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Abstract Whole body diffusion-weighted imaging (WB-DWI) is increasingly used in oncological applications, but suffers from misalignments due to susceptibility-induced geometric distortion. As such, DWI and structural images acquired in the same scan session are not geometrically aligned, leading to difficulties in e.g. lesion detection and segmentation. In this work we assess the performance of the reverse polarity gradient (RPG) method for correction of WB-DWI geometric distortion. Multi-station DWI and structural magnetic resonance imaging (MRI) data of healthy controls were acquired at 1.5T (n = 20) and 3T (n = 20). DWI data was distortion corrected using the RPG method based on b = 0 s/mm2 (b0) and b = 50 s/mm2 (b50) DWI acquisitions. Mutual information (MI) between low b-value DWI and structural data increased with distortion correction (P

Allogeneic hematopoietic stem cell transplantation is associated with several complications and risk factors, for example, graft versus host disease (GVHD), viral infections, relapse, and graft rejection. While high levels of CD3+ cells in grafts can contribute to GVHD, they also promote the graft versus leukemia (GVL) effect. Infusions of extra lymphocytes from the original stem cell donor can be used as a treatment after transplantation for relapse or poor immune reconstitution but also they increase the risk for GVHD. In peripheral blood, 95% of T-cells express the αβ T-cell receptor and the remaining T-cells express the γδ T-cell receptor. As αβ T-cells are the primary mediators of GVHD, depleting them from the graft should reduce this risk. In this pilot study, five patients transplanted with HLA-matched related and unrelated donors were treated with αβ T-cell depleted stem cell boosts. The majority of γδ T-cells in the grafts expressed Vδ2 and/or Vγ9. Most patients receiving αβ-depleted stem cell boosts increased their levels of white blood cells, platelets, and/or granulocytes 30 days after infusion. No signs of GVHD or other side effects were detected. A larger pool of patients with longer follow-up time is needed to confirm the data in this study.

Abstract Evening exposure to short-wavelength light has disruptive effects on circadian rhythms and sleep. These effects can be mitigated by blocking short-wavelength (blue) frequencies, which has led to the development of evening blue-depleted light environments (BDLEs). We have previously reported that residing 5 days in an evening BDLE, compared with residing in a normal indoor light environment of similar photopic lux, advances circadian rhythms and increases the duration of rapid eye movement (REM) sleep in a randomized cross-over trial with twelve healthy participants. The current study extends these findings by testing whether residing in the evening BDLE affects the consolidation and microstructure of REM sleep in the same sample. Evening BDLE significantly reduces the fragmentation of REM sleep (p = 0.0003), and REM sleep microarousals in (p = 0.0493) without significantly changing REM density or the latency to first REM sleep episode. Moreover, the increased accumulation of REM sleep is not at the expense of NREM stage 3 sleep. BDLE further has a unique effect on REM sleep fragmentation (p = 0.0479) over and above that of circadian rhythms phase-shift, indicating a non-circadian effect of BDLE. If these effects can be replicated in clinical populations, this may have a therapeutic potential in disorders characterized by fragmented REM sleep.

Aim: To explore the meaning of adaptation after visceral transplantation in terms of patient experiences, symptoms, self-efficacy, transplant-specific and mental well-being., Design: A convergent parallel mixed-methods study, consisting of interviews and generic as well as transplant-specific questionnaires. Results were integrated using meta-inference., Methods: The study comprises a population of 17 visceral transplant recipients in Scandinavia, 12 women and 5 men with a mean age of 40.6 years (range 19-63 years) and an average follow-up of 9.4 years (range 0-25 years). Data were collected between May 2023 and January 2024 through open-ended in-depth interviews with 12 participants and analysed in accordance with phenomenological hermeneutics. Questionnaires from all 17 participants were analysed to measure transplant-specific well-being, symptoms, self-efficacy as well as anxiety and depressive symptoms., Results: Being a visceral transplant recipient is a dynamic and life-long adaptation process that comprises two distinct yet interconnected trajectories: coherence and endurance. Coherence involves the person's ability to make sense of their situation and find meaning despite the challenges and adversity of the chronic condition. In contrast, endurance involves a person's capacity to withstand hardship and endure unpleasant or difficult experiences. Both trajectories interact dynamically, influencing and reinforcing each other. Resilience based on coherence enabled acceptance and adjustment. Conversely, uncertainty, resignation and feeling unsupported resulted in a lack of acceptance, manifested as resistance. The challenge involved in adaptation was demonstrated by 47% showing borderline elevated or elevated levels of anxiety and 18% reporting symptoms of depression. Self-efficacy varied considerably., Conclusion: The meaning of adaptation after visceral transplantation in terms of experiences, symptoms, transplant-specific and mental well-being is balancing between coherence and endurance facilitated by acceptance and hampered by resistance. The uncertainty inherent in being a visceral transplant recipient may lead to heightened self-rated anxiety symptoms and diminished self-efficacy., Implications for the Profession And/or Patient Care: What problem did the study adress? This study adresses the challenges involved in being a visceral transplant recipient and adapting to life after a visceral transplantation. What were the main findings?, Reporting Method: COREQ checklist (consolidated criteria for reporting qualitative research)., Patient or Public Contribution: No Patient or Public Contribution was organised., (© 2025 The Author(s). Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: The mental health of university students is a global concern, with high rates of depression and anxiety that need to be addressed., Aim: We aimed to compare the mental health of Portuguese, Swedish and German university students in the health and social sciences following the Covid-19 pandemic and to analyze the factors associated with depressive and anxious symptoms in each country., Methods: A cross-sectional study with a sample of students from Portugal, Germany and Sweden was conducted. Data from online questionnaires, including a sociodemographic and clinical questionnaire, the Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder (GAD-7) and the MHI-5 (Mental Health Inventory) was collected from October to December 2022., Results: The sample was composed of 1670 university students. The prevalence of mild to severe depressive symptoms was 72.7 % in Germany, 62.9 % in Sweden, and 60.3 % in Portugal and the prevalence of mild to severe anxiety symptoms was 78.6 % in Portugal, 73.7 % in Germany, and 66.9 % in Sweden. Being a female student, having a previous mental health disorder diagnosis, and poor academic performance were associated with higher severity of depression and anxiety symptoms in all three countries. Country-specific factors associated with more depressive and/or anxiety symptoms were younger age, smoking, low socioeconomic level and living away from home. Swedish students who do not consume alcohol had more anxiety symptoms and German students who do not consume alcohol had more depressive symptoms., Conclusion: The high prevalence of depressive and anxiety symptoms among students in the three countries highlights the need to address modifiable factors that contribute to this mental health burden. Our results, which are in line with international trends, underline the need for policy reforms that target the main determinants of mental health, in particular by improving socio-economic conditions. Addressing these factors could play a crucial role in improving mental health outcomes in this population., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Lara Guedes de Pinho reports was provided by University of Évora. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2025 Published by Elsevier Ltd.)

