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Introduction: The importance of holidays, traditions, and family celebrations to human culture and occupational engagement has been neglected. The aim of this study was to explore how older adults experienced holidays and celebrations with social and physical distancing during the COVID‐19 pandemic. Methods: A secondary analysis was made on data from the At‐Risk Study. Seventeen community‐living adults (11 women and 6 men) aged 71–87 years, from Sweden participated. They were interviewed remotely four times during the first year of the pandemic. Data were analysed with qualitative content analysis. No consumer/community involvement occurred. Findings: Three categories on how the participants hoped for, planned, decided, adapted, avoided, and experienced holidays and celebrations with social and physical distancing included expectations and preparations in unpredictable times; the constant need for re‐evaluation; and almost everything turned out differently. Conclusions: The desire to celebrate despite pandemic restrictions shows the importance and meaning holidays hold for older adults. Celebrations can be disrupted for many reasons, not only as extreme as the ongoing pandemic. For wellbeing in later life health care, social care, and society need to understand the inherent components and acknowledge ways of supporting participation in occasional events such as holidays, traditions, and family celebrations. PLAIN LANGUAGE SUMMARY: Research on the importance of engaging in holidays, traditions, and family celebrations has been limited. Clinical occupational therapists and occupational science researchers tend to focus more on activities of daily living than on activities of life. This study investigated how older adults experienced holidays and celebrations with social and physical distancing during the COVID‐19 pandemic. We revisited data from a previous study called the At‐Risk Study. Seventeen community‐living older adults living in Sweden, ranging from 71 to 87 years old, took part. They were interviewed remotely four times during the first year of the pandemic. Data were analysed with qualitative content analysis. We identified three main themes on how the participants hoped for, planned, decided, adapted, avoided, and experienced holidays and celebrations with social and physical distancing. They were expectations and preparations in unpredictable times; the constant need for re‐evaluation; and almost everything turned out differently. This study shows the broad variety in reasoning and acting in relation to holidays, traditions, and family celebrations under social and physical distancing. However, the desire to celebrate despite pandemic restrictions shows the importance and meaning holidays hold for older adults. Celebrations can be disrupted for many reasons (including health issues) and not all barriers will be as extreme as an ongoing pandemic. To promote wellbeing in later life society, health care, and occupational therapists need to recognise the inherent components and acknowledge ways of supporting participation also in occasional events such as holidays, traditions, and family celebrations. [ABSTRACT FROM AUTHOR]

In extreme situations, the police have limited time to react when a threat or a situation arises suddenly. Situation awareness has been identified as a key factor for success in how tactical decisions are made. This helps the police to perform secure and legally correct interventions and decisions. We collected the primary data from 21 interviews with police officers, supplemented by literature and documents. We analyzed the relationship between tactical methods and situation awareness. The purpose of the article is to explore the relationship between police tactics and police officers' work with situation awareness. Situation awareness has been studied through the lens of the Swedish police general tactical explanation model. We discuss how the general tactical explanation model provides the conditions for the police officers' explanations to achieve situation awareness. We conclude that if the general tactical explanation model is applied during tactical interventions there are better possibilities to achieve situation awareness. [ABSTRACT FROM AUTHOR]

Aim: To describe ambulance clinicians' experiences of self‐determination in older patients. Design: The study had an inductive and explorative design, guided from a life‐world perspective. Methods: Thirty‐two Swedish ambulance clinicians were interviewed in six focus groups in November 2019. The data were analysed with content analysis, developing manifest categories and latent themes. Findings: The ambulance clinicians assessed the older patients' exercise of self‐determination by engaging in conversation and by being visually alert, to eventually gain an overall picture of their decision‐making capacity. This assessment was used as a platform when informing older patients of their rights, thus promoting their participation in care. Having limited time and narrow guidelines counteracted ambulance clinicians' ambitions to support older patients' general desire to avoid hospitalization, which resulted in an urge to displace their responsibility to external decision‐makers. Conclusion: Expectations that older patients with impaired decision‐making ability will give homogeneous responses mean an increased risk of ageist attitudes with a simplified view of patient autonomy. Such attitudes risk the withholding of information about options that healthcare professionals do not wish older patients to choose. When decision‐making is difficult, requests for expanded guidelines may paradoxically risk alienation from the professional nursing role. Implications and Impact: The findings show ambulance clinicians' unwillingness to shoulder their professional responsibility when encountering older patients with impaired decision‐making ability. In assuming that all older patients reason in the same way, ambulance clinicians tend to adopt a simplistic and somewhat ageist approach when it comes to patient autonomy. This points to deficiencies in ethical competence, which is why increased ethics support is deemed suitable to promote and develop ethical competence. Such support can increase the ability to act as autonomous professionals in accordance with professional ethical codes. Reporting Method: This study adhered to COREQ guidelines. Patient and Public Contribution: None. [ABSTRACT FROM AUTHOR]

The aim was to explore political representatives' experiences of child participation in decision‐making processes in municipalities. Interviews were conducted with Swedish politicians (n = 7) representing four municipalities. Qualitative content analysis was used to analyse the data. Politicians had experiences in child participation and methods for involving children and young people in the practice. However, methods were not formalized within the organizations, underlining that work lies ahead to ensure children's participation in decisions that concern them. Further research should focus on methods for including child participation at the municipal level and on following the implementation of the UNCRC. [ABSTRACT FROM AUTHOR]

Aims: To explore Registered Nurses' motives to undergo specialist training and to choose a particular speciality. Design: A descriptive qualitative interview study. Methods: Semi‐structured interviews were conducted during 2021 with 20 Swedish specialist nurse students from different specialisation areas. Qualitative content analysis was used. The COREQ checklist was used to report the study. Results: Specialist nurse students' motivations for further training were divided into three main categories with two sub‐categories each. The main categories were 'toward new challenges and conditions in work life', 'contributions to the development and higher competencies in health care' and 'personal work and life experiences as ground for choice'. Conclusion: Our study demonstrates the importance of motivating factors in the career choices of Specialist nurse students, such as personal challenges, desirable working conditions, career growth opportunities and personal experiences in the career choices. Creating a supportive work environment that helps to prioritise work‐life balance and offers the development of new skills might help retain nurses. No Patient or Public Contribution: No patient or public contribution was used. However, if more nurses would choose to undergo specialist training, especially in areas facing significant shortages, it would most likely lead to improved health‐related outcomes for patients or populations. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the management learning during a long-term crisis like a pandemic. The paper addresses both what health-care managers have learnt during the COVID-19 pandemic and how the management learning is characterized. Design/methodology/approach: The paper is based on a qualitative case study carried out during the COVID-19 pandemic at two different public hospitals in Sweden. The study, conducted with semi-structured interviews, applies a combination of within-case analysis and cross-case comparison. The data were analyzed using thematic deductive analysis with the themes, i.e. sensemaking, decision-making and meaning-making. Findings: The COVID-19 pandemic was characterized by uncertainty and a need for continuous learning among the managers at the case hospitals. The learning process that arose was circular in nature, wherein trust played a crucial role in facilitating the flow of information and enabling the managers to get a good sense of the situation. This, in turn, allowed the managers to make decisions meaningful for the organization, which improved the trust for the managers. This circular process was iterated with higher frequency than usual and was a prerequisite for the managers' learning. The practical implications are that a combined management with hierarchical and distributed management that uses the normal decision routes seems to be the most successful management method in a prolonged crisis as a pandemic. Practical implications: The gained knowledge can benefit hospital organizations, be used in crisis education and to develop regional contingency plans for pandemics. Originality/value: This study has explored learning during the COVID-19 pandemic and found a circular process, "the management learning wheel," which supports management learning in prolonged crises. [ABSTRACT FROM AUTHOR]

