Western Sweden Research Articles

Experienced critical incidents affecting lead-times in the stroke care chain for low-priority patients – A qualitative study with critical incident technique

BackgroundThe time elapsing from the alarm being raised to arrival at the stroke unit is crucial for patients suffering a conceivable stroke. More knowledge is needed about critical incidents—both favourable and unfavourable—affecting the lead time in the care chain. AimTo explore favourable and unfavourable critical incidents (CIs), affecting lead times in the care chain from the alerted ambulance to the stroke unit, as experienced by nurses, for low-priority patients suffering a conceivable acute stroke. MethodThe study had an explorative descriptive design using a qualitative approach of Flanagan's Critical Incident Technique (CIT). Twenty-two nurses involved in the stroke care chain at a hospital in western Sweden were interviewed about their experiences regarding CIs influencing the lead time for low-priority patients. ResultsThere were 363 CIs identified related to human interactions and organizational structures. The types of CIs varied depending on where in the care chain they were experienced. Both favourable and unfavourable factors had an impact on the length of the lead time from alerted ambulance to stroke unit for lowpriority patients. Furthermore, CIs occurring both early and later in the care chain affected the whole process. ConclusionsThere is a need for greater understanding within each interrelated department in the care chain about how CIs at one part of the care chain have an impact on another.

Recurrent and persistent infection with SARS-CoV-2 – epidemiological data and case reports from Western Sweden, 2020

Background Reinfections with SARS-CoV-2 have been reported and most cases were classified as mild. Reports of persistent infection with SARS-CoV-2 are rare. Aim To investigate the frequency of recurrent and persistent infection with SARS-CoV-2. Methods Possible cases of reinfection and persistent infection were retrospectively identified in a database of 59,998 patients. Deep sequencing of SARS-CoV-2 genomes was performed. Results We report the first case of COVID-19 reinfection in Sweden and three cases of infection with persistence over several months. The rate of sequencing-verified reinfection was 0.02% (one patient out of 6014 patients testing positive during the period). Conclusions The reinfected patient had mild symptoms during the second episode, which might reflect partial immunity. The frequency of reinfection during the first wave of the pandemic in western Sweden was very low. Our results indicate that elderly with a putative reinfection more likely have persistent COVID-19.

The “Big Ship” of Wismar: a well-preserved 12th-century cargo vessel from the harbour of Wismar

In December 2017, maritime archaeologists from the state department for archaeology in Mecklenburg Western Pomerania excavated, recovered, and documented a shipwreck in the seaport of Wismar. The wreck of a clinker-built cargo vessel was one of three medieval vessels found during the extension of the commercial port. With riveted outer planking and the presence of bitis, the wreck can be placed in the Nordic shipbuilding tradition. The results of the dendrochronological analysis show that the vessel was built from oak and pine sourced from western Sweden in the period AD 1184–1190. The construction shows striking similarities with a number of large 12th-century cargo vessels found in northern Germany and Scandinavia.

The Korshamn wreck: preliminary investigations of a Nordic clinker-carvel “hybrid” from the late 12th century, and some thoughts on medieval cargo handling

During 2016, several undocumented shipwreck sites were exposed on the sandy shores of Halland, western Sweden. One of the most interesting finds is situated in the shallow bay of Korshamn, close to the medieval town of Falkenberg. A limited test excavation revealed a clinker-built vessel over 13 m long. Dendrochronological analysis suggests that the vessel was built shortly after 1168 from Scandinavian wood. Even though it clearly conforms to contemporaneous Scandinavian ship building practices, there are certain features that appear highly unusual. This paper presents the preliminary results of the excavation. In addition, the kar phenomenon of southern Scandinavia is briefly discussed.

The cerebral palsy panorama study in western Sweden: More associated impairments in cerebral palsy observed.

The cerebral palsy panorama study in western Sweden: More associated impairments in cerebral palsy observed.