Introduction: Women with early bilateral salpingo-oophorectomy (BSO) have greater Alzheimer's disease (AD) risk than women with spontaneous menopause (SM), but the pathway toward this risk is understudied. Considering associative memory deficits may reflect early signs of AD, we studied how BSO affected brain activity underlying associative memory., Methods: Early midlife women with BSO (with and without 17β-estradiol therapy [ET]) and age-matched controls (AMCs) with intact ovaries completed a face-name associative memory task during functional magnetic resonance imaging. Hippocampal activity along the anteroposterior axis during associative encoding and retrieval was compared among three groups (BSO [n = 28], BSO+ET [n = 35], AMCs [n = 40])., Results: Both BSO groups (with and without ET) showed lower posterior hippocampal activation during encoding compared to the AMC group. However, this difference in activation was not significantly correlated with associative memory task performance., Discussion: Early 17β-estradiol loss may influence posterior hippocampal activity during associative encoding, possibly presaging late-life AD., Highlights: After ovarian removal, changes in hippocampal function may affect dementia risk. Midlife ovarian removal is associated with less activation in the posterior hippocampus. Estradiol therapy may ameliorate alterations in brain function during learning., (© 2024 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Background: The introduction of enhanced recovery programmes (ERP) in pancreatic surgery has significantly improved clinical outcomes by decreasing the length of hospital stay, cost and complications without increasing readmissions and reoperations. To complement evidence on these outcomes, there is a need to explore patients' perspectives of a structured ERP. Therefore, this study aimed to explore the health-related quality of life (HRQoL) of patients before and after implementing ERP in pancreaticoduodenectomy ad modum Whipple (PD) at a regional surgical centre., Method: This was an explorative and comparative single-centre study in Sweden. A prospective cohort receiving ERP was included between October 2019 and December 2022 (n = 73) and was compared with a retrospective pre-ERP cohort between October 2011 and December 2013 (n = 65). EQ-5D, the European Organization for Research and Treatment of Cancer (EORCT) Quality of Life Questionnaire Cancer 30 items (QOL-C30), and EORCT Quality of Life Questionnaire pancreatic cancer module (QOL-PAN26) were collected preoperatively and at three and six months postoperatively. Demographic and clinical variables were collected from patient charts. Complications were expressed using the Clavien-Dindo Classification and the Comprehensive Complications Index (CCI)., Results: There were no significant differences in general health, cancer- or disease-specific HRQoL between the pre-ERP and ERP cohorts. Length of stay was significantly shorter in the ERP cohort (16 vs. 11 days; p < 0.001). There was no significant difference in CCI., Conclusion: No significant differences were found in the HRQoL of patients who participated in an ERP compared to those who did not. However, a significant decrease in LoS was found when ERP was applied., Trial Registration: Not applicable., Competing Interests: Declarations. Ethics approval and consent to participate: This study was reviewed and approved by the Swedish ethical review authority, D-nr 2019–20720. The patients were enrolled after receiving both written and verbal information, and after obtaining their written informed consent. Consent for publication: Non applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: The purpose of this paper is to describe first-line managers' (FLMs') experiences and reflections on structural conditions for management practice within hospital settings using Kanter's theory of structural empowerment., Design/methodology/approach: A qualitative deductive approach with a descriptive design was used. Interviews were conducted with 11 FLMs in charge of medical or surgical hospital units spread across Sweden. Data were analyzed using a directed content analysis, based on Kanter's theory of structural empowerment, encompassing such as access to necessary and sufficient resources, information, support and opportunities to learn and develop., Findings: Findings of this study from the FLMs' descriptions and reflections shed light on the impact of power dynamics on the structural conditions for management practice. The availability of nursing staff was a fundamental resource in the FLMs' work performance, ensuring delivery of care to patients and a sound work environment for staff. Additionally, the other structural elements outlined in Kanter's theory were evident in the findings, as the FLMs wished for structured information flow, identified potential and challenged opportunities for development and emphasized the importance of receiving support from people with a genuine understanding of their work situation., Originality/value: The results of this study contribute to the understanding of FLMs' structural conditions for management practice in hospital settings. The paper's originality stems from the use of a deductive approach, providing a structured lens with the potential to inform future research and practice in the field of health-care management., (© Karin Lundin, Bernice Skytt, Marit Silén, Maria Engström and Annika Strömberg.)

Background: Health information technology has developed into a cornerstone of modern healthcare. It has changed workflows and enhanced communication, efficiency, and patient safety. However, technological development has progressed faster than research on its potential effects on care quality and the healthcare work environment. Using the Job Demand-Resources theory, this study investigated the associations between "frustration with technology" and three outcomes: stress, emotional exhaustion, and staff satisfaction with care, holding job resources and the demand workload constant., Method: A cross-sectional correlational study was conducted between January and April 2022. Healthcare staff from different professions (e.g., physicians, registered nurses, physiotherapists, licensed practical nurses) and workplaces (n = 417, response rate 31%) answered a survey regarding job demands and resources in the workplace, frustration with technology, stress, emotional exhaustion, and satisfaction with care. Data were analyzed with Spearman's rank correlation coefficient, the Mann-Whitney U test, and the Kruskal-Wallis test, and multiple variables, one for each outcome, were tested with Generalized Estimated Equations models in SPSS., Results: The bivariate correlation analyses confirmed statistically significant associations between all the independent variables and the outcomes, except for the independent variable high workload. A high workload was associated with stress and emotional exhaustion but not with staff satisfaction with care. In the three GEE models, one for each outcome, higher stress was statistically significantly associated with more frustration with technology and lower scores for the variables participation in decision-making, sense of community at work, and higher workload. Higher emotional exhaustion was associated with more frustration with technology, higher workload, a lower teamwork climate, and lower growth opportunities. Lower staff satisfaction with care was associated with lower scores for the variable participation in decision-making., Conclusions: Taking other variables into account, technology frustration matters in staff ratings of stress and emotional exhaustion, but not with the satisfaction of given care. Future studies should aim to further investigate what causes technology frustration and how to mitigate it., Competing Interests: Declarations. Ethics approval and consent to participate: All participants received written study information via e-mail. This included information on confidentiality, drop-out options, and data storage in accordance with the Helsinki Declaration of Ethical Principles and the General Data Protection Regulation in the EU. All potential participants were informed that answering the survey was viewed as consent to participate in the study and that they could withdraw their consent at any time. The study was approved by the Swedish Ethical Review Authority (Dnr 2020–03749; 2021–06096-02). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Aim: First-line (1L) immunotherapy has yielded superior overall survival (OS) in metastatic melanoma (MM) but some patients are ineligible for immunotherapy or need rapid response with 1L targeted therapy (TT). Materials & methods: Retrospective cohort study of real-world patients treated with 1L immunotherapy (144 BRAF wild type, 85 BRAF -mutated) or 1L TT (143 BRAF -mutated) for MM in Finland during 2014-2021. Results: Baseline brain metastases, liver metastases and elevated LDH were less common, 2-year OS rates were higher (60.3-63.5% vs. 33.8%) and more patients were alive without the next-line treatment (38.0-43.8% vs. 23.3%) in patients with 1L immunotherapy. Conclusion: Real-world patients with 1L immunotherapy for MM had favorable baseline characteristics and better treatment outcomes than observed in patients with 1L TT.

Background: Leadership and access to structural empowerment are known to influence the work life experiences of staff and quality of care. Knowledge about relationships between specific factors of structural empowerment, leadership and management, staff well-being and quality of care at both an individual and unit level is scarce., Aim: To study the relationship between staff-rated access to empowering structures, leadership and management performance, well-being, and quality of care in hospital settings measured at the individual level and aggregated at the unit level., Methods: A cross-sectional correlative design was applied. Questionnaire data from 331 randomized hospital nursing staff working at 38 units in 25 hospitals in Sweden were analyzed using bivariate correlations and general estimation equation (GEE) models., Results: Results from the bivariate analysis of relationships confirmed earlier research. In the GEE models, some unexpected results were found and differences between the individual and unit levels. Adding management and leadership as independent factors in the second model showed few relationships of significance to the outcome variables., Conclusion: Results confirm the importance of staff access to empowering structures in relation to well-being and quality of care. Differences and similarities were shown when studying these relationships at both the individual and unit level. The findings feature implications for hospital management to promote staff access to empowering structures. The findings provide information on how these structures relate to the individual and the unit; information that could be useful when planning or implementing strategies with the aim to promote staff well-being and care quality. The non-significant results for leadership and management in relation to staff outcomes in the GEE-models, raise questions for further research where a shift from individual to organizational focused performances within the field of leadership is implied., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Regional Ethical Review Board of Uppsala (Dnr 2016/107). All informants received written information about the study and confidentiality was guaranteed. A returned and completed questionnaire was considered to be a consent to participate. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Knowledge of access to palliative care services, such as palliative care consultation teams, is crucial to identify areas of improvement for policy and practice. Research on general populations spanning all disease groups and multiple healthcare contexts is needed., Objective: The objective was to investigate the sociodemographic, disease- and care-related, and care structure-related factors associated with palliative care consultations for adult patients in the last week of life., Design: Cross-sectional, general population-level study based on linked Swedish national public authority registers and a national palliative care quality register., Methods: The study population included all adult patients deceased in Sweden between 2013 and 2019 and registered in the Swedish Register of Palliative Care, with an anticipated death, and not enrolled in specialised palliative care. Multivariable logistic regression analyses to investigate association with palliative care consultations., Results: In total, 8.2% of the 265,129 participants had received a palliative care consultation in the last week of life. The main multivariable analysis (Model 1) showed that those dying from neoplasms were more likely to receive a palliative care consultation (odds ratio (OR) 8.55, 95% CI 8.15-8.98) than those dying from circulatory diseases. Palliative care consultation was more likely with an increasing number of symptoms (OR 1.35, CI 1.32-1.37). Patients of old age and patients deceased in hospitals were less likely to receive a palliative care consultation. Moreover, factors such as educational attainment, healthcare region, living in a single-person household, and year of death were also associated with a palliative care consultation in the last week of life., Conclusion: Our findings show inequities in access to palliative care consultations in the last week of life. Considering changes to policy and clinical practice is motivated., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2024.)