Background: Evidence networks facilitate the exchange of information and foster international relationships among researchers and stakeholders. These networks are instrumental in enabling the integration of scientific evidence into decision-making processes. While there is a global emphasis on evidence-based decision-making at policy and organisational levels, there exists a significant gap in our understanding of the most effective activities to exchange scientific knowledge and use it in practice. The objective of this rapid review was to explore the strategies employed by evidence networks to facilitate the translation of evidence into decision-making processes. This review makes a contribution to global health policymaking by mapping the landscape of knowledge translation in this context and identifying the evidence translation activities that evidence networks have found effective. Methods: The review was guided by standardised techniques for conducting rapid evidence reviews. Document searching was based on a phased approach, commencing with a comprehensive initial search strategy and progressively refining it with each subsequent search iterations. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. Results: The review identified 143 articles, after screening 1135 articles. Out of these, 35 articles were included in the review. The studies encompassed a diverse range of countries, with the majority originating from the United States (n = 14), followed by Canada (n = 5), Sweden (n = 2), and various other single locations (n = 14). These studies presented a varied set of implementation strategies such as research-related activities, the creation of teams/task forces/partnerships, meetings/consultations, mobilising/working with communities, influencing policy, activity evaluation, training, trust-building, and regular meetings, as well as community-academic-policymaker engagement. Conclusions: Evidence networks play a crucial role in developing, sharing, and implementing high-quality research for policy. These networks face challenges like coordinating diverse stakeholders, international collaboration, language barriers, research consistency, knowledge dissemination, capacity building, evaluation, and funding. To enhance their impact, sharing network efforts with wider audiences, including local, national, and international agencies, is essential for evidence-based decision-making to shape evidence-informed policies and programmes effectively. [ABSTRACT FROM AUTHOR]

This article presents an analysis of how lesbian couples in Sweden negotiate birth motherhood in a context where equality is thought to be achieved by being and doing the same [Gullestad, M. (2002). Invisible fences: Egalitarianism, nationalism and racism. Journal of the Royal Anthropological Institute, 8(1), 45–63. https://doi.org/10.1111/1467-9655.00098]. We do so by studying narratives of how 20 couples arrived at the decision of who will be the (first) birth mother, a decision unique to a small group of parents with theoretical implications for motherhood norms, kinship and within-couple decision-making extending beyond the couples themselves. Most couples interviewed planned to have two children and take turns carrying, a plan that to some extent solves the challenge of equality and sameness. Genetic links were downplayed and instead, the embodied and often desired experience of pregnancy was foregrounded. In deciding who would be the (first) birth mother, the couples' reasoning centred on age and desire, both presented as harmless and 'natural' determinants that defused a potentially disruptive decision. [ABSTRACT FROM AUTHOR]

Background: A major challenge for primary care is to set priorities and balance demands with available resources. The registered nurses in this study are practice nurses working in primary care offices, playing a large role in initial assessments. The overall objective of this research is to investigate practices of communication and decision-making during nurses' initial assessment of patients' health problems in primary care, examine working mechanisms in good practices and develop feasible solutions. Methods: Project PINPOINT aims for a prospective multicenter study using various methods for data collection and analysis. A purposive sample of 150 patient‒nurse consultations, including 30 nurses and 150 patients, will be recruited at primary care centers in three different geographic areas of southwest Sweden. The study will report on outcomes of communication practices in relation to patient-reported expectations and experiences, communication processes and patient involvement, assessment and decision-making, related priorities and value conflicts with data from patient questionnaires, audio-recorded real-time communication, and reflective interviews with nurses. Discussion: This research will contribute to the knowledge needed for the guidance of first-line decision-making processes to best meet patient and public health needs. This knowledge is necessary for the development of assessments and decisions to be better aligned to patients and to set priorities. Insights from this research can empower patients and service providers and help understand and enhance feasible person-centered communication strategies tailored to patients' level of health literacy. More specifically, this research will contribute to knowledge that can strengthen nurses' communication, assessments, and clinical decision-making in primary care. In the long term, this will contribute to how the competencies of practice nurses and other professionals are organized and carried out to make the best use of the resources within primary care. Trial registration: ClinicalTrials.gov Identifier: NCT06067672. [ABSTRACT FROM AUTHOR]

Amid growing academic discourse on teenagers' political rights, this paper argues that the inclusion of teenagers in the decision-making process at the municipal level has positive effects. Based on qualitative and quantitative research on three municipalities in Greece and Sweden, this paper concludes that a level of awareness of the critical issue of climate change leads to a greater propensity for action from municipal councils aimed at restoring the environment. The findings demonstrate that including teenagers in the decision-making process at the local and regional level could lead to a greater focus on forward-thinking policies, particularly in areas concerning young people, such as environmental preservation efforts and democratic rights. [ABSTRACT FROM AUTHOR]

The aim of this article is to explore how Swedish principals experienced the decentralisation and re-centralisation reforms and how they affected principals' autonomy and decision-making capacity. Data were obtained from three surveys of Swedish principals, carried out in 2005, 2012 and 2019. The results show that principals experienced a high degree of autonomy in their decision-making in 2005 and 2012 and also a balanced control from state and municipalities. At the time of the third study in 2019, principals continue to express a rather high degree of autonomy, but this autonomy is now combined with an increased degree of control. However, given the high degree of autonomy, in combination with low degree of conflicts between different stakeholders, the article concludes that the expression 'in the eye of the storm there is calm' appears to suit Swedish principals' decision-making, at least, in the development of decentralisation and re-centralisation. [ABSTRACT FROM AUTHOR]

In social work, practitioners are often faced with situations in which they have to choose an intervention. A fundamental ethical principle of social work practice is to minimize the risk of adverse effects caused by social services. To adhere to this principle, practitioners must be aware of the possible positive and negative effects of potential services. There are hundreds of interventions currently in use in social work. Although there are a growing number of controlled trials on social work interventions, there are only a few interventions based on research that has the highest degree of certainty, making it difficult to know how and in what way these interventions can support a person in need of assistance. This article, based in part on the experience we gained training practitioners working in Swedish social services, presents a tentative model for assessing the best available evidence comparing interventions when scientific evidence is sparse. [ABSTRACT FROM AUTHOR]

Aim: Prior to certain medical therapies, dental assessment and treatment of oral foci of infection are recommended. The aim of the present study was to acquire a deeper understanding of the decision‐making process regarding the pre‐medical management of root–canal–filled teeth with asymptomatic apical periodontitis (AAP). Methodology: Hospital‐affiliated dentists in Sweden were contacted for a semi‐structured, in‐depth interview. The absolute inclusion criterion was that the dentists had experienced and could recount at least two authentic cases involving root–canal–filled teeth with AAP—one case having resulted in pre‐medical treatment, and one having resulted in expectancy. Fourteen interviews, with fourteen informants, were conducted and included in the study. During the interviews, open‐ended questions and comments encouraging the informants to elaborate and clarify their experiences were offered. The interviews were digitally recorded, transcribed verbatim and analysed using Qualitative Content Analysis with an inductive approach. Results: A theme describing the latent content was identified through interpretation of the collected data: A multifaceted balancing act characterized by a sometimes‐difficult risk–benefit‐estimation, where an increased uncertainty entails an increased reliance on external opinions. Three main categories, comprising four sub‐categories, describing the manifest content were recognized: The tipping scale, The team effort and The frame of reference. Conclusions: The current interview study found pre‐medical decision‐making regarding root–canal–filled teeth with AAP to be a multifactorial and contextual process marked by uncertainty and collaborative measures. Further research, resulting in the development of evidence‐based treatment guidelines, is suggested necessary. [ABSTRACT FROM AUTHOR]

