Swedish Health Care Research Articles

Risk of pre-eclampsia after gastric bypass: a matched cohort study.

To investigate whether gastric bypass before pregnancy is associated with reduced risk of pre-eclampsia. Nationwide matched cohort study. Swedish national health care. A total of 843 667 singleton pregnancies without pre-pregnancy hypertension were identified in the Swedish Medical Birth Register between 2007 and 2014, of which 2930 had a history of gastric bypass and a pre-surgery weight available from the Scandinavian Obesity Surgery Registry. Two matched control groups (pre-surgery and early-pregnancy body mass index [BMI]) were propensity score matched separately for nulliparous and parous births, to post-gastric bypass pregnancies (npre-surgery-BMI = 2634:2634/nearly-pregnancy-BMI = 2766:2766) on pre-surgery/early-pregnancy BMI, diabetes status (pre-surgery/pre-conception), maternal age, early-pregnancy smoking status, educational level, height, country of birth, delivery year and history of pre-eclampsia. Pre-eclampsia categorised into any, preterm onset (<37+0 weeks) and term onset (≥37+0 weeks). In post-gastric bypass pregnancies, mean pre-surgery BMI was 42.9 kg/m2 and mean BMI loss between surgery and early pregnancy was 14.0 kg/m2 (39 kg). Post-gastric bypass pregnancies had lower risk of pre-eclampsia compared with pre-surgery BMI-matched controls (1.7 versus 9.7 per 100 pregnancies; hazard ratio [HR] 0.21, 95% CI 0.15-0.28) and early-pregnancy BMI-matched controls (1.9 versus 5.0 per 100 pregnancies; HR 0.44, 95% CI 0.33-0.60). Although relative risks for pre-eclampsia for post-gastric bypass pregnancies versus pre-surgery matched controls was similar, absolute risk differences (RD) were significantly greater for nulliparous women (RD -13.6 per 100 pregnancies, 95% CI -16.1 to -11.2) versus parous women (RD -4.4 per 100 pregnancies, 95% CI -5.7 to -3.1). We found that gastric bypass was associated with lower risk of pre-eclampsia, with the largest absolute risk reduction among nulliparous women. In this large study including two comparison groups matched for pre-surgery or early-pregnancy BMI, gastric bypass was associated with lower risk of pre-eclampsia.

Swedish translation and cross-cultural adaptation of eight pediatric item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS)\xae

BackgroundThis study is part of the Swedish initiative for the establishment of standardized, modern patient-reported measures for national use in Swedish healthcare. The goal was to translate and culturally adapt eight pediatric Patient-Reported Outcomes Measurement Information System (PROMIS®) item banks (anger, anxiety, depressive symptoms, family relationships, fatigue, pain interference, peer relationships and physical activity) into Swedish.MethodsAuthorization to translate all currently available pediatric PROMIS item banks (autumn, 2016) into Swedish was obtained from the PROMIS Health Organization. The translation followed the Functional Assessment of Chronic Illness Therapy translation recommendations with one major modification, which was the use of a bilingual multi-professional review workshop. The following steps were applied: translation, reconciliation, a two-day multi professional reviewer workshop, back translation, and cognitive debriefing with eleven children (8–17 years) before final review. The bilingual multi-professional review workshop provided a simultaneous, in-depth assessment from different professionals. The group consisted of questionnaire design experts, researchers experienced in using patient-reported measures in healthcare, linguists, and pediatric healthcare professionals.ResultsAll item banks had translation issues that needed to be resolved. Twenty-four items (20.7%) needed resolution at the final review stage after cognitive debriefing. The issues with translations included 1. Lack of matching definitions with items across languages (6 items); 2. Problems related to language, vocabulary, and cultural differences (6 items); and 3. Difficulties in adaptation to age-appropriate language (12 items).ConclusionsThe translated and adapted versions of the eight Swedish pediatric PROMIS item banks are linguistically acceptable. The next stage will be cross-cultural validation studies in Sweden. Despite the fact that there are cultural differences between Sweden and the United States, our translation processes have successfully managed to address all issues. Expert review groups from already-established networks and processes regarding pediatric healthcare throughout the country will facilitate the future implementation of pediatric PROMIS item banks in Sweden.

Risk of venous thromboembolism in a Swedish healthcare system during the COVID-19 pandemic: A retrospective cross-sectional study.