Objective: This study aimed to evaluate the effects of self-reported baseline eating behaviors on 24-month weight change in adults with severe obesity., Methods: A prospective, nonrandomized clinical cohort study on surgical and medical obesity treatment included 971 adults (75% women) with a mean BMI of 42.0 (SD 4.9) kg/m 2 . To assess baseline eating behaviors and binge eating disorder, the Questionnaire on Eating and Weight Patterns-Revised and the Three-Factor Eating Questionnaire were used., Results: In analyses adjusted for treatment, age, sex, baseline weight, and BMI, those with nocturnal eating lost less weight (3.5 kg [95% CI: 0.02-6.9]; p < 0.05) at 24 months compared to those without nocturnal eating. Binge eating disorder was not significantly associated with weight loss over 24 months. Emotional eating was associated with less weight loss at 12 months: 1.16 kg per z score (95% CI: 0.37-1.95; p < 0.05). Compared with completers, dropout from medical obesity treatment was associated with emotional and uncontrolled eating at baseline (both p < 0.001)., Conclusions: The association between pretreatment eating behaviors and weight change was found to be generalizable and not restricted to any specific treatment. Certain eating behaviors may affect weight loss as well as attrition. Identifying eating behaviors that may impair treatment efficacy are suggested in the treatment of severe obesity., (© 2024 The Author(s). Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)

Functional magnetic resonance imaging (fMRI) is a pivotal tool for mapping neuronal activity in the brain. Traditionally, the observed hemodynamic changes are assumed to reflect the activity of the most common neuronal type: excitatory neurons. In contrast, recent experiments, using optogenetic techniques, suggest that the fMRI-signal instead reflects the activity of inhibitory interneurons. However, these data paint a complex picture, with numerous regulatory interactions, and where the different experiments display many qualitative differences. It is therefore not trivial how to quantify the relative contributions of the different cell types and to combine all observations into a unified theory. To address this, we present a new model-driven meta-analysis, which provides a unified and quantitative explanation for all data. This model-driven analysis allows for quantification of the relative contribution of different cell types: the contribution to the BOLD-signal from the excitatory cells is <20 % and 50-80 % comes from the interneurons. Our analysis also provides a mechanistic explanation for the observed experiment-to-experiment differences, e.g. a biphasic vascular response dependent on different stimulation intensities and an emerging secondary post-stimulation peak during longer stimulations. In summary, our study provides a new, emerging consensus-view supporting the larger role of interneurons in fMRI.

Objectives: Adverse events (AEs) may result in serious injuries or death. AEs occur in approximately 9.2% of hospitalizations, with a potential preventability of 43.5%. The aim of this study was to examine whether use of an illustrated patient safety advisory affected information transfer to inpatients regarding how they can participate in their own care to decrease the risk of AEs., Methods: All patients in the control (n = 129) and case/intervention (n = 511) groups received verbal information from healthcare personnel. The intervention group also received the illustrated patient safety advisory, "Your safety at the hospital." Before discharge, patients completed the Quality from the Patient's Perspective questionnaire., Results: Mean patient age was 64.6/62.4 years in the intervention/control group, respectively, and 50% were men. Significant differences between groups were observed for most questions presented from the perceived reality of care perspective, in favor to the intervention group. Patients at surgical wards indicated higher scores on 9 of 12 Quality from the Patient's Perspective questions. Patients with hospital stays ≥4 days, at surgical wards, and living with someone else, placed higher subjective importance to questions concerning, e.g., protection/infection, nutrition, risk of falls and pressure ulcers, and discharge information., Conclusions: Using an illustrated patient safety advisory to complement oral information about patient safety risks resulted in positive responses and a significant difference was demonstrated in how information is perceived. The safety advisory could be used as a tool to decrease AEs. Patients who live alone may need more focused patient safety information to encourage involvement in their own care., Competing Interests: Conflict of interest and source of funding: The study was made possible by grants from The Health & Medical Care Committee of the Regional Executive Board Region Västra Götaland (grant nr: VGFOUREG-835031) and Region Västra Götaland Innovation fund (grant nr: VGRINN-934684). The authors have stated explicitly that there are no conflicts of interest in connection with this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The Safe Environment for Every Kid (SEEK) model was developed to address psychosocial risk factors (financial worries, depressive symptoms, major parental stress, alcohol misuse and intimate partner violence) in the pediatric primary care setting but has not been evaluated from the parents' perspective. To further investigate the usefulness of SEEK, it is important to explore how parents perceive the model., Objective: The aim of the present study was to explore parents' perceptions of the SEEK model as a part of regular health visits in the Child Health Services in Sweden., Participants and Setting: Eighteen parents (13 women and five men) in two Swedish counties participated in the study., Methods: Semi-structured telephone interviews were conducted, and the resulting data were analyzed using reflective thematic analysis., Results: Three themes were identified: Acceptance and understanding of the SEEK model in the child health services, The questionnaire as a bridge to a dialogue, and Feeling trust in the system and the child health nurse's professional competence. Further, an overarching theme was created that encompassed a core meaning of all three themes; SEEK provides a process-oriented framework to receive support in parenting with a focus on child health., Conclusions: The study showed that parents express both acceptance and understanding of the SEEK model and they perceive that the model provides an avenue for repeated dialogues about the family's situation during the child's upbringing and an opportunity to access support if needed., (© 2024. The Author(s).)

Background: In most Western countries, senior workers have increased their participation in the workforce. However, at the same time, early retirement also increases. The reasons behind this early exit from the workforce are still unclear., Objective: This qualitative study aims to explore the antecedents of and experiences with a voluntary exit from working life before the expected retirement age of 65 in Sweden., Methods: Data consist of semi-structured interviews with 18 participants who exited working life between the ages of 61-63. In Sweden, these ages are considered as an early exit from working life since, for many years, the expected retirement age has been 65. Qualitative content analysis with an abductive approach was utilized., Results: The analysis revealed four sub-themes: 1) Health benefits with an early exit from working life (with the categories: own health status, the possibility for recovery time, and avoidance of strain); 2) Having economic conditions that enable an early exit from working life (with the categories: offers from the employer and financial compromises); 3) Social benefits with an early exit from working life (with the categories: enabling more time with my social network and avoidance of unsatisfying social work environment); 4) Self-fulfillment activities during the senior years (with the categories: enabling time for activities beyond work and avoidance of decreased job satisfaction., Conclusion: This variety of antecedents of and experiences with a voluntary early exit from working life before the expected retirement age highlights that the ongoing increased statutory retirement age also increases the risk for extended inequalities among the aging population.

