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Returning to work after cancer: how people with cognitive impairments experience digital work tasks
No full textIntroduction: The increasing digitalization of work, places higher demands on cognitive functions. For cancer survivors, returning to work is often complicated by cognitive impairments. These challenges are especially difficult to manage in digital work environments. Despite the growing number of survivors, research on how these impairments affect digital work tasks remains limited—particularly from an occupational therapy perspective. To support successful vocational rehabilitation and return to work, a deeper understanding of these experiences is needed. Aim: Explore how people with cognitive impairments after cancer and cancer treatment experience digital work tasks when returning to work after sick leave. Methods: A qualitative study with a constructivist grounded theory approach Data were collected through semi-structured interviews with eight participants within the ages 40–55, all of whom had returned to work. Interviews were analyzed through initial, focused, and theoretical coding. Results: The findings resulted in five main categories. From the main categories the core category “Navigating in the dynamic process of re-engaging in digitally demanding work while managing cognitive impairment,” emerged. The main category reflects the ongoing negotiation between limitations and adaptations. Conclusion: Returning to work with digital work tasks after cancer and having cognitive impairments is a complex and dynamic process. The challenges were often invisible an influenced by demanding factors. Participants navigate the challenges with self-developed strategies, working on remote, and redefining identity. This study emphasizes the importance of tailored occupational therapy interventions and workplace adaptations to foster sustainable work participation for cancer survivors
Turning the tide on childhood overweight and obesity : more than a decade of positive change among 4‐year‐olds in Northern Sweden
No full textAim: To study the development of overweight, obesity and underweight among 4-year-olds from 2007 to 2022, covering the COVID-19 pandemic period. Methods: This repeated cross-sectional analysis was conducted in Västerbotten County, northern Sweden. It used data on weight, height, age and sex, which were collected when children attended their 4-year check-ups at any of the 38 Child Health Centres. Results: The data comprised 42 614 4-year-old children (52% boys). From 2007 to 2022, the prevalence of overweight decreased from 13.4% to 9.5% in the boys and from 14.9% to 12.0% in the girls. The prevalence of obesity decreased from 3.7% to 1.8% in the boys and from 2.4% to 2.0% in the girls. During the first year of the COVID-19 pandemic, overweight and obesity temporarily increased for both the boys and girls, but the levels had returned to pre-pandemic levels by 2022. The prevalence of underweight increased among both boys and girls. Conclusion: Our study documents a decline in the prevalence of overweight and obesity among Swedish 4-year-olds over more than a decade, except for a surge during the early COVID-19 pandemic. Additionally, we observed an unexpected increase in the prevalence of underweight during the same period
Implementation of alcohol screening and brief interventions in cardiology : a cross-sectional study of practice in Sweden
No full textAims: To investigate rates of alcohol screening and brief interventions (SBI) in cardiology, and to examine associations between patient characteristics and the implementation of screening and brief interventions (BIs). Methods: Cross-sectional survey of cardiology patients (aged ≥18 years) in three towns/cities in Sweden (Falun, Gävle, Stockholm). Self-reported study outcomes included: (a) being screened for alcohol use and (b) receiving a BI. Covariates included sociodemographic characteristics and clinical factors. We examined associations between covariates and study outcomes using logistic regression models. Results: From a total of 1051 participants (median age = 73 years, 66% men), 54% were screened for alcohol use, mostly by doctors (48%) and nurses (40%). Odds ratios (ORs) for being screened were lower among participants aged ≥80 years (OR = 0.57, 95% confidence intervals (CI) = 0.41–0.79), relative to those aged 65–79 years, and higher among participants with overweight (OR = 1.84, 95%CI = 1.38–2.44). Of those screened, 12% received BIs. Odds ratios for receiving BIs were higher among: men (OR = 3.04, 95%CI = 1.41–6.56), current smokers (OR = 10.88, 95%CI = 3.86–30.69), and participants with hazardous drinking (OR = 5.66, 95%CI = 2.59–12.36). Conclusions: Just over half cardiology patients were screened for alcohol use. Almost two-thirds of those identified with hazardous drinking did not receive BIs. Screening and BI practices varied according to individual participant characteristics, and there was a shortfall in screening among the elderly. Findings indicate inconsistent implementation of European cardiology guidelines, which recommend universal screening, and highlight a need for improved implementation strategies
The effects of decentralisation on patient and service outcomes : a case of the 2018 decentralisation of multidrug-resistant tuberculosis in Zambia
