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Aim: This study aims to describe experiences of the implementation of a new integrated healthcare model for older adults with complex care needs due to multimorbidity, living at home, from a health and welfare personnel perspective. The goal was to diminish hospitalization and still carry out high quality care at home for older adults living with multimorbidity. The model was implemented by two organizations working in cooperation, the municipality, and the region that handles interprofessional social care and healthcare in people's homes., Materials and Method: Open-ended group interviews with personnel were carried out, three of the group interviews pre-implementations of the model, and three of the group interviews post-implementation. The interviews were audiotaped and analysed according to the procedure of thematic analysis., Results: The quality of the integrated care model was based on care-chain cooperation, shared professionalism, and creating relations with the patient including closeness to next of kin, which was underlined by the participants. Unencumbered time gave the professionals the possibility to develop quality in integrated healthcare as part of integrated and person-centred care. The coproduction of education, research interviews and the follow-up meeting identified successes in diminishing hospitalization rates according to the participants' experiences of the post-implementation interviews. An identified failure was, however, that shared professionalism was not developed over time, rather the different responsibilities were accentuated according to the information retrieved at the follow-up meeting., Conclusion: Quality aspects of the model were identified in the present study. However, when implementation of a new model is completed, the organizations always have their own interpretation of how to further understand the model in question., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Gustafsson et al.)

Purpose: To offer guidance for future welfare technology research, this review provides an overview of current knowledge gaps and research needs as reported in primary scientific studies addressing the implementation of welfare technology for older people, people with disabilities and informal caregivers., Materials and Methods: This paper conducted a state-of-the-art review based on systematic searches in 11 databases followed by a descriptive qualitative analysis of 21 selected articles., Results: Knowledge gaps and research needs were identified concerning two categories: research designs and populations and focus of research. The articles reported needs for comparative studies, longitudinal studies, and demonstration trials as well as the development of co-design processes involving technology users. They also called for studies applying a social system theory approach, involving healthy and frail older adults, representative samples of users within and across countries, informal and formal caregivers, inter-and multidisciplinary teams, and care organizations. Moreover, there are reported needs for studies of acquirement, adoption and acceptance of welfare technology, attitudes, beliefs, and context related to welfare technology, caregiver perspectives on welfare technology, services to provide welfare technology and welfare technology itself., Conclusions: There are considerable knowledge gaps and research needs concerning the implementation of welfare technology. They relate not only to the research focus but also to research designs, a social system theory approach and study populations.IMPLICATIONS FOR REHABILITATIONWhen planning for the implementation of welfare technology for older people and persons with disabilities, it is important to be aware that necessary evidence and guidance may not always be available in peer-reviewed scientific literature but considerable knowledge gaps and research needs remain.Actors implementing welfare technology are encouraged to include researchers in their projects to study, document and report experiences made, and thereby contribute to building the evidence base and supporting evidence-based implementation.

Background: The world's growing population of older adults is one population that needs to be focused more regarding subjective well-being. It is therefore important to evaluate self-report instruments that measures general well-being for this specific group - older adults. The aim of the present study was to investigate psychometric properties of the Swedish translation of the GP-CORE (general population - Clinical Outcomes in Routine Evaluation) in a group of older adults (> 65 years)., Methods: In this study, a psychometric evaluation of the GP-CORE is presented for 247 Swedish older adults (> 65 years), 184 women and 63 men who applied for home care assistance for the first time., Results: The psychometric evaluation showed high acceptability; provided norm values in terms of means, standard deviations and quartiles; showed satisfactory reliability in terms of both internal consistency and stability; showed satisfactory validity in terms of convergent and discriminant validity; provided a very preliminary cut-off value and quite low sensibility and sensitivity and showed results which indicated that this scale is sensitive to changes. One gender difference was identified in that women without a cohabitant had a higher well-being than men without a cohabitant (as measured by GP-CORE)., Conclusions: The GP-CORE showed satisfactory psychometric properties to be used to measure and monitor subjective well-being in older adults (> 65 years) in the general population of community dwelling. Future studies should establish a cut-off value in relation to another well-being measure relevant for mental health in older adults., (© 2022. The Author(s).)

