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This study explored the function of school leading in the implementation process of education for sustainable development (ESD) in five Swedish schools employing a whole school approach (WSA). A follow-up study design was used, in which schools that had initiated an ESD project in 2016 were subsequently visited twice for interviews with principals during the project and after it was finalized. The theory of practice architectures in combination with the concept of school improvement capacity was used as the theoretical framework in the analysis. The study showed how school leading should be about enhancing the local school’s capacity to improve. It also showed how specific practice architectures prefigured a WSA to ESD and how school leading in this context was about arranging—or orchestrating—practice architectures in ways that enabled such an approach. The issues of time and endurance were pivotal.Based on the empirical results from this study and school improvement theory, guidelines were developed that can be used to drive a WSA to ESD process forward through three different school improvement phases: initiation, implementation, and institutionalization. The limitations and suggestions for further research are also discussed.

Insect decline, i.e. the rapid loss of insect biodiversity and species abundance, is an imminent crisis that mirrors the global loss of biodiversity and biological annihilation. Conservation scientists have therefore called for effective public education on how to mitigate insect decline. In this paper, we develop the framework “Action Competence for Insect Conservation (ACIC)” as a tool for improving education and citizen action for insect biodiversity conservation. The ACIC is an educational framework to develop peoples' abilities to take actions that sustain insect biodiversity, connecting insect conservation science with social science. This framework is applicable in various contexts and settings in both formal (e.g. schools, universities) and informal (e.g. outreach) education. It can be used to design and improve educational approaches, develop social interventions for insect conservation more generally, and develop instruments to assess such interventions. ACIC builds on the educational concept of Action Competence that goes beyond traditional education, which has focused on theoretical knowledge. Instead, the ACIC aims to foster peoples' action-oriented knowledge, confidence in their actions and willingness to take action. This explicit focus on actions contributes to overcoming gaps between knowledge and action implementation. The ACIC covers not only actions in private greenspaces, but also highlights the importance of actions that address other people in the community along with relevant stakeholders. We believe that the ACIC framework can contribute to identifying and developing effective intervention approaches, which have the potential to support transformational change in sustaining insect biodiversity.

The article demonstrates how a questionnaire gauging students' experiences of participation in decision-making at their school can operationalise student participation in a whole school approach (WSA) to education for sustainable development model. Some 902 students in three upper secondary schools participated in the study by giving their answers to Likert-scale items developed to tap into their experience of participation in the decision-making at their school. The students identified four distinct pathways of participation: (i) School and Leadership, (ii) Teaching and Learning, (iii) Community Connections, and (iv) Student Council. The results are discussed in the light of focus group interviews with eleven of the participants. The student WSA participation questionnaire proved to be a reliable and valid instrument that, together with the student WSA participation model, can be used by school leaders wanting to increase student participation, and by researchers investigating student participation throughout the whole school.

ObjectivesMigrant physicians (MPs) who wish to practise their profession in a new country often must undergo a recertification process, including a licensing exam. In many cases, this is the same licensing exam used for peers educated within the country; however, the pass rate of MPs is usually lower. This study aimed to explore MPs exam results, focusing on MPs that had participated in a complementary programme (CPP) for physicians with a medical degree from outside the European Union/European Economic Area (EU/EEA), and aspects that may influence these.MethodsMixed methods were applied. The data consisted of 2013 to 2019 licensing exam results of 564 physicians in Sweden that were educated outside of the EU. The data was analysed using linear and logistic regression analysis. Further, 14 interviews with MPs were conducted and thematically analysed.ResultsAn interaction between age and CPP participation was found for both the total score in per cent (p=0.01) and for the proportion failing their first attempt (p=0.04). Age was found to be a very strong predictor for failing on the first attempt, with those 45 and older failing on the first attempt in 72 and 82 per cent for CPP and non-CPP participants, respectively. Interview data was categorised into two themes: preparations and biographical aspects, and the exam and exam situation.ConclusionsAge seems to be an important predictor for failing the first attempt. MPs have had less time to familiarise themselves with the exam type and the language used on the exam. To improve exam results, MPs used different strategies and tools, that is, studying with nationally trained physicians, and using old exams and a web-based study tool consisting of common exam subjects. At the same time, these strategies and tools have also become mediators in the socialisation of MPs into the exam context.