ObjectiveThe objective of this study was to investigate the risk and prevalence of venous thromboembolism (VTE) for patients undergoing a diagnostic test for VTE with confirmed COVID‐19 infection compared with patients with no COVID‐19 infection.MethodsThis was a retrospective cross‐sectional study of patients in an integrated healthcare system in Sweden, covering a population of 465,000, with a diagnostic test for VTE between March 1 and May 31 in the years 2015 to 2020. Risk for VTE with COVID‐19 was assessed by logistic regression, adjusting for baseline risk factors.ResultsA total of 8702 patients were included, and 88 of those patients tested positive on the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) polymerase chain reaction test. A positive SARS‐CoV‐2 test did not increase the odds for VTE (odds ratio, 0.97; 95% confidence interval [CI], 0.55–1.74) and did not change when adjusting for sex, previous VTE, previous malignancy, Charlson score, hospital admission, intensive care, or ongoing treatment with anticoagulation (odds ratio, 0.72; 95% CI, 0.16–3.3). The prevalence of VTE was unchanged in 2020 compared with 2015 to 2019 (16.5% vs 16.1%, respectively), and there was no difference in VTE between the SARS‐CoV‐2 positive, negative, or untested groups in 2020 (15.9%, 17.6%, and 15.7%, respectively; P = 0.85).ConclusionsWe found no increased prevalence of VTE in the general population compared with previous years and no increased risk of VTE in patients who were SARS‐CoV‐2 positive, suggesting that SARS‐CoV‐2 status should not influence VTE workup in the emergency department. The prevalence of VTE was high in patients with SARS‐CoV‐2 treated in the intensive care unit (ICU), where the suspicion for VTE should remain high.

“It’s about Living Like Everyone Else”: Dichotomies of Housing Support in Swedish Mental Health Care

The deinstitutionalization of psychiatric care has not only altered the living conditions for people with severe mental illness but has also greatly affected social services staff. In the Mental Health Act launched by the Swedish government in 1995, a new kind of service called ‘housing support’ and a new occupational group, ‘housing support workers,’ was introduced. However, housing support does not currently operate under any specific guidelines regarding the content of the service. This study explores housing support at local level in various municipalities of one Swedish county. The data is based on discussion with three focus groups: care managers, managers for home and community‐based support, and housing supporter workers. The perspective of institutional logics as a specific set of frames that creates a standard for what should or could be done, or alternately what cannot be questioned, is applied to analyze the constructed meaning of housing support. The meaning of housing support is constructed through three dichotomies: process and product, independence and dependence, and flexibility and structure. These dichotomies can be understood as dilemmas inherent in the work and organizing of housing support. With no clear guidelines, the levels of organizational and professional discretion create a space for local flexibility but may also contribute to tremendous differences in defining and implementing housing support. We discuss the potential consequences for housing support users implied by the identified discrepancies.

The Swedish Elderly and Psychiatric Healthcare as Models: An Investigation into the Social Importance of Healthcare and Biomedical Science Research

The Swedish Elderly and Psychiatric Healthcare as Models: An Investigation into the Social Importance of Healthcare and Biomedical Science Research

The effect of user interface on treatment engagement in a self-guided digital problem-solving intervention: A randomized controlled trial

BackgroundResources are spent worldwide on the development of digital platforms and their user interfaces (UIs) for digital mental health services (DMHS). However, studies investigating the potential benefits of different UIs for DMHS are currently lacking. To fill this knowledge gap, the aim of this study was to investigate differences in treatment engagement between two different UIs for DMHS. MethodsA total of 397 participants from the Swedish general public were randomized (1:1) to use a self-guided digital problem-solving intervention during one week, either with an optimized UI (N = 198), based on user experience (UX) design principles and with automated features, or a basic UI (N = 199), analogous with a UI used in Swedish regular health care comprising elementary UI features and less automation. Primary outcome measures were self-rated usability, on the System Usability Scale, and treatment credibility, on the Credibility/Expectancy Questionnaire. Secondary outcome measures included behavioral engagement with the intervention. FindingsThere were no significant differences between the UIs in ratings of usability or treatment credibility. However, participants who used the optimized UI were significantly more engaged with the intervention as measured by usage of the intervention at least once (odds ratio 2.54, 95% CI [1.67, 3.85]), total number of generated solutions (mean difference 1.41, 95% CI [0.72, 2.11]), and mean number of generated solutions per initiated problem-solving attempt (mean difference 1.45, 95% CI [1.06, 1.85]). Other findings included participants using the optimized UI rating the intervention as easier to understand, while feeling more overwhelmed, than those using the basic UI. InterpretationOur findings indicate that an optimized UI based on UX design principles, in comparison to a basic UI comprising elementary UI features, do not affect overall self-rated usability or treatment credibility but increases some measures of behavioral engagement with a digital intervention. FundingFunded by the Government of Sweden, Ministry of Health and Social Affairs.

