Logotyp: till Försvarshögskolans hemsida

Compulsory basic military training is characterized not only by being challenging but also by being stressful. Assuming a high frequency of perceived stress events as a negative outcome of training, this article provides evidence on how the perceived frequency of stressful situations is affected by three types of factors: (i) biological stress response variables measured by hair steroid hormone levels, (ii) personality traits measured using the Big Five personality test, and (iii) group cohesion measures in military squads. A total of 112 conscripts in 11 squads participated in the research at the beginning (T1), in the middle (T2), and at the end (T3) of compulsory basic military training. Hair steroid hormone levels (cortisol, cortisone, and dehydroepiandrosterone (DHEA)) levels were measured by liquid mass spectrometry; other data were collected using self-report questionnaires. The results of the Poisson regression analysis indicated that hair steroid hormone cortisol had a statistically significantly impact and could increase the perceived frequency of stressful situations by up to 1.317 (e(0.275), T2) times. The concentrations of other hormones (cortisone = 1.157, e(0.146), T3 and DHEA = 1.020, e(0.020), T3) also had a statistically significant effect. Other factors had a decreasing effect on the frequency. Extraversion was significant with an effect of 0.907 (e(-0.098), T2) and 0.847 (e(-0.166), T3), while task cohesion had an effect of 0.946 (e(-0.056)) and norm cohesion of 0.954 (e(-0.047)). The research indicates that the three groups of factors affect the perceived frequency of stressful situations during compulsory basic military training, but their impacts are considerably different.

Background In Sweden the surgical surge capacity for mass casualty incidents (MCI) is managed by county councils within their dedicated budget. It is unclear whether healthcare budget constraints have affected the regional MCI preparedness. This study was designed to investigate the current surgical MCI preparedness at Swedish emergency hospitals. Methods Surveys were distributed in 2015 to department heads of intensive care units (ICU) and surgery at 54 Swedish emergency hospitals. The survey contained quantitative measures as the number of (1) surgical trauma teams in hospital and available after activating the disaster plan, (2) surgical theatres suitable for multi-trauma care, and (3) surgical ICU beds. The survey was also distributed to the Armed Forces Centre for Defence Medicine. Results 53 hospitals responded to the survey (98%). Included were 10 university hospitals (19%), 42 county hospitals (79%), and 1 private hospital (2%). Within 8 h the surgical capacity could be increased from 105 to 399 surgical teams, while 433 surgical theatres and 480 ICU beds were made available. The surgical surge capacity differed between university hospitals and county hospitals, and regional differences were identified regarding the availability of surgical theatres and ICU beds. Conclusions The MCI preparedness of Swedish emergency care hospitals needs further attention. To improve Swedish surgical MCI preparedness a national strategy for trauma care in disaster management is necessary.

This study investigated whether there is a relationship between heart rate variability (HRV) versus lifestyle and risk factors for cardiovascular disease in a population of healthy adolescents. HRV is as an index of tonic autonomic activity and in adults HRV is related to lifestyle and risk factors for cardiovascular disease, but it is not known if this is the case in adolescents. HRV was registered for 4 min in sitting position in 99 healthy adolescents (age range 15 years 11 months-17 years 7 months) and repeated after 6 months. On both occasions there were significant correlations (P < 0.05) between physical activity and HRV, with respective r values: high frequency (HF) 0.26, 0.30; low frequency power (LF) 0.35, 0.29 and the standard deviation of inter-beat intervals (SDNN) 0.28, 0.37. There was no significant interaction between first and second measurements. In contrast, there were no correlations to sleeping patterns, eating habits and smoking. Risk factors for cardiovascular disease [body mass index (BMI = weight (kg)/length in m(2)), systolic blood pressure and p-glucose] did not show any repeatable significant correlations to HRV. Multiple regression models showed that physical activity was a predictor for HF, LF and SDNN in both measurements. In conclusion HF, LF and SDNN were reproducible after 6 months and were related to physical activity on both occasions.

