Background: European population cohorts continue to expand our understanding of chronic airways disease and inter-study collaboration may help address the inevitable limitations of study size, duration, era and geography. Towards this aim, CADSET has collated data from ten major general population European cohorts: Asklepios; Copenhagen City Heart Study; Copenhagen General Population Study; ECRHS; HUNT; LEAD; Lifelines, OLIN, Rotterdam Study and WSAS. We included males and females aged 20 to 95 years with baseline demographic and spirometry data.

Results: Data from 262,829 individuals (44% male) from multiple European countries provided good coverage across all adult ages (Fig.1A). Recruitment occurred in every year from 1976 through 2020. 23% were current-smokers and 42% were never-smokers, a pattern varying with advancing age (Fig.1B). The prevalence of airflow limitation varied according to whether lower limit of normal (LLN) or <0.70 thresholds were applied, increasing with age if the latter was used (Fig.1C).

Interpretation: These results fit with previous reports, however the size, geographical reach and span of recruitment provided by this collaboration provides a unique opportunity to explore chronic airways disease development. Together, we are now pursuing research questions previously beyond the scope of individual cohort studies.

Background

As the group of very old persons will form an increasing part of society, the study of how well-being is described and affected by specific factors will be of importance to meet the future needs of these persons. The aim of the study was to increase knowledge of well-being in very old persons by combining assessments and perceptions using the Philadelphia Geriatric Morale Scale (PGCMS).

Method

In a mixed method, convergent parallel design, 52 persons 80 years or older were assessed and interviewed using the PGCMS to combine assessment of morale and descriptions of perceptions of well-being using a mixed method approach.

Results

Quantitative and qualitative results converged in four areas: not feeling lonely and being included, rating and perceiving health as good, high physical function/ability and being physically active, living in own house and feeling at home. Areas perceived as important to well-being captured only in qualitative analysis were having freedom and engagement. An example of insights not achievable from the quantitative or qualitative analysis alone was that individuals with high morale expressed anxiety about losing their health due to potential ageing-related threats and that individuals with low morale struggled with acceptance. Acceptance was the key strategy for handling adverse consequences of ageing in all described areas.

Conclusion

When using standardized assessment scales in clinical practice, it could be useful to combine quantitative and qualitative data. Acceptance was key for well-being; however, acceptance could be resigned or reorienting in nature.

Background: Adult onset asthma is poorly studied and there are few long-term clinical follow-up studies.

Aim: To study clinical characteristics of adult onset asthma in a 15-year follow-up.

Method: Within the Obstructive Lung Disease in Northern Sweden (OLIN) studies, a cohort of n=309 subjects with adult onset asthma (aged 20-60 years) was recruited during 1995-99. The cohort was followed up in 2012-14 (n=205). Structured interviews and clinical examinations including spirometry were performed at both recruitment and follow-up. Skin prick tests were performed at recruitment and blood samples for cell counts and IgE at the follow-up. Asthma control was classified according to GINA 2006.

Results: At follow-up n=182 (89%) still had asthma, while n=23 (11%) were in remission. Among individuals with persistent asthma, mean pre-bronchodilator FEV1 percent of predicted was 89.0 at follow-up, similar as recruitment 88.3. At recruitment 16.5% were smokers, and of these, 86.7% had quit smoking at follow-up. At follow-up, 39% had blood neutrophils ≥4.0x109/L, 23% had blood eosinophils ≥0.3x109/L, and 28% had specific IgE>0.35 IU/ml to any airborne allergen. Any respiratory symptoms were reported by 90% and 31% used medium or high dose inhaled corticosteroids (ICS), 20% low dose ICS whereas 20% had no treatment. 55% had controlled asthma, 32% partly controlled and 13% uncontrolled asthma.

Conclusion: In this 15-year follow-up of adult onset asthma, the majority had persistent asthma. Smoking and high proportion using ICS may contribute to the stable lung function. Still, it should be noted that merely around every other had well controlled asthma.

Background There are few long-term clinical follow-up studies of adult-onset asthma. The aim of this article was to study clinical characteristics of adult-onset asthma in relation to remission and persistence of the disease in a 15-year follow-up.

Methods A cohort of 309 adults aged 20–60 years with asthma onset during the last 12 months verified by bronchial variability, was recruited between 1995 and 1999 from the general population in northern Sweden. The cohort was followed-up in 2003 (n=250) and between 2012 and 2014 (n=205). Structured interviews and spirometry were performed at recruitment and the follow-ups. Bronchial hyperreactivity (BHR) and skin-prick tests were performed at recruitment and blood samples were collected at the last follow-up. Remission of asthma was defined as no asthma symptoms and no use of asthma medication during the last 12 months.

Results Of eight individuals in remission in 2003, five had relapsed between 2012 and 2014 and in total, 23 (11%) were in remission, while 182 had persistent asthma. Those in remission had higher mean forced expiratory volume in 1 s % predicted at recruitment than those with persistent asthma (94.6 versus 88.3, p=0.034), fewer had severe BHR (27.3% versus 50.9%, p=0.037) and they had less body mass index increase (+1.6 versus +3.0, p=0.054). Of those with persistent asthma, 13% had uncontrolled asthma and they had higher levels of blood neutrophils than those with partly controlled or controlled asthma.

Conclusion Higher forced expiratory volume in 1 s % predicted and less-severe BHR was associated with remission of adult-onset asthma, but still, the proportion in remission in this 15-year follow-up was low.

Purpose

To study how preoperative anxiety affects postoperative recovery in orthopaedic surgery based on two specific issues: does preoperative anxiety affect postoperative anxiety, pain, and nausea in the postanesthesia care unit (PACU) and does preoperative anxiety affect the quality of recovery.

Design

This was a nonexperimental quantitative observational study.

Methods

Patients (N = 37) were included through consecutive selection. Anxiety, pain, and nausea were measured preoperatively, 30 minutes after arrival at PACU and before discharge from PACU. Three days after discharge, participants completed the Quality of Recovery Questionnaire by telephone.

Findings

There was a significant correlation between preoperative anxiety and anxiety in PACU as well as anxiety, sadness, and depression 3 days after discharge from PACU.

Conclusions

Patients who experience preoperative anxiety also experience anxiety in PACU. The quality of recovery 3 days after surgery is also affected by preoperative anxiety. Patients experience continued anxiety as well as sadness and depression.

Multimorbidity is an emerging public health priority. This study aims to assess the role of lifestyle and socioeconomic status in the prevalence of multimorbidity and chronic diseases by using two language groups that are part of the same genetic subgroup but differ by daily habits. We conducted a cross-sectional survey in 2016 with randomly selected population sample with 4173 responders (52.3%) aged 20-69 years in Western Finland. We included 3864 Finnish participants with Swedish (28.1%) or Finnish (71.9%) as a native language. We used a questionnaire to assess participants' chronic diseases and lifestyle. We determined multimorbidity as a disease count ≥2.

