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Objective The aim was to explore whether occupational balance is associated with health, health-promoting resources, healthy lifestyle and social study factors among students during higher education within healthcare and social work. Design The study has a multicentre repeated cross-sectional design. Data were collected via a self-reported, web-based questionnaire based on the validated instruments: the 11-item Occupational Balance Questionnaire (OBQ11), the Sense of Coherence (SOC) Scale, the Salutogenic Health Indicator Scale (SHIS) and five questions from the General Nordic Questionnaire (QPS Nordic) together with questions about general health and lifestyle factors. Setting Students at six universities in western Sweden at one of the following healthcare or social work programmes: biomedical scientists, dental hygienists, nurses, occupational therapists, physiotherapists, radiology nurses and social workers. Participants Of 2283 students, 851 (37.3%) participated. Results The students experienced that occupational balance increased during education. The total OBQ11 score was higher among students in semesters 4 and 6/7, compared with semester 1 students. Students with higher OBQ11 also reported higher SOC throughout their education, while health seemed to decrease. Students who reported higher levels of OBQ11 reported lower levels of health and well-being in semesters 4 and 6/7, compared with semester 1. There was an opposite pattern for students reporting lower levels of OBQ11. Conclusions The association between higher levels of OBQ11 and lower levels of health and well-being is remarkable. There is a need for more research on this contradiction and what it means for students’ health and well-being in the long run.

Background Infective endocarditis (IE) is a rare but severe infectious disease. Patients with IE are treated for weeks in the hospital and have profound impairments to their health. New treatment modalities increase options for outpatient care. Little is known about how patients perceive their disease and hospitalisation. We aimed to explore the needs of patients with IE during hospitalisation and the first few months after discharge. Methods In this qualitative study, 20 patients (45-86 years of age) hospitalised due to IE in Swedish hospitals were interviewed a median of 112 (67-221) days after hospitalisation. Data were analysed with qualitative content analysis, identifying eight subcategories, two categories, and an overall theme. Results The overall theme illuminated a spectrum of needs of patients suffering from IE, between treating the disease and meeting the person with the illness. The needs encompassed eight axes with dual focus on both medical excellence and person-centred care. Medical excellence was needed to optimally treat, supervise, and offer follow-up on this rare and severe disease; patients longed to come home, and there were issues of reliability in the healthcare system. Person-centred care was requested, including individualised information leading to knowledge, reorientation, the beginning of health restoration, and being met as a unique person. Symptoms of fatigue, wasting, and cognitive and mental distress were often neglected by the caregiver. Conclusions This explorative study shows the patient's needs as important areas in a spectrum between medical excellence and person-centred care. Care in specialised units secure quality. Early discharge is requested by patients. Multiprofessional individualizing outpatient care needs to develop with preserved safety and medical excellence. The disease trajectory after discharge progresses slowly, and the possibility of mitigating its progress is still unclear. Person- centred care, screening for de

Implementation of artificial intelligence systems for healthcare is challenging. Understanding the barriers and implementation strategies can impact their adoption and allows for better anticipation and planning. This study’s objective was to create a detailed inventory of barriers to and strategies for AI implementation in healthcare to support advancements in methods and implementation processes in healthcare. A sequential explanatory mixed method design was used. Firstly, scoping reviews and systematic literature reviews were identified using PubMed. Selected studies included empirical cases of AI implementation and use in clinical practice. As the reviews were deemed insufficient to fulfil the aim of the study, data collection shifted to the primary studies included in those reviews. The primary studies were screened by title and abstract, and thereafter read in full text. Then, data on barriers to and strategies for AI implementation were extracted from the included articles, thematically coded by inductive analysis, and summarized. Subsequently, a direct qualitative content analysis of 69 interviews with healthcare leaders and healthcare professionals confirmed and added results from the literature review. Thirty-eight empirical cases from the six identified scoping and literature reviews met the inclusion and exclusion criteria. Barriers to and strategies for AI implementation were grouped under three phases of implementation (planning, implementing, and sustaining the use) and were categorized into eleven concepts; Leadership, Buy-in, Change management, Engagement, Workflow, Finance and human resources, Legal, Training, Data, Evaluation and monitoring, Maintenance. Ethics emerged as a twelfth concept through qualitative analysis of the interviews. This study illustrates the inherent challenges and useful strategies in implementing AI in healthcare practice. Future research should explore various aspects of leadership, collaboration and contracts among key st