Background: Complex level-of-care decisions involve uncertainty in which decisions are beneficial for older patients. Knowledge of physicians' decision-making during acute situations in older patients' homes is limited. Therefore, this study aimed to describe physicians' experiences and actions in making complex level-of-care decisions during the assessment of older patients in acute situations within their own homes. Methods: Individual interviews and analyses were performed according to the critical incident technique (CIT). In total, 14 physicians from Sweden were included. Results: In making complex level-of-care decisions, physicians experienced collaborating with and including older patients, significant others and health care professionals to be essential for making individualized decisions regarding the patients' and their significant others' needs. During decision-making, physicians experienced difficulties when doubt or collaborative obstructions occurred. Physicians' actions involved searching for an understanding of older patients' and their significant others' wishes and needs, considering their unique conditions, guiding them, and adjusting care according to their wishes. Actions further involved promoting collaboration and reaching a consensus with all persons involved. Conclusion: Physicians strive to individualize complex level-of-care decisions based on older patients' and their significant others' wishes and needs. Furthermore, individualized decisions depend on successful collaboration and consensus among older patients, their significant others and other health care professionals. Therefore, to facilitate individualized level-of-care decisions, the health care organizations need to support physicians when they are making individualized decisions, provide sufficient resources and promote 24 − 7 collaboration between organizations and health care professionals. [ABSTRACT FROM AUTHOR]

To investigate women's decision-making on induced abortion. A multi-centre cross-sectional survey among 623 abortion-seeking women in Sweden (2021). The perceived difficulty to decide on abortion was measured using a 7-point Likert scale, and analysed with univariate and multivariate analysis (odds ratios [OR], 95% confidence intervals [CI]). About half (n = 322;52%) scored 1–4, suggesting the decision was perceived as easier compared to those (n = 292;48%) who scored 5–7. Reasons for the abortion were: poor economy (n = 166;27%), too early in the relationship (n = 154;25.1%), want to work first (n = 147;23.9%), want to study first (n = 132;21.5%), uncertain about the relationship (104;16.9%), and too young (n = 104;16.9%). Predictors for perceiving the decision as difficult: partner's hesitance (OR = 3.18, CI:1.76–5.73), being born outside the Nordic countries (OR = 2.23, CI:1.28–3.87), having discussed the decision with someone (OR = 2.42, CI:1.67–3.50), age ≥30 (OR = 2.22, CI:1.03–4.76), the Covid-19 pandemic (OR = 2.08, CI:1.20–3.59), and the desire to have children in the future (OR = 1.96, CI:1.18–3.28). After confirmed pregnancy, poor mental well-being was more common among those who scored 5–7 (n = 140;47.9%) compared to those who scored 1–4 (n = 122;37.9), p =.029. Women's decision-making on abortion is complex; in times of crises, the decision procedure may be even more difficult. This valuable knowledge could be used to improve and promote satisfactory counselling beyond medical routines. [ABSTRACT FROM AUTHOR]

Objectives: Do-not-attempt-resuscitation (DNAR) decisions for patients with infratentorial or large supratentorial intracerebral hemorrhages (ICHs) pose clinical and ethical challenges. We aimed to investigate factors associated with DNAR decisions in patients with infratentorial or large (≥30 mL) supratentorial ICH, and differences in complications, treatment, and mortality. Materials & methods: This longitudinal, observational study comprised all patients treated for ICH at three stroke units in Gothenburg, Sweden, between November 2014 and June 2019. Patients were identified in the local stroke register, and additional data were collected from medical records and national registries. Mortality rates were followed 1 year after incident ICHs. Factors associated with DNAR decisions, and one-year mortality were explored. Results: Of 307 included patients, 164 received a DNAR decision. Most (75%) decisions were made within 24 h. DNAR decisions were associated with higher age, pre-stroke dependency, stroke severity, and intraventricular hemorrhage. Patients without DNAR decisions received thrombosis prophylaxis, oral antibiotics, and rehabilitative evaluations more frequently. The one-year survival probability was 0.16 (95% confidence interval [CI] 0.11–0.23) in patients with DNAR decisions, and 0.87 (95% CI 0.81–0.92) in patients without DNAR decision. DNAR decisions, higher age, stroke severity, hematoma volume, and comorbidities were associated with increased one-year mortality. Thrombosis prophylaxis and living alone were associated with a lower hazard. Conclusion: The majority of DNAR decisions for patients with infratentorial or large supratentorial ICH were made within 48 h. Higher age, pre-stroke dependency, high stroke severity, and intraventricular hemorrhage predicted receiving a DNAR decision. DNAR decisions were strongly associated with increased short- and long-term mortality. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to describe parents' reasoning in making decisions about vaccinating their daughters against human papilloma virus (HPV), a part of the Swedish vaccination programme. Method: Twenty parents whose daughter had been offered HPV vaccination participated. Semi‐structured individual interviews were conducted and analysed using thematic analysis. Results: The findings reveal that the decision‐making process is complex. The parents trusted the vaccination programme and saw it as beneficial to society. They also described using different resources to decide about HPV vaccination, but they did not include their daughters in making the decision. Discussion: Parents need better vaccine and health literacy to be able to decide, based on evidence and in consultation with their daughters, on HPV vaccination. School nurses can play an important role in evidence‐based decision‐making about HPV vaccination and introducing children to this health‐promoting intervention. [ABSTRACT FROM AUTHOR]

The decision-making process of experts in forensic psychiatric investigations (FPI) is complex and reasoning regarding psychiatric diagnosis and severe mental disorder (SMD, the judicial concept central to legal exemption in Swedish law) has severe ramifications. Nevertheless, the qualitative aspects of FPI experts' decision-making process have seldom been studied systematically. Method. The participants (N = 41) were FPI experts: forensic psychiatrists (n = 15), forensic psychologists (n = 15) and forensic social workers (n = 11). Using three case vignettes and qualitative content analysis, it was explored how case-specific characteristics could affect which hypotheses FPI experts generated regarding a) psychiatric diagnosis and b) severe mental disorder and c) which information sources they required. Each case vignette described a diagnostically ambiguous case but indicated emphasis on: psychotic symptoms (case 1); personality disorder symptoms (case 2) and neurodevelopmental disorder symptoms (case 3). Results. Experts reasoned in a similar manner regarding generating hypotheses and required information, but also in a case-adapted manner. Experts considered various diagnostic alternatives, and some (e.g. psychosis) were mentioned for all three cases. Other diagnoses were only suggested as hypotheses in certain cases (e.g. case 3: intellectual disability). Discussion. In Sweden, a core basis for SMD is psychotic-like functioning, and psychosis was suggested as a hypothesis for all three cases. Experts reasoned in similar ways regarding SMD in all cases, considering various perspectives for and against SMD. Some case-specific arguments for and against SMD adapted to the psychopathological circumstances were found. These could be related to aspects of the SMD concept that become important to ascertain when the type of psychopathology indicated in the case vignette was present; for example, ascertaining reality monitoring for a person with potential delusions of being followed by a criminal gang requires investigation of criminal history and related conflicts. Taken together, FPI-experts considered a broad range of psychiatric diagnoses in various cases. Their reasoning regarding SMD was both based on general and case-specific (or psychopathology-specific) factors. [ABSTRACT FROM AUTHOR]