Finnish speakers were more likely to have a diagnosis of COPD, heart failure, diabetes, reflux disease, chronic kidney failure, and painful conditions than Swedish speakers. The prevalence of multimorbidity was higher for Finnish speakers in the age group of 60-69 years (41.0% vs. 32.0%, p=0.018) than Swedish speakers. A higher proportion of Finnish speakers smoked, were obese, inactive, and had lower socioeconomic status compared to Swedish speakers. All these factors, in addition to age and female sex, were significant risk factors for multimorbidity. Prevalence of multimorbidity was different in two language groups living in the same area and was associated with differences in lifestyle factors such as smoking, physical inactivity and obesity.

The fabrication of stretchable conductive material through vapor phase polymerization of poly(3,4-ethylenedioxythiophene) (PEDOT) is presented alongside a method to easily pattern these materials with nanosecond laser structuring. The devices were constructed from sheets of vapor phase polymerized PEDOT doped with tosylate on pre-stretched elastomeric substrates followed by laser structuring to achieve the desired geometrical shape. Devices were characterized for electrical conductivity, morphology, and electrical integrity in response to externally applied strain. Fabricated PEDOT sheets displayed a conductivity of 53.1 ± 1.2 S cm−1; clear buckling in the PEDOT microstructure was observed as a result of pre-stretching the underlying elastomeric substrate; and the final stretchable electronic devices were able to remain electrically conductive with up to 100% of externally applied strain. The described polymerization and fabrication steps achieve highly processable and patternable functional conductive polymer films, which are suitable for stretchable electronics due to their ability to withstand externally applied strains of up to 100%.

Introduction: The prevalence of COPD seems to have leveled or decreased in some high income countries. Worldwide, population studies using spirometry have found substantial underdiagnosis of COPD.

Aim: To investigate underdiagnosis and misclassification of COPD in Sweden.

Methods: A randomly selected sample (n=1839; age 21-78 years; women 52.6%) was derived from two large scale population studies in Sweden, the West Sweden Asthma Study (WSAS) and the Obstructive Lung Disease in Northern Sweden (OLIN) Studies. Examinations including spirometry and structured interviews were conducted 2009-2012. COPD was defined following GOLD 2017: post-bronchodilator FEV1/FVC<0.70 and presence of respiratory symptoms. The subjects were asked if prior to the study they had been diagnosed with COPD, chronic bronchitis, emphysema, asthma, and if they used medicines for airway diseases.

Results: Of those with COPD (GOLD) identified at the clinical examinations, 24% had, prior to the study, been diagnosed with COPD, emphysema, or chronic bronchitis (COPD-cluster), while 46% had been diagnosed with the COPD-cluster, asthma, or used medicines for airway disease (any OAD). The corresponding figures for those fulfilling the criteria of COPD GOLD grade ≥2 were 39% (COPD-cluster) and 62% (any OAD). Among the subjects who, prior to the study, had been diagnosed with COPD, 78% fulfilled the criteria of COPD, but among those who had been diagnosed as having any of the diseases in the COPD-cluster, 31% fulfilled the criteria of COPD.

Conclusion: The proportion of underdiagnosis of COPD is still large in Sweden. Some misclassification of COPD was also found. The results reflect underuse of spirometry in primary care.

Objective: To investigate the current prevalence of physician-diagnosed obstructive airway diseases by respiratory symptoms and by sex in Sweden and Finland. Method: In 2016, a postal questionnaire was answered by 34,072 randomly selected adults in four study areas: Västra Götaland and Norrbotten in Sweden, and Seinäjoki-Vaasa and Helsinki in Finland. Results: The prevalence of asthma symptoms was higher in Norrbotten (13.2%), Seinäjoki-Vaasa (14.8%) and Helsinki (14.4%) than in Västra Götaland (10.7%), and physician-diagnosed asthma was highest in Norrbotten (13.0%) and least in Västra Götaland (10.1%). Chronic productive cough was most common in the Finnish areas (7.7-8.2 % versus 6.3-6.7 %) while the prevalence of physician-diagnosed chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) varied between 1.7-2.7% in the four areas. Among individuals with respiratory symptoms, the prevalence of asthma was most common in Norrbotten, while a diagnosis of COPD or CB was most common in Västra Götaland and Seinäjoki-Vaasa. More women than men with respiratory symptoms reported a diagnosis of asthma in Sweden and Seinäjoki-Vaasa but there were no sex differences in Helsinki. In Sweden, more women than men with symptoms of cough or phlegm reported a diagnosis of CB or COPD, while in Finland the opposite was found. Conclusion: The prevalence of respiratory symptoms and corresponding diagnoses varied between and within the countries. The proportion reporting a diagnosis of obstructive airway disease among individuals with respiratory symptoms varied, indicating differences in diagnostic patterns both between areas and by sex.

Background: Little is known on associations between respiratory symptoms and mortality.

Aim: To study whether respiratory symptoms are risk factors for all-cause, respiratory, cardiovascular (CV), and cancer mortality in Sweden and Norway.

Methods: In 1995-1997, population samples (20-69y) were surveyed about respiratory symptoms, and n=7,104 (85.3% of invited, median age 45y) and n=54,240 (70.1%, 44y) participated within the OLIN Studies in Northern Sweden and the HUNT Study in Norway. Mortality was studied until December 31st 2015. Hazard ratios (HR) for associations between respiratory symptoms and mortality were estimated by Cox regression models adjusted for age, sex, educational level, and smoking habits.

Results: The cumulative 20-year mortality was 14.5% in OLIN and 12.6% in HUNT. Dyspnea (mMRC grade≥2) (HR 1.9, 95%CI 1.6-2.2 in OLIN and 1.6, 1.5-1.7 in HUNT), chronic productive cough (1.5, 1.3-1.8 and 1.5, 1.3-1.6), and wheeze (1.3, 1.1-1.5 and 1.3, 1.2-1.4) were associated with increased risk of all-cause mortality. Women reported dyspnea and wheeze more frequently than men in both countries, but the association with mortality was similar in both sexes. Causes of death were studied in OLIN, where dyspnea associated with increased risk of respiratory (3.6, 2.1-6.1), CV (2.1, 1.6-2.7), and cancer (1.3, 1.0-1.8) mortality. Chronic productive cough was associated with increased risk of respiratory (2.4, 1.3-4.3) and cancer (1.6, 1.2-2.2) mortality, while wheeze was associated with increased risk of respiratory (3.5, 2.1-5.7) and CV (1.3, 1.0-1.6) mortality.

