The five aspects mealtime environment observation instrument for assessing mealtime environments in nursing homes: Development and validation

AIMS AND OBJECTIVES

To further develop and validate the Mealtime instrument, an observational instrument for assessing mealtime environments in nursing homes originating from the theoretical framework: Five Aspects Meal Model (FAMM).

METHODOLOGICAL DESIGN AND JUSTIFICATION

A mealtime experience is significant for a sense of well-being. In nursing homes, residents' personal preferences, combined with their diagnoses and different stages of illness, influence their mealtime experience and provide a complexity that has been found difficult to assess. Using FAMM, a theoretical framework as its base, this study, attempts to look at different parts of the mealtime environment. FAMM structures the mealtime environment in to five aspects: room, meeting, product, management control system and atmosphere. This study's design includes instrument development and validation.

ETHICAL ISSUES AND APPROVAL

This study has been approved by the Swedish Ethical Review Authority (dnr 2019-05477).

DESIGN

Methodological study.

RESEARCH METHOD

An existing instrument, the Mealtime instrument with FAMM as a theoretical framework, was used as a foundation for the development of the Five Aspects Mealtime Environment Observation Instrument (FAME-OI). Content validity index (CVI) was used to validate FAME-OI.

RESULTS

FAME-OI's item-CVI, scale-CVI and modified Kappa displayed high validity. Changes were made in its structure and phrasing. These developments resulted in having a distinct structure in FAME-OI, in reference to FAMM.

CONCLUSION

FAME-OI is applicable for clinical use in nursing homes and in research; however, adjustments may be needed before its use in other health care facilities.

Longitudinal Speech Outcome at 5 and 10 Years in UCLP: Influence of Speech Therapy and Secondary Velopharyngeal Surgery

OBJECTIVE

To investigate speech development of children aged 5 and 10 years with repaired unilateral cleft lip and palate (UCLP) and identify speech characteristics when speech proficiency is not at 'peer level' at 10 years. Estimate how the number of speech therapy visits are related to speech proficiency at 10 years, and what factors are predictive of whether a child's speech proficiency at 10 years is at 'peer level' or not.

DESIGN

Longitudinal complete datasets from the Scandcleft project.

PARTICIPANTS

320 children from nine cleft palate teams in five countries, operated on with one out of four surgical methods.

INTERVENTIONS

Secondary velopharyngeal surgery (VP-surgery) and number of speech therapy visits (ST-visits), a proxy for speech intervention.

MAIN OUTCOME MEASURES

'Peer level' of percentage of consonants correct (PCC, > 91%) and the composite score of velopharyngeal competence (VPC-Sum, 0-1).

RESULTS

Speech proficiency improved, with only 23% of the participants at 'peer level' at 5 years, compared to 56% at 10 years. A poorer PCC score was the most sensitive marker for the 44% below 'peer level' at 10-year-of-age. The best predictor of 'peer level' speech proficiency at 10 years was speech proficiency at 5 years. A high number of ST-visits received did not improve the probability of achieving 'peer level' speech, and many children seemed to have received excessive amounts of ST-visits without substantial improvement.

CONCLUSIONS

It is important to strive for speech at 'peer level' before age 5. Criteria for speech therapy intervention and for methods used needs to be evidence-based.

van der Waals induced ice growth on partially melted ice nuclei in mist and fog

Ice nucleation and formation play pivotal roles across various domains, from environmental science to food engineering. However, the exact ice formation mechanisms remain incompletely understood. This study introduces a novel ice formation process, which can be either heterogeneous or homogeneous, depending on the initial conditions. The process initiates ice crystal growth from a nucleus composed of a micron-sized partially melted ice particle. We explore the role of van der Waals (Lifshitz)-free energy and its resulting stress in the accumulation of ice at the interface with water vapor. Our analysis suggests that this process could lead to thicknesses ranging from nanometers to micrometers, depending on the size and degree of initial melting of the ice nucleus. We provide evidence for the growth of thin ice layers instead of liquid water films on a partially melted ice-vapor interface, offering some insights into mist and fog formation. We also link it to potential atmospheric and astrogeophysical applications.

Exploring family functioning and - hardiness in families' experiencing adult intensive care - A cross-sectional study

Being cared for in an intensive care unit affects both the patient being cared for and the family in various ways. The family is of great importance for the recovery of the former intensive-care patient. The aim is to explore family functioning and family hardiness in families of former intensive care patients. A cross-sectional study using two self-reported questionnaires. Former adult intensive care patients and their family were recruited to participate between December 2017 and June 2019. The data were coded and entered the Statistical Package for the Social Sciences version 25, for analysis. To explore questionnaire data, descriptive and inferential statistical analyses were performed. Scale values were calculated on, both family wise and between the patients and the family members. STROBE checklist was used. Data was collected from 60 families (60 former intensive cared patients and 85 family members) and showed that 50 families scored healthy family functioning and 52 high strengths in hardiness. The data showed small variations between and within families for family functioning and family hardiness, there were only two families scoring low for both family functioning and hardiness. The variation was higher within the families, but there was no significance level.The conclusions were that family functioning and hardiness was, to a large extent, assessed as good by the families. Nevertheless, it is important to help the family obtain information and support. So, the family need to continue to communicate, finding coping abilities and strengths in adopting new strategies to protect the family unit. The family are very important for members' mental and physical recovery as the health of one family member affects the family as a unit.

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: Speech proficiency at 10 years of age

BACKGROUND & AIM

To assess consonant proficiency and velopharyngeal function in 10-year-old children born with unilateral cleft lip and palate (UCLP) within the Scandcleft project.