A national Swedish case-control study investigating incidence and factors associated with idiopathic intracranial hypertension

ObjectiveTo study the incidence of idiopathic intracranial hypertension in Sweden and to explore whether previously proposed risk factors are associated with idiopathic intracranial hypertension by investigating the odds of exposure one year prior to diagnosis in patients compared to controls.MethodsUsing Swedish health care registers and validated diagnostic algorithms, idiopathic intracranial hypertension patients diagnosed between 2000–2016 were compared with randomly selected matched controls, five from the general population and five with obesity.ResultsWe identified 902 idiopathic intracranial hypertension patients and 4510 matched individuals in each control group. Mean incidence among inhabitants ≥18 years of age was 0.71 per 100,000; rising from 0.53 in 2000–2005 to 0.95 in 2012–2016. There were increased odds for idiopathic intracranial hypertension patients compared to general population for exposure to: kidney failure (odds ratio =13.2 (4.1–42.0)), arterial hypertension (odds ratio =17.5 (10.5–29.3)), systemic lupus erythematosus (odds ratio =13.8 (4.3–44.7)), tetracyclines, sulphonamides, lithium, and corticosteroids. In obese controls, odds ratios were also significantly increased for these exposures. Hormonal contraceptive use and exposure to pregnancy did not appear to be associated factors for idiopathic intracranial hypertension development.ConclusionsThe incidence of idiopathic intracranial hypertension in Sweden is lower relative to reports from other countries but is on the rise. This case-control study confirms several previously reported risk factors associated with idiopathic intracranial hypertension.

Barriers to accessing health care among undocumented migrants in Sweden - a principal component analysis

BackgroundUndocumented migrants face many hardships in their everyday life such as poor living conditions, discrimination, and lack of access to healthcare. Previous studies have demonstrated considerable health care needs for psychiatric disorders as well as physical diseases. The aim of this paper was to find out the main barriers that undocumented migrants experience in accessing the Swedish healthcare system and to explore their relation with socioeconomic factors.MethodsA cross-sectional study with adult undocumented migrants was performed in the three largest cities of Sweden in 2014–2016. Sampling was done via informal networks. A socioeconomic questionnaire was constructed including 22 barriers to health care. Trained field workers conducted the interviews. A principal component analysis was conducted of all barriers to reveal central components. Then, Pearson’s chi-squared test was used to explore the characteristics of undocumented migrants experiencing barriers to care.ResultsTwo main components/barriers were extracted: “Fear of being taken by police/authorities”, which was related to fear of disclosure by or in relation to seeking health care, and “Structural and psychosocial factors” which was related to practical obstacles or shame of being ill. Lower age (74.1 % vs 56.0 %), lower level of education (75.0 % vs. 45.1 %), and having no children (70.3 % vs. 48.1 %) were significantly related to a higher likelihood of experiencing a barrier.ConclusionFear of deportation and practical and psychosocial factors constitute hinderance of access to healthcare for undocumented migrants in Sweden. This highlights the importance of clear instructions, both to undocumented migrants and health professionals about the right to health care according to the international law on human rights as well as the law of confidentiality.

Communicating the Implementation of Open Notes to Health Care Professionals: Mixed Methods Study.

BackgroundThe literature on how to communicate reform in organizations has mainly focused on levels of hierarchy and has largely ignored the variety of professions that may be found within an organization. In this study, we focus on the relationship between media type and professional responses.ObjectiveThe objective of this study was to investigate whether and how belonging to a profession influences the choice of communication media and the perception of information when a technical innovation is implemented in a health care setting.MethodsThis study followed a mixed methods design based on observations and participant studies, as well as a survey of professionals in psychiatric health care in Sweden. The χ2 test was used to detect differences in perceptions between professional groups.ResultsThe use of available communication media differed among professions. These differences seem to be related to the status attached to each profession. The sense-making of the information appears to be similar among the professions, but is based on their traditional professional norms rather than on reflection on the reform at hand.ConclusionsWhen communicating about the implementation of a new technology, the choice of media and the message need to be attuned to the employees in both hierarchical and professional terms. This also applies to situations where professional employees are only indirectly affected by the implementation. A differentiated communication strategy is preferred over a downward cascade of information.

