Experiences of rejection by mental health patients— A qualitative study

Background and aim: People suffering from mental illness and their experiences of attitudes towards them are rarely investigated from the perspective of the individual. The aim was to gain an understanding of how a group of mental health patients experienced social relationships in personal settings as well as in society. Method: Open interviews with twenty-five mental health patients were conducted and analysed with a qualitative content analysis. Result: The essence of the result was that mental health patients’ experiences are still not taken enough into account, neither by mental health professionals nor by their social networks. This was underpinned by four core categories: Patients’ experience of deteriorated and reduced social contacts due to various degrees of acceptance and knowledge of people in general;service users reported on difficulties with social contacts in general, with family relationships, relationships with friends and workmates and with employers;reduced life opportunities were expressed, including violated self-image and poor coping competence and, ambivalent experiences of contact with the mental health services were reported. Conclusion and clinical implication: The present study contributes to the understanding of mental health patients’ experiences of professional services and of their social networks. This knowledge may strengthen the implications of patient-centred care essential for the outcome of the care.

Use of a National Clinical Final Examination in a Bachelor’s Programme in Nursing to Assess Clinical Competence—Students’, Lecturers’ and Nurses’ Perceptions

Objective: The objective of this study was to evaluate the perceptions of students, lecturers, nurses and clinical lecturers regarding the ability of the National Clinical Final Examination (NCFE) to assess clinical competence, and whether the assessment was consistent with the qualifications for a Bachelor of Science in Nursing as outlined by the Swedish Higher Education Authority. The NCFE is divided into two parts (written and bedside) and aims to evaluate third-year nursing students’ clinical competence. Methods: Data were collected at 10 universities using study-specific questionnaires. The total response rate was 84% (n = 1652). Results: The clinical lecturers indicated that there was a need for improvement in the written part of the examination in order to adequately assess clinical competence. Regarding the bedside part the clinical lecturers, nurses and students perceived that the bedside part of the examination assessed whether the student had the clinical competence required by a newly registered nurse. Conclusion: The two-part examination described in this study was perceived as useful for assessing clinical competence and for the qualification requirements for a Bachelor of Science in Nursing as outlined by the Swedish Higher Education Authority. However, especially the written part requires further development. The model and form of assessment ought to be applicable to graduate nursing programme internationally.

Potential role of an athlete-focused echocardiogram in sports eligibility

Sudden cardiac death(SCD)of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases.Preparticipation screenings(PPs)have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases.The European Society of Cardiology protocol for PPs includes history collection,physical examination and baseline electrocardiogram,while further examinations are reserved to individuals with abnormalities at first-line evaluation.Nevertheless,transthoracic echocardiography has been hypothesized to have a primary role in the PPs.This review aims to describe how to approach an athlete-focused echocardiogram,highlighting what is crucial to focus on for the different diseases(cardiomyopathies,valvulopathies,congenital heart disease,myocarditis and pericarditis)and when is needed to pay attention to overlap diagnostic zone(“grey zone”)with the athlete's heart.Once properly tested,focused echocardiography by sports medicine physicians may become standard practice in larger screening practices,potentially available during first-line evaluation.

Exploring the Implementation of Individual Care Plans in Relation to Characteristics of Staff

The aim was to explore the implementation of individual care plans in municipal elderly care in relation to characteristics of staff. Data regarding characteristics of staff were derived through a questionnaire distributed to all staff working in the care for older people, (N = 908, n = 245) in four municipalities in Sweden. The number of care plans established during a one-year period was collected through a contact person in each municipality. In total 47 individual care plans were established during the study year. Significantly more staff in the municipality that had the most number of established individual care plans agreed that there had been sufficient education (p = 0.017), sufficient time (p = 0.002) and routines established regarding individual care plans (p = 0.014) and had a significantly better job satisfaction (p = 0.001), compared to staff in the other municipalities. Implementation leaders may need to take the working conditions and the perception of available resources among staff into consideration in the on-going process of implementing individual care plans.

