Swedish Health Care Research Articles

Exercise capacity after long-term physical activity on prescription provided by physiotherapists

Background: Research has shown that physical activity on prescription (PAP), used in Swedish healthcare, increases patients’ physical activity, but data are lacking regarding the long-term effects of PAP on exercise capacity. Therefor exercise capacity was evaluated in patients with metabolic risk factors, after 4.5 years of PAP treatment provided by physiotherapists in primary healthcare. Method: This study included 98 patients (49% women; mean age, 56 years) with metabolic risk factors, who were still physically inactive after a previous 6-month PAP treatment. The patients received physiotherapist-provided PAP treatment for 4.5 years, including 11 follow-ups and 6 exercise capacity tests. Results: After 4.5 years, 41 patients completed the final exercise capacity test (58% drop-out rate). Compared to baseline, the whole cohort exhibited a significantly increased exercise capacity (9.1 W, p = 0.014) with a small effect size (r = 0.27), with no significant differences associated with age or gender. Conclusion: The increased exercise capacity may indicate positive effects on longevity, and consolidates previous findings that long-term behavior change is possible among physically inactive patients. It also demonstrates the feasibility of continuous exercise capacity testing with physiotherapist support in an ordinary primary care setting. The drop-out rate and lack of control group complicate the interpretation of the effects of PAP treatment on the increased exercise capacity. Further research should strive for an RCT study design.

Swedish Women’s Health Promotion: A Social Anthropologist’s Perspective

The article presents an analysis of Swedish reproductive policy within the context of socio-economic factors, women’s health concerns, and approaches to maternal and child healthcare in Sweden. The author examines the evolution of social consciousness and practices related to motherhood and childcare, tracing the transition from traditional worldly and social norms and rules, which involved strict observance of religious dogmas, to new forms of family structure and conscious planning of reproductive behavior within families. The author considers the need to address the demographic challenges facing the country as an important motivation for the Swedish social policy since the 1930s. It is evident that economic growth and positive changes in the socio-economic environment have played a key role in the success of the ‘family’ policy. The social rights and opportunities of Swedish citizens, including the implementation of programs aimed at women’s health, have been guaranteed by the state. The implementation of state family policy has facilitated enhanced opportunities and accessibility for Swedish women, enabling them to develop their own life strategies, not only in the labor market but also in the context of their own health. Significant components of this social policy encompass implementation of suitable reproductive policies and material assistance to diverse categories of families, whether engaged in labor market activities or childcare responsibilities.

Swedish Version of the System Usability Scale: Translation, Adaption, and Psychometric Evaluation.

The Swedish health care system is undergoing a transformation. eHealth technologies are increasingly being used. The System Usability Scale is a widely used tool, offering a standardized and reliable measure for assessing the usability of digital health solutions. However, despite the existence of several translations of the System Usability Scale into Swedish, none have undergone psychometric validation. This highlights the urgent need for a validated and standardized Swedish version of the System Usability Scale to ensure accurate and reliable usability evaluations. The aim of the study was to translate and psychometrically evaluate a Swedish version of the System Usability Scale. The study utilized a 2-phase design. The first phase translated the System Usability Scale into Swedish and the second phase tested the scale's psychometric properties. A total of 62 participants generated a total of 82 measurements. Descriptive statistics were used to visualize participants' characteristics. The psychometric evaluation consisted of data quality, scaling assumptions, and acceptability. Construct validity was evaluated by convergent validity, and reliability was evaluated by internal consistency. The Swedish version of the System Usability Scale demonstrated high conformity with the original version. The scale showed high internal consistency with a Cronbach α of .852 and corrected item-total correlations ranging from 0.454 to 0.731. The construct validity was supported by a significant positive correlation between the System Usability Scale and domain 5 of the eHealth Literacy Questionnaire (P=.001). The Swedish version of the System Usability Scale demonstrated satisfactory psychometric properties. It can be recommended for use in a Swedish context. The positive correlation with domain 5 of the eHealth Literacy Questionnaire further supports the construct validity of the Swedish version of the System Usability Scale, affirming its suitability for evaluating digital health solutions. Additional tests of the Swedish version of the System Usability Scale, for example, in the evaluation of more complex eHealth technology, would further validate the scale.