Validation of the diagnosis of eosinophilic esophagitis based on histopathology reports in Sweden.

BackgroundEosinophilic esophagitis (EoE) is a relatively new diagnosis, where until recently a specific international classification of disease code was missing. One way to identify patients with EoE is to use histopathology codes. We validated the clinicopathological EoE diagnosis based on histopathology reports and patient charts to establish these data sources as the basis for a nationwide EoE patient cohort.MethodsThrough the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) study, we randomly selected 165 patients from five Swedish health care regions with a histopathologic diagnosis of EoE. Patients were assigned a histopathology diagnosis of EoE if they had ≥15 eosinophils per high-power field or, in the absence of eosinophil quantification, the pathologist interpreted the biopsy as consistent with EoE. Patient charts were scrutinized to see if the other diagnostic criteria were fulfilled. Of the 131 received patient charts, 111 (85%) had sufficient information to be included in the study.ResultsOf the 111 validated patients, 99 had EoE, corresponding to a positive predictive value of 89% (95% confidence interval = 82–94%). Dysphagia was the most common symptom (n = 78, 70%), followed by food impaction (n = 64, 58%) and feeding difficulties (n = 37, 33%). Twelve patients had coexisting asthma (11%) and 16 allergic rhinitis (14%). Seventeen patients underwent esophageal dilatation (15%), of which seven had more than one dilatation. Ninety-seven (87%) patients had a proton-pump inhibitor treatment ≤2 years before or after the diagnosis. Forty-two patients (38%) had been prescribed inhalation steroids and 64 (58%) had undergone esophageal radiology.ConclusionHistopathology reports from the ESPRESSO cohort with esophageal eosinophilic inflammation are suggestive of EoE.

Team-based visits within Swedish child healthcare services: a national cross-sectional study

ABSTRACT Complex healthcare needs can be met through effective interprofessional collaboration. Since 2014, Swedish Child Healthcare Services (CHS) include universal team-based visits with a nurse and a physician who perform such visits at the age of 4 weeks, 6 months, 12 months, and 2.5 to 3 years, as well as targeted team-based visits to address additional needs. The aim of this study was to describe the prevalence of team-based visits in the Swedish CHS and possible associations between team-based visits and contextual factors that may affect its implementation. A national cross-sectional survey was conducted using a web-based questionnaire distributed to all reachable nurses, physicians, and psychologists (n =3,552) engaged in the CHS. Data were analyzed using descriptive statistics and binary and multivariate logistic regressions. The response rate was 32%. Team-based visits were reported by 82% of the respondents. For nurses and physicians, the most frequent indication was specific ages, while for psychologists it was to provide parental support. Respondents working at Family Centers were more likely to perform team-based visits in general, at 2.5 to 3 years and in case of additional needs, compared to respondents working at Child Health Centers (CHC) and other workplaces. In conclusion, team-based visits are well implemented, but the pattern differs depending on the contextual factors. Targeted team-based visits and team-based visits at the age of 2.5 to 3 years are most unequally implemented.

Validation of the diagnosis of eosinophilic esophagitis based on histopathology reports in Sweden

Background: Eosinophilic esophagitis (EoE) is a relatively new diagnosis, where until recently a specific international classification of disease code was missing. One way to identify patients with EoE is to use histopathology codes. We validated the clinicopathological EoE diagnosis based on histopathology reports and patient charts to establish these data sources as the basis for a nationwide EoE patient cohort.&#x0D; Methods: Through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) study, we randomly selected 165 patients from five Swedish health care regions with a histopathologic diagnosis of EoE. Patients were assigned a histopathology diagnosis of EoE if they had ≥15 eosinophils per high-power field or, in the absence of eosinophil quantification, the pathologist interpreted the biopsy as consistent with EoE. Patient charts were scrutinized to see if the other diagnostic criteria were fulfilled. Of the 131 received patient charts, 111 (85%) had sufficient information to be included in the study.&#x0D; Results: Of the 111 validated patients, 99 had EoE, corresponding to a positive predictive value of 89% (95% confidence interval = 82–94%). Dysphagia was the most common symptom (n = 78, 70%), followed by food impaction (n = 64, 58%) and feeding difficulties (n = 37, 33%). Twelve patients had coexisting asthma (11%) and 16 allergic rhinitis (14%). Seventeen patients underwent esophageal dilatation (15%), of which seven had more than one dilatation. Ninety-seven (87%) patients had a proton-pump inhibitor treatment ≤2 years before or after the diagnosis. Forty-two patients (38%) had been prescribed inhalation steroids and 64 (58%) had undergone esophageal radiology.&#x0D; Conclusion: Histopathology reports from the ESPRESSO cohort with esophageal eosinophilic inflammation are suggestive of EoE.