Background: An inclusive workplace is where everyone is supported to thrive and succeed regardless of their background. Supportive working conditions and general self-efficacy have been found to be important for nurses' perceived competence and well-being at work, however, in the context of being a nurse in a new country, research is limited. Moreover, knowledge is lacking about whether different paths to a nursing license are related to nurses' perceived competence and well-being when working., Objective: To examine determinants and experiences of nursing competence and well-being at work (thriving and stress) among internationally and domestically educated nurses., Design: A longitudinal descriptive and correlational design with a mixed-methods convergent approach was used., Methods: A longitudinal study was conducted between January 2019 and June 2022 with two groups of internationally educated nurses who had completed a bridging program or validation to obtain a Swedish nursing license and one group of domestically newly educated nurses. Data were collected on three occasions: Time1 at the end of the nursing licensure process (n = 402), Time2 after three months (n = 188), and Time3 after 12 months (n = 195). At Time3, 14 internationally educated nurses were also interviewed. Data were analyzed separately and then interpreted together., Results: Multiple regression models showed that greater access to structural empowerment (B = 0.70, 95 % CI [0.31; 1.08]), better cooperation (B = 3.76, 95 % CI [1.44; 6.08]), and less criticism (B = 3.63, 95 % CI [1.29; 5.96]) were associated with higher self-rated competence at Time3, whereas the variable path to a nursing license was non-significant (R 2  = 49.2 %). For well-being, greater access to structural empowerment (B = 0.07, 95 % CI [0.02; 0.12]), better cooperation (B = 0.36, 95 % CI [0.07; 0.66]) and being domestically educated (B = 0.53, 95 % CI [0.14; 0.92]) were associated with higher thriving at work (R 2  = 25.8 %). For stress, greater access to structural empowerment (B = -0.06, 95 % CI [-0.09; -0.02]), better cooperation (B = -0.30, 95 % CI [-0.51; -0.10]), and less criticism (B = -0.28, 95 % CI [-0.46; -0.05]) were associated with having symptoms less frequently while being domestically educated was associated with having stress symptoms more often (B = 0.44, 95 % CI [0.07; 0.81]) (R 2  = 43.3 %). Higher general self-efficacy at Time1 was associated with higher self-rated competence at Time2 (B = 4.76, 95 % CI [1.94; 7.59]). Quantitative findings concurred with findings from interviews with internationally educated nurses. However, qualitative findings also highlighted the importance of previous education, working experience, the new context, and communication abilities., Conclusions: Both quantitative and qualitative data showed that working conditions were important for nurses' self-rated competence and well-being at work. Although communication difficulties, previous education, and working experience were not statistically significant in the multiple regression models, in the interviews these factors emerged as important for internationally educated nurses' competence and well-being., Competing Interests: Declaration of Competing Interest The authors are employed at universities that offer bridging programs, and one of the authors is employed at a university involved in validation. However, the authors have no commercial associations or conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aim: The study aimed to explore the experiences of care and recovery among older patients treated for physical trauma., Design: A qualitative study with a constructivist grounded theory design., Methods: Fifteen in-depth interviews with older adults recovering from physical trauma were conducted and analysed between 2019 and 2023, in accordance with grounded theory methodology., Results: The findings show that for older patients who suffered physical trauma, the core category was the strive to recapture autonomy. This was achieved by means of Adaptation, Reflection and Interactions, which constitute the three main categories. Recovery involves facing and navigating various new life challenges, such as increased dependency on others, managing difficult symptoms and adapting in various ways to everyday life. The recovery process was influenced by fear, hope and the attitude towards new challenges., Conclusion: Older adults being cared for after a traumatic event have a difficult path to recovery ahead of them. Dealing with increased unwanted dependency on others was a main concern for the participants. Undertreated symptoms can lead to undesired isolation, delayed recovery and further increase unwanted dependency. On the other hand, hope, which was defined as having a positive approach to life and longing for the future, was a strong accelerating factor in the recovery process., Impact: As a result of this study, we have established that older patients experience the initial period after trauma as difficult and that support in the initial phase can be helpful when returning home. As healthcare services are under increasing pressure because of an ageing population, this study contributes by addressing an understudied population and clarifying their concerns., Reporting Method: Reporting adheres to the COREQ (COnsolidated criteria for REporting Qualitative research) Checklist., Patient or Public Contribution: No patient or public involvement., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Objective: Ovarian removal prior to spontaneous/natural menopause (SM) is associated with increased risk of late life dementias including Alzheimer's disease. This increased risk may be related to the sudden and early loss of endogenous estradiol. Women with breast cancer gene mutations (BRCAm) are counseled to undergo oophorectomy prior to SM to significantly reduce their risk of developing breast, ovarian, and cervical cancers. There is limited evidence of the neurological effects of ovarian removal prior to the age of SM showing women without the BRCAm had cortical thinning in medial temporal lobe structures. A second study in women with BRCAm and bilateral salpingo-oophorectomy (BSO) noted changes in cognition., Methods: The present, cross-sectional study examined whole-brain differences in gray matter (GM) volume using high-resolution, quantitative magnetic resonance imaging in women with BRCAm and intact ovaries (BRCA-preBSO [study cohort with BRCA mutation prior to oophorectomy]; n = 9) and after surgery with (BSO + estradiol-based therapy [ERT]; n = 10) and without (BSO; n = 10) postsurgical estradiol hormone therapy compared with age-matched women (age-matched controls; n = 10) with their ovaries., Results: The BRCA-preBSO and BSO groups showed significantly lower GM volume in the left medial temporal and frontal lobe structures. BSO + ERT exhibited few areas of lower GM volume compared with age-matched controls. Novel to this study, we also observed that all three BRCAm groups exhibited significantly higher GM volume compared with age-matched controls, suggesting continued plasticity., Conclusions: The present study provides evidence, through lower GM volume, to support both the possibility that the BRCAm, alone, and early life BSO may play a role in increasing the risk for late-life dementia. At least for BRCAm with BSO, postsurgical ERT seems to ameliorate GM losses., Competing Interests: Financial disclosure/conflicts of interest: None reported., (Copyright © 2024 by The Menopause Society.)

Purpose: This study aimed to explore the experiences of head and neck cancer (HNC) survivors with postradiation trismus, specifically how oncological treatment affected their lives, rehabilitation, use of coping strategies, and healthcare experiences., Methods: A qualitative descriptive approach was used and semi-structured interviews of 10 HNC survivors with postradiation trismus were conducted 6-30 months after completing oncological treatment. The interviews were transcribed verbatim and analyzed by qualitative content analysis., Results: The analysis of interviews yielded four main categories: Bodily symptoms, Effects on life, Support from the healthcare system, and Strategies to handle life and symptoms. Participants reported ongoing problems with xerostomia, dysgeusia, eating, and limited physical fitness. Pain related to trismus was not a major issue in this cohort. Participants expressed limitations in their social lives due to their eating difficulties, yet a sense of thankfulness for life and overall satisfaction with the healthcare they received. Psychological and practical coping strategies developed by the participants were also revealed., Conclusion: The results highlight areas of unmet need among HNC survivors that healthcare providers can target by establishing multi-professional teams dedicated to individualizing post-cancer rehabilitation care., (© 2024. The Author(s).)

Importance: Results from long-term follow-up after biliopancreatic diversion with duodenal switch (DS) are scarce., Objective: To compare weight loss, health outcomes, and quality of life 10 years or more after Roux-en-Y-gastric bypass (RYGB) and DS surgery in patients with severe obesity-that is, a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 50 to 60., Design, Setting, and Participants: This open-label randomized clinical trial was conducted at 2 academic bariatric centers in Sweden and Norway. Sixty patients with a BMI of 50 to 60 were included from March 1, 2006, to August 31, 2007. Data were analyzed from August 12, 2022, to January 25, 2023., Interventions: Laparoscopic RYGB or laparoscopic DS., Main Outcomes and Measures: The main outcome was change in BMI after 10 or more years. Secondary outcomes included anthropometric measures, lipid and glycemic profiles, bone mass density, adverse events, gastrointestinal tract symptoms, and health-related quality of life., Results: Forty-eight of the original 60 patients (80%) were assessed after a median of 12 (range, 9-13) years (mean [SD] age, 48.0 [6.0] years; 35 women [73%]). At follow-up, the mean BMI reductions were 11.0 (95% CI, 8.3-13.7) for RYGB and 20.3 (95% CI, 17.6-23.0) for DS, with a mean between-group difference of 9.3 (95% CI, 5.4-13.1; P < .001). Total weight loss was 20.0% (95% CI, 15.3%-24.7%) for RYGB and 33.9% (95% CI, 27.8%-40.0%) for DS (P = .001). Mean serum lipid levels, except high-density lipoprotein cholesterol and hemoglobin A1c, improved more in the DS group during follow-up. Bone mass was reduced for both groups from 5 to 10 years, with lower bone mass after DS at 10 years. Quality-of-life scores (Obesity-Related Problem Scale and the 36-Item Short Form Health Survey) were comparable across groups at 10 years. The total number of adverse events was higher after DS (135 vs 97 for RYGB; P = .02). More patients in the DS group developed vitamin deficiencies (21 vs 11 for RYGB; P = .008) including 25-hydroxyvitamin D deficiency (19 for DS vs 9 for RYGB; P = .005). Four of 29 patients in the DS group (14%) developed severe protein-caloric malnutrition, of whom 3 (10%) underwent revisional surgery., Conclusions and Relevance: In this randomized clinical trial, BMI reduction was greater after DS, but RYGB had a better risk profile over 10 years. Biliopancreatic diversion with DS may not be a better surgical strategy than RYGB for patients with a BMI of 50 to 60., Trial Registration: ClinicalTrials.gov Identifier: NCT00327912.