Predicting arctic-alpine lake dissolved oxygen responses to future tree line advance at the Swedish forest-tundra transition zone.

High latitude regions of the globe are experiencing higher warming rates than many other areas and are expected to undergo dramatic change with future warming (Carpenter et al., 2011; Kuhn et al., 2021). One such change is the poleward advance of tree line into prior tundra environments. While nominally a terrestrial ecosystem change, this advance may dramatically alter aquatic ecosystems, with lakes in particular being highly responsive to events that occur in the surrounding landscape. Klaus et al. (2021) address this important issue by using a space-for-time substitution across 40 Swedish arctic-alpine lakes to understand how a transition from tundra to forested watersheds will influence lake dissolved oxygen (DO).

The use of coping strategies \u201cshift-persist\u201d mediates associations between physical activity and mental health problems in adolescents: a cross-sectional study

BackgroundSelf-perceived mental health problems among adolescents has had an upward trend. Concurrently, adolescents’ physical activity (PA) has been falling whilst sedentary time (SED) has increased. There is a lack of research using accelerometer measured PA and SED to study their relationships to perceived stress and psychosomatic symptoms, both frequently observed mental health problems among adolescents. Whether coping strategies is one of the mechanisms underlying such relationship is less clear.MethodsA total of 2283 13-year olds were enrolled in the baseline examination of the STARS (STudy of Adolescence Resilience and Stress) study in Western Sweden. Light-, moderate-, vigorous-intensity PA (LPA, MPA and VPA) and SED were measured using hip-worn ActiGraph GT3X+ accelerometer. A total of 1284 adolescents provided valid accelerometer data (at least 4 days with ≥10 h per day). PA and SED during school-time and leisure-time were analysed separately. Surveys were utilized to monitor perceived stress, psychosomatic symptoms and the use of coping strategies “shift-persist”. Logistic regression and mediation analyses were performed adjusting for gender, ethnicity, socioeconomic status and puberty development.ResultsWe observed that more time spent in PA was associated with less stress in adolescents. The associations were observed for LPA (Odds ratio for LPA per 60 min: 0.557 (95% CI 0.399–0.776), VPA (Odds ratio for VPA per 15 min: 0.688 (95% CI 0.588–0.806) and MVPA (Odds ratio for MVPA per 15 min: 0.795 (95%CI 0.718–0.879) during leisure time, but not during school time. Similar associations were observed between leisure time PA and psychosomatic symptoms. The associations remained statistically significant even after adjusting for the confounders. Further, our data showed that adolescents who engaged more time in PA during leisure time were more likely to adopt the coping strategies of “shift-persist”. Mediation analysis showed that the use of “shift-persist” mediated the associations between leisure time PA and stress/psychosomatic symptoms.ConclusionsLeisure time physical activity, irrespective of intensity, may facilitate successful coping with stress and stress-related mental health problems in adolescents.

Impact of COVID-19 pandemic on mental health and health behaviors in Swedish adolescents.

Aims: There is an urgent need to explore the impact of the COVID-19 pandemic on adolescent mental health and health behaviours. To date, there are no such studies on Swedish adolescents. As COVID-19 emerged in the middle of our ongoing 2-year follow-up examination of the Study of Adolescence Resilience and Stress, we had the unique opportunity to use the corona outbreak as a ‘natural experiment’ to study the impact of COVID-19 on 15-year-old adolescents in Sweden. Methods: Adolescents (baseline age 13.6±0.4 years) were recruited from schools in western Sweden (during the COVID-19 outbreak schools were kept open for those under 16 years of age). The COVID-19 pandemic reached Sweden on 31 January 2020. A total of 1316 adolescents answered the 2-year follow-up survey before (unexposed to COVID-19 pandemic, controls) and 584 after 1 February 2020 (COVID19-exposed). Data on stress, psychosomatic symptoms, happiness, relationships with parents and peers, school and health behaviours were collected. Results: Adolescents reported higher levels of stress and psychosomatic symptoms and lower levels of happiness at follow-up compared to baseline. These changes occurred to a similar extent in both the control and COVID-19-exposed groups. Likewise, the COVID-19-exposed group showed no deterioration in peer relations or relations with parents versus controls. We did not find any significant differences between groups regarding sleep duration and physical activity. Conclusions: Swedish adolescents exposed to COVID-19 during most of 2020 showed no differences in longitudinal changes in mental health, relationships with parents and peers, and health behaviours compared to those not exposed to COVID-19.