Conclusions: Common respiratory symptoms were similarly associated with increased risk of mortality in adults in Sweden and Norway.

Background

The relationship between lung function decline and eosinophils and neutrophils has important therapeutic implications among asthmatics, but it has rarely been studied in large cohort studies.

Objective

The aim is to study the relationship between blood eosinophils and neutrophils and FEV1 decline in a long-term follow-up of a population-based adult asthma cohort.

Methods

In 2012–2014, an adult asthma cohort was invited to a follow-up including spirometry, blood sampling, and structured interviews, and n = 892 participated (55% women, mean age 59 y, 32–92 y). Blood eosinophils, neutrophils and FEV 1 decline were analyzed both as continuous variables and divided into categories with different cut-offs. Regression models adjusted for smoking, exposure to vapors, gas, dust, or fumes (VGDF), use of inhaled and oral corticosteroids, and other possible confounders were utilized to analyze the relationship between eosinophils and neutrophils at follow-up and FEV1 decline.

Results

The mean follow-up time was 18 years, and the mean FEV 1 decline was 27 ml/year. The annual FEV1 decline was related to higher levels of both blood eosinophils and neutrophils at follow-up, but only the association with eosinophils remained when adjusted for confounders. Further, the association between FEV1 decline and eosinophils was stronger among those using ICS. With EOS <0.3 × 109/L as reference, a more rapid decline in FEV1 was independently related to EOS ≥0.4 × 109/L in adjusted analyses.

Conclusions and clinical relevance

Besides emphasizing the importance of smoking cessation and reduction of other harmful exposures, our real-world results indicate that there is an independent relationship between blood eosinophils and FEV1 decline among adults with asthma.

Background: Severe asthma is a considerable challenge for patients, health care professionals and society, but there are few long-term studies on risk factors for severe asthma.

Aim: To identify baseline risk factors of severe asthma in a longitudinal adult asthma cohort study.

Methods: An adult asthma cohort was identified in 1986-2001 by clinical examinations of population samples within the OLIN studies in northern Sweden. The examinations included structured interviews, spirometry with reversibility testing, skin prick testing and metacholine challenge. The cohort was followed up in 2012-2014 when n=1006 participated (mean age 59y). Adjusted Risk Ratios (RR) for baseline factors as risk factors for GINA defined severe asthma (SA) at follow-up (n=51) were estimated by Poisson regression.

Results: Older age, impaired lung function, increased reversibility and hyperreactivity, asthmatic wheeze, persistent wheeze, nighttime awakenings due to respiratory symptoms, and dyspnea were significant baseline risk factors for SA. Allergic sensitization, smoking, occupational groups or BMI did not predict SA. When adjusted for age, sex and smoking, post-bronchodilator FEV1/FVC<0.7, both present at baseline (RR 4.2, 95%CI 1.8-9.9) and developed during follow-up (2.9, 1.6-5.3), increased the risk. Also FEV1<80% at baseline associated with SA (2.9, 1.6-5.2). Triggers for respiratory symptoms at baseline such as tobacco smoke (2.1, 1.2-3.7) and physical activity (3.5, 1.5-81) associated with SA at follow-up, while pollen and furry animals did not.

Conclusion: Among adults with asthma, impaired lung function, wheeze, dyspnea and nighttime awakenings due to respiratory symptoms are important long-term risk factors for severe asthma.

Background

COPD has increased in prevalence worldwide over several decades until the first decade after the millennium shift. Evidence from a few recent population studies indicate that the prevalence may be levelling or even decreasing in some areas in Europe. Since the 1970s, a substantial and ongoing decrease in smoking prevalence has been observed in several European countries including Sweden. The aim of the current study was to estimate the prevalence, characteristics and risk factors for COPD in the Swedish general population. A further aim was to estimate the prevalence trend of COPD in Northern Sweden from 1994 to 2009.

Methods

Two large random population samples were invited to spirometry with bronchodilator testing and structured interviews in 2009–2012, one in south-western and one in northern Sweden, n = 1839 participants in total. The results from northern Sweden were compared to a study performed 15 years earlier in the same area and age-span. The diagnosis of COPD required both chronic airway obstruction (CAO) and the presence of respiratory symptoms, in line with the GOLD documents since 2017. CAO was defined as post-bronchodilator FEV₁/FVC < 0.70, with sensitivity analyses based on the FEV₁/FVC < lower limit of normal (LLN) criterion.

Results

Based on the fixed ratio definition, the prevalence of COPD was 7.0% (men 8.3%; women 5.8%) in 2009–2012. The prevalence of moderate to severe (GOLD ≥ 2) COPD was 3.5%. The LLN based results were about 30% lower. Smoking, occupational exposures, and older age were risk factors for COPD, whereof smoking was the most dominating risk factor. In northern Sweden the prevalence of COPD, particularly moderate to severe COPD, decreased significantly from 1994 to 2009, and the decrease followed a decrease in smoking.

Conclusions

The prevalence of COPD has decreased in Sweden, and the prevalence of moderate to severe COPD was particularly low. The decrease follows a major decrease in smoking prevalence over several decades, but smoking remained the dominating risk factor for COPD.

Purpose

The purpose of this paper is to discuss conditions for workplace learning (WPL) in relation to temporary agency staffing (TAS), focusing on temporary and regular nurses’ experiences of social relations.

Design/methodology/approach

Data were gathered using qualitative semi-structured interviews with five agency nurses and five regular nurses. Thematic analysis was used to analyse the data.

Findings

Similarities and differences regarding conditions for WPL among “temps” and “regulars” emerged, pointing towards both challenges and opportunities for WPL on various levels. Moreover, although challenges stood out, the context of professional work provides certain opportunities for WPL through, for example, knowledge sharing among nurses.

Research limitations/implications

Results are valid for the interviewees’ experiences of WPL conditions. However, the findings may also have currency in other but similar workplaces and employment circumstances.

Practical implications

Client organisations and temporary work agencies could benefit from developing management and HR strategies aimed at strengthening the opportunities for WPL, related to professional work, to ensure that these opportunities are leveraged fully.

Originality/value

This study adopts a WPL perspective on TAS in the context of professional work, which is still rare.

