Towards a brighter future for institutionalised children? A case study of de-institutionalisation of childcare in Kyrgyzstan.

Institutional care for children, so called orphanages, are still the most common type of alternative care for children deprived of parental care in Kyrgyzstan. The number of children who enter residential care in Kyrgyzstan has increased in recent years – this despite international attention of the need to move away from institutional childcare towards a range of family-based services. Moreover, the current strategy to de-institutionalise childcare in Kyrgyzstan will likely lead to unanticipated consequences and perverse results for vulnerable children. This study contributes to existing research and experiences of de-institutionalisation by analysing the case of Kyrgyzstan where efforts to de-institutionalise childcare is met with challenges. Semi-structured interviews were used to examine respondents‟ perceptions of what some of the principle challenges facing the de-institutionalisation process in Kyrgyzstan are; which the principal factors behind the choice of de-institutionalisation strategy are; and what the principal unanticipated consequences are of the current strategy. Findings suggest that there are several plausible factors behind the challenges to transition to family-based care: incomplete problem diagnosis, different social policy positions, economic, cultural and political constraints, and external pressure

Using mHealth applications for self-care – An integrative review on perceptions among adults with type 1 diabetes

Background Individually designed interventions delivered through mobile health applications (mHealth apps) may be able to effectively support diabetes self-care. Our aim was to review and synthesize available evidence in the literature regarding perception of adults with type 1 diabetes on the features of mHealth apps that help promote diabetes self-care, as well as facilitators and barriers to their use. An additional aim was to review literature on changes in patient reported outcome measures (PROMs) in the same population while using mHealth apps for diabetes self-care. Methods Quantitative and qualitative studies focusing on adults aged 18 years and over with type 1 diabetes in any context were included. A systematic literature search using selected databases was conducted. Data was synthesised using narrative synthesis. Results We found that features of mHealth apps designed to help promote and maintain diabetes self-care could be categorized into self-care data monitoring, app display, feedback & reminders, data entry, data sharing, and additional features. Factors affecting the use of mHealth apps reported in the literature were personal factors, app design or usability factors, privacy and safety factors, or socioeconomic factors. Quality of life and diabetes distress were the most commonly reported PROMs in the included studies. Conclusion We are unable to reach a conclusive result due to the heterogeneity of the included studies as well as the limited number of studies reporting on these areas among adults with type 1 diabetes. We therefore recommend further large-scale studies looking into these areas that can ultimately improve mHealth app use in type 1 diabetes self-care.publishedVersio

Planting a seed - child health care nurses’ perceptions of speaking to parents about overweight and obesity : a qualitative study within the STOP project

Background Nurses in child health care (CHC) centers in Sweden play a key role in the early detection and management of childhood overweight/obesity, through meeting families early, regularly and over many years. However, research focusing on CHC nurses’ perceptions of their role in childhood overweight/obesity management is scarce. As part of the EU-funded project “Science and Technology in childhood Obesity Policy” (STOP), this study examines CHC nurses’ perceptions of speaking to parents about children’s overweight/obesity and of their role in referring children to treatment for overweight/obesity. Methods All registered CHC nurses in Stockholm County (n = 442) received an email invitation letter explaining the study. Individual face-to-face visits (n = 15) in selected centers, and phone calls (n = 24) to nurses working in these centres were also conducted. In total, 17 CHC nurses (all female, average work experience 6.7 years (SD ± 4.9 years)) from 10 municipalities (including four of the top five municipalities with the highest prevalence of overweight and obesity) in Stockholm County were interviewed. The interviews were conducted by phone, transcribed and analyzed using thematic analysis. Results Two main themes were developed through the analysis: 1) The relationship between the nurse and the parent and 2) Glitch in the system. Under the first theme, nurses reported that weight-related discussions were facilitated by building and maintaining trust with parents. However, nurses also said they were reluctant to address children’s weights if this could compromise parents’ trust. Under the second theme, nurses highlighted several organizational barriers to addressing a child’s weight with parents, including insufficient cooperation with other healthcare providers and limited time for visits. Nurses also identified lack of sufficient knowledge about what to offer the family and lack of confidence in their communication skills as additional barriers. Conclusions We found that pediatric nurses perceive relational and organizational factors as barriers to address childhood obesity with parents. To improve care, it is necessary to provide nurses with continuing education about obesity and communication skills and organizational support to improve communication within the healthcare system

