficacy and social support among the YA ALL survivors. Among the siblings however, only general health, vitality, role emotional, mental health and depression were associated with social support, and only general health and mental health were associated with general self-efficacy.

CONCLUSION: The results from this study show that buffering factors, like social support and self-efficacy, may play an important role for psychosocial outcomes and HRQoL among YA ALL survivors later in life. The results suggest that this group could benefit from continuous support in adult life to handle consequences of their pediatric disease. © 2021, The Author(s).

Background: Palliative care is provided at the end of life when curative treatment is no longer possible. Due to the disease, the patient may lose his independence and freedom, which leads to life not functioning as before. The nurse's responsibility is to alleviate patients' suffering during the last period of life and to meet the needs of relatives. In order to promote the patient's quality of life, the nurse should also create a good relationship with the dying person and their relatives. The patient and relatives express that the nurse should take responsibility for communication, information and existential conversations in palliative care. Aim: To describe nurses' experiences of palliative care at the end of life stage in hospital. Method: The study is a systematic literature study with qualitative and descriptive synthesis. Results: After the data analysis, three themes emerged: barriers to providing good palliative care and emotional influences. These include sub-themes and describe nurses' experiences of palliative care. Conclusion: Lack of experience, knowledge and time prevents nurses from providing good palliative care. Communication, collaboration with colleagues, the patient and relatives, as well as emotional commitment and the opportunity for existential conversations were considered important in palliative care. Keywords: end of life, literature study, nurse’s experiences, palliative care, qualitative.

Polyurethane insulation foam, which is used as insulation on district heating steel and copper pipes, is made from polymerisation of polyol and diisocyanates monomers. Installation of new district heating pipes or replacement of old pipes involves masses of welding activities. Welding processes of pre-insulated district heating pipes can cause exposure of polyurethane insulation to high heat generated during the welding process. Temperatures of more than 150 °C can lead to thermal degradation of polyurethane insulation and isocyanates formation. Exposure of isocyanates to welders can cause allergy, irritation of eyes, nose, throat, skin, and lung problems, and isocyanate asthma. In this thesis project welding processes of varying nominal sizes of district heating pipes, varying welding method and consequential formation of isocyanates have been studied. This project has found that selection of welding method plays a key role in the formation of isocyanates. It was identified that although the oxy-fuel welding method is considered as easy method for welding, there is a generation of high heat. This since oxy-fuel welding warm up the district heating pipes to high temperatures, which lead to thermal exposure of polyurethane insulation and ultimate formation of hazardous isocyanates. Other aspect such as varying nominal sizes of the pipes and varying length of insulation-free ends effect the exposure of polyurethane insulation to high heat and eventual formation of isocyanates. This study found that small nominal sizes of district heating pipes DN20, DN25, DN32, DN50, DN65, DN80 of insulation-free ends from 20 to 22 cm, welded by oxy-fuel welding, have a low risk to generate critical high heat 150 °C. But if the length of the insulation-free ends is reduced to 16 cm it can lead to thermal degradation of polyurethane insulation and isocyanates formation. For air samples of isocyanates collected during welding of nominal pipe sizes DN100, DN150, DN200 having insulation-free ends 22-20 cm welded by oxy-fuel welding, the analysis showed notable types of monoisocyanates MIC, PHI, ICA and diisocyanates 4.4´-MDI. The concentration of the detected monoisocyanates ICA and diisocyanates 4.4´-MDI in some samples were higher than the acceptable short-term exposure limit STEL (μg / m3) determined by AFS 2018:1. The presence of large fractions of isocyanates in samples collected from surroundings of high-temperature-exposed polyurethane insulation showed high risks of isocyanates exposure to welders.

Background: In response to the lack of consideration of patient’s kidney function when prescribing drugs, the electronic Clinical Decision Support System (CDSS), Janusmed drugs, and renal function have been developed. This system offers knowledge on prescribing drugs to patients with impaired kidney function. Studies have shown that CDSS has the potential to lower the inappropriate prescription rate for patients with impaired kidney function. However, the general problem that CDSS faces is a low implementation rate because of inadequate usability.

Aim: The aim was to evaluate the usability of the digital interface Janusmed drugs and renal function and map ways to improve the interface.Method: Think aloud sessions and semi-structured interviews were conducted with eight medical doctors and three clinical pharmacists. Data from the think-aloud sessions were structured through an affinity diagram, also called the KJ-method, to obtain a diagram of how the interface is used and possible improvements of the system. Furthermore, Nielsen’s ten usability heuristics were used to evaluate the usability of the system.

Results: A total of six violations were found in the system, but they scored low on severity (1-2 points). The affinity diagram obtained showed the following five main themes on ways to improve the system: interface/technical functions, patient data, renal function, self-assessment, and future development.