Improved self-esteem and body image, as well as reduced experiences of weight stigma are important patient-reported obesity treatment outcomes. However, more knowledge is needed about how individuals who have undergone metabolic and bariatric surgery (MBS) perceive themselves and their bodies and use different coping strategies in relation to body image and self-esteem long-term after MBS. In this qualitative study body image, self-esteem, weight stigma and coping strategies were explored among 18 individuals who underwent MBS more than 10 years ago when interviewed. Using reflexive thematic analysis, two primary themes were identified: 'Experiences of living with a stigmatised body' and 'Coping with weight stigma, body image and self-esteem', and eight sub-themes. Findings capture frequent experiences of weight stigma before bariatric surgery, the need for coping with stigma and body dissatisfaction before and after MBS, and how different coping strategies are related to participants' perceptions of their bodies and self-concepts. More adaptive coping strategies, such as confrontation and cognitive restructuring may facilitate more positive body image outcomes, than more ruminative and avoidant strategies. Understanding adaptive coping strategies can be useful to develop interventions to reduce negative consequences of weight stigma on body image and self-esteem., (© 2024 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Introduction: Cerebrovascular reactivity imaging (CVR) is a diagnostic method for assessment of alterations in cerebral blood flow in response to a controlled vascular stimulus. The principal utility is the capacity to evaluate the cerebrovascular reserve, thereby elucidating autoregulatory functioning. In CVR, CO 2 gas challenge is the most prevalent method, which elicits a vascular response by alterations in inspired CO 2 concentrations. While several systems have been proposed in the literature, only a limited number have been devised to operate in tandem with mechanical ventilation, thus constraining the majority CVR investigations to spontaneously breathing individuals., Methods: We have developed a new method, denoted Additional CO 2 , designed to enable CO 2 challenge in ventilators. The central idea is the introduction of an additional flow of highly concentrated CO 2 into the respiratory circuit, as opposed to administration of the entire gas mixture from a reservoir. By monitoring the main respiratory gas flow emanating from the ventilator, the CO 2 concentration in the inspired gas can be manipulated by adjusting the proportion of additional CO 2 . We evaluated the efficacy of this approach in (1) a ventilator coupled with a test lung and (2) in spontaneously breathing healthy subjects. The method was evaluated by assessment of the precision in attaining target inspired CO 2 levels and examination of its performance within a magnetic resonance imaging environment., Results and Discussion: Our investigations revealed that the Additional CO 2 method consistently achieved a high degree of accuracy in reaching target inspired CO 2 levels in both mechanical ventilation and spontaneous breathing. We anticipate that these findings will lay the groundwork for a broader implementation of CVR assessments in mechanically ventilated patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Magnusson, Engström, Georgiopoulos, Cedersund, Tobieson and Tisell.)

Olfactory dysfunction is a common feature of both postviral upper respiratory tract infections (PV) and idiopathic Parkinson's disease (PD). Our aim was to investigate potential differences in the connectivity of the posterior piriform cortex, a major component of the olfactory cortex, between PV and PD patients. Fifteen healthy controls (median age 66 years, 9 men), 15 PV (median age 63 years, 7 men) and 14 PD patients (median age 70 years, 9 men) were examined with task-based olfactory fMRI, including two odors: peach and fish. fMRI data were analyzed with the co-activation pattern (CAP) toolbox, which allows a dynamic temporal assessment of posterior piriform cortex (PPC) connectivity. CAP analysis revealed 2 distinct brain networks interacting with the PPC. The first network included regions related to emotion recognition and attention, such as the anterior cingulate and the middle frontal gyri. The occurrences of this network were significantly fewer in PD patients compared to healthy controls (p = 0.023), with no significant differences among PV patients and the other groups. The second network revealed a dissociation between the olfactory cortex (piriform and entorhinal cortices), the anterior cingulate gyrus and the middle frontal gyri. This second network was significantly more active during the latter part of the stimulation, across all groups, possibly due to habituation. Our study shows how the PPC interacts with areas that regulate higher order processing and how this network is substantially affected in PD. Our findings also suggest that olfactory habituation is independent of disease., (© 2024. The Author(s).)

The aim of the present study was to describe the experiences of young adults living with cleft lip and palate (CLP) and to explore potential gender differences., A descriptive qualitative study was designed involving semi-structured interviews. The interviews were analyzed using qualitative content analysis, as described by Graneheim and Lundman., A total of 9 women and 8 men, aged 22 to 26 years with UCLP., The main theme identified was: the duality of living with a cleft-being normal yet different, and 2 subcategories: "My cleft and me" and "My cleft and the World." The participants described themselves as normal yet different, both in relation to themselves and in relation to others. They also stated that gender norms regarding appearance affected their lives and how they saw the cleft., This study adds to the growing body of qualitative research on CLP. It highlights the dualistic experiences of feeling normal and different at the same time. The interviews indicated that this dualism was based on context and gender, showing the psychological complexity of an individual. The clinical implications of this study emphasizes the need of a person-centered care approach in the cleft care setting where the clinicians are aware of the potential dualistic experience that also may differ over time that individuals with cleft can experience. This can also help clinicians better understand and help patients reduce distress and strengthen positive coping mechanisms., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

PET/MR systems demanded great efforts for accurate attenuation correction (AC) but differences in technology, geometry and hardware attenuation may also affect quantitative results. Dedicated PET systems using transmission-based AC are regarded as the gold standard for quantitative brain PET. The study aim was to investigate the agreement between quantitative PET outcomes from a PET/MR scanner against a stand-alone PET system. Nine patients with Parkinsonism underwent two 80-min dynamic PET scans with the dopamine transporter ligand [ 11 C]PE2I. Images were reconstructed with resolution-matched settings using 68 Ge-transmission (stand-alone PET), and zero-echo-time MR (PET/MR) scans for AC. Non-displaceable binding potential (BP ND ) and relative delivery (R 1 ) were evaluated using volumes of interest and voxel-wise analysis. Correlations between systems were high (r ≥ 0.85) for both quantitative outcome parameters in all brain regions. Striatal BP ND was significantly lower on PET/MR than on stand-alone PET (-7%). R 1 was significantly overestimated in posterior cortical regions (9%) and underestimated in striatal (-9%) and limbic areas (-6%). The voxel-wise evaluation revealed that the MR-safe headphones caused a negative bias in both parametric BP ND and R 1 images. Additionally, a significant positive bias of R 1 was found in the auditory cortex, most likely due to the acoustic background noise during MR imaging. The relative bias of the quantitative [ 11 C]PE2I PET data acquired from a SIGNA PET/MR system was in the same order as the expected test-retest reproducibility of [ 11 C]PE2I BP ND and R 1 , compared to a stand-alone ECAT PET scanner. MR headphones and background noise are potential sources of error in functional PET/MR studies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights reserved.)

Aims: The aims of the study were to describe sleep quality among community-dwelling older people; determine the association between sleep quality (total and multidimensional), frailty and overall health; study frailty as a mediator in the association between sleep quality and overall health., Design: This longitudinal, correlative study used data from 2020 to 2022., Methods: A total of 181 community-dwelling older people in a city in Southeast China were assessed twice. Sleep quality was measured using the Pittsburgh Sleep Quality Index at Time 1 (year 2020); frailty was measured using the FRAIL scale, and overall health was measured using the EuroQol visual analogue scale at Time 1 and 2 (1 year later). Associations and indirect effects were examined using linear regression analyses using the PROCESS Macro (Model 4)., Results: Poor sleep quality (higher scores) was associated with increased frailty over time (total scale), as well as subjective sleep quality, sleep duration, sleep efficiency and daytime dysfunction. Mediation analyses indicated that frailty change had an indirect effect on the association between sleep quality total score Time (T) 1 and overall health T2 and between the dimensions subjective sleep quality, sleep duration, sleep efficiency and daytime dysfunction and overall health. All analyses were adjusted for age, multimorbidity and overall health T1., Conclusions: Poor sleep quality is a common problem associated with poor overall health after 1 year, and the progression of frailty mediates this association., Impact: The findings provide a better understanding of the association between sleep quality and overall health and elucidate the mediating effect of frailty. Regular screening and effective treatment by healthcare providers for sleep problems and frailty in older people are necessary to improve their overall health and enhance healthy ageing., Patient or Public Contribution: Participants in the study provided the data used for all data analysis in the manuscript. Patient or public were not involved in data analysis, interpretation or manuscript preparation. Staff in the community health centre helped with data collection., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Internationally educated nurses attending a bridging program must demonstrate clinical competence and meet requirements to apply for a nursing license in Sweden., Objectives: To describe preceptors' experiences of supervising internationally educated nurses undergoing clinical practice education during a bridging program., Design: A qualitative descriptive study., Settings: Two universities offering the 1-year bridging program for nurses with a nursing degree from outside European Union/European Economic Area and Switzerland., Participants: Fifteen preceptors, all registered nurses, who supervised internationally educated nurses were included., Methods: Semi-structured interviews were performed, and data were analyzed using qualitative content analysis., Results: Supervising internationally educated nurses was not the same as supervising nursing students and raised feelings of both joy and frustration. Preceptors had to adapt supervision to the student's nursing knowledge and skills. They had to help students communicate in Swedish and form good relationships with other students, patients, and other professionals. Most preceptors requested more information about the student's nurse education, country of education/cultural background, and previous work experiences. Mixed experiences of support from the university, first-line managers, and colleagues were reported., Conclusions: Being a preceptor for internationally educated nurses is a challenge, and supervision training is important for managing preceptorship. To supervise students based on their level of knowledge and skills, more information must be shared with the preceptor. Encounters with others are of importance in the training, where teamwork and person-centered care must be in focus, both in prior theoretical education and in clinical practice education., Competing Interests: Declaration of competing interest The authors are employed at the two universities running the bridging program. The authors had no relationship with the informants prior to data collection., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: Pain is a frequent symptom of head and neck cancer (HNC) but longitudinal studies investigating facial pain are scarce. We aimed to investigate prevalence of facial pain, its effect on health-related quality of life (HRQL) and trismus-related symptoms in a HNC cohort., Methods: Patients (n = 194) were prospectively followed post completion of radiotherapy (RT). Outcome measures included facial pain, HRQL, trismus-specific symptoms, and maximal interincisal opening (MIO)., Results: Facial pain was reported by 50% at baseline. Corresponding figures for 3-, 12-, and 60 months post-RT were 70%, 54% and 41%. Moderate to severe pain was reported in 29-44% of patients reporting pain during the study period. Patients reporting pain scored significantly worse on more HRQL variables and trismus symptoms, as well as had significantly smaller MIO at all follow-up time points., Conclusions: Facial pain was common in HNC patients pre- and post-RT and remained prevalent up to 5 years after completion of RT. Reductions in MIO were associated with more facial pain. Pain was also associated with worse HRQL., (© 2023. The Author(s).)