Aims A short time span from symptom onset to reperfusion is imperative in ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine factors associated with patient decision time for seeking care in STEMI, particularly how symptoms were experienced and affected patient response. Methods and results A multicentre cross-sectional self-report survey study was completed at five Swedish hospitals representing geographic diversity. The 521 patients were divided into three groups based on their time to respond to symptoms: early (<20 min), intermediate (20–90 min), and late responders (>90 min). Only one out of five patients both responded early and called an ambulance within 20 min. Believing symptoms were cardiac in origin [odds ratio (OR) 2.60], male sex (OR 2.40), left anterior descending artery as culprit artery (OR 1.77), and bystanders calling an ambulance (OR 4.32) were factors associated with early response and correct action. Associated symptoms such as dyspnoea (OR 1.67) and weakness (OR 1.65) were associated with an early action (<20 min), while chest pain was not independently associated with response time. Cold sweat (OR 0.61) prevented late care-seeking behaviour as did a high symptom burden (OR 0.86). Conclusion Misinterpretation of symptoms delays correct care-seeking behaviour because patient expectations may not be aligned with the experience when stricken by Myocardial infarction. Therefore, it is imperative to continuously enhance public awareness in correct symptom recognition and appropriate care-seeking behaviour and to make efforts to educate individuals at risk for STEMI as well as their next of kin. [ABSTRACT FROM AUTHOR]

Background: Priority setting in healthcare that aims to achieve a fair and efficient allocation of limited resources is a worldwide challenge. Sweden has developed a sophisticated approach. Still, there is a need for a more detailed insight on how measures permeate clinical life. This study aimed to assess physicians’ views regarding (1) impact of scarce resources on patient care, (2) clinical decision-making, and (3) the ethical platform and national guidelines for healthcare by the National Board of Health and Welfare (NBHW). Methods: An online cross-sectional questionnaire was sent to two groups in Sweden, 2016 and 2017. Group 1 represented 331 physicians from different departments at one University hospital and group 2 consisted of 923 members of the Society of Cardiology. Results: Overall, a 26% (328/1254) response rate was achieved, 49% in group 1 (162/331), 18% in group 2 (166/923). Scarcity of resources was perceived by 59% more often than ‘at least once per month,’ whilst 60% felt less than ‘well-prepared’ to address this issue. Guidelines in general had a lot of influence and 19% perceived them as limiting decision-making. 86% professed to be mostly independent in decision-making. 36% knew the ethical platform ‘well’ and ‘very well’ and 64% NBHW’s national guidelines. 57% expressed a wish for further knowledge and training regarding the ethical platform and 51% for support in applying NBHW’s national guidelines. Conclusion: There was a need for more support to deal with scarcity of resources and for increased knowledge about the ethical platform and NBHW’s national guidelines. Independence in clinical decision-making was perceived as high and guidelines in general as important. Priority setting as one potential pathway to fair and transparent decision-making should be highlighted more in Swedish clinical settings, with special emphasis on the ethical platform. [ABSTRACT FROM AUTHOR]

Background a suspected urinary tract infection (UTI) is the most common reason to prescribe antibiotics in a frail older patient. Frequently, antibiotics are prescribed unnecessarily. To increase appropriate antibiotic use for UTIs through antibiotic stewardship interventions, we need to thoroughly understand the factors that contribute to these prescribing decisions. Objectives (1) to obtain insight into factors contributing to antibiotic prescribing for suspected UTIs in frail older adults. (2) To develop an overarching model integrating these factors to guide the development of antibiotic stewardship interventions for UTIs in frail older adults. Methods we conducted an exploratory qualitative study with 61 semi-structured interviews in older adult care settings in Poland, the Netherlands, Norway and Sweden. We interviewed physicians, nursing staff, patients and informal caregivers. Results participants described a chain of decisions by patients, caregivers and/or nursing staff preceding the ultimate decision to prescribe antibiotics by the physician. We identified five themes of influence: (1) the clinical situation and its complexity within the frail older patient, (2) diagnostic factors, such as asymptomatic bacteriuria, (3) knowledge (gaps) and attitude, (4) communication: interprofessional, and with patients and relatives and (5) context and organisation of care, including factors such as availability of antibiotics (over the counter), antibiotic stewardship efforts and factors concerning out-of-hours care. Conclusions decision-making on suspected UTIs in frail older adults is a complex, multifactorial process. Due to the diverse international setting and stakeholder variety, we were able to provide a comprehensive overview of factors to guide the development of antibiotic stewardship interventions. [ABSTRACT FROM AUTHOR]

Decision support tools for incentivizing environmentally sound decisions in building design, such as LCA (life cycle assessment), have been highlighted as an essential feature for enhancing the realization of more sustainable buildings. Nevertheless, the use of LCA to support decisions in building design is still limited in practice. A better understanding of the social dynamics and detailed contexts of the decisions leading up to a final building design is therefore critical for better integration of LCA-based information in the decision-making processes. This paper reports a qualitative, semi-structured interview study of single-family home producers in Sweden and their decision-making in relation to climate mitigation, with a particular focus on embodied carbon mitigation. By studying a specific branch of the building and construction sector, a more in-depth record can be obtained of the particularities of implementation contexts and decision-making situations in which LCA may, or may not, have a role in driving climate mitigation. Four primary decision contexts in which LCA may have an influential role to drive embodied carbon reduction include: (1) the development of building systems, (2) development and offering of house models, (3) the selection of construction products for the building system as well as for the offer of add-on products to customers, and (4) the dialogues in the individual house-buyer projects. Decision-making that affects sustainable outcomes in this part of the sector is very much dependent on a supporting regulatory context. Over the years, using building LCA in early design stages, for optimization towards low-impact final buildings, has been a repeatedly promoted recommendation both in academia and practice. This study, however, reveals that such a conclusion is too simplistic. The different overarching decision contexts identified for this particular branch display the variety of needs for life cycle-based information. [ABSTRACT FROM AUTHOR]

Background: Which type of information experts use to make decisions regarding legal insanity within forensic psychiatric investigations (FPI) is relatively unknown, both in general and when considering variations due to case context. It is important to explore this area to be able to counteract the effects of various kinds of cognitive bias. Method: The aim was to explore whether FPI expert groups differed regarding case-specific as well as general use of information types required to make decisions on severe mental disorder (SMD). Three FPI case vignettes were presented to three professional groups involved in FPIs in Sweden (n = 41): forensic psychiatrists (n = 15), psychologists (n = 15), and social workers (n = 11). The participants reported which types of information they required to reach conclusions regarding SMD in each case. They also reported which types of information they had used within general FPI praxis during the previous year and the information types' perceived usefulness. Results: The expert groups differed somewhat regarding what type of information they required for the cases (e.g., results from cognitive testing), but some information was required in all cases (e.g., client's self-report). Regarding the preliminary assessment of SMD in the three cases, minor differences were found. Within the general FPI praxis, experts reported using several information types, while the general perceived usefulness of these sources varied. Discussion: The professional groups relied partly on a "core" of information sources, but some case-specific adaptations were found. The professional groups' inclination to suspect SMD also varied somewhat. This indicates a need to explore the potential consequences of these similarities and differences. [ABSTRACT FROM AUTHOR]

For practical decisions on common recurring maintenance actions, the information from routine inspections form a decision basis for the bridge manager. It is often difficult to assess whether this information is sufficient for deciding on a repair action, or if more information is needed. For many bridges the information for supporting decisions may be limited, although those bridges cause large yearly maintenance costs for the society. The purpose of the study presented in this paper is to show how two different models for decision making based on Bayesian decision theory, a point-in-time decision model and a sequential updating decision model, can be used to improve the decision-making process for common maintenance decisions. The models use information from routine inspections and incorporates time dependent aspects such as material degradation and time value of money to improve the decision-making process. The focus is on presenting the methodology with a case study of a concrete bridge in Sweden where the edge beams may have to be replaced. Three assessment approaches are considered: (i) no assessment, (ii) desktop evaluation and (iii) measurements. The main finding is that sequential updating decision making will provide a higher benefit than a point-in-time decision, and thus give higher Value of Information. This value becomes even higher when the measurements are selected for the assessment. The results also show that the edge beams should be replaced. The general approach presented can be applicable to many decision scenarios related to maintenance of deteriorating structures. [ABSTRACT FROM AUTHOR]