Background: Older people with multiple diagnoses often have problems coping with their daily lives at home because of lack of coordination between various parts of the healthcare chain during the transit from hospital care to the home. To provide good care to those persons who have the most complex needs, regions and municipalities must work together. It is of importance to develop further empirical knowledge in relation to older persons with multiple diagnoses to illuminate possible obstacles to person-centred care during the transition between healthcare institutions and the persons livelihood. The aim of the present study was to describe nurses' experienced critical incidents in different parts of the intended healthcare chain of older people with multiple diagnoses., Methods: The sample consisted of 18 RNs in different parts of the healthcare system involved in the care of older people with multiple diagnoses. Data were collected by semi structured interviews and analysed according to Critical Incident Technique (CIT). A total of 169 critical incidents were identified describing experiences in recently experienced situations., Results: The result showed that organizational restrictions in providing care and limitations in collaboration were the main areas of experienced critical incidents. Actions took place due to the lack of preventive actions for care, difficulties in upholding patients' legal rights to participation in care, deficiencies in cooperation between organizations as well as ambiguous responsibilities and roles. The RNs experienced critical incidents that required moral actions to ensure continued person-centred nursing and provide evidence-based care. Both types of critical incidents required sole responsibility from the nurse. The RNs acted due to ethics, 'walking the extra mile', searching for person-centred information, and finding out own knowledge barriers., Conclusions: In conclusion and based on this critical incident study, home-based healthcare of older people with multiple diagnoses requires a nurse that is prepared to take personal and moral responsibility to ensure person-centred home-based healthcare. Furthermore, the development of in-between adjustments of organizations to secure cooperation, and transference of person-centred knowledge is needed., (© 2022. The Author(s).)

The growing older population will increase the demands on the health and welfare systems, including elder care services. One way of meeting these growing service needs is to shift from traditional care services to technologically oriented services. Robotic innovations are gradually being introduced to elder care services. The aim was to explore attitudes toward the use of care robots in elder care services - specifically focusing on situations and interaction, influence, and emotions in interaction with care robots. Data were obtained from visitors at a welfare technology fair ( n = 124). The results show that the most negative attitudes concerned if the care robots were humanized and had emotions. The attitudes toward interacting with care robots in general were predominately positive. In conclusion, concrete usage scenarios in elder care services need to be detected, based both on users' needs, digital literacy and on the maturity of the technology itself.

Introduction: Older adults in municipal residential care are among the most vulnerable and in need of most care. The prevalence of negative events, such as falls and malnutrition, is increased among these older adults. The need for strategies to prevent falls and malnutrition is emphasized in guidelines and systematic, individualized risk assessments are prerequisites for adequate interventions., Objectives: The overall purpose of this study was to investigate the assessed risks of, and risk factors for, falling and malnutrition and the correlations between these assessed risks among older women and men in residential care. Further, the purpose was to investigate the consistency between planned and performed interventions among women and men assessed as at risk., Methods: A cross-sectional registry study based on risk assessment data in the Swedish national quality registry, Senior Alert. Altogether, 5,919 older adults ≥65 in nursing homes and dementia care units in 19 municipalities in Sweden were included., Results: Of the older adults, 77% were at risk of falls, and 59% were at risk of malnutrition. The most prevalent risk factors for falls were previous falls and not being cognitively oriented; and for malnutrition were having mild or severe dementia or depression. A significant positive correlation between the risk of falling and the risk of malnutrition was found. Less than half of the planned interventions for falls and malnutrition were performed. Care staff's least common interventions to prevent falls were balance, muscular function, and strength training, which contrasts with the recommendations; interventions to prevent malnutrition were only partially adhering to recommendations., Conclusions: This cross-sectional registry study points towards the importance of using an evidence-based approach, based on adherence to recommended guidelines, in the prevention of falling and malnutrition. Further, the implementation of clinical practice guidelines is needed, which requires educational training for care staff and supportive leadership., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Purpose: Although studies addressing barriers to and facilitators of implementation of welfare technology have been published, no systematic review synthesising evidence on such factors has been found. The purpose of this study was therefore to identify and synthesise existing primary research on facilitators and barriers that influence the implementation of welfare technology for older people, people with disabilities and informal caregivers., Materials and Methods: A systematic search in 11 databases was performed using predefined inclusion and exclusion criteria to identify empirical studies that assess the implementation of welfare technology for older people, people with disabilities or informal caregivers. The search identified 33 publications with quantitative, qualitative and mixed method designs. The reported findings were thematically synthesised and conceptualised into themes., Results: Six themes of facilitators and barriers that influence the implementation of welfare technology emerged: capacity, attitudes and values, health, expectations, participation and identity and lifestyle. These were presented from five perspectives: older persons and persons with disabilities, informal caregivers, health and care personnel, organisation and infrastructure and technology. The findings may be used as a means to structure the planning and evaluation of implementation processes of welfare technologies for older persons and persons with disabilities and to understand the complexities of implementation., Conclusions: This knowledge generates deepened insights and structures to guide and evaluate the implementation processes of welfare technologies and engenders an understanding of the complexities of implementation.Implications for rehabilitationWhen planning for the implementation of welfare technology for older people and persons with disabilities, it is important to consider capacity, attitudes and values, health, expectations, participation, and identity and lifestyle.Using the result from the study facilitates deepened insights and structures for evaluation of implementation processes of welfare technologies and brings an understanding of the complexities of implementation.Welfare technology should be available, safe, usable and fit the user's daily lives.Implementable welfare technology should focus on needs, but also consider design and possible experienced stigma related to the identity of being a welfare technology user.