A qualitative study of nurses’ experiences of self-care counseling in migrant patients with heart failure

ObjectivesThis study aims to enhance researchers’ and nurses’ understanding of how to best support migrant patients with heart failure in self-care management. Previous research on self-care in heart failure patients has highlighted its importance, particularly among migrant populations. Nurses play an important role in informing and engaging patients with chronic conditions like heart failure to support their active participation in self-care. However, nurses’ experiences of providing self-care counseling to migrant populations with heart failure have not been studied. MethodsA qualitative study was conducted. Nurses working with migrant patients with HF (n = 13) from different types of facility in Western Sweden were interviewed between October and December 2020. Data were collected using semi-structured interviews and analyzed using inductive thematic analysis. ResultsThe main theme that emerged from the interviews was the difficulty for nurses “to find balance” in self-care counseling. The nurses during self-care counseling had: “to accept challenges,” “to use creative strategies,” faced “problems related to health literacy,” and “to work according to their (the nurses’) obligations.” It was evident that nurses faced several challenges in counseling migrants in self-care, including language and cultural barriers, time resource constraints, low levels of health literacy, and experienced disharmony between the law and their professional norms. They perceived building caring relationships with their patients to be crucial to fostering health-promoting self-care processes. ConclusionsTo increase self-care adherence, nurses must become more sensitive to cultural differences and adapt self-care counseling to patients’ health literacy. The findings of this research support and challenge nurses in providing the best counsel to migrant patients with heart failure living in Sweden’s multi-ethnic society. Policymakers in the health care organization should act to facilitate mutual cultural understanding between all involved partners for patient-safe self-care counseling.

Distribution and genetic diversity of two earthworms, Helodrilus oculatus and Satchellius mammalis (Clitellata: Lumbricidae) in Scandinavia

We report on the Scandinavian distribution of two earthworm species, Helodrilus oculatus and Satchellius mammalis. Both appear relatively new to the Scandinavian Peninsula, as they were not included in the monographic revisions of the earthworm fauna of Sweden and Norway in the mid-1900s. We provide recent records of both species from Norway and Sweden, H. oculatus also from Denmark, and haplotype networks of four markers (COI, 16S, H3, and ITS2) are used to visualise the genetic diversity within each species. There is moderate genetic variation in COI for both taxa, and for H. oculatus, there is a West-East division between the specimens from Norway, Gothenburg (western Sweden) and Bavaria (Germany), and the ones from eastern Sweden and the Bornholm island (easternmost Denmark). This could potentially be explained by different origin and colonisation routes. In the other markers the variation is limited, and in the nuclear genes no pattern to support this split is seen. We also analyse the phylogenetic positions of H. oculatus and S. mammalis in the family Lumbricidae by combining our data (including also some12S, 18S and 28S sequences) with a published dataset. We conclude that neither Helodrilus nor Satchellius are monophyletic. Helodrilus oculatus (type species of Helodrilus), however, forms a clade with some of its current congeners.