Education for sustainable development (ESD) is promoted as one important component in the endeavor toward sustainable development. Goal 4 in the Sustainable Development Goals (UN in Sustainable development goals—17 goals to transform our world, 2017) in particular targets the role of ESD in this respect. The importance of cultural specificity in ESD is emphasized in numerous international policy documents, but there are few cross-cultural studies that focus on the broad context of sustainable development and ESD. The current study investigates the sustainability consciousness of grade 12 students (age 18–19) in Taiwan (N = 617) and Sweden (N = 583) and discusses the implications for ESD policy and practice. The findings indicate that significant differences exist between the two samples, both with respect to their sustainability consciousness and within the three sub-constructs of knowingness, attitudes and self-reported behaviors. The differences are considered in light of the cultural value orientations of the East Asian and Western European regions. Implications for ESD are discussed from the perspective of cultural specificity.

The concept of Action Competence (AC) has been interpreted in different ways in various domains of the educational sciences. Given the rising scholarly attention to AC, these diverse interpretations are problematic because they hinder a common understanding of the concept among scholars. We unravel the interpretation of AC as a competence of people versus that of an educational approach. We call the latter education for sustainable development (ESD), and discuss the approach as predominantly being a subjectification model of education. Furthermore, we offer an updated and refined generic definition of action competence as a competence of people. To this end, we develop an ecology of psychological concepts that underpin AC. We present a theoretical perspective based on the concepts of “action” and “competence”, for stronger consideration of AC as a competence of people. We relate this generic concept of AC to concepts such as commitment, passion, knowledge, and self-efficacy for solving controversial problems. Finally, we introduce the specific concept of “Action Competence in Sustainable Development” (ACiSD) to articulate the competence of people to engage in solving sustainability issues.

This study contributes to an operationalization of the concept of action competence for sustainability through the theoretical development and empirical validation of a new 12-item Likert-scale questionnaire: the Self-Perceived Action Competence for Sustainability Questionnaire, SPACS-Q. Other scales in environmental and sustainability education (ESE) typically measure concepts such as pro-environmental and sustainability attitudes and behaviors, and therefore do not fully cover the concept of action competence for sustainability. An action differs from a ‘mere’ behavior in that it is voluntary and targeted at bringing about change, which is the overarching goal of ESE. We define action competence as a latent capacity among individuals to act sustainably. We introduce a novel scale measuring this seminal concept. Totally, 614 Swedish adolescents aged 12-19 participated in this study. The scale includes three latent subconstructs: i) knowledge of action possibilities, ii) confidence in one’s own influence, and iii) the willingness to act. Confirmatory factor analyses, reliability measures and investigation of convergent validity reveal a questionnaire instrument with excellent psychometric quality. We put forward that the SPACS-Q is a novel and theory-driven, empirically reliable and valid, instrument, and encourage fellow researchers to use the SPACS-Q when investigating people’s action competence for sustainability in various contexts.

Background We designed this observational study to investigate the level of patients’ and doctors’ ratings of patient-centred aspects of the primary care consultation. Methods Questionnaire study with patients and doctors. Consecutive patients in a primary care setting and 16 doctors responding post visit. Results are presented as proportions with 95% confidence intervals. Results 411 questionnaires, 223 from patients and 188 from doctors, covered 251 consultations. Both patients and doctors gave the highest possible estimations on the aspects of patient-centred communication and satisfaction less frequently when the patient had other reasons for visit than purely somatic. Unlike the doctors’ estimations, the frequency of highest possible estimations in patient responses dropped if the patients had two to six reasons for visit rather than one. Among the six patient-centred aspects, both patients and doctors gave the highest possible estimation least frequently on the aspect of shared decision-making. Conclusion The results suggest that the nature of the reason, as well as the number of reasons for visit, interferes with the doctors’ level of patient-centred communication. Our results furthermore confirm the findings of previous studies that doctors insufficiently involve patients in their care. Electronic supplementary material The online version of this article (10.1186/s12875-019-0959-y) contains supplementary material, which is available to authorized users.

Previous research has shown that interest in and concern about environmental issues tends to decrease in adolescence, but less is known about adolescents' broader consciousness of sustainable devel ...