A participatory process in all aspects? Negotiating agreements within Swedish healthcare (*)

ABSTRACT This article deals with agreements within healthcare in Sweden, a unitary state where responsibility for healthcare is decentralized to 21 regions with self-rule. The agreements are concluded by the central government and the Swedish Association of Local Authorities and Regions (SALAR). The literature categorizes agreements as a ‘soft’ policy instrument with participation as a crucial aspect. We investigate the process behind the agreements and focus on the participation of SALAR. Our material consists of interviews with respondents of SALAR and the Ministry of Health and Social Affairs. The findings suggest that the process is participatory, but not in all aspects. Differences are noticed during various phases. A conclusion is that the power relationship between the central government and SALAR is unequal. The results contribute to a more nuanced understanding of central–local relations in the era of multi-level governance, highlighting a power hierarchy.

Epidemiology of New Psychoactive Substances in Relation to Traditional Drugs of Abuse in Clinical Oral Fluid Samples

ABSTRACTNew psychoactive substances (NPS) are health‐hazardous through unpredictable toxicity and effects and largely unknown epidemiology, motivating studies of the latter.Up to 138 NPS were retrospectively identified using liquid chromatography‐high resolution mass spectrometry data from all 34 183 oral fluid drug samples collected in one Swedish health care region 2019–2020 representing 9468 psychiatric and addiction care patients. In total, 618 findings representing 58 NPS were detected in 481 samples from 201 patients. Male gender and age ≥25 years correlated positively with NPS use. Ketamine correlated positively with all NPS classes except cannabinoids; additionally, fentanyl, methadone, tapentadol and clonazepam correlated with multiple NPS classes. More numerous traditional drugs of abuse (DoA) correlated positively with sedative/hypnotic NPS, indicating that these are used in broader patient groups than other NPS. Mitragynine correlated negatively with other NPS in general and with several traditional DoA, but positively with the potential opioid abstinence remedies buprenorphine, loperamide and tapentadol aside from ketamine. In conclusion, NPS use is infrequent but occur also at higher ages, certain traditional DoA and particularly ketamine could have clinical value as NPS use signals, and mitragynine exhibited an atypical NPS consumption pattern indicating significant use as an opioid abstinence remedy.

The need for acute assessments in home healthcare - Swedish registered nurses’ experiences

ABSTRACT Purpose The study aims to describe Swedish RNs’ experiences of acute assessments at home. More patients with complex nursing needs are cared for at home due to an ageing population. Registered nurses (RNs) who work with home healthcare need a broad medical competence and clinical experience alongside adapted decision support systems for maintaining patient safety in acute assessments within home healthcare. Methods A content analysis of qualitative survey data from RNs (n = 19) working within home healthcare in Sweden. Results There were challenges in the acute assessments at home due to a lack of competence since several of the RNs did not have much experience working as an RN in home healthcare. Important information was missing about the patients, such as access to medical records due to organizational challenges and limited access to equipment and materials. The RNs needed support in the form of cooperation with a physician, support from colleagues, and a decision support system. Conclusion To increase the possibility of patient-safe assessments at home, skills development, collegial support, and an adapted decision support system are needed. Collaboration with primary healthcare, on-call physicians, and nursing staff, and having the opportunity to consult with someone also provide security in acute assessments.

Bacterial growth and antimicrobial resistance in urinary Escherichia coli isolates among men with lower UTI in Swedish primary healthcare: retrospective data over a 4 year period.