Perceptions of cancer patients and their caregivers regarding COVID-19 pandemic in Ethiopia.

e24116 Background: Limited research is available about COVID 19 pandemic in Ethiopia in general and in relation to cancer care in particular. Ethiopia reported the first COVID-19 in March, 2020. The number of cases is increasing, putting much pressure on oncology care. This study examines what the Ethiopian cancer patients and their caregivers knew about COVID 19 after the initial stages of the pandemic. It also assesses the information needs, psychological experiences as well as the impact of pandemic on oncologist-patient-caregiver communication and treatment process. Methods: A cross-sectional study was conducted among 200 participants (100 cancer patients and 100 caregivers) at the initial stage of pandemic (May 1 - June 30, 2020) at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Data was collected using a pre-tested, structured questionnaire to assess knowledge and perceptions on COVID-19. Ethics approval was obtained from the Ethical Review Board of TASH (04/14/2015) and the Ethical Review Board of Western Sweden (DNR 520-18). Results: The results indicate that though both cancer patients and their caregivers show a high awareness of and knowledge about COVID 19, they need more information about the risks specific to cancer patients. The respondents are also concerned about the risks of pandemic outbreak in Ethiopia and its impact on availability of cancer care treatments in the country. The respondents report experiencing psychological concerns in relation to the pandemic. The higher educated patients and caregivers report being more concerned than the lower educated respondents. Delays in appointments and therapy are the main concerns in relation to cancer care. Further, both patients and caregivers experience that the restrictions on the number of caregivers present during interactions with oncologists negatively influence communication, resulting in relatives being excluded and patients experiencing loneliness and lack of support. Conclusions: Getting a better insight into knowledge and awareness of COVID-19 among cancer patients and their caregivers is essential for managing the effects of pandemic in cancer care. To our knowledge, there was no similar study in Ethiopia. The results of the study contribute to insights into patient and caregiver awareness of COVID 19, essential for adoption of health care protective practices, providing information and managing oncologist-patient-caregiver communication.

Strengthening paediatric competencies and educational skills among general paediatricians.

To develop a coherent programme that addresses the need for continuing professional development in general paediatrics and educational skills for senior paediatricians at outpatient clinics in Sweden today. Educational needs in the target group were investigated using a questionnaire. Themes and sub-themes extracted from responses informed the curriculum formulation of the continuing professional development (CPD) programme, which was completed using a variety of learning, assessment and evaluation methods. Forty-six paediatricians identified 355 clinical situations. Competencies in general paediatrics and educational skills were incorporated in a CPD programme, implemented in western Sweden between 13 October 2016 and 23 May 2019, with 23 learning modules and 18 participants (male/female 3/15, median age 55years). The participants' evaluation emphasised the importance of adult learning principles. Their responses to open reflective questions on 23 May 2109 suggested that the programme offered a learning environment in which they could develop their paediatric and educational practices and improve their mentorship, networks and work-based learning environment. They also described an enhanced feeling of joy at work. The involvement of experienced paediatricians in the programme formulation may be inspirational to clinicians and contribute to the definition, revitalisation and prioritisation of general paediatrics in Sweden in the future.

Increasing Incidence of Primary Aldosteronism in Western Sweden During 3 Decades - Yet An Underdiagnosed Disorder.

ContextPrimary aldosteronism (PA) is the most common cause of secondary hypertension. Yet, the incidence of PA in the general population has not been studied.ObjectiveTo estimate the incidence of PA in the general population.Design and methodsPatients who had received a diagnostic code for PA between 1987 and 2016 were identified in the Swedish National Patient Registry. Assessment of clinical and biochemical data was used to validate the diagnosis. The annual incidence of PA was calculated by using the number of inhabitants in the Västra Götaland County as a reference.ResultsOf 570 identified patients, 473 (83%) had confirmed PA. Eligible for the incidence analysis were 416 patients, 248 (60%) men and 168 (40%) women, diagnosed with PA between 1987 and 2016. The mean (± standard deviation) age at diagnosis was 56 ± 12 years. The median (interquartile range) annual incidence was 2 (1-2) cases per million between 1987 and 1996, 6 (4-9) cases per million between 1997 and 2006 and 17 (12-24) cases per million between 2007 and 2016. At the end of the study (December 31, 2016), 386 patients with confirmed PA were alive and living in the Västra Götaland County, giving a prevalence of 231 cases per million (0.022%).ConclusionsDespite increasing incidence, the proportion of patients identified with PA is lower than expected. Given the serious consequences of untreated PA, the noticeably low prevalence at the end of the study stresses the need to increase the awareness of PA among health care providers.