Hur en leverantör till byggindustrin kan bidra till en miljöcertifiering enligt LEED

Syftet med detta examensarbete är att undersöka vad en leverantör till byggindustrin kan göra för att deras kunder ska uppnå en miljöcertifiering enligt LEED. Studien kan delas upp i tre delar. I den första delen har vi fördjupat oss i de miljöstyrmedel som använts i Sverige idag såsom olika miljöcertifieringssystem och miljöledningssystem. Den andra delen beskriver vilka produkter en leverantör till byggindustri kan erbjuda sina kunder med avseende på de bedömningsområden som finns i miljöcertifieringssystemet LEED. Den tredje delen beskriver vilken syn olika aktörer i byggbranschen har på miljöcertifieringssystem. Genom våra undersökningar kom vi fram till att en leverantör till byggindustrin bör inrikta sig på att arbeta med miljöcertifieringssystemen LEED, BREEAM och/eller Miljöbyggnad. De bör inrikta sig på miljödatabaserna BASTA, SundaHus och Byggvarubedömningen. Vi har kommit fram till att en leverantör till byggindustrin bör erbjuda sina kunder följande tjänster: • Rådgivning på byggarbetsplatsen. • Inneha lättillgänglig och uppdaterad dokumentation över relevanta produkter. • Ha svensk information om de produkter de kan erbjuda med avseende på en miljöcertifiering. • Ha en väl utformad och innehållsrik hemsida med avseende på miljöcertifieringssystem. • Ha en direkt kontaktperson som är inriktad på miljöarbete. Slutligen kom vi fram till att en leverantör till byggindustrin bör ha en intern utbildning för att kunna erbjuda de tjänster som punktlistan ovan visar

The Swedish version of the TeamSTEPPS® teamwork attitudes questionnaire (T-TAQ): A validation study

Background Effective teamwork is essential for delivering safe health care. It is important to increase patient safety in healthcare by conducting interprofessional team training with both healthcare professionals and undergraduate students. Validated questionnaires that evaluate team training activities contribute to valuable knowledge regarding changes in attitudes toward teamwork. The aim of the study was to test the reliability and structural validity of the Swedish version of the TeamSTEPPS® Teamwork Attitudes Questionnaire (T-TAQ). Methods The study had a cross-sectional design. Four hospitals in three health care regions in Sweden participated in the study. In total, 458 healthcare professionals, response rate 39.4%, completed the questionnaire. The T-TAQ, which consists of 30 items and covers five dimensions (Team Structure, Leadership, Situation Monitoring, Mutual Support and Communication), was translated to Swedish. A paper version of the T-TAQ was distributed to healthcare professionals (physicians, registered nurses, midwives, nursing assistants and allied health professionals) from the hospitals. Reliability and validity were tested using Cronbach’s alpha and confirmatory factor analysis. Results Cronbach’s alpha was 0.70 for the total T-TAQ and ranged from 0.41 to 0.87 for the individual dimensions. The goodness-of-fit indexes in the confirmatory factor analysis (Model 2) revealed a normed chi-square of 2.96, a root mean square error of approximation of 0.068, a Tucker-Lewis index of 0.785 and a comparative fit index of 0.808. Conclusions The Swedish version of the T-TAQ has some potential to measure healthcare professionals’ general attitudes toward the core components of teamwork in hospital settings. Further validation studies of the Swedish version of the T-TAQ are required, with samples representing both healthcare professionals and students from various healthcare disciplines and educational levels.publishedVersio

Expanded stability of layered SnSe-PbSe alloys and evidence of displacive phase transformation from rocksalt in heteroepitaxial thin films