Conclusion: Janusmed drugs and renal function is a well-designed and user-friendly CDSS.However, there is still room for further improvements in the design and functionality of the interface that would increase the usability of the system

Aim

The aim of this study is to examine how school principals describe the concept of health and the schools’ work with health promotion. Furthermore, the aim is to analyze and discuss what perspectives that are prominent in the schools’ regarding health. The question formulation of the study complies:

1. How do the schools’ principals describe the concept of health? 2. In what way do the schools’ principals work with health promoting activities? 3. What aspects of health are prominent in the upper secondary school activities?

Method

The study has a qualitative approach with semi-structured interviews as data collection method. The sample consists of six principals and assistant principals operating in five different upper secondary schools. The collected results have been interpreted and analyzed using the WHO health definition, the concept of health literacy and the perception of health as positive or negative along a continuum.

Results

The principals’ definitions of health started with the physical aspect, and thereafter included the psychological and the social aspect of health. The practical working methods that were undertaken to prevent psychological disorders were physical activities and conversations about the pupils’ wellbeing. The conversations were reactive measures when it became visible that the pupil in question took harm or felt bad. The six principals had in common that they worked with an equal treatment plan. Generally, in all of the upper secondary schools, norm critical discussions as well as discussions about value grounds were held. Two ways to work were observed: one school had a supervisor per class who was responsible for health promotion, another school had a senior lecturer in environmental science that ran the school forward in these questions.

Conclusions

The conclusions presented in this study were that all principals were aware of that health according to the WHO definition, consists of a whole; the physical, mental and social aspect. All of the schools used physical activity as treatment for coping with physiological disorders usually caused by stress. This work aligns with Brülde & Tenglands (2003) thoughts about preventing ill health and promoting health by using physical activity. From this point of view there is a demand from the school management to be able to contribute more with physical activity in school and to educate the pupils according to health literacy and give them the tools to manage stress throughout their lives. This aligns with the theory of health literacy, where the ability to make healthy choices is central.

Inom ramen för denna artikel diskuterar vi såväl den psykosociala som den fysiska miljön i skolan. Vidare argumenterar vi för att skolans miljö är av betydelse för elevernas möjligheter att lära sig, likväl som för deras upplevelser av lärandesituationerna. Särskilt intressant blir då att lyssna till eleverna. Syftet med denna artikel är därför att synliggöra och diskutera elevers röster i förhållande till hur skolan kan bli den bästa platsen för lärande. Detta görs med utgångspunkt i forskningsprojektet ”Skolan suger” eller?, där drygt 200 elever i åldrarna 11–15 år deltog. Eleverna fick skriftligen reflektera över hur skolan ska bli en riktigt bra lärandemiljö. För att utveckla skolan till den bästa platsen för lärande uttryckte eleverna en önskan att kunna påverka sin lärandemiljö, att uppnå ömsesidighet och samspel, att kunna hantera tidsregleringen i skolan, samt att uppfylla behov för välbefinnande.

"Dammed taxi cab!" A twelve year old student wrote these words in the margins of a questionnaire in school concerning psychosocial well-being. Within this paper they will serve as a point of departure for the discussion. Can the messages found on the sides of the squares intended for an X in a questionnaire be considered non-messages? Or are these expressions indeed messages that are made silent and therefore can be considered silent messages? Then one might wonder what the meanings of the silent messages are that often occurs in questionnaires? Can, or maybe should, we take notice of these silent messages? According to Polanyi every human being has silent and unexpressed dimensions within themselves, which acknowledge situations where we recognise that we know more than we can explain. This is also stressed by Merleau-Ponty, who argued that something exists beyond what is said, and Bateson emphasised that a non-message is also a message - the silence tells us something. Within this paper we will highlight and discuss the significance of silent messages of communication in general, and especially in questionnaires.

'Dammed taxi cab' - a 12-year-old boy wrote these words in the margins of a questionnaire, and within this paper they will serve as a point of departure for the discussion of the use of questionnaires as a way to voice children's experiences. The overall aim of this paper is to enable understanding of and discuss the use of questionnaires as a way to voice children's experiences. An analysis in accordance with a life-world approach has provided the lens through which to explore messages that can occur in questionnaires. The key research questions that will be explored in an attempt to answer the overall aim are: (i) how can unanswered questions and notes in the margins of a questionnaire be understood? and (ii) why is a questionnaire not always completed, according to the intention of its creators? To develop an understanding of this we analysed a number of questionnaires with unanswered questions and notes in the margins using a life-world approach. During the analysis two themes emerged: silent messages and messages being silenced. Finally, we discuss the legitimacy of questionnaires in childhood research and possible implications for practice when using this method to give voice to children's experiences.