No full textIntroduction: The Zambian government decentralised tuberculosis control programs by transferring responsibility for the care and treatment of multidrug-resistant tuberculosis (MDR-TB) patients from a two-national hospital model to provincial hospitals and other lower-level healthcare structures. Limited evidence exists on the effects of decentralisation on the quality of TB care provided through public sector decentralisation. In this paper, we explored the impact of decentralising MDR-TB on patient and service outcomes. Methods: This study used a mixed-methods approach. Quantitative data were collected through a survey of 244 MDR-TB patients, while qualitative data was collected through interviews with TB coordinators, healthcare providers, patients, and caregivers. Participants were drawn from health facilities and the Ministry of Health. Quantitative data was analysed in STATA version 16.0, while thematic analysis was used for the qualitative data. Results: Decentralisation has improved patient care and management by increasing access to essential commodities such as medication and diagnostic testing. It has led to more equitable distribution of MDR-TB healthcare services and resources across different population groups, regardless of social, economic, or demographic factors. Furthermore, the quality of life for MDR-TB patients has improved, with better adherence to medication resulting from increased family support. Due to decentralisation, tailored community and patient-centred services have been integrated resulting in reduced congestion at facilities. The study also identified challenges, including heavy workload for healthcare staff, fragmented coordination of supervisory responsibilities, and confusion over roles in patient management, which negatively impacted the decentralisation process. Conclusion: The decentralisation of MDR TB services offers significant benefits but is not a guaranteed solution, as poor planning or implementation can lead to challenges in service delivery
A complex intervention to strengthen person-centered care and leadership in residential care facilities (the PERLE study) : protocol for a development and implementation study
No full textBackground: Although the benefits of person-centered care (PCC) are widely recognized, there is a lack of empirical research on how PCC is best developed and implemented by the leaders responsible for driving such initiatives. To achieve meaningful change and ensure the sustainability of PCC practices, it is crucial to understand how leaders can foster care environments rooted in person-centered values while managing operational challenges. This knowledge gap highlights the need for an in-depth exploration of the conceptual foundations, experiences, mechanisms, strategies, and outcomes of person-centered leadership (PCL) to design an intervention for strengthening such leadership. Objective: The Person-Centered Care and Leadership in Residential Care Facilities (PERLE) study aims to (1) explore and develop tools to measure PCL; (2) develop, test, implement, and investigate the effects of an intervention to strengthen PCL in residential care facilities (RCFs) for older people; and (3) generate knowledge about the process of development and implementation of the intervention. Methods: The PERLE study builds on the Medical Research Council framework for the development of complex interventions. It includes several studies with exploratory, descriptive, correlational, and quasi-experimental designs and is based on the research group’s previous research on PCL. The project is composed of 5 work packages (WPs). Each WP includes research questions with different samples; data collection; and methodological approaches, such as qualitative, mixed methods, and quantitative studies. As this project involves sensitive issues, a high level of ethical awareness was maintained throughout. The primary challenge is the possible interference with participants’ work time, which could otherwise be devoted to supporting older people and staff. Nevertheless, the involvement of leaders and staff can lead to valuable knowledge that can improve the quality of PCC. Participants will be provided with both oral and written information about the study and assured of their right to withdraw at any time without providing a reason. Results: As of July 2025, 6 studies in WP I have been conducted, and one is in progress. The conducted studies address leaders’ understanding of PCC, the meaning of PCL in RCFs from the perspective of leaders, the ethical challenges in providing PCC during the COVID-19 pandemic, and the cultural adaptation of the aged care clinical leadership qualities framework. Conclusions: This project aims to provide new insights into the support that first-line managers need to advance PCC in RCFs, highlight their specific challenges, and create tailored support measures for the implementation of PCL. The intervention could potentially reduce staff turnover and related costs while supporting leadership training and education to benefit future leaders in aged care, which may be important from an international perspective
Protocol for the HALDI study : conceptual framework for investigating health and living conditions in an arctic area of Sweden with a multiethnic population