In high-income countries, parental age at first birth has increased and this postponement increases the risk of involuntary childlessness or having fewer children than desired. This interview study was conducted in Denmark and Sweden among childless men (n = 29) in their last year of an education. The aim was to explore the role of individual and societal factors on fertility decision-making and men's reflections on barriers and enablers for earlier family formation. Data were analysed with thematic content analysis. Almost all participants wanted children in the future. Overall, there was a desire to follow the 'right chronology': get educated, having a stable relationship, employment and a good financial status before having children. While most men felt mature enough to have children, they were still not ready. Influences from within the inner social circle, societal expectations, the need for security and stability and being ready to give up freedom and individuality were factors that affected participants' preferred timing of parenthood. Most men did not have suggestions for how earlier family formation could be supported. Results suggest a gap between the ideal biological and ideal social age of family formation that may lead to unfulfilled parenthood aspirations. [ABSTRACT FROM AUTHOR]

Background: Energy communities are emphasized by the EU as important for developing sustainable energy systems that include and engage many people. While many renewables are highly compatible with a more decentralized energy system, research indicates that participation in 'desirable' energy activities and energy decision-making is influenced by social and economic factors, including gender, economic status and home ownership. The overall aim of this article is to contribute to this line of inquiry by exploring how and under which conditions energy communities allow for broader participation in the energy system. This article examines how gender, as a more specific condition, influences the extent to which parties can or cannot engage with collective solar ownership models by means of a qualitative study of 11 solar energy communities and one housing association in Sweden. Results: The study revealed that despite the relative potential for inclusion that they hold, energy communities can raise justice concerns in terms of inequities concerning access, capacity, and opportunity to engage in decision-making. Conclusions: While solely focusing on gender offers a limited view of the dynamics of inclusion and exclusion in renewable energy projects, it is our position that integrating it into the analysis will provide insights into possible measures to remedy limitations and accelerate the renewable energy transition. [ABSTRACT FROM AUTHOR]

Management of patients with temporomandibular disorders (TMD) appears to be more challenging than for other dental conditions. This study aimed to explore the decision‐making process in TMD management, and thereby to conceptualize the decision‐making process in dentistry. Individual semi‐structured interviews were conducted during 2018 and 2019 with a purposive sample of 22 general dental practitioners from the Public Dental Healthcare Services and private practices in the Region of Västerbotten, Northern Sweden. The interviews were analysed using the Grounded Theory approach of Charmaz. Data analysis resulted in the core category 'Combining own competence and others' expectations in the desire to do the right thing'. The dentists showed interest in and a desire to apply professional knowledge, but also reflected on challenges and complexity in the decision‐making process for TMD. The challenges were primarily related to organisational factors and lack of self‐confidence. This identifies a need for re‐organisation of daily clinical management in dentistry, and a need for more postgraduate training to improve self‐confidence. The complexity of the decision‐making process for TMD makes the study findings applicable in other dental situations. [ABSTRACT FROM AUTHOR]

Background: In the European Union alone, more than 100 million people present to the emergency department (ED) each year, and this has increased steadily year-on-year by 2-3%. Better patient management decisions have the potential to reduce ED crowding, the number of diagnostic tests, the use of inpatient beds, and healthcare costs., Methods: We have established the Skåne Emergency Medicine (SEM) cohort for developing clinical decision support systems (CDSS) based on artificial intelligence or machine learning as well as traditional statistical methods. The SEM cohort consists of 325 539 unselected unique patients with 630 275 visits from January 1st, 2017 to December 31st, 2018 at eight EDs in the region Skåne in southern Sweden. Data on sociodemographics, previous diseases and current medication are available for each ED patient visit, as well as their chief complaint, test results, disposition and the outcome in the form of subsequent diagnoses, treatments, healthcare costs and mortality within a follow-up period of at least 30 days, and up to 3 years., Discussion: The SEM cohort provides a platform for CDSS research, and we welcome collaboration. In addition, SEM's large amount of real-world patient data with almost complete short-term follow-up will allow research in epidemiology, patient management, diagnostics, prognostics, ED crowding, resource allocation, and social medicine., (© 2024. The Author(s).)

Background: Older patients are often vulnerable and highly dependent on healthcare professionals' assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy., Aim: To describe ambulance clinicians' understanding of older patients' self-determination when the patient's decision-making ability is impaired., Research Design: A qualitative design with an inductive approach, guided by descriptive phenomenology., Participants: In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews., Ethical Considerations: The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority., Findings: The findings are presented in two themes: (1) Movement between explicit and implicit will ; and (2) Contradictions about the patient's best interests. The clinicians' interpretations are based on an understanding of the patient's situation using substitute decision-making in emergency situations and conversations that reveal the patient's explicit wishes. Sometimes the clinicians collaborate to validate the patient's implicit will, while they at other times subordinate themselves to others' opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient's self-determination., Conclusion: The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient's unique needs based on a holistic perspective and their ability to be autonomous., Competing Interests: Declaration of conflicting interestsThe author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background. Serious games are gaining increasing prominence in environmental communication research, but their potential to form an integrated part of participatory research approaches is still strikingly understudied. This is particularly the case for applications of interactive digital formats in research on environmental challenges of high complexity, such as climate adaptation, which is a specifically suitable case as it involves complex interaction between climate systems and society, but where the response also involves trade-offs with potentially negative – maladaptive – outcomes. Intervention. This article presents the Maladaptation Game, which was designed to facilitate dialogue about potential negative outcomes of agricultural climate adaptation. Methods. We conducted test sessions with agricultural stakeholders in Finland and Sweden, and analysed quantitative and qualitative, audio-recorded and transcribed, material for opportunities and challenges related to dialogues, engagement, interactivity and experienced relevance. Results. The qualitative analysis of recorded dialogues shows that the Maladaptation Game has potential to support dialogue by challenging players to negotiate between options with negative outcomes. The gameplay itself presents opportunities in terms of creating engagement with options that provoke disagreement and debates between players, as well as interactivity, that players reflected upon as quick and easy, while challenges were related to the experienced relevance, in particular the options provided in the game, and its general framing. Conclusions. The results indicate a need for complementary approaches to this type of game but also suggest the importance of moderation when the game design is aimed at creating dialogue around a complex environmental challenge such as agricultural climate adaptation. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding in public continues to be contentious with qualitative evidence confirming that women face many challenges. It is therefore important to gain understanding of not only the challenges but also what women perceive is helpful to breastfeed in public. Methods: A cross-sectional study was conducted with women living in Australia, Ireland or Sweden currently breastfeeding or having breastfed within the previous 2 years. Our objective was to explore and compare what women do when faced with having to breastfeed in the presence of someone they are uncomfortable with and what women think is helpful and challenging when considering whether to breastfeed in public. Data were collected in 2018 from an online survey over a 4 week period in each country. Content analysis revealed data similarity and theme names and definitions were negotiated until consensus was reached. How often each theme was cited was counted to report frequencies. Helpful and challenging aspects were also ranked by women to allow international comparison. Results: Ten themes emerged around women facing someone they were uncomfortable to breastfeed in the presence of with the most frequently cited being: 'made the effort to be discreet'; 'moved to a private location'; 'turned away' and 'just got on with breastfeeding'. Nine themes captured challenges to breastfeed in public with the following ranked in the top five across countries: 'unwanted attention'; 'no comfortable place to sit'; 'environment not suitable'; 'awkward audience' and 'not wearing appropriate clothing'. Nine themes revealed what was helpful to breastfeed in public with the top five: 'supportive network'; 'quiet private suitable environment'; 'comfortable seating'; 'understanding and acceptance of others' and 'seeing other mothers' breastfeed'. Conclusions: When breastfeeding in public women are challenged by shared concerns around unwanted attention, coping with an awkward audience and unsuitable environments. Women want to feel comfortable when breastfeeding in a public space. How women respond to situations where they are uncomfortable is counterproductive to what they share would be helpful, namely seeing other mothers breastfeed. Themes reveal issues beyond the control of the individual and highlight how the support required by breastfeeding women is a public health responsibility. [ABSTRACT FROM AUTHOR]

