Protocol of a mixed method randomized controlled pilot study evaluating a wilderness program for adolescent and young adult cancer survivors: the WAYA study

Introduction The majority of childhood, adolescent and young adult (AYA) cancer survivors suffer from long-term and late effects such as fatigue, psychological distress or comorbid diseases. Effective health promotion strategies are needed to support the health of this vulnerable group. This protocol provides a methodological description of a study that aims to examine the feasibility and safety of performing a randomised clinical trial (RCT) on a wilderness programme that is developed to support the health of AYA cancer survivors. Methods and analysis The pilot RCT study has a mixedmethod design, including quantitative and qualitative evaluations. Participants are AYAs, aged 16–39 years, that have been diagnosed with cancer during childhood, adolescence or young adulthood. A total of 40 participants will be randomly assigned to a wilderness programme (n=20) or a holiday programme (n=20). Both arms include participation in an 8-day summer programme, followed by a 4-day programme 3 months later. Primary outcomes are feasibility and safety parameters such as time to recruitment, willingness to be randomised, programme adherence and adverse effects. Secondary outcomes include self-reported health such as self-esteem, quality of life, self-efficacy and lived experiences. Descriptive statistics will be used to analyse outcomes and explore indications of differences between the programmes. Interviews are analysed by directed content analysis and hermeneutic phenomenology. A convergent parallel mixed-method analysis design will be applied to integrate quantitative and qualitative data. Results of this feasibility study will inform the preparation for a larger RCT with AYA cancer survivors. Ethics and dissemination The study protocol is approved by the Swedish Ethical Review Authority (reference: 2020-00239). This study will be performed between January 2021 and December 2023. Results will be published in international peer-reviewed journals, presented at conferences and disseminated to participants, cancer societies, healthcare professionals and outdoor instructors

Psychological abuse among older persons in Europe: a cross-sectional study

Purpose: Elder abuse is an issue of great concern world‐wide, not least in Europe. Older people are increasingly vulnerable to physical, psychological, financial maltreatment and sexual coercion. However, due to complexities of measurement, psychological abuse may be underestimated. The purpose of this study is to investigate the prevalence of psychological abuse toward older persons within a 12 month period. Design/methodology/approach: The study design was cross‐sectional and data were collected during January‐July 2009 in the survey “Elder abuse: a multinational prevalence survey, ABUEL”. The participants were 4,467 randomly selected persons aged 60‐84 years (2,559 women, 57.3 per cent) from seven EU countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden). The sample size was adapted to each city according to their population of women and men aged 60‐84 years (albeit representative and proportional to sex‐age). The participants answered a structured questionnaire either through a face‐to‐face interview or a mix of interview/self‐response. The data were analysed using descriptive statistics and regression methods. Findings: The prevalence of overall psychological abuse was 29.7 per cent in Sweden, followed by 27.1 per cent in Germany; 24.6 per cent in Lithuania and 21.9 per cent in Portugal. The lowest prevalence was reported in Greece, Spain and Italy with 13.2 per cent, 11.5 per cent and 10.4 per cent, respectively. Similar tendencies were observed concerning minor/severe abuse. The Northern countries (Germany, Lithuania, Sweden) compared to Southern countries (Greece, Italy, Portugal, Spain) reported a higher mean prevalence (across countries) of minor/severe abuse (26.3 per cent/11.5 per cent and 12.9 per cent/5.9 per cent, respectively). Most perpetrators (71.2 per cent) were spouses/partners and other relatives (e.g. children). The regression analysis indicated that being from Greece, Italy, Portugal and Spain was associated with less risk of psychological abuse. Low social support, living in rented housing, alcohol use, frequent health care use, and high scores in anxiety and somatic complaints were associated with increased risk of psychological abuse. Social implications: Psychological abuse was more prevalent in Northern than Southern countries and factors such as low social support and high anxiety levels played an important role. Further studies are warranted to investigate the prevalence of psychological abuse and risk factors among older persons in other EU countries. Particular attention should be paid to severe abuse. Such research may help policy makers and health planers/providers in tailoring interventions to tackle the ever growing problem of elder abuse. Originality/value: The paper reports data from the ABUEL Survey, which collected population based data on elderly abuse

Workplace violence in a large correctional health servce in New South Wales, Australia: a retrospective review of incident management records