Association between bacterial finding, antibiotic treatment and clinical course in patients with pharyngotonsillitis: a registry-based study in primary healthcare in Sweden

BackgroundThe role of non-group A streptococci and Fusobacterium necrophorum in pharyngotonsillitis has been disputed and few prospective studies have evaluated the effect of antibiotic treatment. This study uses registry data to investigate the relation between antibiotic prescription for pharyngotonsillitis in primary healthcare and return visits for pharyngotonsillitis, complications, and tonsillectomy.MethodsRetrospective data were extracted from the regional electronic medical record system in Kronoberg County, Sweden, for all patients diagnosed with pharyngotonsillitis between 2012 and 2016. From these data, two cohorts were formed: one based on rapid antigen detection tests (RADT) for group A streptococci (GAS) and one based on routine throat cultures for β-haemolytic streptococci and F. necrophorum. The 90 days following the inclusion visit were assessed for new visits for pharyngotonsillitis, complications, and tonsillectomy, and related to bacterial aetiology and antibiotic prescriptions given at inclusion.ResultsIn the RADT cohort (n = 13,781), antibiotic prescription for patients with a positive RADT for GAS was associated with fewer return visits for pharyngotonsillitis within 30 days compared with no prescription (8.7% vs. 12%; p = 0.02), but not with the complication rate within 30 days (1.5% vs. 1.8%; p = 0.7) or with the tonsillectomy rate within 90 days (0.27% vs. 0.26%; p = 1). In contrast, antibiotic prescription for patients with a negative RADT was associated with more return visits for pharyngotonsillitis within 30 days (9.7% vs. 7.0%; p = 0.01). In the culture cohort (n = 1 370), antibiotic prescription for patients with Streptococcus dysgalactiae ssp. equisimilis was associated with fewer return visits for pharyngotonsillitis within 30 days compared with no prescription (15% vs. 29%; p = 0.03).ConclusionsAntibiotic prescription was associated with fewer return visits for pharyngotonsillitis in patients with a positive RADT for GAS but with more return visits in patients with a negative RADT for GAS. There were no differences in purulent complications related to antibiotic prescription.

Artificial intelligence and the medical physics profession - A Swedish perspective.

There is a continuous and dynamic discussion on artificial intelligence (AI) in present-day society. AI is expected to impact on healthcare processes and could contribute to a more sustainable use of resources allocated to healthcare in the future. The aim for this work was to establish a foundation for a Swedish perspective on the potential effect of AI on the medical physics profession. We designed a survey to gauge viewpoints regarding AI in the Swedish medical physics community. Based on the survey results and present-day situation in Sweden, a SWOT analysis was performed on the implications of AI for the medical physics profession. Out of 411 survey recipients, 163 responded (40%). The Swedish medical physicists with a professional license believed (90%) that AI would change the practice of medical physics but did not foresee (81%) that AI would pose a risk to their practice and career. The respondents were largely positive to the inclusion of AI in educational programmes. According to self-assessment, the respondents' knowledge of and workplace preparedness for AI was generally low. From the survey and SWOT analysis we conclude that AI will change the medical physics profession and that there are opportunities for the profession associated with the adoption of AI in healthcare. To overcome the weakness of limited AI knowledge, potentially threatening the role of medical physicists, and build upon the strong position in Swedish healthcare, medical physics education and training should include learning objectives on AI.