• We study opportunity cost neglect in public policy and private consumption. • We conduct preregistered experiments with both members of the public and experts. • We find strong evidence of opportunity cost neglect in public policy. • We find no evidence of opportunity cost neglect in private consumption. • Opportunity cost neglect creates artificially high demand for public spending. Opportunity cost is the foregone benefit of options not chosen. If opportunity costs are neglected in decisions about public policy, there is a high risk that the best options are overlooked. We study opportunity cost neglect in public policy in experiments with members of the general public in Sweden and international experts on priority setting in health care (n = 957). We find strong evidence of opportunity cost neglect in public policy, where participants who acted in the role of policy makers were between six and ten percentage points less likely to invest in a public health program when reminded about opportunity costs (money could fund other health programs). To our surprise, we failed to confirm an effect consistent with opportunity cost neglect in private consumption; but exploratory analyses revealed a substantial age effect that reconciles our findings with previous literature. Young participants showed opportunity cost neglect, while the effect was reversed for old participants. The implications of opportunity cost neglect for public policy are substantial, including misallocation of public resources and an artificially high demand for public spending. [ABSTRACT FROM AUTHOR]

Objectives: To explore impairments due to tooth loss and expectations of prosthetic replacements in an urban group and a rural group of patients in Sweden. Material and Methods: Semi‐structured interviews were performed on 35 partially edentulous patients from prosthodontic specialist clinics located in an urban area and a rural area in Sweden. The interviews focused on impairments due to tooth loss and expectations of prosthetic restorations. Analysis was made using the grounded theory approach, allowing in‐depth investigation of the phenomenon. Results: Functional, aesthetic and social impairments were mentioned, and coping strategies (eg chewing differently and laughing less) and modifications (eg age, time and social setting) of the impairments were described. The rural patient group accepted impairments somewhat better than the urban one. Otherwise, there was only minor difference between the groups. Removable prosthodontic restorations were more acceptable among rural patients. Urban patients insisted more often on implant‐based restorations and had higher expectations of longevity. Patients with minor impairments still wanted treatment, based on concerns about the future of their dentition. The interviews themselves generated new thoughts in the patients and were thus considered valuable by the patients. Conclusions: Impairments due to tooth loss and expectations of prosthetic replacements were expressed in the same way in the rural and urban patient groups. However, in the rural population, there was a higher acceptance of impairments and also of removable prosthetic restorations, whereas the urban population expressed a higher demand for implant‐based restorations. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim was to explore and describe the child's active participation in daily healthcare practice at children's hospital units in Sweden. Objectives: (a) Identify everyday situations in medical and nursing care that illustrate children's active participation in decision‐making, (b) identify various ways of active participation, actual and optimal in situations involving decision‐making and (c) explore factors in nursing and medical care that influence children's active participation in decision‐making. Background: Despite active participation being a fundamental right for children, they are not always involved in decision‐making processes during their health care. There still remains uncertainty on how to support children to actively participate in decisions concerning their health care. Design: A qualitative study with overt, nonparticipant observations fulfilling the COREQ checklist criteria. Methods: Observations of interactions between children aged 2 and 17 years with both acute and chronic conditions, their parents, and healthcare professionals were conducted at three paediatric hospitals in Sweden. The Scale of Degrees of Self Determination was used to grade identified situations. The scale describes five levels of active participation, with level one being the least and level five being the most active level of participation. Normative judgements were also made. Results: Children's active participation was assessed as being generally at levels four and five. Children demonstrated both verbal and nonverbal ways of communication during decision‐making. Findings indicated that children's, parents' and healthcare professional's actions influenced children's active participation in decision‐making processes involving healthcare. Conclusions: Healthcare professionals specialised in paediatrics need to embrace both a child perspective and a child's perspective, plan care incorporating key elements of a child‐centred care approach, to ensure children's active participation at a level of their choosing. Relevance to clinical practice: There is a need for awareness creation to help healthcare professionals facilitate children's active participation in their care and decision‐making. [ABSTRACT FROM AUTHOR]

It has previously been demonstrated that decisions made by forensic experts can suffer from issues with both bias and poor reliability. The outcome of Swedish forensic psychiatric investigations can have a major impact on the courts' choice of sanction for a mentally disordered offender. These investigations are performed by multi-professional teams of experts, where each expert is obliged to state their opinion on whether the client has a severe mental disorder (SMD) or not. In the present study, a case vignette design was used to simulate the decision-making process of forensic psychiatric investigations. Of the 73 Swedish experts working with forensic psychiatric investigations, a total of 27 (37%) participated in the study. The results showed that the Swedish experts formulated multiple diagnostic hypotheses about cases throughout the process and revised these hypotheses when presented with new information. There was substantial variation between the experts in which hypotheses were seen as most relevant. While the experts grew more certain of their opinions on SMD during the simulated investigation, there was considerable variation in their opinions both throughout and at the end of the process. Although low statistical power and the sample not being randomized limit generalizations, the results indicate no idiosyncratic patterns in the decision-making processes of Swedish experts or signs of confirmation bias. If used properly, the variation in both process and outcome could be used to safeguard and possibly increase the reliability and validity of the final decision of Swedish forensic psychiatric investigations., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The selection of the most appropriate window and blind design is a challenging task due to the existence of potential conflicts between visual comfort, thermal comfort, energy consumption and life cycle cost. Resolving these conflicts relies on a trade-off window and blind design. This research applied a decision-making framework to select a trade-off window and blind design for an office room in Sweden. The decision-making framework was developed based on integrating the non-dominated sorting genetic algorithm-II and the analytical hierarchy process. The first step in the application of the framework was to generate a model of the office room using EnergyPlus. Six types of window and four types of blind; an internal venetian blind, an internal roller curtain, an external venetian blind and an external overhang panel, were modelled in EnergyPlus. The second step was to run an optimisation using non-dominated sorting genetic algorithm-II. For this purpose, various window and blind design variables were specified in modeFRONTIER platform. The third and last step in the application of the decision-making framework was to select a trade-off window and blind design using analytical hierarchy process. The results show the strength of the decision-making framework in selecting a trade-off design, and thereby the ability to resolve conflicts through intelligent use of simulation in analyzing big-data in built environment, energy and cost sectors. Since, the computation and processing power for performing simulations is constantly increasing, architects and designers can exploit the decision-making framework and locate a trade-off design in a relatively short period of time. [ABSTRACT FROM AUTHOR]