Escherichia coli, the most common bacterium causing urinary tract infections (UTIs), is increasingly reported as resistant to multiple antibiotics. Swedish surveillance data from hospital and primary health care (PHC) report a 17%-19% prevalence of resistance to ciprofloxacin in E. coli from urine cultures in men over 20 years of age. Surveillance data may include nosocomial infections. However, few studies have described resistance in E. coli in men with community-acquired UTI in PHC. We aimed to describe the microbiological results, including antibiotic resistance in E. coli, in men with lower UTI (LUTI) attending PHC. In this retrospective study based on information from electronic medical records, we included patients from 289 PHC centres. For all men aged 18-79 years diagnosed with LUTI in PHC from January 2012 to December 2015, we extracted data on age, UTI diagnosis and results from urine cultures. A total of 17 987 episodes of lower UTI were identified. E. coli was detected in 62% of positive cultures and 63% of detected E. coli isolates were susceptible to all tested antimicrobials. Resistance in E. coli to the first-choice antibiotics pivmecillinam and nitrofurantoin were 2% and 1%, respectively. Resistance to ciprofloxacin was 9%, and to trimethoprim it was 17%. Resistance levels for ciprofloxacin in E. coli among men with LUTI in PHC were lower than in surveillance data. The results of this study point to the importance of surveillance of resistance in urine samples from patients with LUTI in PHC in order to choose the right empirical antibiotic treatment.

Barriers to establishing teledermatoscopy in primary health care in Sweden

IntroductionTeledermatoscopy (TDS) has proven to be effective and reliable for diagnosis of skin malignancies. The factors that determine the success of implementation of TDS are largely unknown.ObjectivesTo investigate barriers to implementation of TDS in primary health care (PHC) at center and individual level.MethodsFollowing introduction of TDS, cross-sectional quantitative data and free text comments were collected by surveys sent to PHC centers and PCH practitioners. Successful implementation was defined as regularly sent cases at center level and self-reported usage at individual level. Factors associated with implementation were evaluated with Chi-square, Kruskal-Wallis test and logistic regression.Results93/117 (78.2%) of PHC centers and 239/725 (32.9%) of PHC practitioners answered the surveys. 54.8% (n = 51) of PHC centers and 64.3% (n = 153) of PHC practitioners had implemented TDS.There was a strong association between hardware arrival before introduction and TDS usage at center level (OR 6.0; 95% CI 1.5–24.3). At individual level, male sex was positively associated with usage (OR 1.9; 95%, CI 1.0–3.4), and for every year of increased age, the chance of using TDS decreased with 3% (OR 1.0, 95% CI 0.9–1.0). No other factor was associated with implementation. “Good” was the most common overall impression (54.8%), and the majority found no problems using the system (> 85%). The most common complaint was technical issues followed by no added value.ConclusionsSuccessful implementation of TDS was strongly associated with hardware arrival at center level, and to male sex and younger age at individual level. Satisfaction was overall high.

Practices Related to Bladder Catheterisation Among Swedish Health Professionals: A Questionnaire Survey

ABSTRACTBladder catheterisation is an invasive procedure that must adhere to precise guidelines established by authorities, hospitals or nursing associations to prevent or minimise associated complications. Research indicates that a significant portion of infections could be averted through dedicated periodic training, monitoring of adherence, optimising workloads and innovating in the development of products designed to mitigate risks or enhance ease of use. This study aims to explore the behaviour of nurses in Sweden concerning bladder catheterisation. An anonymous survey was distributed to groups of nurses in Swedish hospitals and healthcare centres. The survey was designed by an expert nurse team and was meticulously prepared and reviewed by a Swedish physician to ensure content validity, comprehension and clarity. A total of 910 nurses participated in the survey. When questioned about whether they are supervised for guidelines compliance when inserting a urinary catheter, 42.0% admitted to not doing so. In fact, only 9.3% of the respondents claimed that they always receive assistance from a colleague during the catheterisation procedure. Nearly 90% of the participants indicated that they could not consistently maintain sterility during catheter insertion, with the primary source of stress being time pressure during the procedure (21.3%). Among those surveyed, 70.4% acknowledged that, in their last 10 catheter insertions, they inadvertently spilt urine on materials at least once, while 27.7% reported spillage on the bedding and 16.5% on individuals. When asked about the potential advantages of a new catheter with an integrated valve, the most significant advantage cited was the reduced risk of urine leakage (63.0%), followed by the convenience of not having to connect a urine bag or plug (52.1%), and the improved ease of collecting urine samples (42.3%). Only 4.9% of respondents did not identify any potential advantages of this device. The correlation analysis showed an inverse relationship between both the level of stress and experience in bladder catheterisation (Spearman's correlation coefficient = −0.413, p value < 0.001) and the level of stress and the frequency of external help during the catheterisation process (Spearman's correlation coefficient = −0.265, p value < 0.001). The study's findings reveal a lack of supervision during catheterisation and the excessive workload or understaffing that often compels nurses to perform the procedure without the assistance of a colleague. These factors may underlie the insufficient adherence to guidelines and protocols, which can result in errors during insertion, thereby increasing the risk of non‐aseptic insertion and occupational hazards. It appears essential to invest in organisational changes, provide continuous training for their staff and prioritise the development and innovation of new devices to aid healthcare workers in catheter management or addressing the issue of CAUTI from a multifactorial perspective.