CTCs Detection and Whole-exome Sequencing Might Be Used to Differentiate Benign and Malignant Pulmonary Nodules

Background and objective Low-density computed tomography(LDCT)improved early lung cancer diagnosis but introduces an excess of false-positive pulmonary nodules data.Hence,accurate diagnosis of early-stage lung cancer remains challenging.The purpose of the study was to assess the feasibility of using circulating tumour cells(CTCs)to differentiate malignant from benign pulmonary nodules.Materials and methods 122 patients with suspected malignant pulmonary nodules detected on chest CT in preparation for surgery were prospectively recruited.Peripheral blood samples were collected before surgery,and CTCs were identified upon isolation by size of epithelial tumour cells and morphological analysis.Laser capture microdissection,MALBAC amplification,and whole-exome sequencing were performed on 8 samples.The diagnostic efficacy of CTCs counting,and the genomic variation profile of benign and malignant CTCs samples were analysed.Results Using 2.5 cells/5 m L as the cut-off value,the area under the receiver operating characteristic curve was of 0.651(95%confidence interval:0.538-0.764),with a sensitivity and specificity of 0.526 and 0.800,respectively,and positive and negative predictive values of 91.1%and 30.3%,respectively.Distinct sequence variations differences in DNA damage repair-related and driver genes were observed in benign and malignant samples.TP53 mutations were identified in CTCs of four malignant cases;in particular,g.7578115T>C,g.7578645C>T,and g.7579472G>C were exclusively detected in all four malignant samples.Conclusion CTCs play an ancillary role in the diagnosis of pulmonary nodules.TP53 mutations in CTCs might be used to identify benign and malignant pulmonary nodules.

Characteristics of convicted male-on-female rapists in the South of Sweden between 2013 and 2018:a pilot study

The objective of this study was to evaluate the main characteristics of adult male offenders convicted of rape or aggravated rape against adult females.We reviewed all convictions(n=21)based on court documents from the District Court,the Court of Appeal and information from the Swedish Tax Agency in Malmo,Sweden,between 2013 and 2018.The findings indicated that the most common offender characteristics were a single status,mean age of 33 years and foreign background.The rapes primarily occurred within a private setting while the victims(who were often younger and knew the offender)were unconscious.Although assumptions based on these results should be made with caution,our findings provide a clear image of the typical circumstances under which these rapes occurred.This study should be viewed as a first attempt to create a database of characteristics of convicted rapists.As more data are added,more sophisticated analyses can be performed and stronger generalizations may be made.Information of this kind may also be important for further research,classification of rapists in offender profiling,and case linking.

The European registry of quality outcomes for cataract and refractive surgery(EUREQUO):a database study of trends in volumes,surgical techniques and outcomes of refractive surgery

Background:A European web-based registry for refractive surgery was established in 2008;The European Registry of Quality Outcomes for Cataract and Refractive Surgery(EUREQUO).The aim of the registry was to improve treatment and standards of care for refractive surgery.Further aims were to offer a tool for benchmarking by establishing a reference database and for surgeons to enter and analyze their own outcomes.The purpose of this study was to characterize the registry and analyze the data collected during its first decade.Methods:The characteristics of the web-based registry are described.Data collected from February 4^(th) 2004 until June 30th 2014 are included in the analysis.The database is analyzed in terms of surgical technique,indications for surgery,complications,and refractive and visual outcomes.Results:Data have been reported from 47 centers in 14 countries until mid-2014.About 4,000 procedures were reported annually.The most frequent procedure was laser-assisted in-situ keratomileusis(LASIK)with 11697 reported surgeries.Over time in the database,LASIK declined(p<0.001)while photorefractive keratectomy(PRK)and refractive lens exchange(RLE)increased(p<0.001 for both procedures).The indications for surgery,in terms of preoperative refraction and age,were stable over time,for all types of procedures.Surgical complications were reported infrequently and with a well-known relationship to the type of surgical procedure.The reported refractive outcomes were good.The visual outcomes indicate a significant increase of visual acuity after high myopia treatment by phakic intraocular lens in the anterior(phakic IOL AC)and the posterior(phakic IOL PC)chamber and a poorer visual outcome,after both myopia and hyperopia treatment,by epithelial LASIK(Epi-LASIK).Conclusions:We describe the establishment of a European registry for refractive surgery.The database increases at a rate of approximately 4000 refractive procedures per year.The most frequent procedure is LASIK,but both PRK and RLE are an increasing part of the reported procedures.The indications for surgery have been stable over time.Surgical complications and visual outcome vary,depending on the type of surgery.