METHODS & PROCEDURES

Three parallel group, randomized, clinical trials were undertaken as an international multicentre study by nine cleft teams in five countries. Three different surgical protocols for primary palate repair (Arm B-Lip and soft palate closure at 3-4 months, hard palate closure at 36 months, Arm C-Lip closure at 3-4 months, hard and soft palate closure at 12 months, and Arm D-Lip closure at 3-4 months combined with a single-layer closure of the hard palate using a vomer flap, soft palate closure at 12 months) were tested against a common procedure (Arm A-Lip and soft palate closure at 3-4 months followed by hard palate closure at 12 months) in the total cohort of 431 children born with a non-syndromic UCLP. Speech audio and video recordings of 399 children were available and perceptually analysed. Percentage of consonants correct (PCC) from a naming test, an overall rating of velopharyngeal competence (VPC) (VPC-Rate), and a composite measure (VPC-Sum) were reported.

OUTCOMES & RESULTS

The mean levels of consonant proficiency (PCC score) in the trial arms were 86-92% and between 58% and 83% of the children had VPC (VPC-Sum). Only 50-73% of the participants had a consonant proficiency level with their peers. Girls performed better throughout. Long delay of the hard palate repair (Arm B) indicated lower PCC and simultaneous hard and soft palate closure higher (Arm C). However, the proportion of participants with primary VPC (not including velopharyngeal surgeries) was highest in Arm B (68%) and lowest in Arm C (47%).

CONCLUSIONS & IMPLICATIONS

The speech outcome in terms of PCC and VPC was low across the trials. The different protocols had their pros and cons and there is no obvious evidence to recommend any of the protocols as superior. Aspects other than primary surgical method, such as time after velopharyngeal surgery, surgical experience, hearing level, language difficulties and speech therapy, need to be thoroughly reviewed for a better understanding of what has affected speech outcome at 10 years.

WHAT THIS PAPER ADDS

What is already known on the subject Speech outcomes at 10 years of age in children treated for UCLP are sparse and contradictory. Previous studies have examined speech outcomes and the relationship with surgical intervention in 5-year-olds. What this study adds to the existing knowledge Speech outcomes based on standardized assessment in a large group of 10-year-old children born with UCLP and surgically treated according to different protocols are presented. While speech therapy had been provided, a large proportion of the children across treatment protocols still needed further speech therapy. What are the potential or actual clinical implications of this work? Aspects other than surgery and speech function might add to the understanding of what affects speech outcome. Effective speech therapy should be available for children in addition to primary surgical repair of the cleft and secondary surgeries if needed.

Perspectives on weak interactions in complex materials at different length scales

Nanocomposite materials consist of nanometer-sized quantum objects such as atoms, molecules, voids or nanoparticles embedded in a host material. These quantum objects can be exploited as a super-structure, which can be designed to create material properties targeted for specific applications. For electromagnetism, such targeted properties include field enhancements around the bandgap of a semiconductor used for solar cells, directional decay in topological insulators, high kinetic inductance in superconducting circuits, and many more. Despite very different application areas, all of these properties are united by the common aim of exploiting collective interaction effects between quantum objects. The literature on the topic spreads over very many different disciplines and scientific communities. In this review, we present a cross-disciplinary overview of different approaches for the creation, analysis and theoretical description of nanocomposites with applications related to electromagnetic properties.

Parents' experiences of the significance of interpersonal interactions for becoming parents and a family during neonatal intensive care

PURPOSE

To describe parents' experiences of the significance of interpersonal interactions for becoming parents and a family during neonatal intensive care.

DESIGN AND METHODS

We employed a qualitative descriptive design with semi-structured family interviews. Ten families were included from four neonatal intensive care units (NICU) in Sweden. Results were evaluated using thematic analysis.

RESULTS

The results were presented as two themes: 1) Interactions within the family, and 2) Interactions between parents and staff. Analyses revealed that interpersonal interactions could both facilitate and hinder development in becoming a parent and a family.

CONCLUSION

Interactions within the family and with the staff have an important function in the process of becoming a parent and a family. This process would benefit from a systemic approach, focusing on the family as a unit, as unique individuals, and as parents with unique needs and experiences.

PRACTICE IMPLICATIONS

Our findings can facilitate changes to reduce the separation between family members (mother-father-newborn-siblings) during their stay in NICU; guiding parents to take care of their child, while being sensitive and balancing their situation as to where they are in their process; supporting the family through joint conversations by listening to the parents and their expectations and experiences both in the NICU and at home; and encouraging parents to do everyday things together outside NICU like an ordinary family.

Mealtime interventions and their outcomes in care homes for older people considering the five aspects meal model: An integrative review

Mealtimes are important events in care homes for physical and social well-being. However, residents usually have little input concerning meal timings, what food is offered, and how it is served. This integrative review explored mealtime interventions and their outcomes in care homes related to the Five Aspects Meal Model (FAMM). Research articles published 2010-2021 were searched for in ASSIA, CINAHL, PsycINFO, PubMed, and SveMed+ and resulted in 13 articles focusing on interventions. The analysis was based on the aspects of FAMM: room, meeting, product, management control system, and atmosphere. The result shows that even though interventions specifically focused on one aspect, they often evaluated outcomes related to several aspects. Different aspects can work together to foster effective mealtimes. FAMM eased to visualise the usefulness of mealtime interventions from a broad perspective and can be a useful tool for assessing and improving mealtime situations in clinical practice.

Living conditions, lifestyle habits and health among adults before and after the COVID-19 pandemic outbreak in Sweden - results from a cross-sectional population-based study

BACKGROUND

Studies on the public health consequences of COVID-19 pandemic showing data based on robust methods are scarce. The aim of this study was to investigate mental and physical health as well as living conditions and lifestyle habits in the general population before and after the COVID-19 outbreak in Sweden.

METHODS

The study is based on 2273 persons 16-84 years who responded to the national public health survey in February-May 2020 in Värmland county (overall response rate 45%). The differences between early respondents (before the outbreak, n = 1711) and late respondents (after the outbreak, n = 562) were studied using multivariate logistic regression, adjusting for background characteristics: age, gender, educational level, and country of birth. The same analyses were also completed in the corresponding survey carried out in February-June 2018.