Occupational therapists’ experiences of intra-professional collaboration during the discharge process from inpatient care to home healthcare

Introduction Swedish healthcare has undergone significant changes since the transferral of home healthcare from a regional to municipal responsibility, and since the new 2018 law regulating discharge from hospital. This meant changes to ways of working for Occupational Therapists (OTs), as OTs play a key role in planning for discharging patients, a crucial process before patients return home, and in the transition between care givers. Aim The aim of this study is to illuminate how OTs experience the intra-professional collaboration during the discharge process between inpatient care and home healthcare. Methods Interviews were conducted with OTs (N = 12), with even distribution between inpatient care and home healthcare, in three geographical locations in Sweden. Data analysis was performed according to qualitative content analysis. Results A central theme ran through all categories; the multi faces of intra-professional communication are challenging, intertwined and emotional. The categories illuminate experiences in terms of important but neglected patient participation and safety, different forms of mind-set depending on setting, complex rapid communication, unpredictable paths of discharge, unclear responsibility and organisational guidelines and, impact on work health and OT emotions. Conclusion Intra-professional communication is complex with many aspects and perspectives of importance for collaboration to run smoothly, but also the many individuals involved in the collaboration process of discharging a patient. This situates high demands on the professionals involved to distinguish and identify necessary information to make the discharge sound and safe for patient, as well as for relatives, involved services, and manageable for OTs.

EHealth Literacy and Health-Related Internet Use Among Swedish Primary Health Care Visitors: Cross-Sectional Questionnaire Study.

Digitalization has profoundly transformed health care delivery, especially within primary health care, as a crucial avenue for providing accessible, cost-effective care. While eHealth services are frequently highlighted for improving health care availability and promoting equality, it is essential to recognize that digitalization can inadvertently exclude individuals who lack the prerequisites to use eHealth services, that is, those with low eHealth literacy. Previous research has identified lower eHealth literacy among older individuals, those with lower educational levels, and those who use the internet less frequently. However, in a Swedish context, only a few studies have investigated eHealth literacy. This study investigated eHealth literacy and its association with health-related internet use and sociodemographic characteristics among primary health care visitors. This cross-sectional study used a quantitative, descriptive approach. Swedish-speaking patients visiting a primary health care center participated by answering the multidimensional eHealth Literacy Questionnaire (eHLQ) and questions regarding sociodemographic characteristics and internet usage. The study compared mean scores using the Mann-Whitney U test and the Kruskal-Wallis test. A logistic regression analysis also explored the associations between eHealth literacy and significant independent variables identified in the univariate analyses. As a group, the 172 participants rated highest in understanding and engagement with their health (median eHLQ score 3, IQR 2.8-3.4), as well as in feeling secure about the confidentiality of eHealth services (median eHLQ score 3, IQR 2-3), while they rated lower in motivation to use eHealth (median eHLQ score 2.6, IQR 2-3), the suitability of eHealth services to their personal needs (median eHLQ score 2.75, IQR 2-3), and their perceived ability to understand and use health-related internet information (median eHLQ score 2.6, IQR 2-3). The logistic regression analysis identified that lower eHealth literacy was associated with older age, particularly in domains related to finding, understanding, and using health-related internet information (odds ratio [OR] 1.02, 95% CI 1-1.05; P=.03); digital technology use (OR 1.05, 95% CI 1.02-1.08; P<.001); and accessing well-functioning eHealth services (OR 1.02, 95% CI 1-1.05; P=.03). Additionally, in the logistic regression analysis, perceiving health-related internet information as not useful was linked to lower literacy in all eHLQ domains except one. Our findings regarding the primary challenges within our sample underscore the importance of developing and tailoring eHealth services to accommodate users' individual needs better, enhancing motivation for eHealth use, and continuing efforts to improve overall health literacy. These measures, which both eHealth developers and health care professionals should consider, are crucial for addressing the digital divide and expanding access to eHealth services for as many people as possible.