Attention deficit hyperactivity disorder, ADHD, är en av de vanligaste neuropsykiatriska funktionsnedsättningarna hos barn och ungdomar. Funktionsnedsättningen påverkar barnet i både skola, sociala sammanhang och i familjelivet. Detta påverkar i sin tur föräldrars liv. Syfte: Syftet med denna studie var att beskriva föräldrars upplevelse av att leva med barn med ADHD. Metod: Datainsamlingen genomfördes med semistrukturerade intervjuer med tre föräldrar till barn som har diagnosen ADHD samt text från fem föräldrars bloggar. Data analyserades med kvalitativ innehållsanalys med manifest ansats. Resultat: Fyra kategorier framkom i analysen: Att föräldraskapet är utmanande; Att känna sig missförstådd och frustrerad; Att känna trygghet och gemenskap samt Att känna lättnad när livet fungerar. Slutsats: Föräldrar upplevde utmaningar med föräldraskapet, men föräldrautbildning kunde bidra till att stärka föräldrar och öka deras kunskap att hantera vardagen och därigenom få ökad empowerment. Det skulle bidra till att de hade verktyg att stärka barnets självkänsla, vilket kunde öka barnets resiliens mot psykisk ohälsa och bidra till välmående genom livet för barnet och familjen med ADHD.

Implantable neural interfaces advance the possibilities for neuroscientists to study the brain. They are also promising for use in a multitude of bioelectronic therapies. Electrode technology plays a central role in these developments, as the electrode surfaces form the physical interfaces between technology and the biological targets. Despite this, a common understanding of how electrodes should best be evaluated and compared with respect to their efficiency in recording and stimulation is currently lacking. Without broadly accepted performance tests, it is difficult to rank the many suggestions for electrode materials available in the literature, or to identify where efforts should be focused to advance the field most efficiently. This tutorial critically discusses the most relevant performance tests for characterization of neural interface electrodes and explains their implementation, interpretation and respective limitations. We propose a unified standard to facilitate transparent reporting on electrode performance, promote efficient scientific process and ultimately accelerate translation into clinical practice.

Background

Transgender persons face barriers to health care including discrimination and lack of awareness by professionals. This study aimed to describe transgender persons’ experiences of encounters with healthcare staff.

Methods

Participants were recruited through postings in social media and on websites targeting people identifying as transgender. Through an online form, 21 people identifying as transgender provided written self‐reports. These were analysed using a method for inductive qualitative content analysis. The study was conducted in Sweden in 2018.

Results

The results describe transgender persons’ experiences and perceptions of encounters with healthcare staff in one theme: treat me with respect, and three main categories: accept me for who I am; treat me according to my needs; and meet me with competence .

Conclusions

Healthcare professionals can contribute in restoring and upholding transgender people’s trust in health care by accepting their identity and focusing on their healthcare needs while also being informed about transgender people’s needs and realities. A key point in this is recognising transgender person’s vulnerability to violations of dignity in relation to health care.

Purpose

To investigate nurse anesthetists' experiences of strategies that alleviate adult patients' preoperative anxiety before anesthesia administration.

Design

The study has a qualitative approach wherein the data were collected through semistructured interviews. The study included interviews with six active nurse anesthetists with at least 5 years of experience who worked in a hospital in southern Sweden.

Methods

Critical incident technology was used to analyze the data.

Findings

Four different categories emerged: behavior of nurse anesthetist, preoperatively providing information, diverting attention to create security, and medicine as an alternative.

Conclusions

Awareness can increase the use of different strategies by both new and experienced nurse anesthetists, as well as by nurses in preoperative units, which in turn alleviates patient anxiety about anesthesia. This may result in a better perioperative experience for the patient.

Background

The coronavirus pandemic has resulted in an increased number of interhospital transfers of patients with artificial airways. The transfer of these patients is associated with risks and has been experienced as highly challenging, which needs to be further explored.

Aims and objectives

To describe critical care nurses' experiences of caring for critically ill patients with artificial airways during interhospital transfers.

Design

A cross‐sectional study using a qualitative approach was conducted during spring 2020. Participants were critical care nurses (n = 7) from different hospitals (n = 2).

Methods

The data were collected through semi‐structured interviews based on an interview guide. A qualitative content analysis using an inductive approach was performed.

Results

The analysis resulted in one main theme, “Preserving the safety in an unknown environment,” and three sub‐themes, “Being adequately prepared is essential to feel secure,” “Feeling abandoned and overwhelmingly responsible,” and “Being challenged in an unfamiliar and risky environment.”

Conclusions

Critical care nurses experienced interhospital transfers of critically ill patients with artificial airways as complex and risky. It is essential to have an overall plan in order to prevent any unpredictable and acute events. Adequate communication and good teamwork are key to the safe transfer of a critically ill patient in that potential complications and dangers to the patient can be prevented.

Relevance to clinical practice

Standardized checklists need to be created to guide the transfers of critically ill patients with different conditions. This would prevent failures based on human or system factors, such as lack of experience and lack of good teamwork.

Purpose

The aim of this study is to explore patients' experience of pain and postoperative nausea and vomiting (PONV) in the early postoperative period after knee arthroplasties.

Design

This is a retrospective cohort study with a quantitative approach. Data from patients registered in the Swedish Perioperative Registry were used. We used the Strenghtening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies.

Methods

Data were collected from patients (N = 439) undergoing knee arthroplasties. The analysis was performed with descriptive and analytic statistics.

Findings

The findings indicate that women experienced significantly higher levels of pain than men and suffered significantly more often from PONV. However, the relationship of postoperative pain and PONV was not significant. There was also no significance for the relationship among postoperative pain, PONV, and age.

Conclusions

Care needs to be sensitive to differences in experiencing pain and PONV depending on sex or gender bias, with a goal of increasing the equality in care.

Background and Objectives

There is a substantial body of research on advance care planning (ACP), often originating from English-speaking countries and focused on health care settings. However, studies of content of ACP conversations in community settings remain scarce. We therefore explore community-dwelling, older adults’ reasoning about end-of-life (EoL) values and preferences in ACP conversations.

Research Design and Methods

In this participatory action research project, planned and conducted in collaboration with national community-based organizations, we interviewed 65 older adults without known EoL care needs, about their values and preferences for future EoL care. Conversations were stimulated by sorting and ranking statements in a Swedish version of GoWish cards, called the DöBra cards, and verbatim transcripts were analyzed inductively.

Results

While participants shared some common preferences about EoL care, there was great variation among individuals in how they reasoned. Although EoL preferences and prioritizations could be identical, different individuals explained these choices very differently. We exemplify this variation using data from four participants who discussed their respective EoL preferences by focusing on either physical, social, existential, or practical implications.

Discussion and Implications

A previously undocumented benefit of the GoWish/DöBra cards is how the flexibility of the card statements support substantial discussion of an individual’s EoL preferences and underlying values. Such in-depth descriptions of participants’ reasoning and considerations are important for understanding the very individual nature of prioritizing EoL preferences. We suggest future users of the DöBra/GoWish cards consider the underlying reasoning of individuals’ prioritizations to strengthen person-centeredness in EoL conversations and care provision.