Bulk PbSnSe has a two-phase region or miscibility gap as the crystal changes from a Van der Waals-bonded orthorhombic 2D layered structure in SnSe-rich compositions to the related 3D-bonded rocksalt structure in PbSe-rich compositions with large contrast in the electrical, optical, and thermal properties across this transition. With an aim to understand and harness this transition in thin films devices, we epitaxially integrate PbSnSe on GaAs by molecular beam epitaxy using an in-situ PbSe surface treatment and show a significantly reduced two-phase region by stabilizing the Pnma layered structure out to Pb$_{0.45}$Sn$_{0.55}$Se, beyond the bulk-limit of Pb$_{0.25}$Sn$_{0.75}$Se. Pushing further, we directly access metastable two-phase epitaxial films of layered and rocksalt grains that are nearly identical in composition around Pb$_{0.5}$Sn$_{0.5}$Se and entirely circumvent the miscibility gap. We present microstructural evidence for an incomplete displacive transformation from rocksalt to layered structure in these films that we speculate occurs during the sample cool down to room temperature after synthesis. In-situ x-ray diffraction measurement of an as-grown Pb$_{0.56}$Sn$_{0.44}$Se rocksalt film under cryogenic cooling reproduces the key attributes of this transition and validates our hypothesis. Notably, we find well-defined orientation relationships between the phases forming in the process and unconventional strain-relief mechanisms involved in the crystal structure transformation by transmission electron microscopy. Overall, our work adds a scalable thin film integration route to harnessing metastable layered compositions as well as the dramatic contrast in material properties in PbSnSe across a potentially ultrafast structural transition.Comment: 26 pages, 10 figure

Is it safe to exercise during oncological treatment? A study of adverse events during endurance and resistance training–data from the Phys-Can study

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The Association of Time to Organ Procurement on Short- and Long-Term Outcomes in Kidney Transplantation

Background and objectives Transplant centers in Europe aim to minimize the time from brain death to organ procurement (procurement delay), but evidence to justify this is scarce. In the United States, procurement times are significantly longer. Our objective was to analyze how procurement delay associates with kidney allograft outcomes. Design, setting, participants, & measurements Kidney transplantations from brain-dead donors were retrospectively analyzed from the Finnish Kidney Transplant Registry and the Scientific Registry of Transplant Recipients in the United States. Multivariable models were adjusted with donor and recipient characteristics, and the relationship between procurement delay and outcomes was modeled with cubic spline functions. Results In total, 2388 and 101,474 kidney transplantations in Finland and the United States were included, respectively. The median procurement delay was 9.8 hours (interquartile range, 7.8-12.4) in Finland and 34.8 hours (interquartile range, 26.3-46.3) in the United States. A nonlinear association was observed between procurement delay and the risk of delayed graft function, with highest risk seen in short and very long procurement delays. In multivariable models, the lowest risk of delayed graft function was associated with procurement delay between 20 and 50 hours. In multivariable models, longer procurement delay was linearly associated with lower risk of graft loss (hazard ratio, 0.90/1 h longer; 95% confidence interval, 0.88 to 0.92; P Conclusions Longer procurement delay was associated with noninferior or even better kidney allograft outcomes.Peer reviewe

Enhanced recovery protocol in laparoscopic liver surgery

Introduction Enhanced recovery protocols (ERP) accelerate recovery and shorten postoperative hospital stay. This increased knowledge of ERPs has also gradually implemented into liver surgery. However, in laparoscopic liver surgery (LLS), the experience of optimized perioperative care protocols is still limited. Methods We prospectively studied the implementation of multimodal ERP principles to LLS in the first 100 consecutive patients. Opioid-sparing multimodal pain management was applied together with early mobilization already in the postoperative care unit (PACU). Drains and catheters were avoided and per oral intake was initiated promptly. Primary pain control was achieved with iv NSAIDS, low-dose opioid and corticosteroids. Combination of per oral ibuprofen and long-acting tramadol was routinely administered shortly after operation. The multiprofessional adherence to the protocol was also evaluated. Results Investigated LLS was performed during Aug 2016-Apr 2019. Operations were done due to malignancy in 83 (83%) of cases, mostly for colorectal liver metastases (n = 52, 52%). Forty-eight (48%) of the operated patients were female. Median age was 65 years (range 17-91). The American Society of Anaesthesiologists Physical Status (ASA) classification median was three. Median postoperative hospital stay was 2 days (range 1-8 days). More than seventy percent of patients were discharged by the second postoperative day and nearly ninety percent by the third postoperative day. Complications after surgery were few. The new ERP elements were adopted in most of the cases. Conclusions ERP was introduced safely and effectively after LLS. The adherence to the ERP was good. Routine discharge 1-2 days after LLS is realistic and achievable.Peer reviewe