Exposure to geogenic contaminants (GCs) such as metal(loid)s, radioactive metals and isotopes as well as transuraniums occurring naturally in geogenic sources (rocks, minerals) can negatively impact on environmental and human health. The GCs are released into the environment by natural biogeochemical processes within the near-surface environments and/or by anthropogenic activities such as mining and hydrocarbon exploitation as well as exploitation of geothermal resources. They can contaminate soil, water, air and biota and subsequently enter the food chain with often serious health impacts which are mostly underestimated and poorly recognized. Global population explosion and economic growth and the associated increase in demand for water, energy, food, and mineral resources result in accelerated release of GCs globally. The emerging science of "medical geology" assesses the complex relationships between geo-environmental factors and their impacts on humans and environments and is related to the majority of the 17 Sustainable Development Goals in the 2030 Agenda of the United Nations for Sustainable Development. In this paper, we identify multiple lines of evidence for the role of GCs in the incidence of diseases with as yet unknown etiology (causation). Integrated medical geology promises a more holistic understanding of the occurrence, mobility, bioavailability, bio-accessibility, exposure and transfer mechanisms of GCs to the food-chain and humans, and the related ecotoxicological impacts and health effects. Scientific evidence based on this approach will support adaptive solutions for prevention, preparedness and response regarding human and environmental health impacts originating from exposure to GCs.

Background

In the rapid development in prehospital medicine the awareness of the many challenges in prehospital care is important as it highlights which areas need improvement and where special attention during education and training should be focused. The purpose of this study is to identify challenges that physicians face when working in the prehospital environment. The research question is thus; what challenges do physicians face when working in prehospital care?

Method

This is a qualitative study with an inductive approach and is based on individual interviews. The interviews were analyzed using the Classic Grounded Theory (GT) method as an approach. The interviews were conducted as semi-structured interviews via the digital platform Zoom during winter / early spring 2022.

Results

Challenges for prehospital physicians can be understood as a process that involves a balancing act between different factors linked to the extreme environment in which they operate. This environment creates unique challenges not usually encountered in routine hospital practice, which results in trade-offs that they would not otherwise be faced with. Their individual situation needs to be balanced against organizational conditions, which means, among other things, that their medical decisions must be made based on limited information as a result of the constraints that exist in the prehospital environment. They must, both as individuals and as part of a team, maneuver in time and space for decision-making and practical tasks. This theory of balancing different entities is based on four themes; thus the theory is the relation between the four themes: leadership, environment, emotion management and organization.

Conclusions

With the help of previous studies and what we have found, it is reasonable to review what training is needed before starting to work prehospital as a physician. This should include components of the themes we have described: organization, environment, leadership and emotional management.

Aims: In response to the 2009 outbreak of A/H1N1 influenza, Swedish authorities decided on a programme for universal vaccination. Over 60% of the population received at least one dose of vaccine. This study examines demographic factors and perceptions related to the decision whether or not to become vaccinated. Methods: A combined web/postal survey was conducted (n = 1587, response rate 53%) in late spring 2010. Questions reported here concerned perceptions, precautionary behaviours and vaccination decision. Results: Main reasons for becoming vaccinated were concerns about spreading the disease to relatives or in the community and confidence in the good effect of vaccination. Vaccination rates were higher among women, those with young children or belonging to a risk group. Main reasons for abstaining were belief that the flu was not a serious threat, low risk of spreading the disease, concern about side-effects and perceived uncertainties in information. Three profiles representing different patterns of thought and beliefs were identified by cluster analysis, respectively labelled as a vulnerable, a trusting and a sceptical group. Vaccination rates and precautionary behaviours were demonstrated to differ between these groups. Conclusions: Perceptions relating to the 2009 pandemic are likely to influence uptake of vaccination in the future. Authorities need to be aware of different patterns of beliefs and attitudes among the public, and that these may vary in different phases. Communication of risk needs to be dynamic and prepared to engage with the public before, during and even for some time after the acute risk period.

Objective: High-quality healthcare services is delivered by teams rather than individuals and depends heavily on multidisciplinary cooperation between dispersed healthcare professionals. The aim of this scoping review is to identify common barriers and innovative applications of technology supporting team processes and patient safety, in geographically dispersed healthcare services.

Methods: Studies were identified from searches in APA PsychINFO, Epistemonikos and Medline databases, from 2010 to 2023. A detailed search strategy was performed, and studies were included, based on prior established criteria.

Results: Among the 19 studies that fulfilled our inclusion criteria, the majority (85%) were from Europe or North America, and most studies (53%) were quantitative, with a cross-sectional study design. Several reported observed distributed team processes in training and education. Most studies described barriers and detailed how innovative approaches and technological solutions were introduced to improve communication, coordination, and shared mental models in distributed healthcare settings. A small proportion of studies (16%) used health services data to examine interpersonal exchange and team processes.

Conclusion: The scoping review offer recommendations to enhance future research on distributed team processes in healthcare services.

En teoretisk kontroll av luftvärnsbataljonens sjukvårdsfunktion

Syftet med detta arbete är att inom ramen för funktionsmålsättning för Försvarsmaktens hälso- och sjukvård kontrollera om luftvärnsbataljonens sjukvårdsfunktion enligt org. 09 är korrekt dimensionerad.

