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BACKGROUND AND PURPOSE: The objective of this study was to estimate the level of health outcomes and resource use at a hospital level during the first year after a stroke, and to identify any potential differences between hospitals after adjusting for patient characteristics (case mix). METHOD: Data from several registries were linked on individual level: seven regional patient administrative systems, Swedish Stroke Register, Statistics Sweden, National Board of Health and Welfare and Swedish Social Insurance Agency. The study population consisted of 14 125 patients presenting with a stroke during 2010. Case-mix adjusted analysis of hospital differences was made on five aspects of health outcomes and resource use, 1 year post-stroke. RESULTS: The results indicated that 26% of patients had died within a year of their stroke. Among those who survived, almost 5% had a recurrent stroke and 40% were left with a disability. On average, the patients had 22 inpatient days and 23 outpatient visits, and 13% had moved into special housing. There were significant variations between hospitals in levels of health outcomes achieved and resources used after adjusting for case mix. CONCLUSION: Differences in health outcomes and resource use between hospitals were substantial and not entirely explained by differences in patient mix, indicating tendencies of unequal stroke care in Sweden. Healthcare organisation of regions and other structural features could potentially explain parts of the differences identified.

BACKGROUND: The aim of this study was to evaluate the diagnostic accuracy of unenhanced low-dose CT (LDCT) in acute colonic diverticulitis in comparison with contrast-enhanced standard-dose CT (SDCT). METHODS: All patients with clinically suspected diverticulitis who underwent LDCT followed by SDCT between January and October 2017 were evaluated prospectively. CT examinations were assessed for signs of diverticulitis, complications and other differential diagnoses by three independent radiologists (two consultants and one fourth-year resident) using SDCT as the reference method. Sensitivity and specificity were calculated and Cohen's κ coefficient was used for agreement analyses. RESULTS: Of the 149 patients included (mean age 66·7 years, M : F ratio 0·4), 107 (71·8 per cent) had imaging consistent with diverticulitis on standard CT. Sensitivity and specificity values for a diverticulitis diagnosis using LDCT were 95-99 and 86-100 per cent respectively, and respective values for identification of complications were 58-73 and 78-100 per cent. The corresponding κ values among the three readers for diagnosis were 0·984, 0·934 and 0·816, whereas κ values for complications were 0·680, 0·703 and 0·354. Of the 26 patients who presented with other causes of abdominal symptoms identified on standard CT, 23 were diagnosed correctly on LDCT. Missed cases included splenic infarction (1) and segmental colitis (2). CONCLUSION: The diagnostic accuracy of LDCT was high for the presence of acute diverticulitis. However, as signs of complicated disease can be missed using the low-dose protocol, use of LDCT as a primary examination method should not preclude SDCT when complications may be suspected.

Mental health inpatient milieus have repeatedly been found to be associated with passivity, social disengagement, and low levels of interaction with staff. However, little is known about patients' experiences related to different ward activities. In the present study, we aimed to study the reports of activities and associated experiences of patients admitted to acute psychiatric inpatient wards. Disengaged, inactive, and solitary activities were hypothesized to be associated with less reward and more distress than their counterparts. We also aimed to investigate if such activities predicted distress, and if they were associated with clinical severity. Participants (n = 102) recorded their activities along with concurrent ratings of reward and distress in a structured 1-day diary, and nurses provided clinical severity ratings. On average, 3.74 of the 11 hours assessed (34%) were spent doing nothing, only 0.88 hours (8%) were spent with staff, and most of the time was spent in solitude. Doing nothing, being alone, and passivity were associated with the greatest levels of distress and lowest levels of reward, whereas informal socializing demonstrated the opposite pattern. Distress was not predicted by activity or reward when adjusting for baseline distress. Clinical severity was not associated with the amount of time spent alone or the experience of reward during activity. In conclusion, the risk for passivity and social disengagement during admission prevails. This activity pattern could have detrimental emotional consequences and warrants action, but more studies are needed to determine if activity actually precedes emotional experience.