Aim: To describe what suffering multiple concussions meant for former semi-professional or professional hockey players who were forced to end their career. Results: Nine former Swedish hockey players, who once played on national or professional teams were interviewed. The interviews were analyzed with reference to hermeneutic phenomenology to interpret and explain their experiences. The theme of losing one’s identity as a hockey player was constructed from five subthemes: being limited in everyday life, returning to the hockey stadium as soon as possible, forming a post career identity, lacking understanding and support, and preventing injuries by respecting other players. Conclusion: The former hockey players struggled with developing their off-the-ice identities and with finding other sources of meaning for their lives.

Lay abstract

Despite considerable attention to improving the initial management of concussions suffered by hockey players, few studies have examined their long-term effects. In response, the study reported here aimed to describe what suffering multiple concussions meant for former semi-professional or professional hockey players who were forced to end their career. Nine former Swedish hockey players, who once played on national or professional teams were interviewed and the interviews were analyzed in order to interpret and explain their experiences. The overall theme was formulated as losing one’s identity as a hockey player. In conclusion, the former hockey players seem to struggle with developing their off-the-ice identities and with finding other sources of meaning for their lives.

Background

The evaluation of one’s physical health and psychological wellbeing may be subjective. Aspects of functional capacity, including the patients’ own estimation of physical health and wellbeing, have been shown to be strong predictors of postoperative outcomes, therefore, they should be the focus of further research.

Aim.

This study aimed to explore the associations between ASA classification, self-estimated physical health, psychological wellbeing and anxiety among orthopaedic patients.

Methods

This is a longitudinal study with a quantitative approach.

Settings

A central county hospital in northern Sweden.

Results

A high ASA classification rated by anaesthetists was not associated with physical health and psychological wellbeing self-estimated as less than good. A high ASA classification was significantly associated with self-estimated anxiety prior to surgery. Three days and one month post-surgery, the situation was reversed, and the ASA I/II group, to a significantly higher extent, rated that they felt anxiety.

Conclusion

Preoperative screening systems for orthopaedic patients should not only focus on the medical and objective physical issues but also include the patients’ own estimation of their physical health and psychological wellbeing. It is essential that orthopaedic patients receive relevant information that provides a realistic outlook, as well as an honest and optimistic future view.

Att drabbas av akut sjukdom är fysiskt och psykiskt påfrestande för den enskilda individen. Akutmottagningen är ofta den första kontakten patienten har med vården. Många människor som besöker akutmottagningen är svårt sjuka eller skadade. Syftet med litteraturstudien var att beskriva patienters upplevelser av att vårdas på akutmottagningen. Aktuell forskning söktes fram i två databaser. Elva artiklar kvalitetsgranskades med hjälp av SBU:s granskningsmall och bedömdes hålla medel till hög kvalitet. En kvalitativ innehållsanalys med manifest ansats utfördes. Detta resulterade i fyra kategorier; “Att kommunikation och tillräcklig information är värdefullt”, “Att vara tvungen att vänta länge”, “Att inte känna sig sedd och tagen på allvar”och ”Att känna sig sedd och lyssnad på. Resultatet visade hur betydelsefullt information och kommunikation var för vårdupplevelsen på akutmottagningen. Många patienter delade upplevelsen av att väntan var en stor del i att vårdas på akutmottagningen. Sjuksköterskan behöver beakta det humanistiska perspektivet och se till människan som en helhet för att kunna skapa sig förståelse ur ett patientperspektiv.

Background:

Predatory publishing poses a fundamental threat to the development of nursing knowledge. Previous research has suggested that authors of papers published in predatory journals are mainly inexperienced researchers from low- and middle-income countries. Less attention has been paid to contributors from high-income countries.

Aim:

To describe the prevalence and characteristics of Swedish authors publishing in predatory nursing journals.

Design:

Quantitative descriptive case study.

Participants and research context:

Descriptive statistics were used to analyse the academic positions and academic affiliations of the authors of 39 papers published in predatory nursing journals during 2018 and 2019. Predatory nursing journals with Swedish contributors were identified by searching public listings of papers and applying a set of criteria. Journal site archives were used to identify additional papers with Swedish authors.

Ethical considerations:

This study was conducted in accordance with national regulations and ethical principles of research.

Results:

Almost two-thirds of Swedish authors publishing in predatory nursing journals hold senior academic positions. A small group of higher education institutions account for a majority of academic affiliations. Findings suggest that higher education institutions and experienced nursing researchers from Sweden make substantial contributions to predatory nursing journals, but that predatory publication habits might be concentrated in a limited number of academics and research milieus. A year-to-year comparison indicates that the prevalence of publishing in predatory journals might be diminishing.

Discussion:

Swedish nurse researchers help legitimize predatory journals, thus jeopardizing the trustworthiness of academic nursing knowledge. Substandard papers in predatory journals may pass as legitimate and be used to further academic careers. Experienced researchers are misleading junior colleagues, as joint publications might become embarrassments and liabilities.

Conclusion:

While the academic nursing community needs to address the problem of predatory publishing, there is some hope that educational efforts might have an effect on combating predatory publishing in nursing.

From the perspective of psychiatric and mental health nurses in Sweden, this discussion paper aims to position psychiatric and mental health nursing as a transformative force contributing to enforcing person-centered values and practices in health care. We argue the potential impact of psychiatric and mental health nursing on service user health and recovery, nursing student education and values, and the organization and management of health care. Psychiatric and mental health nursing is discussed as a caring, reflective, and therapeutic practice that promotes recovery and health. Implications for nursing education, research, management, and practice are outlined.

Background: Sports-related concussion (SRC) is increasingly recognized as a potential health problem in ice hockey. Quality of life (QoL) in players retiring due to SRC has not been thoroughly addressed. Materials & methods: QoL using the Sports Concussion Assessment Tool 5th Edition, Impact of Event Scale-Revised and Short Form Health Survey was measured in Swedish ice hockey players who retired due to persistence of postconcussion symptoms or fear of attaining additional SRC. Results: A total of 76 players were assessed, on average of 5 years after their most recent SRC. Overall, retired players had a high burden of postconcussion symptoms and reduced QoL. Conclusion: Retired concussed ice hockey players have a reduced QoL, particularly those retiring due to postconcussion symptoms. Symptom burden should be continuously evaluated and guide the decision to retire.

