Suicidal thoughts (ideation) among elite athletics (track and field) athletes: associations with sports participation, psychological resourcefulness and having been a victim of sexual and/or physical abuse.
To examine associations between suicidal ideation and sexual and physical abuse among active and recently retired elite athletics (track and field) athletes.
The study population consisted of all athletes (n=402) selected for a Swedish Athletics team between 2011 and 2017. Data on suicidal ideation, suicidal events (estimated through the 1?year non-sports injury prevalence), lifetime abuse experiences, sociodemographics, sense of coherence and coping strategies were collected using a cross-sectional survey. The data were analysed using binary logistic regression with suicidal ideation and non-sports injury as outcomes.
192 athletes (47.8%) returned data. The prevalence of suicidal ideation was 15.6% (men 17.4%; women 14.2%) and the non-sports injury prevalence was 8.0% (men 11.6%; women 5.7%). Among women, suicidal ideation was associated with having been sexually abused (OR 5.94, 95% CI 1.42 to 24.90; p=0.015) and lower sense of coherence (OR 0.90, 95% CI 0.85 to 0.96; p=0.001) (Nagelkerke R2=0.33). Among men, suicidal ideation was only associated with use of behavioural disengagement for coping (OR 1.51, 95% CI 1.18 to 1.95; p=0.001) (R2 =0.25). Among women, non-sports injury prevalence was associated with having been sexually abused (OR 8.61, 95% CI 1.34 to 55.1; p=0.023) and participating in an endurance event (OR 7.37, 95% CI 1.11 to 48.9; p=0.039 (R2 =0.23), while among men, having immigrant parents (OR 5.67, 95% CI 1.31 to 24.5; p=0.020) (R2 =0.11) was associated with injury outside sports.
About one out of six international athletics athletes reported having experienced suicidal ideation. World Athletics and National Olympic Committees need to include suicide prevention in their athlete protection programmes.
The number of elderly persons with cardiovascular disease is increasing. In Sweden, the incidence of acute myocardial infarction is the highest among individuals aged 85 years and over. However, there is still little evidence about whether this population benefits from established treatments. Furthermore, the values and preferences of octogenarians (age ?80 years), as well as how they could be involved in treatment decisions, have been largely overlooked in research. Overall, increased knowledge about the preferences and expectations of octogenarians is needed to incorporate their treatment expectations into the decision-making process.
This study aimed to describe the treatment choice preferences and post-treatment life expectations of octogenarians with acute coronary syndrome.
A total of 19 patients (eight women, 11 men) aged 80 years and older and diagnosed with non-ST-elevation myocardial infarction or unstable angina were enrolled in this qualitative study. Data were collected between May 2011 and June 2013 through semistructured interviews. The data were analysed using qualitative content analysis.
We identified two main categories: Wanting the best and Hope for increased wellbeing. Participant preferences were influenced by their own and others' previous experiences and their confidence in healthcare professionals. With respect to treatment outcomes, the participants hoped to get well, stay active, experience fewer symptoms and regain vitality.
The studied octogenarians desired the best treatment option and trusted that their healthcare providers will make appropriate recommendations. These patients expected their treatment to result in increased wellbeing and fewer symptoms.
To present specific reference values for cardiorespiratory fitness (CRF) in children with obesity and to analyse secular trends of CRF in the studied population.
Cardiorespiratory fitness, the maximal oxygen uptake (VO2 max), was estimated with the Åstrand-Rhyming submaximal bicycle test, in 705 Swedish children (356 girls, 8-20 years) with obesity according to the International Obesity Task Force (IOTF). Data were collected from 1999 to 2013. Secular trends, analysed with multiple linear regression, were adjusted for age, height and body mass index standard deviation score (BMI SDS).
All children had low CRF compared with normal weight standards but there was a marked variability of CRF in children with obesity, which was possible to quantify with the developed obesity specific CRF reference values. The mean value of absolute VO2 max (L/min) increased with age and relative VO2 max (mL/kg/min) decreased with age in both boys and girls. There was a negative secular trend in both sexes (P
To examine the association between several perinatal and obstetric risk factors and reactive attachment disorder in children diagnosed in specialised services.
In this nested case-control study, 614 cases with reactive attachment disorder and 2423 controls matched with age and sex were identified from Finnish national registers. Conditional logistic regression was used to examine the association between a number of perinatal risk factors and reactive attachment disorder.
The risk for neurocognitive difficulties is increased in children born with foetal growth restriction (FGR), but no data exist yet on their narrative skills. The narrative skills of 8- to 10-year-old children born with FGR between 24 and 40 weeks were compared with those of children born with appropriate growth for gestational age (AGA).