Information access and COVID-19 vaccination hesitancy among foreign-born persons in Sweden – a focus group interview-study

BackgroundIn most countries, lower rates of COVID-19 vaccination have been observed in foreign-born individuals, yet little is known about the underlying reasons, especially as reported by these individuals themselves. This exploratory interview study investigated lack of information access and hesitancy towards taking the COVID-19 vaccine among foreign-born individuals in Sweden.MethodsWe used purposive sampling to recruit foreign-born adults who expressed being hesitant towards getting vaccinated, as well as health guides and doulas who were assigned to spread COVID-19 related information in immigrant-dense urban areas. Data were collected using semi-structured focus group interviews, which were transcribed verbatim and analysed according to systematic text condensation.ResultsThree focus group interviews were conducted with altogether eleven participants. One group consisted of health guides/doulas, while the participants in the other groups were gainfully employed in other jobs, or full-time students, or housewives. Four main themes emerged: (1) Language barriers and sociocultural differences, (2) Consequences of not using official Swedish information, (3) Decision-making on COVID-19 vaccination, and (4) Suggestions to improve information dissemination. The lack of information in other languages than Swedish and lack of effective information channels resulted in that most participants barely used information from official Swedish health care and public health institutions. Instead, they relied on social media, social contacts and international media, through which contradictive and negative information about the vaccine was spread. The decision to get vaccinated or not became a process fraught with insecurities about the effectiveness and side effects of the vaccine, which was balanced against wishing to be protected and to contribute to the battle against COVID-19. The participants suggested that information dissemination could be improved by producing a multilingual information outreach and to increase the use of transmission through social interaction with trusted persons and platforms.ConclusionsAn inadequately adapted information strategy prevented some members of the society from making fact-based decisions about getting vaccinated. Several suggestions for improving dissemination were brought forth that can be tested in future communication strategies.

Nurses' Experiences of Communicating With Families in Municipal Home Health Care.

To illuminate nurses' experiences of communicating with families in home health care. A qualitative inductive approach. An increasing number of ageing and sick people are being granted home health care. Nurses' duties involve caring for both patients and their families, which includes the important task of meeting and talking with them. Fourteen registered nurses working in home health care in Sweden participated in individual narrative semistructured interviews. The interviews were analysed with content analysis. To make sure all components of the study were clear, the Standards for Reporting Qualitative Research checklist was used as a guide. Communication with families was viewed as a crucial action for building rapport to facilitate the involvement and support of families in difficult situations. The nurses highlighted the struggles they sometimes faced in communication when they found it difficult to reach the family. When the communication was supportive for the family, the nurses felt that they were empowering the family members to empower themselves. This study highlights the vital role of communication in home health care nursing. Effective communication fosters trust and enables nurses to meet family needs. Effective communication between nurses and families in home health care is crucial from a health care perspective. Building reciprocal relationships fosters trust, enabling nurses to efficiently identify and address family needs and enhancing the quality of care. No patient or public contribution.

Accessing the Lived Experiences of Children with Illness in Sweden for Health Care Research.