 Frågeställningen är: När, med hänsyn till grupperingsgeometri, medicinska tidskrav samt evakueringskapacitet blir sjukvårdsfunktionen en begränsande faktor för luftvärnsbataljonen.

 För att svara på detta jämförs luftvärnsbataljonens TOEM med kraven ur funktionsmålsättning för Försvarsmaktens hälso- sjukvård i syfte att kontrollera om sjukvårdsfunktionen ges förutsättning att lösa ställda uppgifter. Vidare analyseras faktorerna, aktionsradie, förlustskadeberäkningar preventiv medicin, samt evakueringskapacitet och grupperingsgeometri.

Den viktigaste slutsatsen ur arbetet är: Det är inte sannolikt att samtliga enheter inom bataljonen kan åtnjuta möjligheten till adekvat sjukvård inom de tider som de medicinska kraven ställer.

Burnout was originally conceptualized based on experiences of new professionals. Role clarity, task mastery, and social acceptance are recognized as key resources enabling new professionals’ management of the challenges of the new profession. However, relations between these resources and stress, strain, and burnout have not yet been thoroughly investigated at professional entry. Increased understanding of these relations could have implications for strategies to prevent burnout. The aim of the study was to investigate within- and between-individual effects over the first months and relations to burnout at one-year post-entry. Data (n = 322) was collected weekly over the first 13 weeks and again 9 months later. Relationships were modelled using a multilevel regression model and correlation analysis. Results showed that on weeks when participants experienced higher role clarity, task mastery, and social acceptance, they reported significantly less stress, and that participants who experienced higher levels of the resources in general, reported significantly less strain. Levels of the resources at three months were related to symptoms of burnout at 12 months. The study findings provide support of the role of task mastery, role clarity, and social acceptance as resources buffering the impact of demands at professional entry on experiences of stress, strain, and burnout.

Oncological therapy resembles a military force that eliminates the central power of a country (dominant clone of a cancer) to create a vacuum where insurgents (subclones) thrive and instigate rebellion (relapse). We suggest that military counterinsurgency doctrine can inspire a discussion of cancer that uniquely embraces both cancer cell evolution and tumour microenvironment.

Den svenska säkerhets- och försvarspolitiken kom snabbt att förändras under 2014 efter att Ryssland först ockuperat och sedan annekterat Krimhalvön. Sveriges verklighetsbild förändrades på några få månader, från det att Sveriges statsminister på Folk och Försvarskonferensen i Sälen i januari 2014 sagt att det var svårt att kunna tänka sig att det fanns något avgörande militära hot mot något europeiskt land. För något mer än sju år sedan, den 10 december 2015, beslutade regeringen om en återupptagen totalförsvarsplanering.

Det är inom ramen för denna planering, och den svenska förmågeökning som den syftar till, som våra tankar här riktar sig till. Vi är långt ifrån klara i Sverige. Vi har precis kommit igång. Stora tankar behöver tänkas. Effekt behöver levereras.

Vår uppgift är att lista utmaningar och problem i Sveriges säkerhets- och försvarspolitik inom den pågående totalförsvarsreformen och identifiera utvecklingsbehov inom svensk policy och strategi. Vi ska utmana status quo, vara framåtlutade och argumentera för de reformer som vi anser behövs.Våra slutsatser återfinns inom tre kapitel

Demokratin, rättsstaten och de grundläggande fri- och rättigheterna är Sveriges främsta skyddsvärden.Ett starkt totalförsvar utifrån helhet, enkelhet och effekt.En vassare förmåga.

The aim of the present study was to develop a theoretical understanding of elderly patients' experiences of pain and distress in intensive care, using a grounded theory approach. 18 patients, 7 women and 11 men, were interviewed and observed in an intensive care unit (ICU). Their average age was 76.5, varying from 70–85. A model was generated from data, according to which elderly patients' experiences of pain and distress in intensive care can be described as four interrelated aspects: a sensory, an intellectual, an emotional, and an existential dimension. 16 categories form the four dimensions. The categories, in turn, are grounded in a number of interview and observational data. The sensory dimension is formed by the categories physical pain, physical discomfort, fatigue, and breathing problems, and the intellectual dimension by the categories not knowing, difficulty in expressing oneself/not being understood and confused perception of reality. The categories in the emotional dimension are worry, fear, resignation, bitterness, anger/irritation and dependency. Finally, the existential dimension is formed by the categories despair, threat to life and death acceptance. The categories within the four dimensions may be separate, but often they interact and influence each other in various ways. The model is discussed in relation to existing models and definitions of pain, where the intellectual and existential dimensions in particular have not been emphasized in a similar way.