A prospectively collected cohort of 36 children with FGR was recruited prenatally at a Finnish tertiary hospital from 1998-2001, and 31 children with AGA served as controls. Narrative skills were assessed using a standardised test, and correlations between narrative, communication, reading and spelling skills were studied.
Children born with FGR produced significantly less information and shorter utterances in their narratives than the AGA group. Children born preterm with FGR performed significantly more poorly in their narratives than the preterm AGA group. Poor narrative skills correlated with poor communication, reading and spelling skills.
Children born with FGR had poorer narrative skills compared with their AGA peers at the age of 8-10 years, and narrative skills were linked to other language-based skills, which underlines the importance of early detection and preventive measures to optimise the educational outcome of children born with FGR.
In adults, central fast-frequency sleep spindles are involved in learning and memory functions. The density of local spindles is higher than global spindles, emphasizing the importance of local plastic neural processes. In children, findings on the association of spindles with cognition are more variable. Hence, we aim to study whether the local spindles are also important for neurobehavioral performance in children.
We studied the correlations between local (occurring in only one channel: Fp1, Fp2, C3, or C4), bilateral, and diffuse (occurring in all four channels) spindles and neurobehavioral performance in 17 healthy children (median age 9.6 years).
Local spindles were not as frequent as bilateral spindles (P-values
Polyaromatic hydrocarbons (PAH) are common pollutants of water ecosystems originating from incineration processes and contamination with mineral oil. Water solubility of PAHs is generally low; for toxicity tests with aquatic organisms, they are therefore usually dissolved in organic solvents. Here we examined the effects of a typical model PAH, phenanthrene, and a solvent, acetone, on amphipods as relevant aquatic invertebrate models. Two of these species, Eulimnogammarus verrucosus and Eulimnogammarus cyaneus, are common endemics of the oligotrophic and pristine Lake Baikal, while one, Gammarus lacustris, is widespread throughout the Holarctic and inhabits smaller and more eutrophic water bodies in the Baikal area. Neither solvent nor phenanthrene caused mortality at the applied concentrations, but both substances affected gene expression in all species. Differential gene expression was more profound in the species from Lake Baikal than in the Holarctic species. Moreover, in one of the Baikal species, E. cyaneus, we found that many known components of the cellular xenobiotic detoxification system reacted to the treatments. Finally, we detected a negative relationship between changes in transcript abundances in response to the solvent and phenanthrene. This mixture effect, weaker than the impact by a single mixture component, needs further exploration.
Wide variation exists between the nursing competence requirements seen in the emergency care context and the subsequent design of nursing education programmes. Clarifying nursing roles and scope of practice may shed light on inconsistencies and encourage nurses to work to their full potential.
Describe and clarify the overarching similarities and differences in registered nurses' and nurse specialists' scope of practice in emergency departments.
A qualitative study performed in Finland and Norway, based on 11 interviews analysed by means of qualitative content analysis.
The results are presented in three main categories related to nurses' scope of practice: The nurses share the same role, Competence varies and Same accountability and responsibility, with potential for development of the specialist role.
Given the varying educational systems that currently exist, management teams face a more or less impossible task if attempting to standardise the scope of practice for different professional nurse groups. Still, nurse specialists possess competence that could be utilised to improve patient care and some specialisations seem more suitable for emergency care than others. Individual skills and qualifications should be recognised, which would enable nurses to work to their full potential.
No differences were seen between registered nurses' and nurse specialists' role, and professional accountability and responsibilities in the context studied here, although the level of nursing competence differed. Before and even after consensus on uniform competence standards for the different professional nurse groups is reached, management teams should invest in reviewing nurses' competence in relation to different expertise levels, and strategically recruit so that current health needs in the emergency departments can be met.
Sleeping difficulties are increasingly prevalent among adolescents worldwide and have negative consequences for adolescent health and education. The aim of this study was to describe the reasons for sleeping difficulties as perceived by adolescents. Sleeping difficulties include insufficient sleep, trouble falling asleep, waking up at night or sleep that does not leave an individual rested. Data were collected in 2015 using an open-ended question. The sample consisted of n = 475 adolescents from a city in Sweden, aged 15-16 years, with self-assessed sleeping difficulties. The results described the reasons for the adolescents' sleeping difficulties, at a general, thematic level, as an imbalance between requirements and preconditions, distributed to stress, technology use, poor sleep habits, existential thoughts, needs and suffering. To find a balance in their daily lives, adolescents may need support from parents, school nurses and school health services to deal with their sleeping difficulties.