Children are a relatively marginalized group when doing research in the context of illness, young children particularly so. This even though children can and should contribute their point of view in providing evidence-based care. This article contributes the experiences of Nurse Researchers in gathering research data in Sweden on the lived experiences of children undergoing needle-related medical procedures, living with home mechanical ventilation or undergoing treatment for cancer. Nine published articles from four unique Swedish PhD dissertations in Caring Science formed the basis for the present paper where various open and critical qualitative approaches for gathering data were used. Accessing and interpreting the lived experiences of ill children in healthcare research presents methodological, ethical, and cultural challenges. As with health care contexts in other countries, capturing the ill child's experiences in Sweden requires several different methods. Health researchers in Sweden must navigate a complex landscape of communication barriers, emotional and psychological challenges, and structural issues within the healthcare system to effectively access and understand the lived experiences of children. This paper adds to the knowledge base of research with a focus on gathering the experiences of children with illness within a Swedish health care context. These insights underscore the importance for all researchers of using child-friendly, inclusive methods to understand children's lived experiences thus ensuring their voices are heard and respected in health research. Children's and families' inability to speak the native language of a country cannot be a hinder for inclusion, but rather be encouraged.

Is the diagnosis and treatment of depression gender-biased? Evidence from a population-based aging cohort in Sweden

BackgroundAs compared to men, older women´s higher rates of depression diagnosis and antidepressant use are widely reported. We aimed to: a) explore whether there is a potential gender bias in the clinical diagnosis of depression and antidepressant prescription in an older population from Stockholm; and 2) analyze if such gender bias differs by patients’ age and socioeconomic status.MethodsWe used data from the Swedish National Study on Aging and Care in Kungsholmen, SNAC-K (N = 2,941). We compared gender differences in: (a) clinical diagnosis of depression according to the Swedish National Patient Register (ICD-10 codes F32-F34; F412) (“register-based diagnosis”); (b) SNAC-K-based diagnosis of depression, partially gender-blind, using the Comprehensive Psychopathological Rating Scale (CPRS) and the DSM-IV-TR (“SNAC-K based diagnosis); and (c) antidepressant use (ATC code N06A). To analyze the magnitude of the gender bias in the register-based diagnosis of depression and in antidepressant use, and the role of potential moderating factors, prevalence ratios (PR) were calculated using Poisson regression models. Models were run separately by age and social class.ResultsWomen had a 63% higher probability of having a register-based diagnosis of depression (PR = 1.63[1.23–2.15]) and a 79% higher probability of using antidepressants (PR = 1.79[1.34–2.40]). No gender differences were observed in the SNAC-K-based diagnosis of depression. The gender differences in the register-based diagnosis were narrowed, although remained significant, after considering age, depressive symptoms, and health services use (PR = 1.44[1.10–1.88]), as well as the register-based diagnosis in the case of antidepressant use (PR = 1.31[1.04–1.64]). This gender bias was larger among the younger-old and the most advantaged social class.ConclusionA gender-bias was identified in the diagnosis and treatment of depression in older adults within the Swedish healthcare setting, which could imply that health services may be contributing to the medicalization of women’s mental health. Gender-sensitive clinical and public health interventions are essential to reduce gender disparities in mental healthcare, also in old age.

Qualitative exploration of 3D printing in Swedish healthcare: perceived effects and barriers