This article addresses the dilemmas concerning legislation, individual autonomy and the reality of everyday life for people coping with dementia. We describe and analyse decision-making in relation to older people with dementia in Sweden, within the area of social work regulated by the Social Services Act and the Parental Act. Swedish legislation is based on the individual's autonomy and capacity to consent to services without anyone having legal authority to decide on behalf of the individual. Based on data from interviews with family caregivers living at home, decision-making through family caregivers is discussed and formal guardianship is also considered. Swedish legislation leaves individuals with dementia and family caregivers in a vacuum between self-determination and full autonomy with the ideal of citizenship emphasised and recognised in the Social Services Act on the one hand, and on the other, a strong need for support in everyday life and with decision-making. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate how restricted decision‐making autonomy and conflicting demands impact operational managers' work performance and health. Background: Managers at operational level (first‐ and second‐line managers') in health care organisations are commonly exposed to strain in their work situation with high demands and a challenging work context. Although they play an important role, the knowledge about the causal associations between stressful job demands and their consequences is limited. Methods: A prospective design with questionnaire data collected at two points in time, 1 year apart, from a sample of operational managers (N = 162) at five Swedish hospitals was used to conduct a structural equation model analysis with cross‐lagged paths. Results: Restricted decision‐making autonomy was negatively associated with both the managers' health and their managerial work performance over time. Conclusions: Health care managers' work performance and health may be sustained by the top management allowing them a higher degree of autonomy in their decision‐making. Implications for nursing management: This study suggests that nursing leaders should create the circumstances for operational managers' to have higher levels of autonomy in their area of responsibility and the freedom to prioritize their managerial workload. [ABSTRACT FROM AUTHOR]

The aim of this study was to gain a deeper understanding of Swedish social workers' experience of disabled children's participation, to discover in what ways their knowledge about impairment and disability, combined with legal literacy and local context influence children's participation in formal meetings and decision making. Seven focus-group interviews were conducted with 35 municipal social workers from communities in different parts of Sweden. The phenomenological analysis resulted in the overarching theme of elusive participation, in which participation was described as difficult to grasp both in relation to what was supposed to be achieved and what it was meant to result in. Elusive participation entailed a discrepancy between policy and practice, norms and perception of normality, conflicting perspectives and needs, judgment of children's abilities. These findings underline the importance of creating safe spaces in which social workers have the opportunity for critical reflections and shared discussions about social work practice. [ABSTRACT FROM AUTHOR]

• Subjective norm, farmers perceived social pressure, influence mastitis control. • Farmers' perception of being able to control the mastitis situation decides which preventive actions are used. • Understanding how to affect farmers behavior in their usage of preventive actions can have positive effects on animal health and welfare. Mastitis control options (MCOs) are management actions that are adopted to prevent mastitis in dairy herds. In this study, the psychological constructs attitude, subjective norms and perceived behavioral control are used to explain farmers' adoption of MCOs. So far, little research has used psychological constructs to explain adoption of MCOs. Based on recommendations by a Swedish dairy association (Växa) aimed at farmers, a total of 15 different management areas, representing MCOs for contagious and environmental bacteria, were used to characterize adoption behaviors. A total of 286 Swedish full-time farmers specializing in dairy production participated in the survey. Four different farmer groups were identified through a cluster analysis of similarities in how farmers adopted MCOs together with data on bulk milk somatic cell count and subjectively evaluated somatic cell counts on the farms. Regression analyses were performed to test whether the psychological constructs could explain differences in adoption across the MCO groups. Results revealed that farmers' decisions about which set of mastitis control options to adopt as preventive actions were explained by the farmers' perceived behavioral control of the situation and by differences in subjective norm. The attitude construct did not contribute to predicting the adoption of mastitis control options. Results suggest that work aimed at implementing MCOs should be complemented by programs specifically designed to improve the ability of farmers to use and/or combine MCOs to both alleviate and prevent mastitis. They also suggest that there is little to gain from programs aimed at fostering attitudes to prevent mastitis. We interpret the findings as indicating a need to strengthen perceived behavioral control as well as subjective norms among Swedish farmers' regarding their preventive work with mastitis. Understanding how to affect farmers' behavior, and thus reducing and controlling mastitis, will have positive effects on animal health and welfare in general. [ABSTRACT FROM AUTHOR]

Life cycle assessment (LCA) is a commonly used method for assessing environmental impacts of systems, but cannot produce absolute values, i.e. a comparison with existing calculated values, which represents limits of what can be emitted into the environment. Therefore, absolute environmental sustainability assessments have been developed to assess impacts against the planetary boundaries (PBs) of the safe operating space for humanity. Since PB-LCAs are novel, it is useful to analyze both results from this method and conventional LCAs, something which has not been done before. This study applied both methods to two full-scale sanitation systems in the city of Helsingborg, Sweden. The current conventional system for handling wastewater with active sludge and food waste to biogas production was compared with the novel project H+ source separation system with three pipes (food waste, grey and black water) with increased resource recovery through anaerobic digestion, ammonia stripping, struvite precipitation and pelletization. The Planetary Boundaries LCA (PB-LCA) results showed that both systems exceeded eight of the assigned shares of PBs, including climate change and biogeochemical flows of nutrients. Traditional LCA (ReCiPe impact assessment) showed net savings for the H+ system in a few categories and considerable reductions in several impacts, e.g., global warming potential (GWP), stratospheric ozone depletion, terrestrial acidification, and water consumption. In PB-LCA the H+ system gave additional impacts in both assessments for a few categories, mostly due to high consumption of chemicals in the ammonium stripping process used for nutrient recovery. In conclusion, the combined assessments highlight hot-spots for process optimization in the H+ system. From a methodological standpoint, PB-LCA still needs improvements to better reflect avoided burdens and results from traditional LCA should be fully transparent and analyzed carefully. The assessment methods complement each other and can be combined to better represent environmental performances of systems. [Display omitted] • Planetary Boundaries LCA was compared to the traditional LCA for sanitation systems. • Source separation in 3 streams in Sweden performed better in 10 categories in Recipe. • Eight of the Boundaries were exceeded but the avoided burdens are not represented. • Electricity and chemicals played major roles in the systems assessed. • Improvements are needed in PB-LCA to also reflect the benefits of the systems. [ABSTRACT FROM AUTHOR]

Dual residence, where children live with each parent for approximately equal amounts of time, is increasingly common for children who have experienced parental separation or divorce. This article explores the perspectives of Swedish children growing up in dual residence arrangements, focusing on their influence over the residence arrangements and practices therein. Alternating one's home life across two households requires organizing and a great deal of decision-making to make everyday life work for children and their families. Drawing on twenty qualitative in-depth interviews with children aged 9 to 17, this paper explores these decision-making practices. Findings demonstrate that children want to have the choice to influence and take part in the decision-making practices of their dual-residence arrangements, and that most children do influence the way their dual-residence arrangements are shaped albeit to different degrees. However, some children are prevented from having this influence despite their wish to have a say. Barriers and enablers are further discussed in relation to children's influence within their families. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the provision of palliative care and related decision-making in Swiss pediatric oncology settings. The aim was to determine if and when children who died from cancer received palliative care, whether there were differences by cancer diagnosis, and inclusion of children in decision-making regarding palliative care.Methods: Using a standardized data extraction form, a retrospective review of medical records of deceased pediatric patients was conducted. The form captured information on demographics, diagnosis, relapse(s), treatments, decision-making during palliative care, and circumstances surrounding a child's death.Results: For 170 patients, there was information on whether the child received palliative care. Among those, 38 cases (22%) did not receive palliative care. For 16 patients, palliative care began at diagnosis. The mean duration of palliative care was 145 days (Mdn = 89.5, SD = 183.4). Decision to begin palliative care was discussed solely with parent(s) in 60.9% of the cases. In 39.1%, the child was involved. These children were 13.6 years of age (SD = 4.6), whereas those not included were 7.16 years old (SD = 3.9). Leukemia patients were less likely to receive palliative care than the overall sample, and patients with CNS neoplasms received palliative care for a longer time than other patients.Conclusions: There are still high numbers of late or non-referrals, and even children older than 12 years were not involved in decision-making regarding palliative care. These results do not align with international organizational guidelines which recommend that palliative care should begin at diagnosis. [ABSTRACT FROM AUTHOR]