Findings from a large study investigating the association between atopic dermatitis and autoimmune diseases

British Journal of DermatologyVolume 185, Issue 2 p. e39-e39 Plain Language SummaryFree Access Findings from a large study investigating the association between atopic dermatitis and autoimmune diseases First published: 16 August 2021 https://doi.org/10.1111/bjd.20531AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Abstract Linked Article: Ivert et al. Br J Dermatol 2021; 185:335–342. Atopic dermatitis (AD) is one of the most common chronic skin disorders globally and causes dry skin and recurrent itchy lesions. The proportion of people who have AD during a 1-year period is about 17% among adults and 23% among children. Some studies have shown that AD is associated with autoimmune diseases. Autoimmune diseases occur when the body’s immune system attacks its own healthy cells and tissues. The aim of our study was to investigate the association between AD and autoimmune disease among Swedish patients aged 15 years or older. We used data from Swedish national healthcare registers and compared over 100,000 individuals diagnosed with AD with just over a million people from the healthy population who did not have AD. This is, to our knowledge, the largest study within this field. We found that adults with AD were more often diagnosed with autoimmune diseases compared with adults without AD. Autoimmune disorders involving the skin, the stomach or gut (such as Crohn disease, coeliac disease and ulcerative colitis), or the connective tissue (such as bones, tendons or ligaments) were most commonly associated with AD. In patients with more than one autoimmune disease, the association grew stronger with each additional disease. Greater awareness, screening and monitoring of autoimmune diseases can help ensure patients receive appropriate treatment and may also provide greater knowledge about AD. Further studies are needed, especially to identify patients with AD who are at higher risk for autoimmune diseases, and to explore if AD severity and treatment may affect the associations we found. Volume185, Issue2August 2021Pages e39-e39 RelatedInformation

Persistence of antidepressant use among refugee youth with common mental disorder

BackgroundThe objective of this study was to investigate whether persistence of antidepressant use differs between refugee youth and Swedish-born youth after a diagnosis of a common mental disorder (CMD), and if clinical and sociodemographic factors are associated with antidepressant discontinuation. MethodsYouth aged 16-25 years, with an incident diagnosis of CMD (depression, post-traumatic stress disorder (PTSD), anxiety disorders) accessing specialized healthcare in Sweden 2006-2016 were included. New users were identified with a one-year washout period. Refugees (N=1575) were compared with Swedish-born youth (N=2319). Cox regression models [reported as adjusted Hazard Ratios (HRs) with 95% confidence intervals (CIs)] were used to investigate factors associated with discontinuation of antidepressant use. ResultsAmong youth (mean age 20.9 years, SD 2.7, 50% females), the median duration of antidepressant use differed considerably between refugee (101 days, IQR 31-243) and Swedish-born youth (252 days, IQR 101-558). Refugees were more likely to discontinue treatment (HR 1.61, 95% CI 1.47-1.77). Factors associated with an increased risk for discontinuation in refugees included ≤5 years duration of formal residency (HR 1.28, 95% CI 1.12-1.45), antidepressant type, and dispensing lag (time from prescription to dispensing) of >7 days (1.43, 1.25-1.64), whereas PTSD (0.78, 0.64-0.97) and anxiolytic use (0.79, 0.64-0.96) were associated with a lower discontinuation risk. LimitationsOnly persons treated in specialized healthcare could be included. ConclusionThe relatively short treatment durations among refugee youth suggest that antidepressant treatment may not be optimal in CMD, and better monitoring of treatment as well as transcultural education of healthcare personnel are warranted.

Patients’ experiences of malpractice in psychotherapy and psychological treatments: a qualitative study of filed complaints in Swedish healthcare

ABSTRACT Malpractice issues in psychotherapy and psychological treatments refer to the unethical behavior of a psychologist or psychotherapist toward the patient. The current study reviewed complaints directed at psychologists and psychotherapists in Sweden with regard to possible incidents of malpractice. Eligible cases were retrieved from a database managed by the Health and Social Care Inspectorate [Inspektionen för vård och omsorg (IVO)], an administrative authority responsible for the safety and quality of healthcare and social services delivery. These cases were analyzed using thematic analysis. In total, 33 complaints matched the keywords proposed by IVO, and were scrutinized in detail. The cases primarily involved psychiatric care by a psychologist in outpatient settings, although many cases comprised multiple healthcare providers responsible for the patient’s care, or targeted the healthcare unit as a whole. The results demonstrated that different forms of malpractice occur, and can be classified in two general themes, Incorrect administration and implementation and Attitude and behavior, which involve organizational aspects as well as examples of malpractice and unethical behavior. Implications for clinical practice and future research include further training in ethics and malpractice, video recording or auditing sessions, routine outcome monitoring, and providing patients with information on how to file complaints.