Objectives: Depression is increasing and is a leading cause of disease burden among adolescents. Available evidence-based treatments with medication or psychotherapy have modest effects. Aerobic exercise is a hopeful alternative as an augmenter or a stand-alone treatment. Qualitative studies have shown that participants in group exercise for adolescent depression experienced improved mood and a sense of achievement, commitment and empowerment. This study aimed to explore not only adolescents’ but also parents’ and healthcare professionals’ experiences of a group exercise intervention for adolescents with depression. Methods: Nine adolescents who had participated in a group aerobic exercise intervention for 12 weeks, eight parents and two healthcare professionals were interviewed. We used a latent qualitative content analysis with an inductive approach that resulted in nine sub-categories, three categories and an overarching theme. Results: The experiences of a group exercise intervention for adolescents with depression were expressed in the overarching theme ‘Group exercise for adolescent depression promotes empowerment and engagement in everyday life’, based on three categories: exercise alleviates depressive symptoms, exercise contributes to balance in life and exercise promotes self-esteem. However, there was variation in our results, in that not all participants experienced improvements from exercising. Adolescents described more varied experiences, while parents and healthcare professionals mainly expressed positive views. Conclusions: Our findings suggest that group exercise for adolescent depression promotes empowerment and engagement in everyday life, according to adolescents, and more clearly so according to parents and healthcare professionals. © The Author(s) 2024.

Weighted blankets are a non-pharmacological intervention for treating sleep and anxiety problems in children with attention-deficit/hyperactivity disorder. However, research on the efficacy of weighted blankets is sparse. The aim of this randomized controlled trial with a crossover design (4 + 4 weeks) was to evaluate the efficacy of weighted blankets on sleep among children with attention-deficit/hyperactivity disorder and sleeping problems. Children diagnosed with uncomplicated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attention-deficit/hyperactivity disorder with verified sleep problems were randomized to start with either a weighted blanket or a lighter control blanket. Data collection was performed at weeks 0, 4 and 8 using actigraphy, questionnaires and a daily sleep diary. T-tests were used to evaluate efficacy. The study included 94 children with attention-deficit/hyperactivity disorder (mean age 9.0 [sd 2.2] years; 54 [57.4%] boys). Weighted blankets had a significant effect on total sleep time (mean diff. 7.72 min, p = 0.027, Cohen's d = 0.24), sleep efficiency (mean diff. 0.82%, p = 0.038, Cohen's d = 0.23) and wake after sleep onset (mean diff. −2.79 min, p = 0.015, Cohen's d = −0.27), but not on sleep-onset latency (p = 0.432). According to our exploratory subgroup analyses, weighted blankets may be especially beneficial for improving total sleep time in children aged 11–14 years (Cohen's d = 0.53, p = 0.009) and in children with the inattentive attention-deficit/hyperactivity disorder subtype (Cohen's d = 0.58, p = 0.016). Our results suggest that weighted blankets may improve children's sleep and could be used as an alternative to pharmacological sleep interventions. © 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society., Funding: This work was supported by external grants from The Knowledge Foundation [number 20200012], Swedish Research Council for Health Working Life and Welfare (Forte) [number 2021-00664]; Majblomman foundation and different grants from Region Halland.