Validity of the French version of Catquest-9SF and use of an electronic notepad for entering patient-reported outcome measures

Background:The Catquest-9SF questionnaire is a patient reported outcome measure that quantifies the visual benefits from cataract surgery.The purpose of this study was to translate and adapt the Catquest-9SF questionnaire for France,to assess its psychometric properties via Rasch analysis,and to assess its validity when completed using an electronic notepad.Methods:The Catquest-9SF questionnaire was translated following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research.Catquest-9SF and clinical data were collected from patients before and after routine cataract surgery.All questionnaire data were collected via an electronic notepad.Rasch analysis was performed to assess psychometric properties,and sensitivity to change was analysed for patients with complete paired pre-and post-operative questionnaires.Results:A complete filled-in preoperative questionnaire was obtained for 848 patients.Rasch analysis showed good precision(person separation:2.32,person reliability:0.84),ordered category probability curves,no item misfit,and unidimensionality.The respondents were slightly more able than the level of item difficulty(targeting:−1.12 logits).Sensitivity was analysed on 211 paired questionnaires,and the postoperative questionnaires showed a clear ceiling effect.The effect size was 2.6.The use of an electronic notepad for completing the questionnaire worked out very well after some adjustments.Conclusions:The French version of Catquest-9SF has good psychometric properties and is suitable for use in French-speaking patients.The use of the Catquest-9SF questionnaire in an electronic format showed good validity.

Aerobic bacteria associated with chronic suppurative otitis media in Angola

Background:Chronic suppurative otitis media(CSOM)is an important cause of hearing loss in children and constitutes a serious health problem globally with a strong association to resource-limited living conditions.Topical antibiotics combined with aural toilet is the first-hand treatment for CSOM but antimicrobial resistance and limited availability to antibiotics are obstacles in some areas.The goal of this study was to define aerobic pathogens associated with CSOM in Angola with the overall aim to provide a background for local treatment recommendations.Methods:Samples from ear discharge and the nasopharynx were collected and cultured from 152 patients with ear discharge and perforation of the tympanic membrane.Identification of bacterial species was performed with matrix-assisted laser desorption/ionization-time of flight mass spectrometry and pneumococci were serotyped using multiplex polymerase chain reactions.Antimicrobial susceptibility testing was done according to EUCAST.Results:One hundred eighty-four samples from ear discharge and 151 nasopharyngeal swabs were collected and yielded 534 and 289 individual isolates,respectively.In all patients,correspondence rate of isolates from 2 ears in patients with bilateral disease was 27.3%and 9.3%comparing isolates from the nasopharynx and ear discharge,respectively.Proteus spp.(14.7%),Pseudomonas aeruginosa(13.2%)and Enterococcus spp.(8.8%)were dominating pathogens isolated from ear discharge.A large part of the remaining species belonged to Enterobacteriaceae(23.5%).Pneumococci and Staphylococcus aureus were detected in approximately 10%of nasopharyngeal samples.Resistance rates to quinolones exceeded 10%among Enterobacteriaceae and was 30.8%in S.aureus,whereas 6.3%of P.aeruginosa were resistant.Conclusions:The infection of the middle ear in CSOM is highly polymicrobial,and isolates found in nasopharynx do not correspond well with those found in ear discharge.Pathogens associated with CSOM in Angola are dominated by gram-negatives including Enterobacteriaceae and P.aeruginosa,while gram-positive enterococci also are common.Based on the results of antimicrobial susceptibility testing topical quinolones would be the preferred antibiotic therapy of CSOM in Angola.Topical antiseptics such as aluminium acetate,acetic acid or boric acid,however,may be more feasible options due to a possibly emerging antimicrobial resistance.