AIM: This study compared elderly patients' reported experiences of pain and distress with enrolled nurses' assessments and related potential differences to patient and enrolled nurse characteristics.

BACKGROUND: Many elderly suffer from chronic pain but few studies have focused on this group of patients.

METHODS: Data were collected through personal interviews with 38 patients and questionnaires completed by 38 enrolled nurses.

FINDINGS: Enrolled nurses underestimated patients' experiences of physical pain, physical discomfort, breathing problems, resignation, and dependency. Pain and distress were overestimated by enrolled nurses who had lower scores on three of the five personality scales used. In contrast, enrolled nurses who had higher scores on these personality scales tended to underestimate the patients' pain and distress.

CONCLUSIONS: There is a need to develop staff training programmes in order to optimize the care for elderly patients with chronic pain in the community.

Chronic pain represents a major health problem among older people. The aims of the present study were to: (i) identify various profiles of pain and distress experiences among older patients; and (ii) compare whether background variables, sense of coherence, functional ability and experiences of interventions aimed at reducing pain and distress varied among the patient profiles. Interviews were carried out with 42 older patients. A cluster analysis yielded three clusters, each representing a different profile of patients. Case illustrations are provided for each profile. There were no differences between the clusters, regarding intensity and duration of pain. One profile, with subjects of advanced age, showed a decreased functional ability and favourable scores in most of the categories of pain and distress. Another profile of patients showed favourable mean scores in all categories. The third cluster of patients showed unfavourable scores in most categories of pain and distress. There appears to be a need to treat the three groups of patients in different ways in the caring situation.

The aim of this study was to explore postoperative experiences of pain and distress in elderly patients, as well as interventions aimed at reducing these conditions, on three occasions. The study group was composed of 100 patients who had undergone elective surgery in two orthopedic and two general surgical units. Of the 50 patients in the orthopedic units, 26 had undergone hip arthroplasty and 24 knee arthroplasty: of the 50 patients in the general surgical units, 23 had had breast cancer surgery, and 27 abdominal surgery. The patients were interviewed, using a structured interview format, on three occasions; at the ward on the first and second day after surgery, and by telephone about ten days after discharge from hospital. Within both the sensory and the emotional dimensions, logistic regression analyses showed that the dependent variables of pain and distress were significantly related above all to type of surgery and sense of coherence (SOC). In a cluster analysis, three meaningful clusters of patients were obtained. The patients in the different profiles showed variations in their experiences of pain and distress. The 12 patients with the least favorable scores had weaker SOC than the patients in the other profiles. It is concluded that type of surgery and psychological factors influenced patients' experiences of pain and distress after undergoing surgery. These experiences should be reduced by identifying risk patients, and improving assistance and support in the nursing ward, and also when patients have returned home.

In contrast to the vast majority of Western countries, Sweden left large segments of the society open instead of imposing a lockdown to combat the spread of the coronavirus. As a result, the Swedish COVID-19 measures, largely devised by its expert agency on health, garnered widespread international attention. Despite the global interest in the corona strategy of the Public Health Agency of Sweden (PHAS), there are currently no systematic studies on their COVID-19 policy. The present investigation focuses on the controversies that have characterized PHAS' work with reference to risk assessments, facemasks, voluntarism, testing, and the protection of the elderly during the pandemic. Overall, this inquiry demonstrates that PHAS' risk assessments were initially overly optimistic and their facemask recommendations in conflict with large segments of the scientific community for an extensive period. Yet, their voluntary measures worked moderately well. In their testing, PHAS did not manage to deliver on their promises in time, whereas several measures implemented to protect the elderly were deemed inadequate and late. 

Many countries around the world are facing a shortage of healthcare resources, especially during the post-epidemic era, leading to a dramatic increase in the need for self-detection and self-management of diseases. The popularity of smart wearable devices, such as smartwatches, and the development of machine learning bring new opportunities for the early detection and management of various prevalent diseases, such as cardiovascular diseases, Parkinson’s disease, and diabetes. In this survey, we comprehensively review the articles related to specific diseases or health issues based on small wearable devices and machine learning. More specifically, we first present an overview of the articles selected and classify them according to their targeted diseases. Then, we summarize their objectives, wearable device and sensor data, machine learning techniques, and wearing locations. Based on the literature review, we discuss the challenges and propose future directions from the perspectives of privacy concerns, security concerns, transmission latency and reliability, energy consumption, multi-modality, multi-sensor, multi-devices, evaluation metrics, explainability, generalization and personalization, social influence, and human factors, aiming to inspire researchers in this field.