Study objectives: To examine differences in sample characteristics and longitudinal sleep outcomes according to weighted blanket adherence. Methods: Children with attention-deficit/hyperactivity disorder (ADHD) (n =94), mean age 9.0 (sd 2.2, range 6-14) participated in a 16-week sleep intervention with weighted blankets (WB). Children were classified as WB adherent (use of WB ≥ 4 nights/week) or non-adherent (use of WB ≤ 3 nights/week). Changes in objectively measured sleep by actigraphy, parent-reported sleep problems (Children's Sleep Habits Questionnaire (CSHQ)) and child-reported Insomnia Severity Index (ISI) were evaluated according to adherence with mixed effect models. Gender, age, and ADHD subtype were examined as potential moderators. Results: Children adherent to WBs (48/94) showed an early response in sleep outcomes and an acceptance of the WB after four weeks of use as well as a decrease in parent- (CSHQ) (-5.73, P = .000) and child-reported sleep problems (ISI) (-4.29, P = .005) after 16 weeks. The improvement in sleep was larger among WB adherent vs. non-adherent (between-group difference: CSHQ: -2.09, P = .038; ISI: -2.58, P =.007). Total sleep time was stable for children adherent to WB but decreased for non-adherent (between-group difference: +16.90, P = .019). Conclusions: An early response in sleep and acceptance of the WB predicted later adherence to WBs. Improvements in sleep were more likely among WB adherents vs. non-adherents. Children with ADHD may thus benefit from using WBs to handle their sleep problems. © 2024 American Academy of Sleep Medicine

Background: Approximately 7.6% of children are diagnosed with attention deficit/hyperactivity disorder (ADHD), and sleep impairments affect 25–85%. There is a noticeable lack of research on girls and sex differences. The aim of this study was to examine sex differences in children with uncomplicated ADHD and sleep problems. Methods: Cross-sectional baseline data were retrieved from a randomized controlled trial with weighted blankets (55 boys and 41 girls, 6–14 years) on a cohort recently diagnosed with uncomplicated ADHD and sleep problems. Differences between boys and girls in ADHD symptoms, objectively and subjectively measured sleep, anxiety, and functioning were examined via parent- or self-reported validated instruments. Results: Girls reported significantly lower (worse) satisfaction with well-being, life overall, and school, but not for family. Parents reported more sleep anxiety and night-time wakings among boys, but no sex differences in other measures and also not in self-reported measures or objective sleep measures. Children who reported worry, sadness, or unhappiness had more sleep problems. Conclusions: Boys with ADHD and sleep problems may need support with sleep-related anxiety and night-time wakings, while girls may require support with overall functioning. Additionally, children who express feelings of worry, sadness, or unhappiness alongside their ADHD symptoms should have attention given to their sleep. © 2024 by the authors. Licensee MDPI, Basel, Switzerland.

Aim: Drastic diet interventions have been shown to promote rapid and signifi-cant compositional changes of the gut microbiota, but the impact of moderate diet variations is less clear. Here, we aimed to clarify the impact of moderate diet variations that remain within the spectrum of the habitual human diet on gut microbiota composition.Methods: We performed a pilot diet intervention where five healthy volunteers consumed a vegetarian ready- made meal for three days to standardize dietary intake before switching to a meat- based ready- made western- style meal and high sugar drink for two days. We performed 16S rRNA sequencing from daily fecal sampling to assess gut microbiota changes caused by the intervention diet. Furthermore, we used the volunteers' fecal samples to colonize germ- free mice that were fed the same sterilized diets to study the effect of a moderate diet inter-vention on the gut microbiota in a setting of reduced interindividual variation.Results: In the human intervention, we found that fecal microbiota composition varied between and within individuals regardless of diet. However, when we fed the same diets to mice colonized with the study participants' feces, we observed significant, often donor- specific, changes in the mouse microbiota following this moderate diet intervention.Conclusion: Moderate variations in the habitual human diet have the potential to alter the gut microbiota. Feeding humanized mice human diets may facilitate our understanding of individual human gut microbiota responses to moderate dietary changes and help improve individualized interventions., AIM: Drastic diet interventions have been shown to promote rapid and significant compositional changes of the gut microbiota, but the impact of moderate diet variations is less clear. Here, we aimed to clarify the impact of moderate diet variations that remain within the spectrum of the habitual human diet on gut microbiota composition.METHODS: We performed a pilot diet intervention where five healthy volunteers consumed a vegetarian ready-made meal for three days to standardize dietary intake before switching to a meat-based ready-made western-style meal and high sugar drink for two days. We performed 16S rRNA sequencing from daily fecal sampling to assess gut microbiota changes caused by the intervention diet. Furthermore, we used the volunteers' fecal samples to colonize germ-free mice that were fed the same sterilized diets to study the effect of a moderate diet intervention on the gut microbiota in a setting of reduced interindividual variation.RESULTS: In the human intervention, we found that fecal microbiota composition varied between and within individuals regardless of diet. However, when we fed the same diets to mice colonized with the study participants' feces, we observed significant, often donor-specific, changes in the mouse microbiota following this moderate diet intervention.CONCLUSION: Moderate variations in the habitual human diet have the potential to alter the gut microbiota. Feeding humanized mice human diets may facilitate our understanding of individual human gut microbiota responses to moderate dietary changes and help improve individualized interventions.