RESULTS

Statistically significant differences between the groups were obtained for economic difficulties and worry about losing one's job, which were more common among late respondents, and for sleeping difficulties, which were more common among early respondents after adjusting for background characteristics. There were no differences in other living conditions nor in lifestyle factors. Prevalence of good self-rated health, high blood pressure, aches in shoulders or neck, anxiety or worry and stress did not differ between the groups. In 2018, the only statistically significant difference between early and late respondents concerned economic difficulties.

CONCLUSIONS

Very few differences in living conditions, lifestyle factors and health were observed in the study population before and after the COVID-19 outbreak. The results suggest that, in addition to a possible decrease in sleeping difficulties, the prevalence of being worried about losing one's job increased among the employed after the outbreak.

Living conditions, lifestyle habits and health among adults before and after the COVID-19 outbreak

Background

Studies on the public health consequences of COVID-19 pandemic based on robust data and methods are scarce. The aim of this study was to investigate mental and physical health as well as living conditions and lifestyle habits in the general population before and after the COVID-19 outbreak in Sweden in spring 2020.

Methods

The study is based on 2,273 persons 16-84 years who responded to the national public health survey in spring 2020 in Värmland county (overall response rate 45%). The differences between early (n = 1,711) and late (n = 562) respondents were studied using multivariate logistic regression, adjusting for background characteristics age, gender, educational level, and country of birth. Similar analyses were also completed in the corresponding survey carried out in spring 2018.

Results

Statistically significant differences between the groups were obtained for economic difficulties and worry about losing onés job, which were more common among late respondents, and for sleeping difficulties, which were more common among early respondents. There were no differences in other living conditions nor in lifestyle factors. Prevalence of good self-rated health, high blood pressure, aches in shoulders or neck, anxiety or worry and stress did not differ between the groups. In 2018, the only statistically significant difference between early and late respondents concerned economic difficulties.

Conclusions

Very few differences in living conditions, lifestyle factors and health were observed in the study population before and after the COVID-19 outbreak when adjusted for background characteristics. The results suggest that, in addition to a possible decrease in sleeping difficulties, the prevalence of being worried about losing one's job increased among the employed after the outbreak.

Key messages

The results suggest that the prevalence of being worried about losing one’s job increased among the employed after the outbreak.

More research on the short- and long-term public health consequences of the pandemic in the general populations and in different subgroups, using robust data and methods, is needed.

Family health conversations versus support group conversations when a family member has been critically ill: A mixed methods study

Introduction: When a family member has been critically ill and cared for at an intensive care unit the individual family member as well as the family system are affected and in need of support. The aim of this study was to compare and contrast the responses from 2 different types of follow-up interventions for families of critically ill persons, focusing on individual hopes, health-related quality of life, family functioning and ability to cope with challenges. Method: Adult family members from 3 hospitals attended 1 of 2 interventions 2 months after intensive care. The family health conversation included the family. The support group conversation included just family members and not the patient who had experienced intensive care. Data were collected via self-reported questionnaires and follow-up interviews with family members. Quantitative and qualitative data were first analyzed separately, and the results were then integrated through mixed methods analysis. Results: A total of 38 family members took part in the interventions. Family members in the 2 intervention groups talked about how they had more hope for the future, and about how talking within the family and the group had helped them justify their feelings, which empowered them in the transition toward a healthier quality of life. Comparisons of the interventions show a higher significance of family function and hope in the family health conversation. Discussion: The article illustrates a disparity between how family members function and the needs they have for follow-up. We discuss what kind of follow-up these persons need. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Parents' experiences of family health conversations after having a child in need of neonatal intensive care

BACKGROUND

When a newborn child requires neonatal intensive care, it is often the beginning of a journey of stress and worry for the parents. Such situations could cause difficulties in problem-solving and communication within the family and result in decreased family functioning. Studies have shown that nurse-led interventions in the form of Family Health Conversations promote family's well-being and functioning and strengthen their relationships. However, this model has not previous been used and evaluated with families who have a child in need of neonatal intensive care.

AIM

To describe parents' experiences of participating in Family Health Conversations after having a child in need of neonatal intensive care.

METHOD

Family interviews were conducted with 12 families from three neonatal intensive care units in southern Sweden, six months after a Family Health Conversations intervention. Data were analysed using qualitative content analysis.

FINDINGS

The parents experienced the Family Health Conversations as an opportunity to co-create a comprehensive picture of what had happened after their child was born. Parents shared their experiences of the Family Health Conversations in terms of feeling validated and strengthened as individuals, as a couple, and as a family. They found the conversations to be supportive to their well-being and to processing experiences and becoming equipped for the future. The parents reported that it was valuable to talk with conversational leaders who had knowledge in neonatal care and who thereby understood what the parents were talking about. This provided a different type of support compared with other conversational contacts.

CONCLUSION

These results highlight the importance of having an early onset of family conversations in order to help the parents to cope with their challenges and improve their well-being.

Dignity as an Intersubjective Phenomenon: Experiences of Dyads Living With Serious Illness

Research results suggest that illness can undermine patients' dignity and that dignity can be understood as an experience formed in communion with others. The aim of this study was, therefore, to illuminate the meanings of lived experiences of dignity as an intersubjective phenomenon from the perspective of dyads in palliative care. The authors analyzed transcripts from interviews with nine dyads using a phenomenological-hermeneutical method. Within the contexts of the dyadic relationship and the dyadic-health care professional relationship, the authors' interpretation revealed two meanings based on the participants' lived experiences: "Being available," related to responding and being responded to in terms of answerability and we-ness, and "Upholding continuity," linked to feeling attached through the maintenance of emotional bonds and being connected through upholding valued activities and qualities in daily living. The authors further reflected on the meanings in relation to philosophically grounded concepts such as presence, objectification, dependence, and dyadic body.