Purpose: The Purpose of the study was to investigate the construct validity and internal consistency of the LaMI among staff in the context of elderly care in Sweden., Design/methodology/approach: Questionnaire data from a longitudinal study of staff working in elderly care were used. Data were collected using the Leadership and Management Inventory. First data collection was for explorative factor analysis ( n = 1,149), and the second collection, one year later, was for confirmatory factor analysis ( n = 1,061)., Findings: The explorative factor analysis resulted in a two-factor solution that explained 70.2% of the total variance. Different models were tested in the confirmatory factor analysis. The final model, a two-factor solution where three items were omitted, showed acceptable results., Originality/value: The instrument measures both leadership and management performance and can be used to continually measure managers' performances as perceived by staff to identify areas for development., (© Bernice Skytt, Hans Högberg and Maria Engström.)

Purpose: Multiple vendors are currently offering artificial intelligence (AI) computer-aided systems for triage detection, diagnosis, and risk prediction of breast cancer based on screening mammography. There is an imminent need to establish validation platforms that enable fair and transparent testing of these systems against external data., Approach: We developed validation of artificial intelligence for breast imaging (VAI-B), a platform for independent validation of AI algorithms in breast imaging. The platform is a hybrid solution, with one part implemented in the cloud and another in an on-premises environment at Karolinska Institute. Cloud services provide the flexibility of scaling the computing power during inference time, while secure on-premises clinical data storage preserves their privacy. A MongoDB database and a python package were developed to store and manage the data on-premises. VAI-B requires four data components: radiological images, AI inferences, radiologist assessments, and cancer outcomes., Results: To pilot test VAI-B, we defined a case-control population based on 8080 patients diagnosed with breast cancer and 36,339 healthy women based on the Swedish national quality registry for breast cancer. Images and radiological assessments from more than 100,000 mammography examinations were extracted from hospitals in three regions of Sweden. The images were processed by AI systems from three vendors in a virtual private cloud to produce abnormality scores related to signs of cancer in the images. A total of 105,706 examinations have been processed and stored in the database., Conclusions: We have created a platform that will allow downstream evaluation of AI systems for breast cancer detection, which enables faster development cycles for participating vendors and safer AI adoption for participating hospitals. The platform was designed to be scalable and ready to be expanded should a new vendor want to evaluate their system or should a new hospital wish to obtain an evaluation of different AI systems on their images., (© 2023 The Authors.)

Background: Psychosocial risk factors in the home may impair children's health and development and increase the risk of maltreatment. The Safe Environment for Every Kid (SEEK) model was developed to provide pediatric primary care professionals with a structured way to identify common psychosocial problems. The SEEK model includes use of the Parent Screening Questionnaire (SEEK-PSQ) at routine preventive child health visits, discussion with parents about their responses and, when indicated, referral to relevant services. The SEEK-PSQ has not previously been available in Swedish. The aim of the present study was to evaluate the psychometric properties of an adapted Swedish version of the SEEK-PSQ (PSQ-S)., Methods: This study is part of a cluster-randomised controlled trial of SEEK in the Swedish child health services. To validate the PSQ-S, parents (n = 852) with children 0-18 months of age were invited to complete a survey including the PSQ-S as well as evidence-based standardized instruments for the targeted psychosocial risk factors: economic worries, depressive symptoms, parental stress, alcohol misuse and intimate partner violence (IPV). Baseline data from 611 (72%) parents were analysed regarding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each risk factor., Results: As a whole, the PSQ-S had a sensitivity of 93%, specificity of 52%, PPV of 67% and NPV of 87%. For mothers and fathers combined, sensitivity was 80% for economic worries, 89% for depressive symptoms, 78% for parental stress, 47% for intimate partner violence (IPV) and 70% for alcohol misuse. Specificity was highest for IPV and alcohol misuse (91%) and lowest for depressive symptoms (64%). NPV values were high (81-99%) and PPV values were low to moderate (22-69%) for the targeted problems. Sensitivity was higher for mothers compared to fathers for economic worries, depressive symptoms and IPV. This difference was particularly evident for IPV (52% for mothers, 27% for fathers)., Conclusion: The SEEK-PSQ-S demonstrated good psychometric properties for identifying economic worries, depressive symptoms, parental stress and alcohol misuse but low sensitivity for IPV. The PSQ-S as a whole showed high sensitivity and NPV, indicating that most parents with or without the targeted psychosocial risk factors were correctly identified., Trial Registration: ISRCTN registry, study record 14,429,952 ( https://doi.org/10.1186/ISRCTN14429952 ) Registration date 27/05/2020., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: A reduction in mortality risk of COVID-19 throughout the first wave of the pandemic has been reported, but less is known about later waves. This study aimed to describe changes in hospitalizations and mortality of patients receiving inpatient geriatric care for COVID-19 or other causes during the pandemic., Methods: Patients 70 years and older hospitalized in geriatric hospitals in Stockholm for COVID-19 or other causes between March 2020-July 2021 were included. Data on the incidence of COVID-positive cases and 30-day mortality of the total ≥ 70-year-old population, in relation to weekly hospitalizations and mortality after hospital admissions were analyzed. Findings The total number of hospitalizations was 5,320 for COVID-19 and 32,243 for non-COVID-cases. In COVID-patients, the 30-day mortality rate was highest at the beginning of the first wave (29% in March-April 2020), reached 17% at the second wave peak (November-December) followed by 11-13% in the third wave (March-July 2021). The mortality in non-COVID geriatric patients showed a similar trend, but of lower magnitude (5-10%). During the incidence peaks, COVID-19 hospitalizations displaced non-COVID geriatric patients., Interpretation: Hospital admissions and 30-day mortality after hospitalizations for COVID-19 increased in periods of high community transmission, albeit with decreasing mortality rates from wave 1 to 3, with a probable vaccination effect in wave 3. Thus, the healthcare system could not compensate for the high community spread of COVID-19 during the pandemic peaks, which also led to displacing care for non-COVID geriatric patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Garcia-Ptacek et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: International collaborative programs and student active learning are encouraged; yet, little is known about them., Purpose: To compare nursing students' self-rated nurse professional competence (NPC) and general self-efficacy between those enrolled in an international collaborative program, which focused on student active learning, and those enrolled in a traditional lecture-based program at the end of graduation and 1 year later., Methods: This prospective comparative study distributed a questionnaire to 137 nursing students enrolled in the 2 bachelor-level programs at a university in southeastern China., Results: At the end of graduation, students enrolled in the international collaborative program reported higher scores for NPC factors, medical and technical care and general self-efficacy, than those enrolled in the traditional lecture-based program. One year later, they reported higher scores for total NPC, value-based nursing care, medical and technical care, care pedagogics, documentation and administration of nursing care, and general self-efficacy than others., Conclusion: This study found that the nursing students enrolled in the international collaborative program reported higher self-rated competence., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc.)