Background: Artificial intelligence (AI) is often presented as a technology that will change healthcare and be useful inclinical work in disease prediction, diagnosis, and precision health. More knowledge is needed regarding the value of AI applications based on the perspectives of healthcare leaders to understand their roles as gatekeepers and facilitatorsfor successful implementation. The purpose of the study: To explore healthcare leaders’ perceptions of the value of AI applications in clinical work. Methods: The study had an explorative qualitative approach. Individual interviews were conducted from October2020 to May 2021 with 26 healthcare leaders with different experiences in implementing AI in clinical practice in acounty council in Sweden. Inductive qualitative content analysis was used, and eight sub-categories and threecategories emerged. Findings: The value of AI applications in clinical care was described in terms of expected benefits for patients as toolssupporting person-centered information and individualized self-management. The expected benefits for healthcareprofessionals included decision-support in diagnostics, risk assessments, and treatment recommendations but alsoproviding warning systems and second opinions in clinical work. On an organizational level, the benefits comprisedpatient safety and decision-support in prioritizing healthcare resources in and across healthcare organizations. Conclusions: The healthcare leaders perceived that AI applications would provide value on different levels inhealthcare for patients, healthcare professionals, and organizations. Across these levels, the implementation of AI cansupport person-centeredness, patient self-management, quality of care, patient safety, and resource optimization.

Background: Artificial intelligence (AI) is predicted to improve healthcare, increase efficiency, save time and resources. However, research shows an urgent need to develop guidance to ensure that the use of AI in healthcare is ethically acceptable. Purpose: To develop an ethical model to support AI implementation in practice. Methods: The study used an explorative and empirically driven qualitative design. Individual interviews were conducted with 18 healthcare professionals from two emergency departments in Sweden where the county council has developed an AI application to predict the risk for unexpected mortality within 30 days after visiting an emergency department. A deductive analysis based on ethical theory i.e virtue, deontology and consequentialism, was used. Findings: The developed model shows how the healthcare professionals use ethical reasoning in relation to the implementation of AI. In relation to virtue ethics, moral considerations in relation to the use of AI were mentioned. In relation to deontology, considerations were mentioned on actions performed based on information acquired from the technology and adherence to specific duties, roles and responsibilities. In relation to consequentialism, considerations about how to provide better resources more rapidly in an equal way and how the technology can be adjusted to each patients’ individual needs and preferences in order to support decisions, self-determination, and actions that are in the patients best interest. Conclusions: Our findings provide an ethical model demonstrating the relevance of virtue, deontology and consequentialism when AI are to be implemented in practice.