Purpose: To conduct a systematic review of existing methods to evaluate the individual aspects of welfare technology from the perspectives of independence, safety, activity, and participation. Furthermore, the study aimed to describe outcomes that have been the focus of previous research to evaluate individual aspects of welfare technology in older persons living in ordinary housing. Materials and methods: A systematic literature review in PubMed, CINAHL Plus, PsycINFO, Scopus, and Web of Science. Studies selected were those that explored the use of assistive and welfare technology devices from older persons' perspectives, and which considered the concepts of independence, safety, activity and participation, and quality of life. Results: A broad spectrum of instruments was applied in the studies. For independence, three questionnaires were used in the identified studies. For safety, one instrument was used in two versions. To study activity and participation as well as quality of life, several scales were used. Additionally, several studies included qualitative approaches for evaluation, such as interviews, or posed one or more questions regarding the effects of welfare technology. Conclusions: The integration of digital assistive and welfare technology should be based on the needs of older persons, and those needs must be assessed using reliable and relevant instruments. The heterogeneity of the target group, i.e., older persons, together with the fact that assessments must give consideration to identifying goals, obstacles, and risks as well as users' preferences, implies a person-centred approach.Implications for rehabilitationThe integration of digital assistive and welfare technology should be based on older persons' needs, and those needs must be assessed using reliable and relevant instruments.The heterogeneity of the target group, i.e. older persons, together with the fact that assessments must give consideration to identifying goals, obstacles and risks as well as users' preferences, implies a person-centred approach.The ideal would be one coherent model that explores the use of digital assistive and welfare technology from the individual, economic as well as organisational dimensions. This would cover the different needs and expectations of various stakeholders, including economic and organisational, but also the needs of the older person.

This paper reports a study conducted to illuminate older adults' perceptions of multiproffesional team's caring skills as success factors for health support in short-term goal-directed reablement. The fact that older adults are given perquisites to live in their own homes puts great demands on the professional care given them at home. An option offered could be short-term goal-directed reablement delivered by an interprofessional team. This means after periods in hospitals to strengthen their multidimensional health, older adults' reablement processes are supported to return to their daily life as soon as possible. Crucial in making these intentions a reality seems to be identifying the professional's approach that works as success factors for health support in the reablement process. A descriptive qualitative design with a phenomenographic approach based on interviews with 23 older persons who had received short-term goal-directed reablement at home after a period at hospital was used. The study was approved by an ethical board. The analysis revealed four major referential aspects of multiproffesional team's caring skills as success factors for health-support in short-term goal-directed reablement: a motivating caregiver, a positive atmosphere-creating caregiver, a human fellowship-oriented caregiver and a caregiver that goes beyond the expected. In this study, all caring skills in the continuum are perceived as positively loaded necessities in different situations during the reablement process. Caring skills as success factors are initially shown at a practical level, such as how the professional caregivers encourage and motivate the older persons in different training situations. At a deeper level, the caregivers open their hearts and have the capacity to go beyond the expected in the professional caregiver-patient relationship. The multiproffesional team's best fit caring skills during the home reablement process need to be addressed as evidence base in the area of elderly home care., (© 2019 Nordic College of Caring Science.)