Children with home mechanical ventilation-Parents' health-related quality of life, family functioning and sleep

AIM

Children requiring home mechanical ventilation (HMV) have grown in number and complexity. Parents of children with HMV are often responsible for the advanced homecare. This study explored the health-related quality of life (HRQoL), family functioning and sleep in parents of children with HMV. A secondary aim was to explore the impact on HRQoL, family functioning and sleep of selected potential determinants.

METHODS

Questionnaires were completed by 45 mothers and 40 fathers, to 55 children receiving HMV. Parents were identified via respiratory clinics in the Swedish national quality register for oxygen and home respiratory treatment and invited to participate between December 2016 and December 2018.

RESULTS

There were no differences between mothers and fathers overall HRQoL or family functioning reports, although differences within the physical (P < .043) and cognitive (P < .009) functioning dimensions were found. One of four parents reported moderate or severe insomnia. The variability in HRQoL and family functioning was predicted by HMV mode and sleep quality to an extent of 45% and 21%, respectively.

CONCLUSION

Sleep quality and the child's HMV mode predicted parental HRQoL and family functioning. The results underscore the importance of evaluating parents' sleep and of being aware that invasive ventilation influences parental HRQoL and family functioning.

The Influence of Socioeconomic Factors on Quality-of-Life After Laparoscopic Gastric Bypass Surgery

INTRODUCTION

Patients with low socioeconomic status have been reported to experience poorer outcome after several types of surgery. The influence of socioeconomic factors on health-related quality-of-life (HRQoL) after bariatric surgery is unclear.

MATERIALS AND METHODS

Patients operated with a primary laparoscopic gastric bypass procedure in Sweden between 2007 and 2015 were identified in the Scandinavian Obesity Surgery Register. Patients with a completed assessment of health-related quality-of-life based on the Obesity-related Problem Scale (OP Scale) were included in the study. Socioeconomic status was based on data from Statistics Sweden.

RESULTS

A total of 13,723 patients (32% of the 43,096 operated during the same period), with complete OP scores at baseline and two years after surgery, were included in the study. Age, lower preoperative BMI, male gender, higher education, professional status and disposable income as well as not receiving social benefits (not including retirement pension), and not a first- or second-generation immigrant, were associated with a higher postoperative HRQoL. Patients aged 30-60 years, with lower BMI, higher socioeconomic status, women and those born in Sweden by Swedish parents experienced a higher degree of improvement in HRQoL. Postoperative weight-loss was associated with higher HRQoL (unadjusted B 16.3, 95%CI 14.72-17.93, p < 0.0001).

CONCLUSION

At 2 years, a strong association between weight loss and improvement in HRQoL was seen, though several factors influenced the degree of improvement. Age, sex, preoperative BMI and socioeconomic status all influence the postoperative HRQoL as well as the improvement in HRQoL after laparoscopic gastric bypass surgery.

Premelting of ice adsorbed on a rock surface

Considering ice-premelting on a quartz rock surface (i.e. silica) we calculate the Lifshitz excess pressures in a four layer system with rock–ice–water–air.

Dyadic effects of type D personality and perceived control on health-related quality of life in cardiac arrest survivors and their spouses using the actor-partner interdependence model

BACKGROUND

There is a lack of knowledge about factors associated with health-related quality of life in cardiac arrest survivors and their spouses. In addition, survivors and spouses are likely to affect each other's health-related quality of life.

AIMS

The aim was to investigate if a distressed personality and perceived control among cardiac arrest survivors and their spouses were associated with their own and their partner's health-related quality of life.

METHODS

This dyadic cross-sectional study used the actor-partner interdependence model to analyse associations between a distressed personality (type D personality), perceived control (control attitudes scale), and health-related quality of life (EQ index and EQ visual analogue scale).

RESULTS

In total, 126 dyads were included in the study. Type D personality and perceived control in cardiac arrest survivors were associated with their own health-related quality of life. In their spouses, a significant association was found for type D personality but not for perceived control. In addition, type D personality and perceived control in survivors were associated with health-related quality of life in their spouses.

CONCLUSIONS

Type D personality and perceived control are factors that might be considered during post cardiac arrest, because of the associations with health-related quality of life in survivors and spouses. More research is needed to test psychosocial interventions in the cardiac arrest population in order to improve health-related quality of life.

Determinants of self-rated general health among men and women 70 years or older in Sweden 2017

Background

Goal 3 of the 2030 Agenda for Sustainable Development states that ensuring healthy lives and promoting the well-being at all ages is essential. But health and well-being still vary between different groups. The aim of this study was to find factors associated with self-rated health that can explain the differences among people 70 years or older in Sweden.

Methods

The study is based on a cross-sectional population survey conducted in five counties in Mid-Sweden in 2017. An age-specific questionnaire for persons 70 years or older was used. The response rate was 65% and the study population included 9 482 persons who answered all questions used in the study. Multivariate binomial logistic regression with outcome good or very good self-rated general health was used for the analysis.

Results

The overall prevalence of good or very good self-rated health was 54%. The factors with the strongest positive associations with good/very good self-rated health were: good appetite (OR: 4.48; 95% CI: 3.41-5.88) and physical activity (2.07; 1.87-2.2 9). The strongest negative associations were found for: need for help in everyday life (0.37; 0.24-0.57), troubled by loneliness once a week or more often (0.40; 0.34-0.47), obesity (0.55; 0.48-0.63), troubled by loneliness some times a month (0.59; 0.50-0.71), sedentary 10 hours/day or more (0.61; 0.52-0.72), and being patronized (0.65; 0.55-0.76). Other statistically significant positive factors were e.g. to have someone to confide in, participation in activities with others, trust in people in general, feeling safe in residential neighbourhood and access to personal support. Included in the analysis, but not statistically significant, were sex, country of birth and care of relatives.