The aim of the study was to identify patterns of physical, psychological, and social conditions that may be of prognostic value when it comes to assessing continued care of patients clinically ready for discharge; a related aim was to evaluate instruments used for this identification, especially a Swedish version of the health assessment form. The sample consisted of 53 consecutive patients (mean age 82.8 years, SD = 6.6 years) All patients came from their own homes and were admitted to surgical and orthopaedic departments. Interviews were carried out on the day the patients were assessed as medically ready for discharge, and a second time 1 month later. The health assessment form measured the persons' social and environmental situation, health history, and functional health status, and another instrument measured the persons' sense of coherence. Few significant differences in functional health status were noted between persons who could return to their homes (n =25) and persons who were referred to institutions after discharge (n = 17). However, the persons being referred to institutions showed less favourable scores within the areas of mood, sense of coherence, and worries about their home accommodation situation. When another sub-group was included (patients who died between the interview occasions; n = 8), significant differences were also noted in the health functions breathing, digestion, elimination, and body movement. Sense of coherence had a significant prognostic value for the continued care after discharge irrespective of whether the deceased patients were included or not.

The main aim of this study was to assess the reliability and validity of a Swedish translation of the NEECHAM Confusion Scale among 73 patients having surgery for hip fractures. Cronbach's alpha before and 7 days after surgery were .73 and .82, respectively. Principal-component analyses yielded three factors explaining 69% of the variance of the variables preoperatively and 73.6% of the variance 7 days postoperatively. Four months after discharge vital function, factor II in the NEECHAM scale, significantly predicted the total score on the Ferrans and Powers Quality of Life Index. Items reflecting information processing, behavior, and urinary continence, factor I, also predicted functional capacity, using the Standardized Practical Equipment test, a tool measuring instrumental daily activity. The scale seems to be a reliable and valid instrument for evaluating acute confusional state among patients with hip fracture.

Background 

Empirical research on shared mental models (SMM) in virtual environments are almost non-existent. Pre-hospital emergencies presents an opportunity to examine team processes in virtual teams because the dispatcher is geographically separated from the ambulance and at the same time plays a significant role in coordinating, organizing, obtaining, evaluating, and conveying relevant information to the deployed ambulance. The present study aimed at mapping team behavior and cognition in critical real-life emergency medical missions based on the concept of SMM. 

Methods 

By investigating the frequencies of coordinating mechanisms and team competencies based on voice recordings from real-life missions, differences in team behavior between low and high-complexity missions were investigated. 

Results 

Lower frequencies of team competencies and coordinating mechanisms were found in high compared to low-complexity missions. The results showed a different profile in communication between high and low-complexity missions with more frequent use of both coordinating mechanisms and team competencies in low-complexity missions. Furthermore, the profiles revealed that SMM and closed loop communication were the only coordinating mechanism used, and leadership and team orientation were the only competencies exercised. 

Conclusion 

It was concluded that the lack of visual input of a team member during team interaction could lead to team process loss due to a breakdown of the team into sub-units. Potential improvement of team behavior is discussed within the SMM framework. 

In recent decades there has been an increased emphasis on non-technical skills in medical teams. One promising approach that relates teamwork to medical efficiency is the theory of Shared Mental Models (SMM). The aim of the present study was to investigate the suitability of the Shared Mental Model approach for teamwork between operators in emergency medical communication centers and the first line ambulance personnel in real-life settings. These teams collaborate while working from geographically dispersed positions, which makes them distinct from the kinds of teams examined in most previous research on team effectiveness. A pressing issue is therefore whether current models on co-located teams are valid for medical distributed teams. A total of 240 participants from 80 emergency medical teams participated in the study. A team effectiveness model was proposed based on identified team coordinating mechanisms and the “Big five” team processes. Path analyses showed that SMM was positively associated with team effectiveness (i.e., performance satisfaction and situational awareness) and negatively related to mission complexity. Furthermore, the coordinating mechanisms of SMM and Closed Loop Communication was positively related to “Big five” team scores. However, no effects were found for the “Big five” team processes on effectiveness, which could indicate that the model needs to be adjusted for application to geographically dispersed teams. Possible implications for team training of distributed emergency response teams are discussed.

Background

Diagnostic testing is essential for disease surveillance and test–trace–isolate efforts. We aimed to investigate if residential area sociodemographic characteristics and test accessibility were associated with Coronavirus Disease 2019 (COVID-19) testing rates.