Cardiovascular risk factors in gout, psoriatic arthritis, rheumatoid arthritis and ankylosing spondylitis: a cross-sectional survey of patients in Western Sweden

ObjectivesWe aimed to compare traditional (trad) cardiovascular risk factors (CVRFs) among patients with gout, psoriatic arthritis (PsA), rheumatoid arthritis (RA) and ankylosing spondylitis (AS) stratified by sex.MethodsA survey was sent...

Subjective health complaints in early adolescence reflect stress: A study among adolescents in Western Sweden

Aims: Mental health problems are common among Swedish adolescents and are sometimes referred to as ‘stress-related’. The overall aim of this study is to do an analysis of subjective health complaints (SHCs) and perceived general stress among adolescents in Sweden, both their prevalence and association, by gender, migration background, family structure and socioeconomic conditions. Methods: Data from the baseline (comprising 2283 adolescents aged 13) of the STudy of Adolescence Resilience and Stress (STARS) study in Västra Götaland in Sweden were used. SHCs were measured by the Psychosomatic Problems Scale (PSP-scale) and self-reported stress was measured by Cohen’s Perceived Stress Scale (PSS-10). Socioeconomic conditions were measured with the Family Affluence Scale (FAS) and the MacArthur Scale of Subjective Social Status (SSS). Statistical analyses included Student’s t-tests and ANOVAs of means, linear and logistic regression analyses and Pearson’s correlations. Results: Social inequalities in both SHCs and self-reported stress were found; levels were higher among girls, adolescents living with one parent or in families with less favourable socioeconomic conditions. Self-reported stress and SHCs were found to be strongly correlated (r=0.70). Correlations with self-reported stress were stronger for psychological complaints (r=0.71) than for somatic complaints (r=0.52). Correlations did not vary with socioeconomic conditions of the family. Conclusions: SHCs do reflect general stress among adolescents, and it is appropriate to address the complaints as ‘stress-related’. Measures to improve adolescents’ mental health by reducing levels of SHCs should pay special attention to stressors in adolescents’ daily lives and strengthening adolescent’s coping resources and strategies.

Job demands, work engagement and job turnover intentions among registered nurses: Explained by work-family private life inference

The job demands on nurses have increased. Conflict between work life and family life may lead to stress and lower work engagement. Consequently, nurses may choose a different career path or leave the profession. Examine the extent to which perceived job demands (interpersonal conflicts at work and workload), work engagement, work-family conflict and family-work conflict are associated with turnover intentions, and examine a possible moderating effect of work-family conflict on the relationship between the intention to leave the nursing profession, job demands and work engagement. Cross-sectional study using Hobfoll's Conservation of Resources theory. Data were collected from a sample of 807 registered nurses (RNs) from western Sweden. Tests of moderation were conducted using the PROCESS software macro developed by Andrew F. Hayes. Work-family conflict was a significant moderator in the relationship between the intentions to leave the nursing profession and work engagement as well as interpersonal conflicts at work. Low work engagement, high work-family conflict and high job demands intensify turnover intentions in well-educated and well-experienced nurses. The results imply that work-family conflict has a greater impact when RNs experience lower work engagement. In other words, higher motivation implies a lower moderation effect of work-family conflict. Managers should promote a positive working climate by listening to and providing nurses with opportunities to develop their skills. By so doing, managers can gain better understanding of nurses' resources, knowledge and work situation, thus strengthening nurses' confidence and ability to practice their profession.

Changes in walking ability, intellectual disability, and epilepsy in adults with cerebral palsy over 50 years: a population-based follow-up study.