No full textObjectives: Despite increasing research interest in the health and well-being of the Indigenous Sámi people, knowledge remains fragmented and insufficient. The HALDI study aims to examine health status, well-being, and associated determinants within a multi-ethnic context, focusing on the Sámi people in Sweden. This protocol outlines the study’s objectives, design, and methodology, with the goal of generating representative data to inform future research, policy, and interventions targeting Sámi health. Design: To ensure relevance, initial focus groups discussions identified key health issues for the Sámi people in Swedish Sápmi. Based on these findings, a comprehensive questionnaire was developed, encompassing socioeconomic status, ethnicity, psychiatric and somatic disorders, and self-perceived health. All adults in Jokkmokk municipality (n = 4077) were invited to participate. The following year, a clinical examination was conducted, including measures such as blood pressure, pulse, height, weight, blood sampling, and an updatet questionnaire on health status, dietary habits, and, for those aged 65 years and above, assessments of frailty and cognition. A total of 1682 individuals (41%) responded to the first questionnaire; 68% identified as Swedish, 22% as Sámi, and 7% with other ethnic identities. In the clinical study, 706 participated with similar ethnic proportions. Conclusion: This is the first study in Sweden to incorporate ethnic self-identification in a multi-ethnic population. By presenting the study protocol and sample characteristics, we highlight the potential for future analyses to inform evidence-based health interventions and policy to improve outcomes for the multi-ethnic Arctic population
Prevalence and gender‐specific correlates of hazardous and binge drinking among Swedish and Finnish older adults
No full textBackground: Alcohol consumption is a leading modifiable risk factor for a range of diseases and social harms globally. Older adults are vulnerable to alcohol-related harms due to physiological changes, multimorbidity, and medication use; however, many older adults continue to drink at high-risk levels. This study examined the prevalence and gender-specific correlates of hazardous and heavy episodic drinking (HED) among Swedish and Finnish community-dwelling older adults. Methods: Cross-sectional data from the 2021/2022 Gerontological Regional Database (GERDA) survey included 11,747 participants aged 65, 70, 75, 80, 85 and 90 years. Missing data were multiple imputed by chained equations. Hazardous drinking was defined as an AUDIT-C score of four or more, and HED was defined as consuming six or more drinks on a single occasion at least monthly. Sociodemographic, psychosocial, functional status, and health-related factors were analyzed using multinomial and logistic regression models, stratified by gender and accounting for regional differences. Results: Overall, 30.2% (95% CI, 29.0–31.4) of men and 9.8% (95% CI, 9.1–10.6) of women were classified as hazardous drinkers. HED prevalence was 13.0% (95% CI, 12.1–13.9) in men and 2.9% (95% CI, 2.5–3.3) in women. Hazardous drinking and HED in women were associated with higher socioeconomic status and psychosocial stressors, such as depression and bereavement, while functional and health-related factors were significant predictors of problematic alcohol use in men. Across both genders, religious participation was a protective factor, while self-reported cardiovascular disease was associated with increased risk of hazardous drinking. Conclusions: Hazardous and HED are prevalent among older adults in Sweden and Finland with some regional differences, and notable gender differences in associated risk factors. There is a need for interventions that focus on strengthening resilience to psychosocial stressors and provide older adults with clear, consistent health communication about alcohol's harmful effects on cardiovascular and overall health
Nurses' experiences of caring for patients with anorexia nervosa in psychiatric and somatic healthcare settings
No full textBakgrund: Anorexia nervosa (AN) är en allvarlig psykiatrisk sjukdom som påverkar patientens kroppsuppfattning och matvanor med en intensiv rädsla att gå upp i vikt. AN är den vanligaste typen av ätstörning och har hög risk för dödlighet. Sjukdomen leder ofta till omfattande psykiska och fysiska komplikationer och samsjuklighet med psykisk ohälsa är vanligt förekommande. Sjuksköterskor har en central roll i vården av patienter med AN genom att främja hälsa, minska lidande och skapa en förtroendefull vårdrelation. Brist på kunskap, och utbildning, kring AN hos sjuksköterskor kan påverka vårdkvalitén negativt. Anhöriga har en viktig roll i återhämtningsprocessen för patienter med AN, och sjuksköterskan förväntas stödja både patienter och närstående på ett personcentrerat vis. Vid livshotande tillstånd kan tvångsvård enligt lagen om psykiatrisk tvångsvård (LPT) bli nödvändig. Syfte: Att beskriva sjuksköterskors erfarenheter av att vårda patienter med anorexia nervosa inom psykiatrisk och somatisk vård.Metod: Tematisk analysmetod där nio artiklar kvalitetgranskades, och sammanställdes enligt en sex stegs metod. Artiklarna hittades genom manuell sökning, samt specificerade sökningar i databaserna PubMed och Cinahl. Resultat: Sjuksköterskor upplever svårigheter i att etablera vårdrelationer med patienter med AN. Emotionell belastning, kunskapsbrist och etiska utmaningar framkom som centrala aspekter. Vård och behandling kräver balans mellan struktur och flexibilitet, samt ett holistiskt, interdisciplinärt förhållningssätt.Konklusion: Sjuksköterskors erfarenhet i mötet med patienter med AN präglas i stort av emotionella, etiska och organisatoriska utmaningar. Resultatet visar behovet av ökad kunskap, strukturer av stöd, och ett mer personcentrerat, holistisk arbetssätt för att skapa en trygg och tillitsfull vårdrelation och därmed öka motivationen hos patientgruppen att fullfölja behandling.