Varje år examineras tusentals studenter till legitimerade sjuksköterskor. Den första tiden beskrivs som påfrestande då de möts av nya utmaningar. Syftet med denna litteraturstudie var att beskriva nyexaminerade sjuksköterskors upplevelser av att vara ny inom yrket. För att besvara syftet genomfördes en kvalitativ litteraturstudie där 17 vetenskapliga artiklar analyserades med en kvalitativ innehållsanalys med en manifest ansats. Analysen resulterades i sex huvudkategorier; att kunskap och erfarenhet av omvårdnad har stor betydelse, att stöd från arbetskamrater påverkar trivseln i yrket, att ha eget ansvar vid hög arbetsbelastning är en utmaning, att yrket påverkar en som person även utanför arbetet, att yrket inte motsvarar förväntningar samt att vara osäker i yrkesrollen. Det framkom att nyexaminerade sjuksköterskor upplevde brist på kunskap och osäkerhet i yrkesrollen samt att reflektion kunde stärka den professionella utvecklingen. Hög arbetsbelastning bidrog till att de inte hann utföra den bästa omvårdnaden. Kollegors inställning hade betydelse för att trivas på arbetsplatsen. På fritiden var det svårt att sluta tänka på arbetet och egenvård var viktigt för att må bra. En slutsats som kan dras är att stöd och reflektion är viktigt för att trivas och utvecklas i sin profession och att sjuksköterskestudenter bör förberedas på bästa sätt inför yrket.

Aim

This study aimed to test the validity and reliability of the Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire in a nursing context.

Design

Non‐experimental and cross‐sectional.

Methods

The instrument was translated from English to Swedish using a translation and back‐translation procedure. Data for the validity and reliability analysis were collected from Registered Nurses in specialist education (n = 156) at two Swedish universities.

Results

The Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire is a valid and reliable instrument that assesses the reflective capacity of healthcare practitioners. Our findings suggest a unidimensional structure of the instrument, excellent internal consistency and good reliability.

Conclusion

The Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire has a degree of reliability and validity that is satisfactory, indicating that the instrument can be used as an assessment of reflective capacity in nurses.

Purpose

To study the factors influencing early postoperative recovery after laparoscopic cholecystectomy.

Design

A nonexperimental retrospective study.

Methods

The study was performed using records from all patients who had undergone laparoscopic cholecystectomy at a hospital in Northern Sweden in 2017 (219 patients in total). Nonparametric data were analyzed using Spearman's rho, Mann-Whitney U test, and logistic regression. Parametric data were analyzed using Pearson's correlation, an independent t test, and analysis of variance.

Findings

The length of stay in the postanesthesia care unit was not predicted by factors such as age, gender, body mass index, American Society of Anesthesiologists classification, postoperative nausea and vomiting, premedication, or type of surgery. Younger age and high classification level were significant predictors of pain during rest and pain when in motion. No significant predictors of postoperative nausea were found. The majority of study participants experienced little or no pain or nausea. The documentation of pain, nausea, and premedication was inadequate in many cases.

Conclusions

Nurses in postanesthesia care units should work to preventively identify and address patients’ medical and emotional needs so that optimal conditions for postoperative recovery can be provided.

Objectives

The aim was to identify predictors of electronic cigarette (e-cigarette) use among teenagers.

Design and setting

A prospective population-based cohort study of schoolchildren in northern Sweden.

Participants

In 2006, a cohort study about asthma and allergic diseases among schoolchildren started within the Obstructive Lung Disease in Northern Sweden studies. The study sample (n=2185) was recruited at age 7–8 years, and participated in questionnaire surveys at age 14–15 and 19 years. The questionnaire included questions about respiratory symptoms, living conditions, upper secondary education, physical activity, diet, health-related quality of life, parental smoking and parental occupation. Questions about tobacco use were included at age 14–15 and 19 years.

Primary outcome

E-cigarette use at age 19 years.

Results

At age 19 years, 21.4% had ever tried e-cigarettes and 4.2% were current users. Among those who were daily tobacco smokers at age 14–15 years, 60.9% had tried e-cigarettes at age 19 years compared with 19.1% of never-smokers and 34.0% of occasional smokers (p<0.001). Among those who had tried e-cigarettes, 28.1% were never smokers both at age 14–15 and 19 years, and 14.4% were never smokers among the current e-cigarette users. In unadjusted analyses, e-cigarette use was associated with daily smoking, use of snus and having a smoking father at age 14–15 years, as well as with attending vocational education, physical inactivity and unhealthy diet. In adjusted analyses, current e-cigarette use was associated with daily tobacco smoking at age 14–15 years (OR 6.27; 95% CI 3.12 to 12.58), attending a vocational art programme (OR 2.22; 95% CI 1.04 to 4.77) and inversely associated with eating a healthy diet (OR 0.74; 95% CI 0.59 to 0.92).

Conclusions

E-cigarette use was associated with personal and parental tobacco use, as well as with physical inactivity, unhealthy diet and attending vocational upper secondary education. Importantly, almost one-third of those who had tried e-cigarettes at age 19 years had never been tobacco smokers.

Obstetrisk fistel beskrivs som en abnormal gång mellan vaginan och urinblåsan och/eller rektum, där urin och/eller avföring läcker ut okontrollerat. Den vanligaste orsaken till utvecklandet av obstetrisk fistel är en dystoki. Att drabbas av obstetrisk fistel innebär en stor risk att bli stigmatiserad samt att det är ett tillstånd som är förödande för kvinnors välbefinnande, mentala hälsa och liv. För att en kvinna ska kunna återgå till det liv hon levde innan utvecklandet av obstetrisk fistel så krävs en återintegrering. Syftet med studien var att beskriva faktorer som påverkar kvinnors återintegrering efter korrektiv operation för obstetrisk fistel. Denna studie har utgått ifrån en integrerad metodartikel med en induktiv ansats, där studien har utgått ifrån syftet utan något teoretiskt ramverk. Analysen resulterade i fyra kategorier, hälsa, stöd, ekonomi och kunskap. Resultatet visade att en lyckad korrektiv operation underlättade kvinnors återintegrering tillsammans med stöd från familj och samhälle. Dock fanns det en stor risk för kvinnor utan stöd att ha fortsatta och djupare depressioner. Kvinnorna kunde inte åstadkomma en lyckad återintegrering om de inte fick tid och stöd för att återhämta sig. Detta gällde också ekonomiskt stöd. Denna litteraturöversikt kan tillföra en ökad förståelse till sjukvårdspersonal som arbetar med denna patientgrupp, för hur obstetrisk fistel påverkar kvinnor samt vilka faktorer som påverkar kvinnors återintegrering.

Background

The aim of the present study was to estimate the societal costs and the key cost drivers for patients with severe asthma in Sweden. In addition, health-related quality of life (HRQOL) and morbidity of patients with severe asthma is described.

Methods

The study population comprised adults with severe asthma recruited from a large asthma cohort within the Obstructive Lung Disease in Northern Sweden (OLIN) studies. During 2017, patients were interviewed quarterly over telephone regarding their resource utilization and productivity losses.