Objective: The goal of this study was to investigate whether bariatric surgery is associated with substance use disorder (SUD) with substances other than alcohol., Methods: The prospective, controlled Swedish Obese Subjects study enrolled 2010 patients with obesity who underwent bariatric surgery (gastric bypass n = 265; vertical banded gastroplasty n = 1369; gastric banding n = 376) and 2037 matched control individuals receiving usual obesity care. Participants with SUD other than alcohol use disorder were identified using International Statistical Classification of Diseases (ICD) codes from the Swedish National Patient Register (covering treatment in hospital but not primary care). Those with a history of non-alcohol SUD were excluded. Median follow-up was 23.8 years., Results: During follow-up, non-alcohol SUD incidence rates per 1000 person-years with 95% CI were 1.6 (0.8-3.1), 0.8 (0.5-1.2), 1.1 (0.5-2.2), and 0.6 (0.4-0.8) for gastric bypass, vertical banded gastroplasty, gastric banding, and control individuals, respectively. Only gastric bypass was associated with increased incidence of non-alcohol SUD (adjusted hazard ratio 2.54 [95% CI: 1.14-5.65], p = 0.022) compared with control participants., Conclusions: Gastric bypass surgery was associated with increased risk of non-alcohol SUD, and this should be considered in long-term postoperative care., (© 2023 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)

Aim: The aim of the study was to explore the work conditions that influence the opportunities for professional development of specialist nurses in surgical care., Design: A qualitative descriptive design was used., Methods: With a purposeful sampling procedure, 14 specialist nurses in surgical care were included. Four focus-group interviews were conducted during November to December 2021 and deductively analysed using the Job Demand-Resource theory as a guiding framework. Reporting adheres to COREQ guidelines., Findings: Work conditions that were identified as job demands and that inhibited nurses' opportunities for professional development were mainly found at an organizational and leadership level. Primarily, those conditions included role ambiguity and time constraints caused by uncompensated nursing shortages that restricted the nurses from exercising their role. Such conditions could also discourage other nurses from further education. Job demands were seen as largely compensated for by work conditions identified as job resources and located mainly at an individual level, for example finding the work interesting and multifaceted. Most prominent was the participants' inner motivation to work with surgical patients and to continue to develop themselves and other nurses professionally., Conclusions: A prerequisite for professional development is that the specialist role is clearly defined in collaboration with representatives from the nursing profession and universities. Hence, hospital organizations need to reflect on how to utilize the competence. Also, it is important that nurse leaders promote the specialist nurses' motivation by supporting them in the exercise of their role., Impact: Findings from this study revealed work conditions that need to be acknowledged during hospital organizations' endeavours to maintain and enhance nursing competence., Patient or Public Contribution: Patient or public contribution was not applicable since the study focused on specialist nurses' working conditions., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aim: To systematically analyse and synthesize studies investigating job satisfaction (including turnover and turnover intention) and wellbeing (physical, social and psychological including work stress, acculturation stress and sick leave) among migrant care workers in nursing homes., Design: An integrated review was conducted., Methods: Joanna Briggs Institute's manual guided the analysis of qualitative data (n = 31). Quantitative data (n = 17) were summarized and integrated with the qualitative findings., Results: Migrants described high job demands, limited control and social support, and stress possibly related to acculturation. Although, compared to natives (born in the country), inconsistent results were reported about wellbeing and job satisfaction, migrant care workers reported enjoying the relational aspects of work and feeling pride when providing care. A satisfying work environment for migrant care workers enables them enjoying working in elderly care with pride., Public Contribution: Help managers to promote an inclusive working life in line with the United Nations Sustainable Development Goal number 8., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Plants produce diverse chemical defenses with contrasting effects on different insect herbivores. Deploying herbivore-specific responses can help plants increase their defensive efficiency. Here, we explore how variation in induced plant responses correlates with herbivore species, order, feeding guild, and level of specialization. In a greenhouse experiment, we exposed 149 plants of Salix fragilis (Linnaeus, 1753) to 22 herbivore species naturally associated with this host. The insects belonged to four orders (Coleoptera, Lepidoptera, Hemiptera, and Hymenoptera), three feeding guilds (external leaf-chewers, leaf-tying chewers, and sap-sucking), and included both dietary specialists and generalists. Following herbivory, we quantified induced changes in volatiles and nonvolatile leaf metabolites. We performed multivariate analyses to assess the correlation between herbivore order, feeding guild, dietary specialization, chewing damage by herbivores, and induced responses. The volatile composition was best explained by chewing damage and insect order, with Coleoptera and Lepidoptera eliciting significantly different responses. Furthermore, we recorded significant differences in elicited volatiles among some species within the two orders. Variation in nonvolatile leaf metabolites was mainly explained by the presence of insects, as plants exposed to herbivores showed significantly different metabolites from controls. Herbivore order also played a role to some extent, with beetles eliciting different responses than other herbivores. The induction of volatile and nonvolatile leaf metabolites shows different levels of specificity. The specificity in volatiles could potentially serve as an important cue to specialized predators or parasitoids, increasing the efficacy of volatiles as indirect defenses. By contrast, the induction of nonvolatile leaf metabolites was largely unaffected by herbivore identity. Most nonvolatile metabolites were downregulated, possibly indicating that plants redirected their resources from leaves in response to herbivory. Our results demonstrate how diverse responses to herbivores can contribute to the diversity of plant defensive strategies., Competing Interests: There are no conflicts of interest to declare., (© 2023 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Background: Nurses and social workers are two common professions with a university degree working within municipal nursing care and social welfare. Both groups have high turnover intention rates, and there is a need to better understand their quality of working life and turnover intentions in general and more specifically during the Covid-19 pandemic. This study investigated associations between working life, coping strategies and turnover intentions of staff with a university degree working within municipal care and social welfare during the Covid-19 pandemic., Methods: A cross-sectional design; 207 staff completed questionnaires and data were analyzed using multiple linear regression analyses., Results: Turnover intentions were common. For registered nurses 23% thought of leaving the workplace and 14% the profession 'rather often' and 'very often/always'. The corresponding figures for social workers were 22% (workplace) and 22% (profession). Working life variables explained 34-36% of the variance in turnover intentions. Significant variables in the multiple linear regression models were work-related stress, home-work interface and job-career satisfaction (both for the outcome turnover intentions profession and workplace) and Covid-19 exposure/patients (turnover intentions profession). For the chosen coping strategies, 'exercise', 'recreation and relaxation' and 'improving skills', the results (associations with turnover) were non-significant. However, comparing the groups social workers reported that they used 'recreation and relaxation' more often than were reported by registered nurses., Conclusions: More work-related stress, worse home-work interface and less job-career satisfaction together with Covid-19 exposure/patients (Covid-19 only for turnover profession) increase turnover intentions. Recommendations are that managers should strive for better home-work interface and job-career satisfaction, monitor and counteract work-related stress to prevent turnover intentions., (© 2023. The Author(s).)