The mineral content of dental hard tissues has traditionally been measured by destructive tests such as transverse microradiography. Microfocus X-ray computed tomography (micro CT) has enabled non-destructive 3D assessment of tooth demineralization. This study compared the preventive effects of silver diammine fluoride (SDF) and potassium iodide (KI) in comparison with fluoride varnish. SDF has been known to arrest caries but darkens the tooth. KI creates a precipitate with SDF that reduces the discoloration, but its effects on SDF efficacy in terms of preventing demineralization of at-risk root dentin surfaces is unknown. Bovine root dentin blocks were randomly distributed into four groups and subjected to a pretreatment in each group (n = 8); Control: deionized water (DIW); F-Varnish: 5% sodium fluoride varnish: 38% Saforide; SDF+KI: SDF followed by saturated solution of KI in DIW. The treated dentin was subjected to 8 cycles of demineralization (pH 5) for 14 h and remineralization in artificial saliva (pH 7) for 10 h. Specimens were then scanned for 12 min using micro CT at 73 KV and 1012 µA with 8.3 μm resolution. The 3D images were analyzed in Amira software to calculate lesion depth (LD), surface layer mineral density (SL) and mineral loss (ΔZ) for each specimen. One-way ANOVA with Bonferroni posthoc showed that there was a statistically significant difference between Control and all three other groups for all parameters (P < 0.001), however, there was no statistical difference among F-Varnish, SDF and SDF+KI (P > 0.05). Single application of F-Varnish, SDF and SDF+KI showed comparable preventive effects against root dentin demineralization. Application of KI did not affect anti-demineralization properties of SDF in this study. Micro CT is a quick and effective method for objective and high-resolution characterization of dentin caries lesions.

The human resting muscle tone (HRMT) system provides structural and functional support to skeletal muscle and associated myofascial structures (tendons, fascia) in normal life. Little information is available on changes to the HRMT in bed rest. A set of dynamic oscillation mechanosignals ([Hz], [N/m], log decrement, [ms]) collected and computed by a hand-held digital palpation device (MyotonPRO) were used to study changes in tone and in key biomechanical and viscoelastic properties in global and postural skeletal muscle tendons and fascia from a non-exercise control (CTR) and an exercise (JUMP) group performing reactive jumps on a customized sledge system during a 60 days head-down tilt bed rest (RSL Study 2015-2016). A set of baseline and differential natural oscillation signal patterns were identified as key determinants in resting muscle and myofascial structures from back, thigh, calf, patellar and Achilles tendon, and plantar fascia. The greatest changes were found in thigh and calf muscle and tendon, with little change in the shoulder muscles. Functional tests (one leg jumps, electromyography) showed only trends in relevant leg muscle groups. Increased anti-Collagen-I immunoreactivity found in CTR soleus biopsy cryosections was absent from JUMP. Results allow for a muscle health status definition after chronic disuse in bed rest without and with countermeasure, and following reconditioning. Findings improve our understanding of structural and functional responses of the HRMT to disuse and exercise, may help to guide treatment in various clinical settings (e.g., muscle tone disorders, neuro-rehabilitation), and promote monitoring of muscle health and training status in personalized sport and space medicine.

The purpose of this study was to develop an interview guide for use by primary healthcare professionals to support them in identifying the rehabilitation needs of forced resettled women from the Middle East living with chronic pain. Previous findings together with the existing literature were used as the basis for developing the interview guide in three steps: item generation, cognitive interviews, and a pilot study. The study resulted in a 16-item interview guide focusing on patients' concerns and expectations, with consideration of pre-migration, migration, and post-migration factors that might affect their health. With the help of the guide, patients were also invited to identify difficulties in their daily activities and to take part in setting goals and planning their rehabilitation. The current interview guide provides professional guidance to caretakers, taking a person-centered participative point of departure when meeting and planning care, for and together, with representatives from dispersed ethnic populations in Sweden. It can be used together with the patient by all staff members working in primary healthcare, with the aim of contributing to continuity of care and multi-professional collaboration.

Meeting patients from other countries constitutes a challenge for health care. The purpose of this study was to increase knowledge about tacit understandings of treatment in practice by determining the perceptions of chronic pain and rehabilitation directed to resettled women from the Middle East, from a variety of health care professionals within primary care. Based on the results, we find a need to support and increase knowledge among health care professionals to involve the patient and consider her beliefs, expectations, background, current life situation, and spirituality, and to involve family in rehabilitation.

Background: As dispersed ethnic populations in Swedish society expand, the healthcare system need to adapt rehabilitation services according to their needs. The experiences of trauma and forced resettlement have a continuing impact on health and musculoskeletal pain, as well as the intersecting structures that prerequisite the possibilities in the new country. To understand the specific needs of women from the Iraqi diaspora in Sweden, there is a need to elucidate the effects of pain on their everyday life., Aims: To elucidate everyday life with chronic pain from the perspective of women from the Iraqi diaspora in Sweden., Methods: Qualitative interview study according to Glaser's grounded theory., Results: The results from 11 interviews suggest that pain was associated with dependency on society as well as on family. It resulted in a struggle for sense of control, framed by faith in God, influenced by the healthcare system, and with support from family. The women's testimony of lack of continuity of care, resulting in recollection of lived traumas in every visit, is a vital sign of the unconscious power relations within health care and how representatives from health care, instead of being the ones who help the women forward, become the ones who hold them back., Conclusions: The results show the importance of challenging the normative assumptions embedded in health care and treatment for patients with chronic pain and of including the voice of "others".