BackgroundLittle is known about workplace violence among correctional health professionals. This studyaimed to describe the patterns, severity and outcomes of incidents of workplace violenceamong employees of a large correctional health service, and to explore the help-seekingbehaviours of staff following an incident.MethodsThe study setting was Justice Health, a statutory health corporation established to providehealth care to people who come into contact with the criminal justice system in New SouthWales, Australia. We reviewed incident management records describing workplace violenceamong Justice Health staff. The three-year study period was 1/7/2007-30/6/2010.ResultsDuring the period under review, 208 incidents of workplace violence were recorded. Verbalabuse (71%) was more common than physical abuse (29%). The most (44%) incidents ofworkplace violence (including both verbal and physical abuse) occurred in adult maleprisons, although the most (50%) incidents of physical abuse occurred in a forensic hospital.Most (90%) of the victims were nurses and two-thirds were females. Younger employees andmales were most likely to be a victim of physical abuse. Preparing or dispensing medicationand attempting to calm and/or restrain an aggressive patient were identified as ‘high risk’work duties for verbal abuse and physical abuse, respectively. Most (93%) of the incidents ofworkplace violence were initiated by a prisoner/patient. Almost all of the incidents receivedeither a medium (46%) or low (52%) Severity Assessment Code. Few victims of workplaceviolence incurred a serious physical injury – there were no workplace deaths during the studyperiod. However, mental stress was common, especially among the victims of verbal abuse(85%). Few (6%) victims of verbal abuse sought help from a health professional.ConclusionsAmong employees of a large correctional health service, verbal abuse in the workplace wassubstantially more common than physical abuse. The most incidents of workplace violenceoccurred in adult male prisons. Review of the types of adverse health outcomes experiencedby the victims of workplace violence and the assessments of severity assigned to violentincidents suggests that, compared with health care settings in the community, correctionalsettings are fairly safe places in which to practice

Violence in caring : Risk factors, outcomes and support

The overall aim of this dissertation is to promote knowledge of violence against personnel in municipal caring by studying its magnitude, the risk factors involved, its consequences, and the significance of social support and prevention. A subsidiary aim was to develop methods for surveying and analyzing workplace violence in a care setting. The five papers in this dissertation are based upon three studies: a pilot study; a literature review based on database searches; and, a nationwide questionnaire survey of the seven largest occupations in municipal nursing and caring (administrators, nursing specialists, supervisors, direct carers, nursing auxiliaries, assistant nurses, and personal assistants). A total of 2,800 individuals were covered by the survey. Violence was defined broadly, encompassing both verbal and physical aggression aimed at personnel. The pilot study consisted in the testing of a recording form (list) to be used in the workplace, which resulted in a large number of violent incidents being reported. The literature review highlighted five distinct focuses of research on violence in a work setting. With the review as a foundation, a model for the identification and analysis of risks of violence was developed. The model operates at three levels: individual (specific factors), workplace (situational factors), and organization (structural factors). It was found in the questionnaire study that over half of respondents had been exposed to violence or threat of violence on one or several occasions over the previous year. Over nine percent reported that they had been exposed on a daily basis, but there were also cases of aggravated physical violence. All occupational groups were exposed, but degree of exposure varied between groups. Low age and short occupational tenure proved to act as risk factors, as too did certain types of workplaces, working full-time with patients/clients, reorganization (downsizing), and high workload. The consequences of acts of violence were many and varied. Financial, health-related, emotional, work-related, and social impacts were all reported. One out of five victims of violence sustained physical injuries, and emotional reactions were common. Violent acts did not only affect work with care recipients but also impacted on personnel s leisure time. Scarcely four out of ten had received support or help following an act of violence, while six out of ten stated that some kind of preventive intervention had been made in their workplace. The overall results indicate that violence is a work-environment problem within the health-and-care sector. Indeed, for many it is a daily recurring problem. Acts of violence have different consequences according to the individual and the workplace.Våld i omsorgsarbete Riskfaktorer, konsekvenser och stöd Avhandlingens övergripande syfte är att öka kunskapen om våld mot personal i kommunalt omsorgsarbete genom att studera dess magnitude, riskfaktorer, konsekvenser och betydelsen av social support och prevention. Ett ytterligare syfte var att utveckla metoder för kartläggning och analys av våld i omsorgsarbete. Avhandlingen grundar sig på tre studier, vilka behandlas i fem papers: en pilotstudie, en litteraturinventering i ett antal databaser och en rikstäckande enkätundersökning bland de sju största yrkesgrupperna inom kommunal vård- och omsorg (handläggare, specialister, föreståndare, vårdare, vårdbiträden, undersköterskor och personliga assistenter). Totalt 2 800 personer ingick enkätstudien. I avhandlingens studier definieras våld brett och omfattar både verbal och fysisk aggression mot personal. Under pilotstudien provades en registreringslista för lokalt arbetsmiljöarbete och ett stort antal incidenter rapporterades. Litteraturinventeringen lyfte fram fem skilda fokus i forskningen om våld i arbetssammanhang. En modell för identifiering och analys av våldsrisker utvecklades, bl a med litteraturinventeringen som bas. Modellen tar fasta på tre nivåer i en organisation, d v s individ (specifika faktorer), arbetsplats (situationella faktorer) och organisation (strukturella faktorer). Resultaten från enkätstudien visade att över hälften av de svarande hade blivit utsatta för våld eller hot om våld en eller flera gånger under det senaste året. Över nio procent uppgav att de blivit utsatta dagligen. Verbalt våld var vanligt, men även grövre fysiskt våld förekom. Alla yrkesgrupper var utsatta men graden varierade. Låg ålder och kort anställningstid visade sig vara riskfaktorer. Typ av arbetsplats, att arbeta hela tiden med vårdtagare, omorganisation (downsizing) och hög arbetsbelastning var andra riskfaktorer. Konsekvenserna av våldshändelserna var många och varierande. Ekonomiska, hälsorelaterade, emotionella och arbetsrelaterade samt sociala konsekvenser rapporterades. En av fem hade fått fysiska skador. Emotionella reaktioner var frekventa. Våldshändelser påverkade inte bara arbetet med vårdtagarna utan också fritiden. Knappt fyra av tio hade fått stöd och hjälp efter våldshändelsen. Sex av tio rapporterade att förebyggande insatser hade genomförts på arbetsplatsen. Avhandlingens samlade resultat pekar på att våld är ett arbetsmiljöproblem inom vård- och omsorgssektorn. Det är ett dagligt problem för många. Våldshändelser kan leda till olika konsekvenser för individen och för arbetsplatsen. Nyckelord: Våld, vård- och omsorgspersonal, riskfaktorer, arbetsförhållanden, konsekvenser, hjälp och stöd, förebyggande, modell, registrerin