Hälso- och sjukvården är en av flera aktörer som är involverade i patienters sjukskrivning. År 2006 infördes den så kallade sjukskrivningsmiljarden för att stimulera landstingen i att förbättra kvaliteten i sjukskrivningshanteringen och att ge den ökad prioritet. Olika områden har betonats i sjukskrivningsmiljarderna, såsom kompetens, samverkan och jämställd sjukskrivning – samtliga har haft ett starkt fokus på att utveckla ledning och styrning av sjukskrivningsfrågan. 

Syftet med den här studien var att få ökad kunskap om hur chefer på olika nivåer inom hälso- och sjukvården leder och styr arbetet med patienters sjukskrivning och om detta förändrats sedan 2007, då en motsvarande studie gjordes. 

Metod: Kvalitativ och kvantitativ innehållsanalys har genomförts av semistrukturerade intervjuer med 72 chefer på tre nivåer inom hälso- och sjukvården; landstings- och regiondirektörer (nivå 1), chefer direkt underställda dessa och med övergripande ansvar för sjukhusvård respektive primärvård (nivå 2), samt strategiskt valda verksamhetschefer inom primärvård och sjukhusvård (nivå 3). Resultaten har jämförts med dem från 2007. 

Resultat: Cheferna på samtliga tre nivåer såg nu ledning och styrning av sjukskrivningshantering som ett ansvar för cheferna i linjeorganisationen, vilket var en stor skillnad mot 2007. Det var stora variationer i hur ansvaret utövas, men analysen pekar på att frågan i högre utsträckning nu ägs och hanteras av cheferna, ofta med stöd av resurser utanför linjen. Frågan fanns också på agendan i högre utsträckning än tidigare på samtliga chefsnivåer – särskilt stor var förändringen på verksamhetsnivå. Många chefer beskrev att de nu leder och styr sjukskrivningsområdet på samma sätt som andra områden och att sjukskrivningsfrågan är införlivad med verksamhetens ordinarie ledningssystem. Chefernas kompetens i att leda och styra sjukskrivningsfrågan bedöms ha ökat sedan 2007. 

Samverkan med Försäkringskassan har utvecklats. Etablerade former för samverkan finns på flera strukturella nivåer, och omfattar främst kompetensutveckling och hantering av specifika patientärenden och ibland projekt. Samverkan beskrevs generellt som positiv och ansågs ha lett till ökad förståelse för varandras uppdrag och roller. Samverkan med Arbetsförmedlingen och kommuner nämndes ibland; däremot nämndes samverkan med arbetsgivare eller företagshälsovård ytterst sällan. 

Intern samverkan mellan kliniska verksamheter i sjukskrivningshanteringen har utvecklats men behöver förbättras ytterligare. I många verksamheter ingår flerprofessionellt samarbete i det patientnära arbetet med sjukskrivningar, som en del av överenskomna rutiner. Chefer beskriver att intern och extern samverkan underlättas av koordinatorer som organiserar och stöttar hanteringen av sjukskrivning och rehabilitering. 

Kompetens och kompetensutveckling inom försäkringsmedicin framstod nu som ett relativt prioriterat område för cheferna, på samtliga nivåer och i betydligt högre utsträckning än 2007. Utbildningsinsatser har gjorts i samtliga landsting, dels som begränsad fortbildning,främst för läkare, dels som utbildning av expertresurser. Man lyfte behovet av kontinuerlig kompetensutveckling. Utbildningsinsatser uppfattas som nödvändiga men tidskrävande och att det är en utmaning att leda och styra detta då frågan sällan har hög prioritet bland läkare.

Jämfört med 2007 har en tydlig förändring skett vad avser chefernas förhållningssätt till sjukskrivningsfrågan som blivit mer positiv. Sjukskrivning beskrevs nu som en del av vård och behandling. 

Jämställd sjukskrivning är ett prioriterat område i sjukskrivningsmiljarden och finns nu på agendan i högre grad än 2007; få har dock vidtagit konkreta åtgärder. Ibland nämndes planer på åtgärder, och många hade tagit fram - eller planerade att ta fram - könsuppdelad sjukskrivningsstatistik. Området upplevdes som svårt och komplicerat att leda och styra, bland annat på grund av bristande kunskap inom området. 

År 2007 framkom att kvalitetssäkring av arbetet med sjukskrivningar i princip inte förekom. Här har en utveckling skett. Uttalanden om kvalitet i och kvalitetssäkring av arbetet med sjukskrivningar handlade framför allt om uppföljning. Uppföljning begränsades i flera uttalanden till mätning av villkor som anges i sjukskrivningsmiljarden, så som andel läkarintyg som godkänts av Försäkringskassan. Mer sällan inbegrep uppföljning förbättringsarbete baserat på återkoppling eller analys av sjukskrivningsprocessen eller andra kvalitetsindikatorer. 