The Sami are an indigenous population with multiple languages and dialects living in northern areas of Sweden, Norway, Finland, and the Kola Peninsula. The South Sami population lives in central regions of Sweden and Norway, and consist of about 2000 people. In this study, 56 older South Sami people from Sweden participated. Semi-structured interviews were conducted over the telephone and analysed through qualitative content analysis. The main findings show that older South Sami people's expectations of having care providers with a South Sami background speaking South Sami in home nursing care contain contradictions in and between participants. Participants had different preferences regarding having care providers with a South Sami background speaking South Sami in the future. When providing care to older South Sami people, individual adjustments are of importance, and our study showed that participants had different expectations despite having similar backgrounds.
In Norway, 6000 patients were operated on due to hip fracture in 2016. Hip fracture results in increased suffering and often in a dramatic change in an older person's life. The experience of suffering in patients with hip fracture, or nursing staff's perception of it in the preoperative period, is sparsely studied. The perspective of the study was based on caring sciences.
The aim of this study was to gain a deeper understanding of subjective experiences of suffering among elderly hip-fracture patients during the preoperative period, seen from the patients' and nurses' perspective.
A Q-methodological approach was used. Forty statements (Q-sample), based on interviews and theory, were ranked in a forced-choice distribution curve from 'mostly agree' to 'mostly disagree', followed by postinterviews. Nine patients and five nurses participated. A by-person factor analysis in the form of principal component analysis with varimax and hand rotation was conducted.
Three factors, also called viewpoints, emerged as follows: (i) 'Feeling safe through presence, trust and hope'; (ii) 'Feeling safe occurs when the patient is seen, met and informed'; and (iii) 'Feeling alone and angry at oneself'. A polarisation between participants occurred, since the youngest patients (median age 73), the oldest patients (median age 90) and the nurses were represented in each specific factor.
There exist differences between how the nursing staff, the youngest and the oldest elderly patients experienced the preoperative period and what can enhance or alleviate their suffering. Where the youngest elderly communicated safety through trust and relatives' presence, the oldest elderly communicated insecurity in relation to staff and experienced severe pain and loneliness. Nursing staff and one patient emphasised the importance of seeing the patient in the first meeting to establish a feeling of security.
Recent studies have suggested an association between prenatal paracetamol exposure and adverse neurodevelopmental outcomes in children. However, these findings may be confounded by unmeasured factors related to maternal use of paracetamol and child outcomes.
To examine the association between duration and timing of prenatal paracetamol exposure on parent-reported communication skills, behaviour, and temperament in preschool-aged children, with focus on the role of unmeasured confounding.
We used data from the Norwegian Mother and Child Cohort Study. Linear and generalised linear models with inverse probability weights and robust standard errors were used to quantify the association between prenatal paracetamol exposure and continuous and categorical outcomes.
Of the 32 934 children included in our study, 8374 (25.4%), 4961 (15.1%), and 1791 (5.4%) were prenatally exposed to paracetamol in one, two, and three trimesters, respectively. Children exposed to paracetamol in two trimesters scored lower on shyness compared with unexposed children (ß -0.62, 95% confidence interval [CI] -1.05, -0.19). Children exposed to paracetamol in three trimesters had a moderate increased risk of internalising behaviour problems (relative risk (RR) 1.36, 95% CI 1.02, 1.80) and borderline externalising behaviour problems (RR 1.22, 95% CI 0.93, 1.60) compared with unexposed children. Children exposed to paracetamol in 2nd/3rd trimester scored lower on shyness (ß -0.32, 95% CI -0.66, 0.02) compared with unexposed children. Sensitivity analyses indicated that unmeasured confounders play an important role and may potentially bias the effect estimates away from the null.
Timing of exposure and short-term use of paracetamol during pregnancy do not seem to pose any substantial risk of the outcomes examined. Although we found an association between paracetamol use in multiple trimesters and lower shyness and greater internalising behaviour in preschool-aged children, we cannot rule out chance or unmeasured confounding as possible explanations for these findings.
To describe medication safety, transformational leadership and their relationship as evaluated by Registered Nurses.
Medication safety is one of the aspects of patient safety and an important part of nurses' daily practices. Nurse managers can ensure medication safety by adopting a transformational leadership style. However, little evidence exists regarding how transformational leadership relates to medication safety.
Data were collected from Registered Nurses (n = 161) in three Finnish hospitals in May 2016 using an electronic questionnaire incorporating the Transformational Leadership Scale (TLS) and Medication Safety Scale (MSS). Data were analysed using statistical analyses including descriptive analyses, principal component analysis and multivariate analyses. STROBE reporting guidelines were followed (see Appendix S1).
Nurses evaluated medication safety and transformational leadership in their units to be excellent and good, respectively. There was a moderate but statistically significant correlation between transformational leadership and medication safety. The medication competence of nurses and the management of nursing processes were significantly related to medication safety.