Research has explored how care managers in elder care - who often function as 'street-level bureaucrats' - regard professional discretion. The way in which length of work experience affects care manager's use of professional discretion remains, however, unexplored. This article present findings from 12 focus groups with 60 care managers. By bringing attention to how care managers experience the needs assessment process, this article sheds light on how these 'street-level bureaucrats' struggle when they try to balance their client's needs against institutional frameworks and local guidelines. Length of work experience seems to play a role in how care managers claim to use professional discretion. Experienced care managers describe how they deviate from the guidelines at times in order to create an increased scope of action in their decision-making process. Those with less time in the profession describe greater difficulties in this respect. Findings suggest that research should explore if length of work experience plays a role in the actual way in which care managers assess needs and make decisions. As such, they contribute to our understanding of how needs assessment processes are navigated by professionals while also pointing towards the nature of professional discretion in gerontological social work. [ABSTRACT FROM AUTHOR]

A growing body of literature argues that subjective factors can more accurately explain individual adaptation to climate change than objective measurers of adaptive capacity. Recent studies have shown that personal belief in climate change and affect are much better in explaining climate awareness and action than income, education or gender. This study focuses on the process of individual adaptation to climate change. It assesses and compares the influence of cognitive, experiential and structural factors on individuals’ views and intentions regarding climate change adaptation. Data from this study comes from a survey with 836 forest owners in Sweden. Ordinal and binary logistic regression was used to test hypotheses about the different factors. Results show that cognitive factors—namely personal level of trust in climate science, belief in the salience of climate change and risk assessment—are the only statistically significant factors that can directly explain individuals’ intention to adapt to climate change and their sense of urgency. Findings also suggest that structural or socio-demographic factors do not have a statistically significant influence on adaptation decision-making among Swedish forest owners. The study also offers valuable insights for communication interventions to promote adaptation. Findings strongly suggest that communication interventions should focus more strongly on building trust and addressing stakeholders’ individual needs and experiences. [ABSTRACT FROM AUTHOR]

It has often been argued that identities have a strong connection to stories and storytelling and thus that life stories should be used to individualize care for people with dementia. A problem with this view is that storytellers are seen as individuals, freely reflecting on, composing, and telling life stories. This view becomes especially problematic when persons with dementia tell stories in institutional contexts where certain information is requested and necessary for decision-making. The aim of this study is to investigate how autobiographical stories are used and what functions they have in assessment meetings involving persons with dementia. Fifteen assessment meetings were audio-recorded and transcribed. Narratives were extracted and analyzed by coding who the narrator or narrators were, what the narrator(s) accomplished by telling this story, and what the consequences were for the ongoing meeting. It was found that all interlocutors told stories about the person with dementia. These stories were found to have three functions: (1) to justify why care services were needed; (2) to describe experiences about previous care; and (3) to provide a good working climate. Thus, not all autobiographical stories are the person's story. For care managers in their everyday work it is important to be aware of this and not only be satisfied with a story that suits the organization's needs. Furthermore, stories told in assessment meetings often positioned the person as dependent on others, which could undermine the identity and sense of self of the person with dementia. [ABSTRACT FROM AUTHOR]

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Patients with temporomandibular disorders ( TMD) seem to go undetected and not adequately managed within dentistry. To identify these patients, three screening questions (3Q/ TMD) have been introduced within dentistry in parts of Sweden. It is not known whether 3Q/ TMD affects the clinical decision-making for these patients. The aim of this study was to evaluate the outcome of 3Q/ TMD on the clinical decision-making and to analyse whether gender, age and the fee system the individual was assigned to were related to prescribed TMD treatment. This cohort study was carried out within the Public Dental Health service in Västerbotten, Sweden. As part of the routine dental check-up, a health declaration including 3Q/ TMD was completed. The study population was randomly selected based on their 3Q/ TMD answers. In total, 300 individuals with an affirmative answer to any of the 3Q/ TMD, and 500 individuals with all negative answers were selected. The 3Q/ TMD includes questions on weekly jaw-face-temple pain (Q1), pain on function (Q2) and catching/locking of the jaw (Q3). The 3Q/ TMD was analysed in relation to prescribed treatment assessed from dental records. There was significantly more treatment performed or recommended for 3Q-positives (21·5%), compared to 3Q-negatives (2·2%) ( P < 0·001). The odds ratio for TMD-related treatment for 3Q-positives versus 3Q-negatives was 12·1 (95% CI: 6·3-23·4). Although affirmative answers to the 3Q/ TMD was related to TMD treatment, the majority of individuals with a screen positive still did not, according to dental records, receive assessment or treatment. Further studies are needed to better understand the clinical decision-making process for patients with TMD. [ABSTRACT FROM AUTHOR]

To further the understanding of climate change adaptation processes, more attention needs to be paid to the various contextual factors that shape whether and how climate-related knowledge and information is received and acted upon by actors involved. This study sets out to examine the characteristics of forest owners' in Sweden, the information and knowledge-sharing networks they draw upon for decision-making, and their perceptions of climate risks, their forests' resilience, the need for adaptation, and perceived adaptive capacity. By applying the concept of ego-network analysis, the empirical data was generated by a quantitative survey distributed to 3000 private forest owners' in Sweden in 2014 with a response rate of 31%. The results show that there is a positive correlation, even though it is generally weak, between forest owner climate perceptions and (i) network features, i.e. network size and heterogeneity, and (ii) presence of certain alter groups (i.e. network members or actors). Results indicate that forest owners' social networks currently serve only a minimal function of sharing knowledge of climate change and adaptation. Moreover, considering the fairly infrequent contact between respondents and alter groups, the timing of knowledge sharing is important. In conclusion we suggest those actors that forest owners' most frequently communicate with, especially forestry experts providing advisory services (e.g. forest owner associations, companies, and authorities) have a clear role to communicate both the risks of climate change and opportunities for adaptation. Peers are valuable in connecting information about climate risks and adaptation to the actual forest property. [ABSTRACT FROM AUTHOR]

Objectives: A substantial proportion of women who undergo an abortion continue afterwards without switching to more effective contraceptive use. Many subsequently have repeat unintended pregnancies. This study, therefore, aimed to identify and describe health professionalś experiences of providing contraceptive counselling to women seeking an abortion.Methods: We interviewed 21 health professionals (HPs), involved in contraceptive counselling of women seeking abortion at three differently sized hospitals in Sweden. The interviews were recorded and transcribed verbatim and analysed using conventional qualitative content analysis.Results: Three clusters were identified: 'Complex counselling', 'Elements of counselling' and 'Finding a method'. HPs often experienced consultations including contraceptive counselling at the time of an abortion as complex, covering both pregnancy termination and contraceptive counselling. Women with vulnerabilities placed even greater demands on the HPs providing counselling. The HPs varied in their approaches when providing contraceptive counselling but also in their knowledge about certain contraception methods. HPs described challenges in finding out if women had found an effective method and in the practicalities of arranging intrauterine device (IUD) insertion post-abortion, when a woman asked for this method.Conclusions: HPs found it challenging to provide contraceptive counselling at the time of an abortion and to arrange access to IUDs post-abortion. There is a need to improve their counselling, their skills and their knowledge to prevent repeat unintended pregnancies. [ABSTRACT FROM AUTHOR]