Conclusions

Good self-rated health is more common among persons 70 years or older who have good appetite, are physically active and have good social relations.

Key messages

To promote good self-rated health in persons 70 years or older it is essential to enhance possibilities for social interaction and social support. Also promoting healthy lifestyle in form of physical activity and healthy eating habits is important.

Large sociodemographic differences in response rates and methods in a population survey in Sweden

Background

Declining response rates in population surveys may decrease the representativeness and introduce bias in survey results. This study investigated sociodemographic differences in response rates and methods in a population survey in Sweden.

Methods

The study is based on a large population survey conducted in five counties in Mid-Sweden in 2017. Three age-specific questionnaires for persons 18-29, 30-69 and 70 years or older were designed to study living conditions, life style factors and health. The sample was random and stratified by gender, age group and municipality, and comprised 78 000 persons 18 years or older. Up to two reminders were sent, the last reminder consisted of a short version of the questionnaire. The survey could be answered using a written questionnaire or on-line. The web-questionnaire was available in Swedish and English.

Results

The overall response rate was 44% with the lowest participation rate in ages 18-29 years (26%) and highest in ages 70-84 years (70%). Women, persons with high educational level, and persons born in Sweden were more prone to respond than others. Those aged 18-29 years were overrepresented in the sample and the participation rate would have been 46% if the sample had been unstratified by age. The majority of the respondents answered the written questionnaire, even though it was more common that younger people responded via the web compared to older people. In total, 8% of the respondents replied to the short form and this was most common (17%) among those born outside the Nordic countries.

Conclusions

In line with previous research, the results indicate large sociodemographic differences in response rates. The response methods also vary between sociodemographic groups, and knowledge about these differences may be helpful when designing future population surveys.

Key messages

The response rate was higher among older people, women, persons with high educational level, and persons born in Sweden than among other groups. Persons born outside the Nordic countries were most prone to respond to the short form and younger people replied more often to the web-questionnaire than older people.

Processes toward the end of life and dialysis withdrawal Physicians' and nurses' perspectives

BACKGROUND

Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory.

AIM

The aim was to explore physicians' and nurses' perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease.

RESEARCH DESIGN AND PARTICIPANTS

A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data.

ETHICAL CONSIDERATIONS

Ethical approval was obtained (Dnr 2014/304-31).

FINDINGS AND DISCUSSION

Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient's decision-making process, The challenge awaiting the family members' processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress.

CONCLUSION

There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient's possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.

Population health status based on the EQ-5D-Y-3L among adolescents in Sweden: Results by sociodemographic factors and self-reported comorbidity

Purpose

The EQ-5D-Y-3L is a generic health-related quality of life (HRQoL) measure developed for youth from 8 years old. The aim of this study is to present population health status, based on the EQ-5D-Y-3L, among adolescents in Sweden, by sex, age, self-reported comorbidity and parents’ occupational status.

Methods

Data were obtained from a cross-sectional total survey among students, aged 13–18 years, in a Swedish County year 2014. The survey included EQ-5D-Y-3L, questions regarding self-reported health, disease, functional impairment and mental distress. Parents’ occupational status was used as a proxy for socio-economic status.

Results

A total of 6574 participants answered all the EQ-5D-Y-3L dimensions (mean age was 15.9 years, same proportion of boys and girls). Girls reported more problems than boys in the dimensions ‘doing usual activities’, ‘having pain or discomfort’ and ‘feeling worried, sad or unhappy’, and lower mean VAS score. Respondents with one or both parents unemployed reported more problems with usual activities, pain/discomfort and in the mood dimension than those with both parents employed. Those with comorbidity had in general more problems in all dimensions and lower mean VAS score. The highest impact on VAS score was found for adolescents who reported that they always felt depressed.

Conclusions

Sex, age, self-reported comorbidity and parents’ occupational status were associated with HRQoL determined by the EQ-5D-Y-3L in the general population of adolescents. The ability of EQ-5D-Y-3L to distinguish adolescents’ health status based on these factors confirms the instrument’s usefulness in assessment of HRQoL and as guidance for prioritization.

Electronic supplementary material

The online version of this article (10.1007/s11136-018-1985-2) contains supplementary material, which is available to authorized users.

Ideas of home in palliative care research: A concept analysis

AIM

To explore the concept of home and its' expressed spatialities in current palliative care research.

BACKGROUND

Home is a central environment for living, caring, and dying. However, pure investigations of the sets of ideas linked to the concept seemed missing. Although identified as an important location, spatial perspectives expressed through the concept of home appeared unexplored.

DESIGN

Rodgers' evolutionary concept analysis.

DATA SOURCES

Scientific articles published between January 2009 and September 2015.

REVIEW METHODS

Rodgers' evolutionary concept analysis. Resulting attributes were explored from two geographically informed spatial perspectives.

RESULTS

As main results, six attributes were identified and explored: Home as actor-capable of acting; emotional environment-something people have feelings for; place-a part of personal identity and a location; space-complex and relational spatial connections and a site for care; setting-passive background and absolute space; becoming-a fluid spatiality constantly folded. Examples of attributes and suggestions for further concept development were identified.

CONCLUSIONS

The concept reflects various sets of ideas as well as expressing both relational and absolute perspectives of space. The most challenging for nursing research and practice seems to be investigation, operationalization, and testing the implementation of sets of ideas reflecting a relational thinking of space.

Experiences of encounters with healthcare professionals through the lenses of families living with chronic illness

AIMS AND OBJECTIVES

To describe and explore the experience of healthcare encounters in families living with chronic illness.

BACKGROUND

Living with chronic illness is a family concern and often includes frequent encounters with healthcare professionals. These encounters affect how persons with illness and family members handle everyday life. Disease-related explanations are perceived by healthcare professionals as being of higher importance than the actual experience of illness, even though patients are concerned with issues involving their everyday life.

DESIGN

A descriptive design with a qualitative approach.