The value of interdisciplinary treatment for sickness absence in chronic pain: A nationwide register-based cohort study.

Interdisciplinary treatment (IDT) is an internationally recommended intervention for chronic pain, despite inconclusive evidence of its effects on sickness absence. With data from 25,613 patients in Swedish specialist healthcare, we compared sickness absence, in the form of both sick leave and disability pensions, over a 5-year period between patients either allocated to an IDT programme or to other/no interventions (controls). To obtain population-average estimates, a Markov multistate model with theory-based inverse probability weights was used to compute both the proportion of patients on sickness absence and the total sickness absence duration. IDT patients were more likely than controls to receive sickness absence benefits at any given time (baseline: 49% vs. 46%; 5-year follow-up: 36% vs. 35%), and thereby also had a higher total duration, with a mean (95% CI) of 67 (87, 48) more days than controls over the 5-year period. Intriguingly, sick leave was higher in IDT patients (563 [552, 573] vs. 478 [466, 490] days), whereas disability pension was higher in controls (152 [144, 160] vs. 169 [161, 178] days). Although sickness absence decreased over the study period in both IDT patients and controls, we found no support for IDT decreasing sickness absence more than other/no interventions in chronic pain patients. In this large study of chronic pain patients in specialist healthcare, sickness absence is compared over a 5-year period between patients in an interdisciplinary treatment programme and other/no interventions. Sickness absence decreased over the study period in bothgroups; however, there was no support forthat it decreased more with interdisciplinary treatment than alternative interventions.

Defibulated immigrant women’s sexual and reproductive health from the perspective of midwives and gynaecologists as primary care providers in Sweden – A phenomenographic study

ObjectiveTo capture care providers’ perceptions of defibulated immigrant women’s sexual and reproductive health, illuminated by their experiences as care providers for these women. MethodsIndividual interview study with 13 care providers at Swedish healthcare facilities: six gynaecologists and seven midwives caring for defibulated immigrant women, analysed with a phenomenographic method. FindingsOne of the care providers’ perceptions of women who had been defibulated was that they had an altered genital function, meaning a wider introitus, improved vaginal intercourse, and more ease urinating and menstruating. The care providers also perceived that women who were defibulated had to balance their wellbeing, struggling between a positive self-image and handling their emotions. Existing in-between cultural values led to a fear of being excluded while at the same time having a desire to be included in the new culture. ConclusionDefibulation affects women’s sexual and reproductive health and calls for a holistic perspective when providing services, individualized according to the woman’s care needs. Support and counselling, should include information about defibulation already during the adolescent years to promote sexual and reproductive health and well-being.

Shift and night work during pregnancy and preterm birth-a cohort study of Swedish health care employees.

BackgroundPrevious studies of preterm birth (PTB) concerning night work have been inconclusive and partly limited by imprecise data on working schedules. This study investigated the risk of PTB in relation to detailed, registry-based data on working hours.MethodsIn a register-based prospective cohort study, we identified 4970 singleton births with information on PTB from the Swedish Medical Birth Register of health care employees in Stockholm. Day-by-day information on working hours 2008–16 was obtained from a computerized employee register. Odds ratios (ORs) of PTB according to work hour characteristics were analysed by logistic regression adjusted for mother’s age, stature, body mass index (BMI), parity, smoking habits, education, profession and country of birth.ResultsThere was an increased risk of PTB among those who frequently worked night shifts (>25 times) [OR, 1.62; 95% confidence interval (CI), 1.03–2.53] and who ever worked ≥3 consecutive night shifts (OR, 1.43; 95% CI, 1.03–1.99) during the first trimester. Frequently (> 8 times) working 3 or more consecutive nights, and frequently (>18 times) having quick returns from night shifts (<28 h) during the first trimester showed 3–4 fold increased risk of PTB. Moreover, working frequent (>20 times) long shifts (≥10 h) (OR 1.63; 95% CI, 1.07–2.49) during the first trimester and working any Week >40 h (OR 2.05; 95% CI, 1.31–3.22) during the third trimester were associated with PTB.ConclusionsIn this cohort of Swedish health care employees with registry-based data on working hours, night work, especially working frequent consecutive nights, and quick returns from night shifts during the first trimester were associated with increased risk of PTB among pregnant women.