Just nu pågår en digital transformation av svensk hälso- och sjukvård och artificiell intelligens (AI) är tänkt att vara lösningen på många av de utmaningar sjukvården står inför. I en kunskapssammanställning från Myndigheten för arbetsmiljökunskap (MYNAK) (2020) om digitalisering och arbetsmiljö påtalas att den snabba tekniska utvecklingen kommer att förändra arbetsmiljö och yrkesrollers karaktär. Professionellas arbete är traditionellt omgärdat av gränser och att upprätthålla gränserna kring det egna kunskapsområdet är en grundläggande del av professionens utveckling. Digitalisering och implementering av olika former av teknik kan förändra professionella gränser och därmed generera så kallat gränsarbete (Petersson, 2020) som kan indelas i tre former; konkurrenskraftigt gränsarbete, kollaborativt gränsarbete och konfigurativt gränsarbete (Langley et al. 2019). De tre formerna av gränsarbete är ofta sammanflätade i praktiken, men konfigurativt gränsarbete kan dock beskrivas som en kraft som driver de andra två kategorierna av gränsarbete, eftersom det riktar sig emot andras aktiviteter i syfte att utforma gränser för förändring mellan grupper (Langley et al., 2019). Denna studie fokuserar på hur gränserna kring vårdprofessionernas arbete kan förändras vid implementering av AI och på vilket konfigurativt gränsarbete som aktörer på ledningsnivån i ett sjukvårdssystem förutser kommer att ske när sjukvården blir mer datadriven genom användning av AI-analyser.Vi genomförde semistrukturerade intervjuer med 26 ledare som var i en position att potentiellt påverka implementeringen och användningen av AI i en svensk region. Intervjuerna analyserades med hjälp av kvalitativ innehållsanalys. Analysen i studien fokuserar på den konfigurativa formen av gränsarbete.Sammantaget visar resultatet att ledarna beskriver olika typer av konfigurativt gränsarbete. Ledarna har makten att bedriva gränsarbete som förändrar gränserna kring vårdpersonalens arbete och de beskriver att de, medve

Vi kommer att presentera ett nytt forskningsprojekt vid Högskolan i Halmstad med finansiering från Vetenskapsrådet, som förväntas bidra med kunskap om hur arbetets gränser i hälso- och sjukvården förändras vid implementering av artificiell intelligens (AI). Hälso- och sjukvården i Sverige brottas idag med utmaningar kring att klara av att fördela resurser där de gör mest nytta, säkerställa kvalitet i den vård som ges och att ställa om till en mer digitaliserad vård som sker i mer samproduktion mellan vårdpersonal och patienter. Ett teknikområde som förväntas kunna bidra till att lösa dessa utmaningar är AI, men forskning har visat att det finns många hinder för att lyckas med att införa och använda AI-applikationer inom hälso- och sjukvården. Hälso- och sjukvårdspersonal har en viktig roll att spela i förändringsarbete inom vården och AI-applikationer kan komma att konkurrera med det monopol på kunskap i förhållande till hälsa och behandling av sjukdomar som vårdpersonalen erhållit genom lång akademisk utbildning, träning och praktisk erfarenhet. Det övergripande syftet med forskningsprojektet ImpAI är att generera ny kunskap om implementering och användning av AI-applikationer i rutinsjukvård och hur professionella roller kan fungera som barriärer under implementeringsprocessen. Det teoretiska ramverket består av professionsteori med fokus på tillit och arbetets gränser samt implementeringsteori. Projektet bygger på olika case i form av AI-applikationer som implementeras under 2023–2024 i Region Halland, Sverige och mixad metod används vid processutvärderingen av dessa case. Resultatet kommer både att främja förståelsen för hur processer kan etableras vid införande av AI applikationer i hälso- och sjukvården och bidra med information om hur sådana processer kan bygga på hälso- och sjukvårdspersonalens kompetens och roller.

Background Fatigue is common and can be challenging after stroke. Aim To explore how post-stroke fatigue (PSF) was experienced and handled among people with stroke in their performance of everyday activities and in participation in social activities five years after stroke. Methods Nine persons who perceived PSF one year after stroke onset were interviewed five years later. The interviews were analysed using qualitative content analysis. Results Most participants experienced PSF even five years after stroke and reported longstanding difficulties in everyday activities. Handling fatigue-a long slow process with invisible adjustments in everyday life emerged as the theme. By implementing new strategies in everyday life their PSF lessened over time. Understanding among significant others as to how PSF appears and providing information about PSF early after stroke was perceived important. Conclusion This study adds new knowledge regarding experiences of PSF and long-term support needs. Even if PSF still was reported the participants experienced improvements in everyday life through the application of new strategies. Information about PSF and strategies for managing everyday life should be provided during rehabilitation. Significance This study is one out of only a few focussing on long-term PSF and adjustment to its consequences in everyday life.