METHODS

Narrative family interviews were conducted with twelve families, using a qualitative content analysis.

RESULTS

One main category was indicated following analysis, specifically "The impact of an accompanying family member." Additionally, three subcategories were revealed; "The importance of collaboration," "Mutual understanding," "A desire to be confirmed in one's illness".

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

Having a participating family member increased the sense of power in families during encounters with healthcare professionals. This participation constitutes a level of support, making it easier for families to handle everyday life due to illness. Family members are, in most cases, included in discussions and decisions, both before and after encounters, and it should be a natural for healthcare professionals to invite them to the encounter too. This is an offer that may not fit every family, but the person with illness or the family should at least have the opportunity to choose.

A shared respite--The meaning of place for family well-being in families living with chronic illness

Living with chronic illness is a family affair that involves ongoing changes and challenges in everyday life. When life changes, the environment is important for family health and well-being. The relation between a place and a family is rarely described, and therefore the aim of this study was to explore the meaning of place for family well-being in families living with chronic illness. A qualitative design was chosen. Data were collected by photovoice combined with narrative family research interviews with 10 families living with chronic illness. A phenomenological hermeneutic analysis was used to interpret the data. The results showed that the meaning of place for family well-being in families living with chronic illness can be described as "a shared respite." This main theme included three subthemes: "a place for relief," "a place for reflection," and "a place for re-creation." These results were further understood by means of the concept place security. Feeling well means having place security in these families. Through knowledge about the meaning of place for family well-being, health care personnel can stimulate families living with chronic illness to find respite in places that contribute to well-being, both in familiar and new places.

Assessing family resources: validation of the Swedish version of the Family Hardiness Index

All families face normative transitions. Some are perceived as stressful and calls for family resources to maintain or restore family well-being. In times of illness, families also need to develop strengths and capabilities to enhance family well-being. The way these are developed is related to family hardiness. Family hardiness is thus seen as a family resource, and the Family Hardiness Index (FHI) was developed to measure family stress resistance and adaptation resources. The index was not available in Swedish and no extensive international psychometric evaluation was found. Therefore, the aim was to translate and validate the Swedish version of the FHI. The study was approved by a Regional Ethical Review Board. Data from 174 Swedish participants, family members to persons with cognitive dysfunctions (n = 95) and nursing students (n = 79) were included. Family members were enrolled in outpatient clinics in primary care and rehabilitation, and nursing students at a nursing school. Psychometric properties were evaluated through calculations of missing data, distributions of item and scale scores, item correlations, Cronbach's alpha, confirmatory factor analyses and correlations with theoretically related constructs. Sample scores had acceptable data quality, internal consistency for the FHI total scale was satisfactory (α = 0.86), and construct validity was supported. Our findings cast some doubt on the intended interpretation since confirmatory factor analyses showed that a modified four-subscale version, excluding one subscale, showed best fit. The Control subscale lacked important psychometric properties in terms of homogeneity, internal consistency and construct validity. The sample size was probably sufficiently large for the factor analyses, but the subgroup analyses should be treated with caution. The conclusion is that the Swedish version of the FHI is a promising scale for assessing family hardiness, but more solid evidence for the factor structure in various Swedish and international samples is needed.

VELOCITY-RESOLVED [C ii] EMISSION AND [C ii]/FIR MAPPING ALONG ORION WITH HERSCHEL

We present the first ~7.5'×11.5' velocity-resolved (~0.2 km s^-1) map of the [C ii] 158 μm line toward the Orion molecular cloud 1 (OMC 1) taken with the Herschel/HIFI instrument. In combination with far-infrared (FIR) photometric images and velocity-resolved maps of the H41α hydrogen recombination and CO J=2-1 lines, this data set provides an unprecedented view of the intricate small-scale kinematics of the ionized/PDR/molecular gas interfaces and of the radiative feedback from massive stars. The main contribution to the [C ii] luminosity (~85 %) is from the extended, FUV-illuminated face of the cloud (G₀>500, n_H>5×10³ cm^-3) and from dense PDRs (G≳10⁴, n_H≳10⁵ cm^-3) at the interface between OMC 1 and the H ii region surrounding the Trapezium cluster. Around ~15 % of the [C ii] emission arises from a different gas component without CO counterpart. The [C ii] excitation, PDR gas turbulence, line opacity (from [¹³C ii]) and role of the geometry of the illuminating stars with respect to the cloud are investigated. We construct maps of the L[C ii]/L_FIR and L_FIR/M_Gas ratios and show that L[C ii]/L_FIR decreases from the extended cloud component (~10^-2-10^-3) to the more opaque star-forming cores (~10^-3-10^-4). The lowest values are reminiscent of the "[C ii] deficit" seen in local ultra-luminous IR galaxies hosting vigorous star formation. Spatial correlation analysis shows that the decreasing L[C ii]/L_FIR ratio correlates better with the column density of dust through the molecular cloud than with L_FIR/M_Gas. We conclude that the [C ii] emitting column relative to the total dust column along each line of sight is responsible for the observed L[C ii]/L_FIR variations through the cloud.

Disparities in mental health among adolescents with and without impairments

Aim: To analyse whether there are differences in mental health among adolescents with and without various kinds of impairments, taking into account the number of impairments and gender. Methods: Data from the study Life & Health – Young People conducted in a Swedish county in 2011 was used. The survey included all students in grades 7 (13–14 years) and 9 (15–16 years) in compulsory school and grade 2 (17–18 years) in upper secondary school; there were 7793 respondents (81.0%). The students answered a questionnaire anonymously during school hours. Various measures of mental health were assessed in the groups: hard of hearing, visual impairment, motor impairment, difficulties in reading/writing/dyslexia, attention deficit hyperactive disorder/attention deficit disorder, other impairment, no impairment. Results: Of the studied impairments, difficulties in reading/writing/dyslexia are the most common (6.3%), followed by hard of hearing (5.4%). To have at least one impairment is more common among boys (18.2%) than girls (15.4%). In the impairment group, 21.5% have multiple impairments. Adolescents with impairments have worse mental health than those without, and those with multiple impairments have particularly higher odds ratio to have worse mental health. There are also differences in mental health between number and various kinds of impairments and between girls and boys. Conclusion: Adolescents with impairments, particularly girls and those with multiple impairments, have considerably worse mental health than others. These inequalities in health are an immense challenge, not only for those directly involved with the impaired: they affect everyone involved with the goal health equity for the whole population.