Background and Aims: After bariatric surgery, micronutrient deficiencies may lead to anaemia. To prevent post-operative deficiencies, patients are recommended lifelong micronutrient supplementation. Studies investigating the effectiveness of supplementation to prevent anaemia after bariatric surgery are scarce. This study aimed to investigate the relationship between nutritional deficiencies and anaemia in patients who report use of supplementation two years after bariatric surgery versus patients who do not., Methods and Results: Obese (BMI≥35 kg/m 2 ) individuals (n = 971) were recruited at Sahlgrenska University Hospital in Gothenburg, Sweden between 2015 and 2017. The interventions were Roux-en-Y gastric bypass (RYGB), n = 382, sleeve gastrectomy (SG), n = 201, or medical treatment (MT), n = 388. Blood samples and self-reported data on supplements were collected at baseline and two years post treatment. Anaemia was defined as haemoglobin <120 g/L for females and <130 g/L for males. Standard statistical methods, including a logistic regression model and a machine learning algorithm, were used to analyse data. The frequency of anaemia increased from baseline in patients treated with RYGB (3·0% vs 10·5%; p < 0·05). Neither iron-dependent biochemistry nor frequency of anaemia differed between participants who reported use of iron supplements and those who did not at the two-year follow-up. Low preoperative level of haemoglobin and high postoperative percent excessive BMI loss increased the predicted probability of anaemia two years after surgery., Conclusion: The results from this study indicate that iron deficiency or anaemia may not be prevented by substitutional treatment per current guidelines after bariatric surgery and highlights there is reason to ensure adequate preoperative micronutrient levels., Trial Registration: March 03, 2015; NCT03152617., Competing Interests: Declaration of competing interest BE reports personal fees from Navamedic and personal fees from Novo Nordisk, outside the submitted work. GH has received payments for lectures from Novo Nordisk and AstraZeneca. The other authors have no competing interests to declare., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Severe obesity in adolescents has a profound impact on current and future health. Metabolic and bariatric surgery (MBS) is increasingly used in adolescents internationally. However, to our knowledge, there are no randomised trials examining the currently most used surgical techniques. Our aim was to evaluate changes in BMI and secondary health and safety outcomes after MBS., Methods: The Adolescent Morbid Obesity Surgery 2 (AMOS2) study is a randomised, open-label, multicentre trial done at three university hospitals in Sweden (located in Stockholm, Gothenburg, and Malmö). Adolescents aged 13-16 years with a BMI of at least 35 kg/m 2 , who had attended treatment for obesity for at least 1 year, passed assessments from a paediatric psychologist and a paediatrician, and had a Tanner pubertal stage of at least 3, were randomly assigned (1:1) to MBS or intensive non-surgical treatment. Exclusion criteria included monogenic or syndromic obesity, major psychiatric illness, and regular self-induced vomiting. Computerised randomisation was stratified for sex and recruitment site. Allocation was concealed for both staff and participants until the end of the inclusion day, and then all participants were unmasked to treatment intervention. One group underwent MBS (primarily gastric bypass), while the other group received intensive non-surgical treatment starting with 8 weeks of low-calorie diet. The primary outcome was 2-year change in BMI, analysed as intention-to-treat. The trial is registered at ClinicalTrials.gov, NCT02378259., Findings: 500 people were assessed for eligibility between Aug 27, 2014, and June 7, 2017. 450 participants were excluded (397 did not meet inclusion criteria, 39 declined to participate, and 14 were excluded for various other reasons). Of the 50 remaining participants, 25 (19 females and six males) were randomly assigned to receive MBS and 25 (18 females and seven males) were assigned to intensive non-surgical treatment. Three participants (6%; one in the MBS group and two in the intensive non-surgical treatment group) did not participate in the 2-year follow-up, and in total 47 (94%) participants were assessed for the primary endpoint. Mean age of participants was 15·8 years (SD 0·9) and mean BMI at baseline was 42·6 kg/m 2 (SD 5·2). After 2 years, BMI change was -12·6 kg/m 2 (-35·9 kg; n=24) among adolescents undergoing MBS (Roux-en-Y gastric bypass [n=23], sleeve gastrectomy [n=2]) and -0·2 kg/m 2 (0·4 kg; [n=23]) among participants in the intensive non-surgical treatment group (mean difference -12·4 kg/m 2 [95% CI -15·5 to -9·3]; p<0·0001). Five (20%) patients in the intensive non-surgical group crossed over to MBS during the second year. Adverse events (n=4) after MBS were mild but included one cholecystectomy. Regarding safety outcomes, surgical patients had a reduction in bone mineral density, while controls were unchanged after 2 years (z-score change mean difference -0·9 [95% CI -1·2 to -0·6]). There were no significant differences between the groups in vitamin and mineral levels, gastrointestinal symptoms (except less reflux in the surgical group), or in mental health at the 2-year follow-up., Interpretation: MBS is an effective and well tolerated treatment for adolescents with severe obesity resulting in substantial weight loss and improvements in several aspects of metabolic health and physical quality of life over 2 years, and should be considered in adolescents with severe obesity., Funding: Sweden's Innovation Agency, Swedish Research Council Health., Competing Interests: Declaration of interests KJ has received speaker honoraria from Novo Nordisk, and reimbursement for educational activities from Johnson & Johnson unrelated to the submitted Article. All reimbursements were directed to her clinical institution. TO participated in advisory boards and educational activities for Johnson & Johnson and Novo Nordisk unrelated to the submitted article, and reimbursements were directed to his academic institution. MN reports advisory board participation for Ethicon, Johnson & Johnson, and Itrim. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Aim: To explore the quality-of-life among community-dwelling older adults in China and to examine the associations between frailty, sociodemographic characteristics and quality-of-life., Design: A cross-sectional correlational study was adopted., Methods: Questionnaire study of 311 community-dwelling older adults using the Life Satisfaction Questionnaire and FRAIL scale., Results: Highest quality-of-life was found for the physical symptoms factor and the lowest for quality of everyday activities/fun. Frailty was associated with total quality-of-life and the physical symptoms and sickness impact factors. For total quality-of-life, the odds of being in the group with a median score or more decreased for frail older people (OR 0.30) versus non-frail and increased for those with medical insurance from employer versus basic (OR 2.30) and those doing exercise ≥30 min 3 days/week or more versus less (OR 2.12). Registered nurses caring for community-dwelling older adults should screen for and prevent frailty and encourage exercise to improve their quality-of-life., (© 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: A high level of competence among staff is necessary for providing patient-safe surgical care. Knowledge regarding what factors contribute to the professional development of specialist nurses in surgical care and why they choose to remain in the workplace despite high work requirements is needed. To investigate and describe the organizational and social work environment of specialist nurses in surgical care as part of studying factors that impact on professional development., Method: This was a cross-sectional study with a strategic convenience sampling procedure that recruited 73 specialist nurses in surgical care in Sweden between October to December 2021. The study was guided by STROBE Statement and checklist of cross-sectional studies. The validated Copenhagen Psychosocial Questionnaire was used, and additional demographic data. Descriptive statistics were performed and the comparison to the population benchmarks was presented as the mean with a 95% confidence interval. To study potential differences among the demographic and professional characteristics, pairwise t tests were used with Bonferroni adjustment for multiple comparisons with a significance level of 5%., Results: Five domains were identified as factors related to success, as they received higher scores in relation to population benchmarks: quality of leadership, variation of work, meaning of work and work engagement as well as job insecurity. There was also a significant association between a having a manager with low nursing education and job insecurity (p = 0.021)., Conclusions: Quality of leadership is important for the professional development of specialist nurses in surgical care. Strategic work seems to include managers with a higher nursing education level to prevent insecure professional working conditions., (© 2023. The Author(s).)

Objective: One way to decrease adverse events is to increase patient participation in their own care. Sahlgrenska University Hospital has introduced a patient safety advisory, consisting of an animated video and structured oral information. This article investigates how the animated video and structured oral information regarding was perceived by the patients and determines which communication method the patients preferred., Method: In this study, we compared patients' attitudes toward patient safety information delivered in video or oral format. Data were collected after intervention through a survey consisting of 5 questions., Results: One hundred thirty-four patients were recruited to the study. Ninety-two patients either watched the video or received oral information. Forty-two patients were given both oral information and viewed the video. Information received by the patients was rated as good or very good by 90% of those viewing the video and by 100% who received the oral presentation ( P = 0.007). Of the 42 participants who received both formats, 74% preferred the oral presentation ( P < 0.001)., Conclusions: The patients thought the patient safety information to be good and beneficial. An informative video can complement the oral information, but not replace, when informing patients about patient safety. Providing patients with information in a manner they prefer may increase patient's involvement in their care and possibly reduce the risk of adverse events., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Autologous conditioned serum (ACS) is used to treat osteoarthritis in horses, although its effects are not fully investigated., Objectives: To investigate the effects of equine serum and conditioned serum on chondrocytes stimulated with interleukin (IL)-1β and cartilage explants with mild osteoarthritis., Study Design: In vitro experimental study., Methods: The effect of three different serum preparations (unincubated control [PS], serum incubated 24 h [PS24h] and serum incubated 24 h in ACS containers [PCS]) pooled from lame horses were tested in two in vitro models. IL-1β and IL-1 receptor antagonist (IL-1Ra) concentrations were measured in all sera. In model 1, chondrocyte pellet cultures were stimulated with IL-1β prior to treatment with the serum preparations for 2 and 48 h. Microarray, polymerase chain reaction, and matrix metallopeptidase-13 analyses were performed. In model 2, cartilage explants from horses with structural osteoarthritis were treated with PS or PCS on days 0, 6 and 12, or left untreated, and evaluated at day 24 using the OARSI grading scale for histological evaluation of articular cartilage., Results: The IL-1Ra concentration in PS24h and PCS was significantly higher than in PS. In model 1, inflammation- and cartilage matrix degradation-related genes were upregulated after 48 h in all treatment groups versus untreated controls. Cartilage matrix molecules, aggrecan and collagens, were downregulated in PS24h- and PCS-treated pellets versus untreated controls. Growth factor signalling genes were upregulated-FGF7 in all treatment groups, BMP2 in PS24h-, and INHBA in PCS-treated-compared with untreated controls. In model 2, the OARSI score at day 24 was not significantly different between treatment groups., Main Limitations: Results from in vitro models cannot be directly translated to in vivo situations., Conclusions: In vitro treatment with conditioned serum did not alleviate IL-1β-induced responses in chondrocyte pellets or lead to morphological improvement in osteoarthritic cartilage explants., (© 2022 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.)