Validation of guidelines for genetic investigation of myeloid neoplasms with germline predisposition : results from a prospective cohort study
No full textPurpose: In a multicenter prospective cohort study, we assessed the diagnostic yield of the Nordic guidelines for germline investigation in myeloid neoplasms and mapped the spectrum of inherited and somatic variants. Experimental Design: Eighty-five patients (acute myeloid leukemia, n = 38; myelodysplastic syndromes, n = 26; thrombocytopenia, n = 14; and other, n = 7) fulfilling the Nordic criteria for germline investigation, based on (i) medical history or family history suggestive of a germline condition and (ii) relevant findings from the somatic diagnostic work-up (CytoMol), were recruited. The genetic analysis included enhanced whole-exome sequencing (n = 69) or sequencing of specific variants of interest (n = 16). Results: Pathogenic or likely pathogenic (P/LP) germline variants were identified in 35% of patients (30/85). The diagnostic yield varied from 6% (1/16) in the family history group to 52% (17/33) in the CytoMol group. Germline DDX41 P/LP variants were the most frequent finding (13/30, 43% of all positive cases) almost exclusively found within the CytoMol group (12/13). Seven variants of unknown significance were also detected (TERT n = 2 and DDX41, RTEL1, ETV6, PARN, and SAMD9 n = 1). Five patients carried a P/LP variant in genes associated with another hereditary cancer syndrome (BRCA1 n = 3; PALB2 n = 1; and CHEK2; n = 1). Survival analysis showed a trend for longer survival among patients with acute myeloid leukemia and confirmed or suspected germline predisposition that underwent allogeneic stem cell transplantation. Conclusions: The implementation of the Nordic guidelines in a prospective Swedish cohort results in a high overall diagnostic yield (35%), proving the feasibility and utility of these or similar guidelines in a clinical setting
Rationale and design of a registry-based randomized controlled study of personalized biomarker-based risk score-guided stroke prevention treatment in atrial fibrillation
No full textBackground: Stroke and reduced survival are devastating complications of atrial fibrillation (AF). Biomarker-based ABC-AF risk scores improve risk prediction in AF, and risk-guided treatment recommendations may improve patient outcomes. Design: The ABC-AF study is a national, multicenter, prospective, registry-based, randomized controlled, parallel-group, open-label study. Its primary objective is to evaluate whether ABC-AF risk score-guided treatment recommendations improve outcomes in patients with AF. Consenting patients with AF registered in the Swedish national quality register for AF, AURICULA AF, will be randomized in a 1:1 ratio to either ABC-AF risk score-guided treatment recommendations or standard care. For participants in the active arm, investigators will receive a visual presentation of stroke and bleeding risks along with recommendations regarding the choice of oral anticoagulant (OAC) and additional treatments for stroke and bleeding prevention. In the control arm, patients are managed at the discretion of the investigator. Outcomes: The primary outcome is a composite of stroke or death. Secondary outcomes include the composite of stroke, death, and major bleeding, and the individual components of the primary outcome, myocardial infarction, and hospitalization for heart failure; and a safety endpoint of major bleeding. Study enrollment commenced on October 25, 2018, and terminated on May 12, 2023, after 3,933 patients had been recruited. Study results are expected in 2025. The ABC-AF study evaluates whether a personalized treatment recommendation strategy—guided by the biomarker-based ABC-AF risk score decision support— improves outcomes in AF