Families living with chronic illness: beliefs about illness, family, and health care

Beliefs can be described as the lenses through which we view the world. With emerging illness, beliefs about the illness experience become important for nurses to understand to enhance well-being and healing. The aim of this study was to illuminate illness beliefs of families living with chronic illness. A qualitative design was chosen, including repeated narrative research interviews with seven Swedish families living with chronic illness. Hermeneutic analysis was used to interpret the transcribed family interviews. The result described beliefs in families, both within and across families. Both core beliefs and secondary beliefs about illness, family, and health care were revealed. Illness beliefs have importance for how families respond to and manage situations that arise from their encounters with illness. Nurses have to make space for and listen to families' stories of illness to become aware of what beliefs may support and encourage family well-being and healing. The Illness Beliefs Model provides a touchstone whereby nurses can distinguish both individual and shared beliefs within families living with chronic illness and provide ideas for family intervention if needed.

What factors can be protective for both self-rated oral health and general health?

The aim of this study was to analyze if the same protective factors are significant for both self-rated health and oral health. It was hypothesized that these factors should be the same. The material is based on a population sample of 17 113 women and men aged 18-84 years in one county in central Sweden.The response rate was 61%. The data were collected through a postal questionnaire "Life and Health" in 2008. The questionnaire comprised of 149 questions and was divided into a number of areas, e.g. socioeconomic conditions, quality of life, social relations, lifestyle, and health. To analyze the strength of the protective factors whilst taking into account the relationships between the various independent variables, multivariate analyses were conducted using binary multiple logistic regression. The outcome measures with the strongest association to general health is belonging to the age group 18-34 years, positive faith in the future, good sleeping pattern and to be employed/self-employed/retired. The outcomes with the strongest association to oral health are good finances, belonging to the age group 18-34 years, to be born in Sweden and positive faith in the future. Conclusions. This study shows that, in general, the same protective factors are significant for both self-rated health and self-rated oral health, making it possible to use the same approach to strengthen both general health and oral health. One important outcome, not often considered, is having positive faith in the future. It is a task for the health care system to strengthen people's faith in the future, partly through a very high quality care when needed, but also through active health promotion that increases the chances of a healthy life, both from a public health perspective as from an oral health perspective.

Primary lysis of eosinophils in severe desquamative asthma

Primary lysis of eosinophils liberates free eosinophil granules (FEGs) releasing toxic proteins in association with bronchial epithelial injury repair. Eosinophil lysis may be significantly pathogenic. Bronchial mucosal FEGs are associated with uncontrolled asthma, severe asthma, aspirin-sensitive asthma, and lethal asthma. FEGs in the bronchial wall may characterize severe asthma without sputum eosinophilia. Excessive numbers of sputum FEGs occur in severe exacerbations of asthma and are reduced along with clinical improvement. Occurrence of FEGs affects interpretation of other sputum biomarkers including numbers of eosinophils, ECP, and eosinophil-stained macrophages. Thus, eosinophil lysis produces FEGs as bronchial biomarkers of severe asthma. Blood eosinophils in severe asthma seem primed exhibiting a propensity to lyse that is greater the more severe the asthma. Proclivity of blood eosinophils to lyse also distinguished three levels of severity among children with exacerbations of asthma. Numerous FEGs releasing toxic proteins occur in association with grave derangement and shedding of epithelium in severe asthma. Subepithelial FEGs correlate negatively with intact bronchial epithelium in clinically uncontrolled asthma. Significant correlations between sputum ECP, Creola bodies, and severity of asthma exacerbations have also been demonstrated. Hence, eosinophil lysis apparently causes epithelial desquamation in severe asthma. Exaggerated epithelial repair in turn would contribute to inflammatory and remodelling features of severe asthma. Perseverance of FEGs together with maintained disease activity, despite treatment with 'eosinophil-depleting' steroids and anti-IL5 biologicals, agrees with the possibility that eosinophil lysis is worthy target for novel anti-asthma drugs. Priming and lysis of eosinophils, and protein release from FEGs, are regulated and can be targeted. Eosinophil lysis and FEGs belong to the disease picture of severe asthma and need consideration in asthma studies concerned with phenotypes, biomarkers, roles of epithelial injury/repair, and targeting novel drugs.

Examining Family Responses to Family Systems Nursing Interventions: An Integrative Review

To add to the small, but growing, number of literature reviews of family interventions in health care, a systematic literature search of Family Systems Nursing intervention research resulted in the inclusion of 17 empirical research reports. Family Systems Nursing intervention research to date has primarily used qualitative methods and a few quasi-experimental designs using pre-post outcome measures. Families' responses to Family Systems Nursing interventions were categorized in this integrative review using the cognitive, affective, and behavioral domains of family functioning proposed by Wright and Leahey. Family response in the cognitive domain found improved understanding, capability, and enhanced coping. The affective response categories showed caring more about each other and the family, improved family emotional well-being, and improved individual emotional well-being. Finally, family responses in the behavioral domain comprised caring more for each other and the family, improvement in interactions within and outside family, and healthier individual behavior. These findings may guide the design of future family nursing intervention research and the selection of family outcome measures to examine the usefulness of Family Systems Nursing interventions. More intervention research using experimental and quasi-experimental designs is needed to strengthen the evidence for Family Systems Nursing practice.

Family health conversations: how do they support health?