This study investigated the experience of living with chronic orofacial pain. Participating in this study's individual in-depth interviews were 6 participants with chronic orofacial pain who were undergoing treatment at a pain clinic. In consideration of the empirical nature of the study, the interviews were transcribed verbatim and analyzed from an interpretive phenomenological approach. The participants in the study experienced various types of loss as a result of chronic pain, such as the loss of employment, self-identity, and the ability to enjoy eating and engaging in social activities. Other findings revealed a disbelief among the families and medical community in the pain reported by the participants in this study. In addition, the current study explores the dissatisfaction of these participants with their journey through the health care system. Previous studies have concentrated on chronic pain predominantly through quantitative methods based on measurements, such as questionnaires. The biomedical aspects of pain are essential to report, yet the emphasis on this can result in overlooking the experience of living with chronic pain. Qualitative methodologies are necessary for gaining a more profound understanding of and appreciation for the individual patient and his or her unique perspective. The present study may benefit those living with chronic pain, since this sharing of experiences can help sufferers feel less isolated in their agony. The current article's intention is to report these experiences in such a way that chronic pain sufferers and laypeople can comprehend and relate to them. In addition, the findings of this study should promote the knowledge and understanding of health care providers who deal with chronic pain sufferers, so that treatment is provided with more empathy and compassion. Knowledge Transfer Statement: The findings of the present study may assist health care professionals interacting regularly with sufferers of chronic pain to gain a deeper understanding of the chronic pain experience and how to best support these patients.

PURPOSE: Automated collection of image data from DICOM headers enables monitoring of patient dose and image quality parameters. Manual monitoring is time consuming, owing to the large number of exposure scenarios, thus automated methods for monitoring needs to be investigated. The aim of the present work was to develop and optimise such a method. MATERIAL AND METHODS: Exposure index values from digital systems in projection radiography were collected over a period of five years, representing data from 1.2 million projection images. The exposure index values were converted to detector dose and an automated method for detection of sustained level shifts in the resulting detector dose time series was applied using the statistical analysis tool R. The method combined handling of outliers, filtering and estimation of variation in combination with two different statistical rank tests for level shift detection. A set of 304 time series representing central body parts was selected and the level shift detection method was optimised using level shifts identified by ocular evaluation as the gold standard. RESULTS: Two hundred and eighty-one level changes were identified that were deemed in need of further investigation. The majority of these changes were abrupt. The sensitivity and specificity of the optimised and automated detection method concerning the ocular evaluation were 0.870 and 0.997, respectively, for detected abrupt changes. CONCLUSIONS: An automated analysis of exposure index values, with the purpose of detecting changes in exposure, can be performed using the R software in combination with a DICOM header metadata repository containing the exposure index values from the images. The routine described has good sensitivity and acceptable specificity for a wide range of central body part projections and can be optimised for more specialised purposes.

Abstract Background: Community-based Bilingual Doulas (CBDs) are women from migrant communities trained to support and comfort migrant women during labour and birth. The aim of the study was to describe CBDs’ experiences of supporting migrant women during labour and birth, working alongside caregivers, and to explore CBDs perceptions of their work situation in a Swedish setting. Methods: As part of an ongoing randomised trial of CBD support in Stockholm, Sweden, semi-structured individual interviews were conducted with nine of the 35 participating CBDs. Results: The overarching theme which emerged was “Multi-tasking bilingual doulas bridging gaps – despite standing on fragile ground”. To reach out a helping hand and receive appreciation from the women when their needs were met, motivated the CBDs to continue despite the constraints related to roles, working conditions and boundaries. The CBDs felt proud of being acknowledged, although they did also feel a need for more supervision and education. Conclusion: The CBDs experienced their doula tasks as meaningful and emotionally rewarding, which mostly outweighed the challenges of their work which they saw as insecure, exhausting and underpaid. If CBDs are implemented on a larger scale, the scope of their role, education, access to supervision and working conditions all need to be better addressed.

Abstract Background: Forced migration has been shown to have a negative impact on family dynamics, parenting and the parent-child relationship. Parental support programmes aim to strengthen family functioning and the parent-child relationship and to promote the mental health of children and parents. However, there is a lack of knowledge on how parenting support programmes can be implemented for newly arrived immigrant parents. This process evaluation, therefore, describes the implementation of a successful parenting programme for immigrant parents from Somalia and identifies key components in the implementation process. Method: This process evaluation considered context, implementation and mechanism of impact, in accordance with the Medical Research Councils guidance. Data were collected through focus group discussions, a questionnaire, attendance lists, field and reflection notes, and observations of the sessions. The data were then analysed using content analysis and descriptive statistics. Results: The findings showed that of the 60 parents who were invited to the parenting programme, 58 participated in the sessions. The study showed that involving key individuals in the early stage of the implementation facilitated reaching the Somali-born parents in the parenting programme. To retain the participants in the programme, parents were offered free transportation. The programme was implemented and delivered as intended. A majority of the parents were satisfied with the programme, and they reported increased knowledge about children’s rights and the support they might seek from social services. Conclusions: This study illustrates how a parenting support programme can be implemented for Somali-born parents and provides guidance on how to engage and attract immigrant parents to participate in parenting support programmes.