BackgroundThree-dimensional (3D) printing produces objects by adding layers of material rather than mechanically reducing material. This production technology has several advantages and has been used in various medical fields to, for instance, improve the planning of complicated operations, customize medical devices, and enhance medical education. However, few existing studies focus on the adoption and the aspects that could influence or hinder the adoption of 3D printing.ObjectiveTo describe the state of 3D printing in Sweden, explore the perceived effects of using 3D printing, and identify barriers to its adoption.MethodsA qualitative study with respondents from seven life science regions (i.e., healthcare regions with university hospitals) in Sweden. Semi-structured interviews were employed, involving 19 interviews, including one group interview. The respondents were key informants in terms of 3D printing adoption. Data collection occurred between April and May 2022 and then between February and May 2023. Thematic analysis was applied to identify patterns and themes.ResultsAll seven regions in Sweden used 3D printing, but none had an official adoption strategy. The most common applications were surgical planning and guides in clinical areas such as dentistry, orthopedics, and oral and maxillofacial surgery. Perceived effects of 3D printing included improved surgery, innovation, resource efficiency, and educational benefits. Barriers to adoption were categorized into organization, environment, and technology. Organizational barriers, such as high costs and lack of central decisions, were most prominent. Environmental barriers included a complex regulatory framework, uncertainty, and difficulty in interpreting regulations. Technological barriers were less frequent.ConclusionsThe study highlights the widespread use of 3D printing in Swedish healthcare, primarily in surgical planning. Perceived benefits included improved surgical precision, innovation, resource efficiency, and educational enhancements. Barriers, especially organizational and regulatory challenges, play a significant role in hindering widespread adoption. Policymakers need comprehensive guidance on 3D printing adoption, considering the expensive nature of technology investments. Future studies could explore adoption in specific clinical fields and investigate adoption in non-life science regions within and outside Sweden.

Contextualising the job demands-resources model: a cross-sectional study of the psychosocial work environment across different healthcare professions.

The deteriorating psychosocial work environment among healthcare workers in Sweden, influenced by demanding working conditions and resource constraints, affects individual well-being and patient care quality. Healthcare workers, including physicians, registered nurses, and nursing assistants, often work interdependently and share workplaces, yet are three completely different professions. Nonetheless, comprehensive studies comparing their psychosocial work environments are scarce; often focusing on healthcare workers either separately or as a homogenous group, but rarely comparative. Utilising the job demands-resources model, this study investigated variations in the psychosocial work environment among Swedish healthcare workers. We wanted to identify how the antecedents of individual well-being, in the form of demands and resources, differed between healthcare workers. Data from the 2022 Longitudinal Occupational Health Survey for Health Care in Sweden were analysed; the participants included 7589 physicians, registered nurses, and nursing assistants. The analysis involved descriptive statistics, including measures of means and analysis of covariance (ANCOVA), employing the Bonferroni correction for multiple post hoc comparisons. The ANCOVA was also stratified by working factors, including years of work experience and employment within the private/public sector. The study revealed significant variations in how healthcare workers perceive their psychosocial work environment. Physicians faced the highest level of Quantitative Demands (mean (x̄) 3.15; 95% CI 3.11-3.19), while registered nurses reported the most Emotional Demands (x̄ 3.37; 95% CI 3.32-3.41). Nursing assistants had the highest grand means for the imbalance between Efforts and Rewards (Effort Reward Imbalance) (x̄ 1.49; 95% CI 1.49-1.49) and an imbalance between Work and Private Life (Work-Life Interference) (x̄ 3.20, 95% CI 3.15-3.25), along with limited resources. The stratified analysis showed that years of experience and the sector affected healthcare workers' perceptions of their psychosocial working environment. For example, registered nurses working in the private sector reported better working conditions thanregistered nurses working in the public sector. The situation for nursing assistants was reversed. Psychosocial work environments are experienced differently between and within healthcare professions in Sweden. This study provides crucial insights for improving workplace conditions and consequently enhancing healthcare professionals' well-being and quality of patient care.

Cost-effectiveness analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at low risk of surgical mortality in Sweden.