Research shows that living with illness can be a distressing experience for the family and may result in suffering and reduced health. To meet families' needs, family systems intervention models are developed and employed in clinical contexts. For successful refinement and implementation it is important to understand how these models work. The aim of this study was therefore to describe the dialogue process and possible working mechanisms of one systems nursing intervention model, the Family Health Conversation model. A descriptive evaluation design was applied and 15 transcribed conversations with five families were analyzed within a hermeneutic tradition. Two types of interrelated dialogue events were identified: narrating and exploring. There was a flow between these events, a movement that was generated by the interaction between the participants. Our theoretically grounded interpretation showed that narrating, listening, and reconsidering in interaction may be understood as supporting family health by offering the families the opportunity to constitute self-identity and identity within the family, increasing the families' understanding of multiple ways of being and acting, to see new possibilities and to develop meaning and hope. Results from this study may hopefully contribute to the successful implementation of family systems interventions in education and clinical praxis.

Robocasting of biomimetic hydroxyapatite scaffolds using self-setting inks

A new self-setting ceramic ink was developed for robocasting of biomimetic hydroxyapatite scaffolds, based on alpha-tricalcium phosphate and gelatine. After setting a biomimetic hydroxyapatite is obtained, with higher reactivity and resorbability than high-temperature sintered hydroxyapatite. The setting reaction of the ink results in a significant increase of the mechanical properties of the scaffolds.

Caries in five different socio-economic clusters in Orebro county

AIM

This study assessed the prevalence of socio-demographic clusters in a Swedish county and the relationship of socio-demographic clusters and caries.

METHODS

All 2-19-year-olds (n = 58,573) who attended a routine check-up in Orebro County in 2005-2007 were involved in this study. Initially, two-stage cluster analyses were used to identify outliers. Secondly, the Ward method which is a hierarchical clustering method was used to conduct the final analysis. Bivariate logistic regression was also used to study the relationship between cluster membership and caries. The smallest study unit used in the initial analysis for geographical area is known as key code area, which is a geographical entity defined by the municipalities themselves. Decayed surface (DS/ds) has been used as a measure of dental caries.

RESULTS

The county of Orebro clustered in five different socioeconomic clusters. Each cluster was defined by proportion of people over 75 years, native-born, single parents, and those with low incomes and low level of education. Odds ratio (OR) for having DS/ds > 0 in the last dental check-up during 2005-2007 was 1.5 (cluster 1), 1.3 (cluster 2), 1.4 (cluster 3) and 3.8 (cluster 4) compared with the most socioeconomically favoured cluster (cluster 5).

CONCLUSION

Cluster analysis of socioeconomic data is a useful tool to identify neighbourhoods with different socio-economic conditions.

Fabrication and evaluation of SixNy coatings for total joint replacements

Wear particles from the bearing surfaces of joint implants are one of the main limiting factors for total implant longevity. Si(3)N(4) is a potential wear resistant alternative for total joint replacements. In this study, Si(x)N(y)-coatings were deposited on cobalt chromium-discs and Si-wafers by a physical vapour deposition process. The tribological properties, as well as surface appearance, chemical composition, phase composition, structure and hardness of these coatings were analysed. The coatings were found to be amorphous or nanocrystalline, with a hardness and coefficient of friction against Si(3)N(4) similar to that found for bulk Si(3)N(4). The low wear rate of the coatings indicates that they have a potential as bearing surfaces of joint replacements. The adhesion to the substrates remains to be improved.

A selective follow-up study on a public health survey

BACKGROUND

The non-response rates in surveys are increasing which is problematic as it means that a progressively smaller proportion of the population represents the majority, and it is uncertain how health survey results are affected. This follow-up was performed on the non-responders to the postal questionnaire in the public health survey Life and Health, conducted in Örebro County Council, Sweden, where large differences in response rates had been found between different socio-demographic groups and geographical areas. The main objective was to analyse non-response bias regarding self-rated health.

METHODS

This follow-up study was conducted as a census to all non-responders in the area that had the lowest response rate and, in one other geographical area used as a control. It was carried out by telephone interviews, 49.3% (580 individuals) answered the follow-up. The outcome variable was self-rated health, a main variable in public health surveys. Differences in response patterns between responders and initial non-responders were approximated by prevalences with confidence intervals and adjusted odds ratios.

RESULTS

Poor health was more common in the initial non-response group than among the responders, even with consideration given to sex, age, country of birth and education. However, good health was equally common among responders and initial non-responders.

CONCLUSIONS

Public health surveys can be biased due to certain groups being under-represented or not represented at all. For this reason, in repeated public health surveys, we recommend selective follow-ups of such groups at regular intervals.

How much information is remembered by the patients? A selective study related to health education on a Swedish public health survey

The purpose of this study was to investigate the degree to which patients have perceived that they got questions or advice about eating habits and smoking habits at their last visit at the dental clinic and if this information was differently distributed between different age groups. A further aim was to study whether there were differences in the proportions of questions and advice given to individuals who perceived problems regarding caries and gum bleeding compared to those that did not feel they had problems. The results are based on a postal questionnaire survey,"Life and Health 2008". The study was conducted in a population of women and men aged 18-84 years in 5 counties in Sweden. A total of 68,710 questionnaires were sent out and the response rate was 59.2%. Substantial differences in proportions existed between age groups regarding who received questions and advice related to dental caries and periodontal disease. The differences between age groups regarding information were statistically significant since it was less common that older people got questions and advice than younger.These differences also exist, but less pronounced, between those with disease related problems and those without.Three factors were statistically significantly associated with information. Age, education level and problems with caries or bleeding gums had statistical effect on the prevalence of questions and advice related to eating habits or smoking habits respectively. In conclusion, it is an urgent need of education in methods for dental staff if they want to contribute to changes in life style behaviors for their patients since most patients today don't perceive that they got important disease relevant information at the last dental visit.