Methods

We included 426 224 patient-initiated COVID-19 polymerase chain reaction tests from Uppsala County in Sweden from 24 June 2020 to 9 February 2022. Using Poisson regression analyses, we investigated if postal code area Care Need Index (CNI; median 1.0, IQR 0.8–1.4), a composite measure of sociodemographic factors used in Sweden to allocate primary healthcare resources, was associated with COVID-19 daily testing rates after adjustments for community transmission. We assessed if the distance to testing station influenced testing, and performed a difference-in-difference-analysis of a new testing station targeting a disadvantaged neighbourhood.

Results

We observed that CNI, i.e. primary healthcare need, was negatively associated with COVID-19 testing rates in inhabitants 5–69 years. More pronounced differences were noted across younger age groups and in Uppsala City, with test rate ratios in children (5–14 years) ranging from 0.56 (95% CI 0.47–0.67) to 0.87 (95% CI 0.80–0.93) across three pandemic waves. Longer distance to the nearest testing station was linked to lower testing rates, e.g. every additional 10 km was associated with a 10–18% decrease in inhabitants 15–29 years in Uppsala County. The opening of the targeted testing station was associated with increased testing, including twice as high testing rates in individuals aged 70–105, supporting an intervention effect.

Conclusions

Ensuring accessible testing across all residential areas constitutes a promising tool to decrease inequalities in testing.

Background and Purpose

The present study was conducted to examine passive hip range of motion (PROM) for patients with hip dysfunction, including pain, with or without hip osteoarthritis, to arrange and describe PROM patterns and to count the number of hips presenting Cyriax's and Kaltenborn's capsular patterns.

Method

The study is theory-testing, observational, cross-sectional and descriptive. One hundred and sixty-eight patients (mean age 61.7 years, range 36–90 years), 50 with no hip osteoarthritis, 77 with unilateral hip osteoarthritis and 41 with bilateral osteoarthritis, based on radiological reports, were consecutively recruited by physicians in primary health care and orthopaedic settings. One examiner tested PROM bilaterally, by use of a goniometer and a standardized protocol. PROM limitations were calculated by comparing norms from the symptom-free hips (n = 100) in the study, from Kaltenborn and, in patients with unilateral hip osteoarthritis (n = 77), from the non-osteoarthritis hip. The limitations were arranged by size in PROM patterns. The patterns and the numbers of hips with patterns corresponding to Cyriax's and Kaltenborn's capsular patterns were counted.

Results

Between 68 and 138 PROM patterns were identified by use of different PROM norms for defining limitations. Few osteoarthritis hips showed Cyriax's capsular pattern and none Kaltenborn's capsular pattern.

Conclusions

The concept of capsular pattern for the hip should be re-examined. No support was found in the present study for its existence. It is impossible to anticipate radiological evidence of hip osteoarthritis from the multitude of PROM patterns. Every patient should be regarded as unique.

Objective

To evaluate, in an exploratory study, a hip school led by physical therapists for patients with hip dysfunction including pain.

Methods

Physicians in primary care and orthopedic units consecutively recruited patients by residential area to a treatment group (T group; n = 77) and a control group (C group; n = 68), mean age 61.8 years, 59 men, 86 women. Ninety-nine of the 145 subjects had radiologic hip osteoarthritis. Outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Nottingham Health Profile (NHP).

Results

After hip school (6 months) the T group showed greater reduction on the subscales of pain and activity limitations (WOMAC) than the C group. The subscales sleep disturbances, pain, and physical mobility (NHP) showed improvement for the T group compared with at start. The results for the T group persisted after an additional 6 months.

Conclusion

A hip school may reduce pain and activity limitations and improve health-related quality of life for patients with hip dysfunction including pain.

Objective: To test if decreased parental protective behaviors, monitoring behaviors, and parental catastrophizing mediate relief of gastrointestinal symptoms in children 8–12 years with functional abdominal pain disorders(FAPDs). The study uses secondary data analyses of a randomized controlled trial in which exposure-based online cognitive behavioral therapy (ICBT) was found superior to treatment as usual in decreasing gastrointestinal symptoms.

Methods: The ICBT included 10 weekly modules for children and 10 weekly modules for parents. Treatment as usual consisted of any medication, dietary adjustments, and healthcare visits that the participants engaged in during 10 weeks. All measures were self-assessed online by parents. Biweekly assessments of the Adult Responses to Children’s Symptoms (ARCS), Protectand Monitor subscales, and the Pain Catastrophizing Scale, parental version (PCS-P) were included in univariate and multivariate growth models to test their mediating effect on the child’s gastrointestinal symptoms assessed withthe Pediatric Quality of Life Gastrointestinal Symptoms Scale (PedsQL).