Results

Estimated mean annual asthma-related costs per patient with severe asthma amounted to €6,500, of which approximately €2400 and €4100 were direct and indirect costs, respectively. The main cost drivers for direct costs were hospitalizations followed by drugs: approximately €1000 and €800, respectively. Patients on treatment with regular oral corticosteroids (OCS) had greater direct costs compared with those without regular OCS treatment. Co-morbid conditions were common and the costs were substantial also for co-morbid conditions, with a total cost of approximately €4200. The OCS group had significantly lower HRQOL compared to the non-OCS group.

Conclusions

The societal costs due to severe asthma were substantial. Costs for co-morbid conditions contributed substantially to both direct and indirect costs. The direct costs were significantly higher in the maintenance OCS-group compared to the non-maintenance OCS-group. These results indicate a need for improved management and treatment regimens for patients with severe asthma.

Background: Quality-adjusted life-years (QALYs) is commonly used in health-economic evaluations. QALY-weights combine health status and time into one measure.

Aims: To investigate the association between multimorbidity and QALY-weights among adults with asthma and COPD.

Methods: Within the OLIN-studies in northern Sweden, a random sample was invited to a postal questionnaire survey. A random sample of 1016 responders was invited to clinical examinations and interviews in 2009 (737 participated, ages 21-86 years), of which 605 completed the health-related quality of life (HRQL) questionnaire SF-36. QALY-weights were derived from the SF-36 data using the SF-6D tool via the standard gamble method. The SF-6D scores are equivalent to QALY-weights with low values representing poor health and the score one representing perfect health.

Results: Of the 605 participants, 74 had current asthma, 81 had COPD (FEV1/FVC<0.7), 66 had heart disease, 30 had diabetes, 30 had rheumatic disease, and 160 had hypertension. There was an association between an increasing number of morbid conditions and lower QALY-weights (p<0.001). The mean QALY-weight tended to be lower among subjects with asthma compared to COPD, 0.77 and 0.81, respectively (p=0.078). Subjects with COPD and two or more non-respiratory conditions had significantly lower QALY-weights compared to subjects with COPD alone (0.75 vs.0.83, p=0.016). No significant difference in QALY-weights was found among asthmatics with versus without other non-respiratory conditions.

Conclusions: Subjects with asthma tended to have lower QALY-weights compared to subjects with COPD. Having two or more non-respiratory conditions affected the QALY-weight negatively among subjects with COPD but not among subjects with asthma.

In recent years, person-centred care has become one of the major goals of health and social care policies. A method used, to facilitate collaboration and integrate the person’s perspective in the decision-making process, is the collaborative care planning process. The collaborative care planning process, taking place within primary health care with actors from different welfare services, is a relative new phenomenon. There is a need for more research to understand the process and outcomes.

The overall aim of the thesis was to explore and describe the collaborative care planning process as a person-centred practice. This was achieved by conducting four studies describing the collaborative care planning conference (I), exploring how the person-centred practice framework can be applied to professionals participating in collaborative care planning (II), exploring which attributes contribute to making the collaborative care planning process work for all participants (III) and exploring documented collaborative care plans (IV). 

The design of the studies were a single – instrumental qualitative case study (I), explorative deductive approach (II), qualitative explorative with a grounded theory approach (III) and explorative descriptive approach (IV). Using different methodologies, data were collected through interviews with older adults, their care partners and health and social care professionals, focus group discussion with health and social care managers, observations of collaborative care planning conferences and documented collaborative care plans. Data were analysed with qualitative case study, qualitative content analysis, constructivist grounded theory and content analysis.

Older adults wanted to be actively engaged in decision-making processes regarding their care and services. However, the professionals had challenges in carrying out the collaborative care planning process (I). Collaborative care planning and person-centred practice was a complex process that needed to take into account system factors both on macro- and micro level (II). A joint philosophy, an ethic, could facilitate and guide professionals in everyday practice (III). The collaborative care plans had poor quality, insufficient content and lack of personcentredness (IV). Further research is needed to understand the role of the documented collaborative plan and the best way of working to make the collaborative care planning process and collaborative care plan person-centred. To gain a deeper understanding of the studies (I – IV) results an interpreted synthesis were conducted resulting in two common threads, personhood and power asymmetry. The two common threads were discussed using philosophy and Paul Ricoeur’s (1994) “little ethics”. The collaborative care planning process has to be seen in a larger context for it to be person-centred. All levels, the older adult and their care partners, the professionals and the organizations, need to be permeated of ethics and human values, and these have to be visible in every action and practice. Health and social care are relational practices and organizations. During the collaborative care planning the professionals, the older adults, and their care partners become interwoven. By using reciprocity and balancing the different dimensions and perspectives, the plan, their relationships and the organizations can improve. 

In conclusion, the thesis highlight the importance of ethics, relationships and reciprocity during the collaborative care planning process. The philosophical texts by Ricoeur expand the perspectives and contribute to a greater understanding of the collaborative care planning process as a person-centred practice.

Aim

To explore how person‐centred practice framework can be applied to professionals participating in collaborative planning.

Design

An explorative, deductive approach.

Method

Eleven professionals from health care and social care participated in the study. A deductive content analysis was performed using a framework for person‐centred practice for the analysis.

Results

Practicing person‐centred care and collaborative planning is a complex process that needs to take into account system factors on both the macro‐ and the microlevel. Everyone working within the system needs to apply the same approach. Using a framework analysis offered new insights into how person‐centred care is expressed in practice during collaborative planning between the patient, and healthcare and social care professionals.

Introduction

Living with whiplash‐associated disorders (WAD) means living every day under the influence of pain and limitations. As the incidence of WAD and the related intensity of pain are somewhat higher among women than men, the aim of the present study was to describe women's experiences of living with WAD.

Methods

A purposive sample of seven women participated in individual in‐depth qualitative interviews, the transcripts of which were subjected to qualitative content analysis.

Results

The results of the analysis suggested six themes of women's experiences with WAD: living with unpredictable pain; trying to manage the pain; living with limitations; being unable to work as before; needing support and understanding; and learning to live with limitations. The findings showed that unpredictable pain limited women's strength to engage in activities of daily life and be as active as before. Support and understanding were important for their ability to manage changes in their daily lives.

Conclusions

Pain considerably affects the daily lives of women with WAD, particularly by limiting their ability to perform activities and to enjoy their professional and social lives. As women with WAD need support with managing their daily lives, nurses and other healthcare personnel should adopt a person‐centred approach, in order to support such women according to their individual needs and circumstances.