Dispersed ethnic populations believe their health to be worse than the ethnic majority group in Sweden. Most studies in rehabilitation exclude dispersed ethnic populations who can not read or speak the national language although this group seems to be in need of rehabilitation to a larger extent than privileged majority groups. The aim of the study was to examine the experience of living with musculoskeletal pain and experience of health care among dispersed ethnic populations of Muslim women. The method used was inspired by Grounded Theory in this study. Interviews were made with five first-generation Muslim immigrant women who had come to Sweden via Iraq as refugees. Two interviews were performed with interpreters. A preliminary core category 'The magnitude of reciprocity' based on three categories emerged from the analysis: (1) Impact of pain, (2) Managing pain and (3) Facing health care. Chronic pain limited the informants physically and emotionally, as well as impacting on their everyday life. Informants managed their pain primarily through medicine and physical activity, which gave at least temporary relief. Health care providers were perceived as doing their best but experiences of bad meetings were also witnessed. The factors important in achieving a good meeting in this study appeared to be; time, dialogue, honesty and understanding. Communication skills, feelings of being taken seriously and a sense of security were additional factors. Not being properly examined, or offered optimal treatment, not being believed or understood, were all seen as signs of dismissal within health care. The limitations of this study are primarily concerned with language difficulties resulting in various shortcomings. Reciprocal recognition and support connected to the specific life experiences of women that come with forced resettlement from the Muslim world to the European diaspora is a vital part of a holistic approach to pain management., (© 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.)

Background: Sickness absence is very high in Sweden. The reasons for this phenomenon are not well known. The aim of this study was to investigate the association between degree of self-reported sickness absence and health. The hypothesis was that individuals with long-term sickness absence would report more symptoms and lower self-rated health. Another hypothesis was that women are more likely to self-rate psychiatric diagnoses compared to men, who are more likely to self-rate musculoskeletal diagnoses., Methods: The data was obtained with a postal survey questionnaire answered by 43,589 individuals, a Swedish random population sample of men and women aged 18-84 years. The response rate was 65%. This study included 19,826 individuals aged 18-64 years old and still at work. They were divided into four groups, based on the number of reported days of sickness absence during the past year., Results: Approximately 40% of the individuals at work mentioned that they had been absent due to illness sometime during the past year. Of those who had been absent 90 days or more, two thirds were women. There was a significant difference between the groups in self-rated health (p < 0.05). Every fifth woman (19.4%) and every fourth man (25.9%) in the group with a sickness absence of more than 89 days rated their health as poor or very poor, but a large proportion, 43.5% of the women and 31.6% of the men, rated their health as good. Long-term illnesses and complaints differed between the groups. The correlations between the groups and illness were mostly significant (p < 0.01). Two thirds of the subjects had both psychiatric and musculoskeletal symptoms. There was a significant difference among them, as men more often had musculoskeletal diagnoses. One third had only psychiatric or musculoskeletal symptoms and in those groups there were no significant diagnosis differences between the sexes., Conclusion: Individuals with long-term sickness absence reported more symptoms and lower self-rated health than did those who had not been absent at all, and than those who had been ill 1-28 days. Men and women sick-listed 29 days or more generally reported more illness and complaints. No sex differences among psychiatric and musculoskeletal diagnoses were found, but when reported both psychiatric and musculoskeletal symptoms the musculoskeletal diagnoses were significant among men.

The aetiopathogenesis of the diabetic nephropathy today is still unknown. Uncontested is the contribution of chronic hyperglycemia in the pathogenesis of diabetic nephropathy. For this, there are convincing evidences from clinical and experimental experiences including transplantation surgery. The quality of the metabolic adjustment of the diabetics from the first time of diabetes manifestation is important to prevent the development of diabetic nephropathy. For this, an almost normoglycemic compensation of the glucose metabolism is mandatory. More problematically is the management of the diabetic metabolism during chronic renal insufficiency. Considerable fluctuations of the blood glucose concentration are predominately in the daily profile. The intensive conventional metabolic therapy by multiple insuline injections under self control of the blood glucose level are indicated absolutely in those patients. The therapeutic aim is a smoothing of the blood glucose fluctuation. With that it is possible--together with the elimination of hemodynamic risk factors--to delay effectively a progradient decline of the glomerulo-filtration rate and to improve the assumption to an invasive therapy.