Results: A total of 90 dyads of children with FAPDs and their parents were includedin the study, of which 46 were randomized to ICBT and 44 to treatment as usual. The PCS-P was found to mediate change in the PedsQL ab = 0.639 (95% CI0.020–2.331), while the ARCS Monitor ab = 0.472 (95% CI −1.002 to 2.547), and Protect ab= −0.151 (95% CI −1.455 to 0.674) were not mediators of change.

Conclusions: To target parental catastrophizing in ICBT for pediatric FAPDs is potentially important to reduce abdominal symptoms in children.

The aim of the study was to determine if using linen in hospital beds affects patients' well-being An experimental group consisting of 52 patients (mean age 64 4 years) at a medical ward used linen in the bottom sheet, the protective sheet, the pillow-case and the patient gown for 4 weeks A control group consisting of 40 patients (mean age 67 5 years) at the same ward was observed for 4 weeks using the conventional material (cotton, cotton/polyester) Marginal positive effects on patients' well-being were noted when linen was used It was discussed that the relative importance of the bed material to patients' well-being may be low, compared to medical treatment, nursing, etc Given the high cost of linen, about 15 times more than the conventional material, it was suggested that the health care system should refrain from large-scale use of linen in hospital beds

The aim of the study was to explore personality development during nursing education. The sample consisted of 122 Swedish nursing students. Ninety-three per cent of the students were female and the mean age at the beginning of the nursing education (which lasts for two years) was 27.6 years. Personality inventories were administered at the beginning and end of the education. The post-education assessment rendered several statistically significant differences of means. Compared with the pre-education assessment, the nursing students reported a more positive profession-oriented self-perception at the end of the education, a stronger ideal, real, and mirror identity, a reduced trait anxiety, stronger needs for achievement, exhibition, autonomy, dominance, and nurturance, and a weaker abasement need. The practical significance of the results was discussed.

The main aim was to study the predictive power of sense of coherence regarding future needs of care among elderly patients evaluated as medically ready for discharge from somatic emergency care. A secondary aim was to study the consistency of sense of coherence over time among patients with this kind of experience. The sample consisted of 53 Swedish patients (mean age 82.8 years, SD = 6.6 years) who had completed their medical treatment at surgical or orthopaedic departments. The predominant diagnosis was lower limb fractures. Sense of coherence was assessed twice, on the day the patient was evaluated as medically ready for discharge and 1 month later. On the second assessment occasion, 28 patients had returned to their homes, 17 were staying at institutions, and eight had died. Patients who returned to their homes reported the strongest sense of coherence while still in hospital. Patients who were staying at institutions scored lowest on the overall sense of coherence scale and on the comprehensibility subscale. Patients who died before the second measurement occasion scored lowest on the meaningfulness subscale. A correlation of 0.51 was noted between the two assessments of sense of coherence, indicating a moderate temporal consistency

Drawing on previous research, two hypotheses were tested: (1) the higher the frequency of daily uplifts and use of functional coping strategies, and the lower the frequency of daily hassles and use of dysfunctional coping strategies, the lower the prevalence of stress‐related symptoms will be, and vice versa; and (2) the direct relationship between the personality dimension emotional stability and stress‐related symptoms, will be moderated by daily hassles, daily uplifts and coping processes. A quantitative test of a qualitatively developed model was performed. A questionnaire was sent to all Swedish military veterans who had served in the period 2011–2015 and 1859 individuals (1,614 men and 199 women, 46 individuals did not mark gender) responded (40.5% total response rate). All analyses were made separately for men and women. Comparisons between theoretically favorable and unfavorable profiles across the model variables, daily uplifts, daily hassles, functional coping and dysfunctional coping (based on a cluster analysis), showed considerable differences regarding the prevalence of stress‐related symptoms as predicted by the model and supporting the first hypothesis. Regression and moderation analyses yielded limited support for the second hypothesis. As predicted, female veterans reported a higher frequency of physical, emotional and cognitive stress‐related symptoms than male veterans. The main conclusion is that the theoretical model stood up well when empirically tested and offers a promising approach to future studies on everyday stress and health. The results contribute with new knowledge of military veterans compared to the main stream PTSD, depression and drug abuse‐oriented studies.