Integrating health care services has proven to be important from both the patient and organizational perspectives. This study explores what defines a perceived well-functioning collaboration in the inter-organizational process of providing assistive devices in Sweden. Two focus groups comprising participants with profound knowledge of collaboration were performed, and data were analyzed in five steps, resulting in a data structure. Results yield the identification of three interacting processes: coordinating efforts to patient needs, ensuring evidence-based practice, and planning for efficient use of resources. These processes affected one another, and, therefore, would likely not have been effectively managed separately. The study contributes to theories of process management and organization by specifically focusing on how to analyze and improve sustainable collaboration in health care processes at both the management and professional levels. Theoretical frameworks that show different ways of organizing collaboration, as well as the concepts of action nets and boundary objects, can support both analysis and planning of collaboration. The intention would be to develop integration in inter-organizational health care processes, resulting in more person-centered care.

Purpose: To explore interpersonal relationships within online educational spaces and to connect the discussion to health and well-being among students and teachers. Method: We apply different perspectives to analyse the complexity of interpersonal relationships in online educational spaces, based on the philosophies of Nel Nodding, Maurice Merleau-Ponty, and Alfred Schutz. We use a qualitative methodological combination—philosophical explorations, literature review, and text analysis—to offer significant insights that will substantially inform contemporary theories in research addressing interpersonal relationships in online education. Results: We illuminate and theorize about interpersonal relationships in terms of being cared for, confirmed by, and connected to others as dimensions of significance for health and well-being in educational spaces in the form of flexible online courses at the university level. Conclusion: We argue that all education should strive to provide caring relationships and educate for both self-understanding and group understanding, and contribute to school as a place where happiness and joy for genuine learning and knowledge are promoted. To achieve this, it is of significance to also be connected to and confirmed by others, teachers as well as students, and also to exist in a (class)room that provides room for interpersonal relationships: in real life or online.

The rate of mental ill health has increased among children and youth during the past decade in Scotland and Sweden. School is important in influencing both health and education. The starting point for health promotion in school involves those who are affected, the students. The aim of this study was to describe and understand how mental health can be promoted in school from the perspective of young people. A total of 14 Scottish and Swedish young people aged 15–21, 11 girls and 3 boys from 3 municipalities, participated in 4 focus groups. The phenomenological analysis resulted in one main theme: Everyone is being there for each other encompassing three themes without any relative order of precedence: being in a safe, inclusive, and well-informed space; meeting adults who are available, listening, and taking action; and feeling significant and being of significance to others. Based on these findings, we suggest the following aspects to be essential when aiming to promote mental health in schools: (1) value and appreciate young people’s experiences, (2) view everyone in school regardless of age or profession to be an important piece in the mental health promotion puzzle by adopting a “whole school approach,” (3) foster a listening culture that focuses on building enabling relationships, (4) promote health and learning simultaneously to increase health literacy, (5) educate about mental health to minimize stigma and increase confidence in taking appropriate action.

A challenge facing the Arctic region is the disengagement of both education and work among its youth. Only by supporting young people who are struggling with mental and physical health challenges can we begin to address this societal challenge. Education, mental health and social inclusion are prominent factors for future employment, income and independent living for young people. The aim of this study was to describe and understand the experiences of good conditions for health and learning in schools in the Arctic region. The 5-D appreciative inquiry method was used to explore 47 students’ and professionals’ experiences and future visions of their school. A phenomenological analysis resulted in three themes: “Standing as one”, “Having an apple a day”, and “Finding the end of the rainbow”. The findings revealed the necessity of promoting health and learning simultaneously in school and viewing health holistically. Health-promoting relationships permeate the findings of good conditions for health and learning. We argue for considering mandatory health education to increase students’ health literacy and making student participation and staff collaboration a priority in schools in the Arctic region. These findings, their practical implications, and future research directions are discussed.

The aim was to increase the understanding for students' experiences of mental health and their suggestions on how mental health can be promoted in school. A secondary analysis was performed of data from four previous studies with a total of 76 students, 36 boys 40 girls, 10-21 years. The analysis resulted in three themes; School feels open minded, We have invigorating relationships and I feel safe and acknowledged. The students described a school with a salutogenic perspective in which mental ill-health is acknowledged and accepted. They emphasized the importance of adults taking responsibility for health-promoting relationships. The students wished to feel good enough and appreciate predictable structures and positive expectations from adults. Participatory processes at the organizational, group and individual levels are discussed and practical implications are suggested.

The prevalence of asthma is higher in Sweden and Finland than in neighbouring eastern countries including Estonia. Corresponding difference in bronchial eosinophilic inflammation could be studied by F_ENO measurements. We aimed to compare F_ENO in adult general populations of Sweden, Finland, and Estonia, to test the plausibility of the west-east disparity hypothesis of allergic diseases.

We conducted clinical interviews (N = 2658) with participants randomly selected from the general populations in Sweden (Stockholm and Örebro), Finland (Helsinki), and Estonia (Narva and Saaremaa), and performed F_ENO (n = 1498) and skin prick tests (SPT) in 1997–2003.

The median (interquartile range) of F_ENO (ppb) was 15.5 (9.3) in Sweden, 15.4 (13.6) in Finland and 12.5 (9.6) in Estonia. We found the lowest median F_ENO values in the Estonian centres Saaremaa 13.1 (9.5) and Narva 11.8 (8.6). In the pooled population, asthma was associated with F_ENO ≥25 ppb, odds ratio (OR) 3.91 (95% confidence intervals: 2.29–6.32) after adjusting for SPT result, smoking, gender and study centre. A positive SPT test increased the likelihood of asthma OR 3.19 (2.02–5.11). Compared to Saaremaa, the likelihood of having asthma was higher in Helsinki OR 2.40 (1.04–6.02), Narva OR 2.45 (1.05–6.19), Örebro OR 3.38 (1.59–8.09), and Stockholm OR 5.54 (2.18–14.79).

There was a higher prevalence of asthma and allergic airway inflammation in adult general populations of Sweden and Finland compared to those of Estonia. Atopy and elevated F_ENO level were independently associated with an increased risk of asthma. In conclusion, the findings support the earlier west-east disparity hypothesis of allergic diseases.

Visualization and expression of health-related experiences and conditions by young migrants from five different countries residing in Sweden were examined in this study. Using photovoice, the participants were invited to describe and discuss their experiences in three stages: (a) document and portray their everyday lives by taking pictures, (b) discuss their findings, and (c) present their views on health to the adults who are present in their everyday life and that are important for improving young migrants’ health conditions. The overall findings indicate that temporal, spatial, and social conditions are important for the well-being of these young migrants. Thus, in order for the young migrants to feel well in a new cultural context, a search for meaning and meaningfulness in relation to time, place, and other people was important. These findings are discussed in light of social, mental, and existential health dimensions and in relation to the selected study methods.