Nurse managers' transformational leadership style can promote medication safety in units. The medication competence of nurses must be addressed because assurance and confidence in their own expertise in pharmacotherapeutic tasks positively affects their perceptions of medication safety.
Falls among inpatients are common. The method used by The Norwegian Patient Safety Campaign to measure the adverse events is the Global Trigger Tool, which does not look at the causation for falls. This study was aimed at investigating major risk factors for falls in the hospital setting.
This retrospective case-control study was conducted at Telemark Hospital in Norway, in the period from September 2012 to August 2014. A total of 842 patients from three wards were included, whereof 172 cases had experienced one or more fall(s) during hospitalisation and 670 random controls had not fallen. Data were analysed according to a pragmatic strategy.
Compared with patients who did not fall, patients who fell were 21 times more likely to have poor balance (OR = 21.50, 95% CI: 10.26-45.04) and 19 times more likely to have very poor balance (OR = 19.62, 95% CI: 9.55-40.27), twice as likely to be men (OR = 1.82, 95% CI: 1.24-2.68), and 50% increased probability of fall with every 10 year increase of age (OR = 1.51, 95% CI: 1.34-1.69). Furthermore, the patients who fell were more likely to use antidepressant drugs (OR = 3.85, 95% CI: 1.09-13.63), antipsychotic drugs (OR = 3.27, 95% CI: 1.94-5.51), anxiolytic/hypnotic drugs (OR = 1.80, 95% CI: 1.22-2.67) and antiepileptic drugs (OR = 1.13, 95% CI: 1.11-4.06) than patients who did not fall.
During hospital stay, patients who fell had a higher risk profile than patients who did not fall. Clinicians should work to improve patients' safety and reduce the risk of falls by accurately assessing balance and mobility as a form of primary prevention. We recommend that a review of the patient medications should be conducted upon falling, as a form of a secondary preventive strategy against falls.
Every year, patients are affected by suffering and death caused by adverse events in connection with health care and the most common adverse events are healthcare-associated infections (HAI). The Swedish Patient Act from 2015 strengthens the patient's position in health care; however, there is lack of knowledge of how healthcare staff experience the possibilities to make the patient involved in the preventive work of HAI.
To describe healthcare professionals' views on the patient's prerequisites to be co-creator in preventing HAI in connection with hospital care.
This study had a qualitative descriptive design with semi-structured individual interviews. Qualitative inductive content analysis was used to analyse the transcribed interview data. The study setting was a hospital in Sweden in 2015. Interviews were carried out among six healthcare professionals.
In the analysis, 5 themes and 14 categories were identified in three different domains: Organisation, Healthcare staff and Patient. The result indicates an obstacle in each domain for the patient to become co-creator in preventing HAI. In Organisation domain, a lack of organizational structure such as elaborated working methods to involve the patient was pointed out. In the domain Healthcare staff, it showed that the professionals allocate the responsibility of preventing HAI to the patient but only if they had to or if they trusted the patient. In the Patient domain, the result states that the patient was perceived as passive; they did not take own initiatives to get involved.
The patient has an important role in successful HAI prevention work and should be considered as an obvious co-creator. Nevertheless, this study shows that neither organisation nor healthcare staff are sufficiently prepared for this. The organisation must make an anchored, structured and systematic work centred on the patient's needs and give more support both to healthcare professionals and patients.
Massive infusions of crystalloids into bleeding hypotensive patients can worsen the outcome. Military experience suggests avoiding crystalloids using early damage control resuscitation with blood components in out of hospital setting. Civilian emergency medical services have since followed this idea. We describe our red blood cell protocol in helicopter emergency medical services (HEMS) and initial experience with prehospital blood products from the first 3 years after implementation.
We performed an observational study of patients attended by the HEMS unit between 2015 and 2018 to whom packed red blood cells, freeze-dried plasma, or both were transfused. The Student's two-sided T-test was used to compare vitals in prehospital phase with those at the hospital's emergency department. A p-value
Objectives: This study investigates the association between living alone and mortality over a recent 19-year period (1992-2011). Method: Data from a repeated cross-sectional, nationally representative (Sweden) study of adults ages 77 and older are analyzed in relation to 3-year mortality. Results: Findings suggest that the mortality risk associated with living alone during old age increased between 1992 and 2011 (p = .076). A small increase in the mean age of those living alone is partly responsible for the strengthening over time of this association. Throughout this time period, older adults living alone consistently reported poorer mobility and psychological health, less financial security, fewer social contacts, and more loneliness than older adults living with others. Discussion: Older adults living alone are more vulnerable than those living with others, and their mortality risk has increased. They may have unique service needs that should be considered in policies aiming to support aging in place.