To determine if walking ability and presence of intellectual disability and epilepsy change from childhood to 50years of age in individuals with cerebral palsy (CP), and if such changes are related to age, sex, or CP subtype. This was a population-based follow-up study of 142 adults born from 1959 to 1978 (82 males, 60 females; mean age 48y 4mo, range 37-58y; 44% unilateral, 35% bilateral, 17% dyskinetic, and 4% ataxic CP) listed in the CP register of western Sweden. We compared childhood data with a follow-up assessment in 2016. At follow-up, walking ability had changed significantly (p<0.001). The proportion of participants walking without aids had decreased from 71% to 62%, and wheelchair ambulation increased from 18% to 25%. Walking ability was related to subtype (p=0.001), but not to age, sex, pain, fatigue, or body mass index. The proportion classified as having intellectual disability had increased from 16% to 22% (p=0.039) and the proportion with epilepsy from 9% to 18% (p=0.015). Of those with childhood epilepsy, 46% were seizure-free without medication. Walking ability and the presence of intellectual disability and epilepsy had changed significantly since childhood. Life-long access to specialized health care is warranted for re-evaluation of impairments, treatment, and assistance. What this paper adds Changes in impairments in individuals with cerebral palsy (CP) over time are related to CP subtype. After 50years, walking ability in CP may have deteriorated or improved. Intellectual disability in CP may not always be detected in early childhood assessments. Epilepsy in CP may develop after childhood or may be outgrown.

The history of settlement and agrarian land use in a boreal forest in V\xe4rmland, Sweden, new evidence from pollen analysis

Shielings are the historically known form of transhumance in Scandinavia, where livestock were moved from the farmstead to sites in the outlands for summer grazing. Pollen analysis has provided a valuable insight into the history of shielings. This paper presents a vegetation reconstruction and archaeological survey from the shieling Kårebolssätern in northern Värmland, western Sweden, a renovated shieling that is still operating today. The first evidence of human activities in the area near Kårebolssätern are Hordeum- and Cannabis-type pollen grains occurring from ca. 100 bc. Further signs of human impact are charcoal and sporadic occurrences of apophyte pollen from ca. ad 250 and pollen indicating opening of the canopy ca. ad 570, probably a result of modification of the forest for grazing. A decrease in land use is seen between ad 1000 and 1250, possibly in response to a shift in emphasis towards large scale commodity production in the outlands. Emphasis on bloomery iron production and pitfall hunting may have caused a shift from agrarian shieling activity. The clearest changes in the pollen assemblage indicating grazing and cultivation occur from the mid-thirteenth century, coinciding with wetter climate at the beginning of the Little Ice Age. The earliest occurrences of anthropochores in the record predate those of other shieling sites in Sweden. The pollen analysis reveals evidence of land use that predates the results of the archaeological survey. The study highlights how pollen analysis can reveal vegetation changes where early archaeological remains are obscure.

Mapping recreational activities in coastal and marine areas – PPGIS findings from western Sweden

• Outdoor recreation is an often overlooked planning category in the coastal zone. • PPGIS is a useful method approach to collect spatial input on outdoor recreation. • Public data collection provides important spatial insights in coastal zone planning. • National, regional and local planning work benefits from collection of PPGIS data. • The PPGIS approach can favorably be anchored among local and regional planners.

A bridge over troubled water? – Exploring learning processes in a transition program with newly graduated nurses

Successful preparation of newly graduated nurses (NGN) is a critical concern for the healthcare sector. This study explores the learning processes enacted in a transition program with NGNs implemented in hospitals in western Sweden. Group interviews with NGNs and ward managers were conducted, with the data analyzed using qualitative thematic analysis. The following themes were identified as the learning processes secured through the program: Recognizing the NGNs' role as novice practitioners, Emphasizing newly graduated nurses as learners, and Progressing towards a comprehensive nursing role. To support these learning processes, the program should provide opportunies to consolidate and reconcile NGNs’ experiences as novices in healthcare environments where effective performance is crucial. If NGNs are supported in these ways, the program can make salient contributions to develop the knowledge bases of their occupational expertise.