Background Previous studies have found that sickness absentees have an excess risk of premature death. Most of the studies compared sickness absentees with non-sickness absentees, with 1 report including the total population. However, no study to date has investigated in detail how the risk of premature death varies over the time course of a sick-leave spell. Methods A population-based cohort of all 5.6 million people aged 16–64 years was followed up for 6 years. Hazard rates with 95% CI for mortality in the total population, sickness absentees with sick-leave spells exceeding 30 days and non-sickness absentees, were estimated over time and were standardised so that the distribution of background variables in all 3 groups was as close as possible to that in the total population. Results The standardised hazard rate of premature death at the first day under risk for the sickness absentees was 13.58 (95% CI 13.26 to 13.95) deaths per 1000 person-years, 2.29 (2.24 to 2.35) in the total population and 0.90 (0.87 to 0.94) among non-sickness absentees. The standardised hazard rates of premature death at 6 years was 3.42 (3.22 to 3.62) among sickness absentees, 3.48 (3.43 to 3.52) in the total population and 2.61 (2.57 to 2.66) among the non-sickness absentees. The hazard rates varied greatly across sick-leave diagnoses. Conclusions Right after start of a sick-leave spell exceeding 30 days, sickness absentees were at higher risk of premature death than the total population. The difference in risk, however, decreased over time and vanished completely after 6 years of follow-up.

During the past decade, numerous schools in Sweden have implemented education for sustainable development (ESD) as an explicit guiding approach in teaching. In this paper, we investigate the effect ...

This study extends previous environmental education research on gender differences by investigating the gender gap between boys' and girls' sustainability consciousness. The issue of whether the gender gap in environmental education can be identified also in sustainability education is addressed. It has been suggested that Education for Sustainable Development (ESD) is a teaching approach that could play a key role in diminishing the gender gap. However, the possible gender-specific effect of an ESD-oriented teaching approach is empirically untested. A survey instrument was used to detect the hypothesized gender gap in students' sustainability consciousness on a sample of 2,413 Swedish students aged 12–19. Findings reveal a gender gap in students' sustainability consciousness. The gender gap increases throughout the age span and is amplified in ESD-oriented schools.

Background Many doctors fail to practice Evidence-Based Medicine (EBM) effectively, in part due to insufficient training. We report on the design, fate and impact of a short learner-centered EBM train-the-trainer program aimed at all 2400 doctors at the Karolinska University Hospital in Sweden on the heels of a tumultuous merger, focusing particularly on whether it affected the doctors’ knowledge, attitudes and skills regarding EBM. Methods We used a validated EBM instrument in a before-and-after design to assess the impact of the training. Changes in responses were analyzed at the individual level using the Wilcoxon matched pairs test. We also reviewed documentation from the program – including the modular EBM training schedule and the template for participants’ Critically Appraised Topic reports – to describe the training’s content, design, conduct, and fate. Results The training, designed to be delivered in modules of 45 min totaling 1.5 days, failed to reach most doctors at the hospital, due to cost cutting pressures and competing demands. Among study participants (n = 174), many reported suboptimal EBM knowledge and skills before the training. Respondents’ strategies for solving clinical problems changed after the training: the proportion of respondents reporting to use (or intend to use) secondary sources “Often/very often” changed from 5 % before the training to 76 % after the training; in parallel, reliance on textbooks and on colleagues fell (48 to 23 % and 79 to 65 %, respectively). Participants’ confidence in assessing scientific articles increased and their attitudes toward EBM became more positive. The proportion of correct answers in the EBM knowledge test increased from 52 to 71 %. All these changes were statistically significant at p

Plasmodium falciparum 's ability to invade erythrocytes is essential for its survival within the human host. Immune mechanisms that impair this ability are therefore expected to contribute to immunity against the parasite. Plasma of humans who are naturally exposed to malaria has been shown to have growth-inhibitory activity (GIA) in vitro . However, the importance of GIA in relation to protection from malaria has been unclear. In a case-control study nested within a longitudinally followed population in Tanzania, plasma samples collected at baseline from 171 individuals (55 cases and 116 age-matched controls) were assayed for GIA using three P. falciparum lines (3D7, K1, and W2mef) chosen based on their erythrocyte invasion phenotypes. Distribution of GIA differed between the lines, with most samples inhibiting the growth of 3D7 and K1 and enhancing the growth of W2mef. GIA to 3D7 was associated with a reduced risk of malaria within 40 weeks of follow-up (odds ratio, 0.45; 95% confidence interval [CI], 0.21 to 0.96; P = 0.04), whereas GIA to K1 and W2mef was not. These results show that GIA, as well as its association with protection from malaria, is dependent on the P. falciparum line and can be explained by differences in erythrocyte invasion phenotypes between parasite lines. Our study contributes knowledge on the biological importance of growth inhibition and the potential influence of P. falciparum erythrocyte invasion phenotypic differences on its relationship to protective immunity against malaria.