The aim of this study was to scrutinize the relationship between personality type as described by Grossarth-Maticek and Eysenck, health-related behaviours, and indicators of transitory ill health in a community sample. The sample consisted of all per sons aged 40 years (45 men and 35 women) in a Swedish municipality who agreed to take part in a health examination at the primary health care centre of the municipality. The Short Interpersonal Reactions Inventory (Grossarth-Maticek and Eysenck, 1990) was used to measure personality type. Self-report data were obtained regarding seven health-related behaviours. Health was assessed in three ways; self-report (paper and pencil), self-report (interview response to physician), and measures of 36 biological variables including immune system indicators. The allocation of persons to the different personality types proved problematic using the established methods. By combining the types, according to Eysenck's personality model, and performing a cluster analysis on this combination, a ‘healthy’ and a ‘stressed’ profile were identified within both the male and the female group of subjects. Persons in the healthy personality cluster showed more favourable scores on the health-related behaviour indices and on the self-report health scales than the persons in the stressed cluster. They also tended to score lower than those in the stressed cluster on most of the biological markers known to increase during acute stress. The possibility that this implies a higher level of strain for the persons in the stressed cluster on various bodily systems is discussed.

The aim was to examine hair cortisol levels and self-reported stress amongst conscripts during their basic military training, and how they are related to four types of theory-derived determinants. The following prediction was made: lower levels of perceived stress and hair cortisol will be associated with: (1) higher levels of emotional stability (the individual nonmilitary aspect); (2) a lower degree of private life problems (the contextual nonmilitary aspect); (3) more positive attitudes toward the military, higher engagement in military service, and higher adaptability to military conditions (the individual-military aspect); and (4) stronger group cohesion and better leadership (the contextual-military aspect). The sample consisted of a total of 107 male Lithuanian conscripts. Assessments were made at the beginning of their basic military training, in the middle, and at the end. Established instruments were used on all self-reported scales. Hair cortisol levels were established through analyses of hair samples. Low to moderate levels of stress were found throughout the basic training period regarding perceived stress levels. Hair cortisol levels were mainly unrelated to the self-rating scales. Regarding perceived stress, the prediction was fully confirmed. The future value of the theoretical model is discussed.

Relationships between antecedent person variables (sex and age), empathic understanding, content of communication, and patients' emotional reactions were studied in 3200 patient-assistant nurse dyadic interactions. The sample consisted of 32 psychiatric patients (20 males and 12 females, mean age: 61 years) and eight female assistant nurses at a nursing-home in Sweden. Four assistant nurses were younger (25 years old or less) and four were older (45 years old or more). All interactions were regular morning meetings at which the patient's activity plans for the day were discussed. These meetings were held in each patient's private room, and lasted for about 15 min. High empathic understanding on part of the helper covaried with more communication of "everyday character" and communication dealing with "personal and emotional qualities", with less communication dealing with "facts and practical issues", and with a more cheerful emotional state among the patients during the encounters. Male patients were more cheerful during encounters with younger assistant nurses while female patients were more cheerful when interacting with older assistant nurses. Helpers with higher scores on empathic understanding seemed to have a higher awareness of relational history.

The paper is theoretical, patient centred, and focuses on the two following questions: (1) In what way might a stress theoretical approach further our understanding of how helping can affect somatic and psychological processes in patients, and (2) in what way might stress theory offer action oriented guidelines for those who offer help ? A stress model is outlined involving relationships between a patient's cognitive appraisal of a given care situation, his or her coping efforts, and emotional and physiological reactions. Several conditions, related to the patient and to the care giving situation, which might influence the patient's appraisal process are discussed. Possible short- and long-term effects of helping in the somatic and psychological domains are presented. Two examples of common care situations are analysed to show how stress theory may offer helpers an action oriented tool. The concept of participatory caring, implying not only patient involvement but actual power sharing between patients and health professionals, is discussed.

The purposes of this study were twofold. The first was to investigate if relaxation training conducted by nurses as an integral part of their caring activities affected breast cancer patients' experiences of radiotherapy sessions as well as their general wellbeing. Second was to evaluate a pedagogical model for large scale application of relaxation training as an integral part of caring. The sample consisted of 64 consecutive outpatients with breast cancer at a Swedish oncology clinic, receiving their first radiotherapy treatment course following surgery. Every second patient was assigned to an experimental group (n= 32, mean age: 59.5 years) and every other second patient was assigned to a control group (n= 32, mean age: 60.0 years). The programme resulted in the following general effects: fewer perceived daily hassles and a more cheeful overall mood state. The following treatment situation specific effects were noted: programme participants appraised the treatment sessions as successively more benign-positive and less threatening. They also reported more perceived muscular tensions during treatment sessions. Most goals concerning the routinization of the pedagogical model were reached.