The Italian Catquest-9SF cataract questionnaire: translation, validation and application

Background:To validate the Catquest-9SF questionnaire in Italian,assess the change in visual disability with cataract surgery and determine the correlation between pre-operative Catquest-9SF scores and Lens Opacities Classification System(LOCS)III cataract grading.Methods:Prospective,questionnaire validation study.The Catquest-9SF questionnaire was forward and back translated and completed by 209 Italian patients before and three months following cataract surgery.Rasch analysis was used to assess its psychometric properties.Results:The Italian Catquest-9SF demonstrated ordered response categories,unidimensionality(item fit statistics range:0.73–1.34),adequate person separation(2.04),and no differential item functioning.Mistargeting was evident with a mean difference in item difficulty and person ability of 2.04 logits but improved with inclusion of pre-operative data only.There was a statistically significant(Friedman tests,p<0.001)median improvement in visual disability of 1.92,3.57,1.44 and 2.94 logits in patients undergoing first eye surgery with and without ocular comorbidity,and second eye surgery with and without ocular comorbidity respectively.There was no statistically significant difference in the improvements among the four groups(Kruskal-Wallis H test,X^(2)(3)=5.445,p=0.142).There was no correlation between Catquest-9SF scores and nuclear opalescence(r_(s)=0.049,p=0.478),nuclear colour(r_(s)=0.008,p=0.909),cortical(r_(s)=0.066,p=0.341),and posterior subcapsular components(r_(s)=0.048,p=0.494).Conclusions:The Italian Catquest-9SF demonstrated good psychometric properties and is suitable for use in Italian speaking patients.There were similar improvements in visual disability in patients undergoing first or second eye surgery,with or without ocular comorbidity.There was no correlation between pre-operative Catquest-9SF scores and LOCS III cataract grading.

Catquest-9SF functioning over a decade–a study from the Swedish National Cataract Register

Background:The Swedish National Cataract Register(NCR)collects data on cataract surgery outcomes during March,including patient-reported outcomes using the Catquest-9SF questionnaire for over 11 years.Previous studies from NCR have shown that the preoperative visual acuity has improved over time.The main purpose of this study was to evaluate the Catquest-9SF Rasch scoring performance in this changing environment.A second purpose was to describe clinical data over the same period for those who completed the questionnaire.Methods:The performance of the Catquest-9SF was analysed by a separate Rasch analysis for each year,resulting in a preoperative and postoperative score for each participating patient in the annual cohorts.The clinical data and questionnaire scoring were analysed for each year in the period 2008-2018 inclusive.Results:Data were available for 42,023 eyes for 11 annual cohorts(2008-2018).The psychometric properties of the questionnaire were stable during the study period.Person separation(precision)for the whole period was 2.58 and varied between 2.45 and 2.72.The person reliability was 0.87 and varied between 0.86 and 0.88.The targeting of question difficulty to person ability became less accurate over time meaning that the item activities became easier to carry out without difficulty.The average targeting for the whole period was−2.06 and changed from−1.92 in 2008 to−2.31 in 2018.The person score improved both before surgery and after surgery,indicating that patients are undergoing surgery at a more able level and getting better outcomes.The average improvement by surgery decreased from 3.41 logits in 2008 to 3.21 logits in 2018(p=0.003).Over time,patient age decreased from 75 to 74 years(p<0.001)and the proportion of women decreased from 63.9 to 57.9%(p<0.001).The mean preoperative visual acuity in both the operated eye and the better eye improved over time(0.47 to 0.40 logMAR,p<0.001 and 0.22 to 0.19 logMAR,p<0.001,respectively),as did the mean postoperative visual acuity in the operated eye(0.14 to 0.09 logMAR,p<0.001).Conclusions:The Catquest-9SF retained stable psychometric properties over this 11-year period although more recent cohorts included slightly younger patients with somewhat better vision.

Holding Sweden hostage:firearm-related violence

Swedish as well as foreign publications have reported a sharp increase in firearm-related violence in Sweden. None of these publications, however, combined official statistics from the Swedish police, the National Council for Crime Prevention (NCCP), and the National Board of Health and Welfare (NBHW), to study firearm-related violence in the last 2 years:2016–2017. The results of this study show that firearm-related violence in Sweden has greatly increased compared to other Scandinavian countries, especially in recent years. This is probably the reason for the increase in the rate of deadly violence. Further, the increasing number of gangs and criminal networks, as well as the high inflow of illegal firearms to Sweden, is believed to have contributed to the disturbing increase of firearm-related vio-lence in the country. Although Sweden is one of the most democratic and freest countries in the world, and has some of the world's strictest gun laws, the country still faces signifi-cant firearm-related violence. This study not only reveals the increasing rate of firearm-related violence in Sweden, but also shows that Sweden is in dire need of additional policies to combat the illegal flow of firearms and to curb gang criminality.