Transcatheter aortic valve implantation (TAVI) has shown similar or improved clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis at low risk for surgical mortality. This cost-utility analysis compared TAVI with SAPIEN 3 versus SAVR in symptomatic severe aortic stenosis patients at low risk of surgical mortality from the perspective of the Swedish healthcare system. A published, two-stage, Markov-based cost-utility model that captured clinical outcomes from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated according to Recommended Therapies (SWEDEHEART) registry (2018-2020) was adapted from the perspective of the Swedish healthcare system using local general population mortality, utility and costs data. The model had a lifetime horizon. Model outputs included changes in direct healthcare costs and health-related quality of life from using TAVI as compared with SAVR. TAVI with SAPIEN 3 resulted in lifetime costs per patient of 940,541 Swedish krona (SEK) and lifetime quality-adjusted life years (QALYs) per patient of 7.16, whilst SAVR resulted in lifetime costs and QALYs per patient of 821,380 SEK and 6.81 QALYs, respectively. Compared with SAVR, TAVI offered an incremental improvement of +0.35 QALY per patient at an increased cost of +119,161 SEK per patient over a lifetime horizon, resulting in an incremental cost-effectiveness ratio of 343,918 SEK per QALY gained. TAVI with SAPIEN 3 is a cost-effective option versus SAVR for patients with symptomatic severe aortic stenosis at low risk for surgical mortality treated in the Swedish healthcare setting. These findings may inform policy decisions in Sweden for the management of this patient group.

I had to tell to survive“- a cross-sectional study on exposure to intimate partner violence in pregnant women and the importance of screening

BackgroundThere is a lack of knowledge in Swedish healthcare regarding correlations of exposure to intimate partner violence (IPV) from before to during pregnancy, and associated factors as well as pregnant women’s perceptions related to screening for IPV in healthcare settings. The frequency of women exposed to IPV during pregnancy is difficult to establish as it is reported at different rates across different studies, depending on the definitions and screening strategies used. Aims1. Describe prevalence of IPV experienced by pregnant women. 2. Investigate changes in IPV exposure before and during pregnancy. 3. Examine frequency of screening and women’s opportunities and willingness to talk about IPV exposure. Methods.A cross-sectional survey in Stockholm, Sweden. Findings6.2 % of women (n = 202) reported exposure to IPV before pregnancy and 2.1 % (n = 72) reported exposure during pregnancy, of these, sixteen women reported exposure only during pregnancy. There were significant associations between exposure to IPV and symptoms of depression, age, living situations and employment status. Sixty-four percent of the exposed women were asked about violence in healthcare settings. DiscussionAn important finding was that the frequency of IPV decreased from before to during pregnancy. The reasons for this are unknown but may be multi-factorial. ConclusionOur investigation provides crucial insights into IPV during pregnancy. Results highlight that relying solely on prevalence rates is inadequate to understand the complexity of IPV exposure related to pregnancy. Screening for IPV and understanding how women perceive and disclose their exposure is complex yet vital for midwives in antenatal care.

Photo-supported conversations about well-being (BeWellTM) for patients with exhaustion disorders – a controlled clinical intervention study

Introduction Health-promotion approaches to address stress-related exhaustion disorders, reduce personal suffering, improve coping and participation in everyday life are needed in primary care. The aim of this study was to investigate self-reported health and well-being before and after an intervention focusing on well-being with photo-supported conversations (BeWellTM). Material and methods Eighty-one patients (69 women), 20–67 years old, with exhaustion disorders were recruited at Swedish primary health care centres (PHCC) to a controlled clinical study. The intervention group (n = 40) were offered BeWell™ by therapists in addition to care as usual. Controls (n = 41) received only care as usual. The primary outcome, self-rated symptoms of exhaustion (Karolinska exhaustion disorder scale, KEDS), and secondary outcomes, anxiety and depression, sense of coherence, quality of life, occupational balance, and work ability, were assessed by validated questionnaires. Non-parametric statistical analyses were used to compare data collected directly after the treatment period with baseline measures. Results Demographics and self-rated baseline measures of health and well-being were comparable between the groups, apart from sick leave being more common in the intervention group. Participants in the intervention group reduced their level of exhaustion more than the control group (median difference on KEDS −9.0 vs −4.0, p = .035). However, the size of the KEDS reduction was related to baseline KEDS and, not independently associated with group assignment. Both groups improved regarding secondary outcome measures. Conclusion Stress-related symptoms decreased considerably over the treatment period for both groups. The potential benefit of the BeWell™, which was intended to facilitate recovery, needs to be further evaluated.