Abstract Background: Forced migration has been shown to have a negative impact on family dynamics, parenting and the parent-child relationship. Parental support programmes aim to strengthen family functioning and the parent-child relationship and to promote the mental health of children and parents. However, there is a lack of knowledge on how parenting support programmes can be implemented for newly arrived immigrant parents. This process evaluation, therefore, describes the implementation of a successful parenting programme for immigrant parents from Somalia and identifies key components in the implementation process. Method: This process evaluation considered context, implementation and mechanism of impact, in accordance with the Medical Research Councils guidance. Data were collected through focus group discussions, a questionnaire, attendance lists, field and reflection notes, and observations of the sessions. The data were then analysed using content analysis and descriptive statistics. Results: The findings showed that of the 60 parents who were invited to the parenting programme, 58 participated in the sessions. The study showed that involving key individuals in the early stage of the implementation facilitated reaching the Somali-born parents in the parenting programme. To retain the participants in the programme, parents were offered free transportation. The programme was implemented and delivered as intended. A majority of the parents were satisfied with the programme, and they reported increased knowledge about children’s rights and the support they might seek from social services. Conclusions: This study illustrates how a parenting support programme can be implemented for Somali-born parents and provides guidance on how to engage and attract immigrant parents to participate in parenting support programmes.

The article consists in a report of the community safety programme to reduce the prevalence of non-intentional injuries that was launched in Falun in 1989 and built up gradually. Evaluation of the results was based on data elicited by a local surveillance system (out-patients) and hospital discharge data (in-patients), both of which registers indicated significant reductions in injury rates. Although the reduction was most prominent in the targeted risk categories (particularly in falls due to slipping or stumbling, resulting in femoral fractures), spin-off benefits were also observed. The manifest potential for economy in health care costs is also discussed.

Abstract Background: Forced migration has been shown to have a negative impact on family dynamics, parenting and the parent-child relationship. Parental support programmes aim to strengthen family functioning and the parent-child relationship and to promote the mental health of children and parents. However, there is a lack of knowledge on how parenting support programmes can be implemented for newly arrived immigrant parents. This process evaluation, therefore, describes the implementation of a successful parenting programme for immigrant parents from Somalia and identifies key components in the implementation process. Method: This process evaluation considered context, implementation and mechanism of impact, in accordance with the Medical Research Councils guidance. Data were collected through focus group discussions, a questionnaire, attendance lists, field and reflection notes, and observations of the sessions. The data were then analysed using content analysis and descriptive statistics. Results: The findings showed that of the 60 parents who were invited to the parenting programme, 58 participated in the sessions. The study showed that involving key individuals in the early stage of the implementation facilitated reaching the Somali-born parents in the parenting programme. To retain the participants in the programme, parents were offered free transportation. The programme was implemented and delivered as intended. A majority of the parents were satisfied with the programme, and they reported increased knowledge about children’s rights and the support they might seek from social services. Conclusions: This study illustrates how a parenting support programme can be implemented for Somali-born parents and provides guidance on how to engage and attract immigrant parents to participate in parenting support programmes.

Identifying and making visible the cultivated parts of a town is essential to understanding the complexity of the medieval and early modern town. To study historical gardens, you need to work inter- or multidisciplinarily. The following article will present some results from an interdisciplinary horticultural archaeological study of the town of Linköping during the period approximately 1600–1800, where results from two large-scale archaeological investigations, macrofossil analyses and analyses of three historical maps have been put together in an analysis of the towns cultivated parts. By showing how the different source materials both confirm and complement each other, a new way of approaching questions about a town´s complexity, formation and development is presented.

This paper aims to strengthen reflective practice by amending it with a better understanding of power relations. We address the critique that power relations have not received enough attention in reflective practice. We take the core components of the cyclical conception of reflective practice – routinized action, encounter of surprise, reflection and new action – and amend these with Mark Haugaard’s understanding of reification. This concept signifieshow arbitrary power relations appear as more than social constructs and hence are stabilized into a given social order. Amending reflective practice à la Gibbs and Schön with the concept of reification, we design a model, The Reflection Cycle, which is tested through practical trials. These are conducted with facilitators of communication to generate insights of relevance to the relational professions where reflective practice is applied. We analyze the facilitators’ written reflections, observe them reflecting, and interview them about their reflection experience. We find that amending reflective practice with the concept of reification can enable practitioners to destabilize their taken-for-granted systems of meaning and generate ideas about how to restabilize these, to allow for a broader action repertoire. Our contribution to the theory of reflection is to outline a novel conception of power-sensitive reflective practice.