Chefens ansvar för att skapa goda administrativa förutsättningar för arbetet med sjukskrivningar framhölls nu på samtliga tre nivåer; detta diskuterades endast i begränsad omfattning 2007. Administrativa förutsättningar som nämndes var riktlinjer och rutiner, tid för såväl patientarbete som för kompetensutveckling, tillgång till kompetensstöd från experter, lättillgänglig och korrekt information samt olika ”verktyg”. Resultatet pekar på att man i hög grad har infört rutiner för olika aspekter av sjukskrivningsarbetet, men det fanns fortsatt behov av effektivisering och kvalitetsförbättring, inte minst vad gäller IT- stöd. 

Sjukskrivningsmiljarden bedöms ha haft mycket stor betydelse för att fokus har satts på sjukskrivningsfrågorna i landstingen. Många ansåg att sjukskrivningsmiljarden behövs ytterligare några år, även om det framkom en ambivalens till denna form av statlig styrning. Kortsiktigheten i överenskommelserna, att de kommer sent och att det nu finns fler miljardsatsningar ansågs göra verksamheten svårare att styra. 

Slutsatser: Ledning och styrning av sjukskrivningshantering har i större utsträckning blivit en del av den ordinarie verksamheten inom sjukvården, och chefens roll i relation till sjukskrivningshanteringen har blivit tydligare jämfört med 2007. Sjukskrivningsmiljarden tycks ha haft en stor betydelse för att sätta sjukskrivningsfrågan på agendan på samtliga nivåer i hälso- och sjukvården. Sjukskrivning ses nu i stor utsträckning som en del av vård och behandling som skall ledas och styras på motsvarande sätt som annan verksamhet, till exempel vad gäller riktlinjer, rutiner och kvalitetssäkring. Sjukskrivningsfrågan är dock en fråga bland många andra, och det finns behov av särskilt stöd till linjen i att hantera den. Vi fann en stor förändring i chefernas syn på det egna ansvaret i sjukskrivningsfrågan, särskilt på verksamhetschefsnivå. Hälso- och sjukvården har med andra ord kommit en bra bit på väg i sjukskrivningsfrågan. 

Mycket återstår dock att göra för att säkra ledningssystem, rutiner, och tillräckliga administrativa förutsättningar för ett optimalt arbete med hantering av patienters sjukskrivning. Särskilt gäller detta kvalitetssäkring, jämställd sjukskrivning, administrativa förutsättningar och den interna samverkan mellan olika kliniker.

The covid-19 pandemic wasn´t something anyone could have prepared for. The global spread of the infection forced countries to make drastic changes. Workplaces and educational institutions were ordered into work from home policies, to the extent possible, which in turn had a sinificant impact on remote learning for students at universities and colleges. The intention of this study was to describe and document experiences of connection and prerequisities to their learning, and how they were affected by the involuntary restrictions brought on by the covid-19 pandemic. The study grounds in two theories and students chosen learning strategies during the distance courses will be presented. The teories used to interpret the result of the study are the social cultural perspective on learning and health theory SOC, also referred to as ”sense of coherense”. The data for the study was collected through semistructured interviews. Two focus group interviews alongside four individual interviews were analyzed using utilizing qualitycontent analysis. The result showed different experiences among the students, both positive and negative that had impact on them during distance studies with a general result that the ability for learning had changed. The result may offer ideas to necessary measures for educational institutions and guidence to help promote wellbeing and learning strategies for students. Since the study´s linked to both health and learning provides relevance for the health pedagogical perspective.

BackgroundPreventive and scalable interventions, accessible to all, to counteract childhood obesity are urgently needed. We have recently developed a novel, digital parental intervention (MINISTOP 2.0 app) available in Swedish, Somali, Arabic and English. We have previously reported its positive effects on childrens health behaviors and on parental self-efficacy. However, before introducing the app at scale in primary child healthcare, implementation aspects also need to be explored.AimThis study aims to explore and describe user experiences as well as acceptability and feasibility of the MINISTOP 2.0 app-based intervention in a diverse group of parents (end-users) and Swedish child healthcare nurses (implementers).MethodsIndividual interviews were conducted with Swedish- (n = 9), Somali- (n = 9), Arabic- (n = 5) and English-speaking (n = 1) parents as well as Swedish primary child healthcare nurses (n = 15). Data was analyzed using content analysis with an inductive latent approach.ResultsParents described how the app facilitated behavior change through increased awareness regarding current diet and physical activity behaviors. Furthermore, the evidence-based app content further facilitated trust and behavior change. Both parents and nurses acknowledged the apps preventive potential and the potential for reaching parents with diverse backgrounds or in need of extra support.ConclusionThe MINISTOP 2.0 app was perceived as a useful tool for health promotion both by parents and healthcare professionals, especially since it was adapted to several languages. These findings coupled with the previously shown beneficial effects on health behaviors support the large-scale implementation of the app in primary child healthcare.