Asiakaskokemuksen kehittäminen IT-kehityshankkeissa

Asiakaskokemus on viime vuosina noussut monen yrityksen kehityksen keskiöön. Yritykset ovat pakotettuja huomioimaan asiakkaan läpi kaiken toiminnan. Tämän työn tavoitteena oli löytää keinoja, joilla asiakaskokemusta voidaan kehittää IT-kehityshankkeiden aikana. Alun perin tarve työlle syntyi arjen keskustelussa. Kohdeorganisaatio on ollut useamman vuoden yrityskauppojen kohteena, jonka seurauksena sekä sisäiset ohjeistukset että ulkoinen toimintaympäristö on muuttunut. Työssä kuvataan asiakaskokemukseen vaikuttavia tekijöitä, kehityshanketta, sekä tuodaan esiin jatkokehitystarpeita. Tutkimus on toteutettu laadullisena toimintatutkimuksena, jossa on narratiivisia piirteitä. Tutkimuksessa on haastateltu asiakkaiden edustajia sekä osallistettu kohdeorganisaation henkilöstöä. Haastatteluiden perusteella pyrittiin selvittämään haastateltavien tiimien ja omakohtaisten kokemusten kautta parhaita käytäntöjä, eniten lisäarvoa tuottavia hetkiä, sekä kehittämistä vaativia asioita. Kehitystyö toteutettiin syklisesti, ja kehitettävistä asioista viestittiin laajasti. Tutkimus nosti esiin paljon kehityskohteita, joista työn aikana valittiin kehitettäväksi kolme pääteemaa. Työn tuloksena saatiin rakennettua selkeät suuntaviivat asiakaskokemuksen kehittä miseksi, sekä suunnitelma muutosten toteuttamiseksi. Osa kehitystyöstä tehtiin työn tekemisen yhteydessä

Home/Work : Möbler för att bryta stillasittande

Home/work: objekt för hemmet att interagera, leka och träna med. I Sverige sitter vi i genomsnitt 10h/dag, vilket är associerat med en lång rad risker, så som kardiovaskulära sjukdomar, högt blodtryck, högt blodsocker, övervikt, onormala kolesterolnivåer etcetera. Home/work är ett försök att knuffa i gång oss som sitter för mycket att få in mer rörelse i vardagen. Objekten är inspirerade av klättergrepp, crashpads och bouldering. Projektet ifrågasätter begreppet ergonomi och dess inneboende positiva konnotation. Home/work: piece of furniture for the home to interact, play and exercise with. In Sweden we sit in average 10H/day. This is associated with a lot of risks, such as cardiovascular diseases, increased blood pressure, high blood sugar, excess body fat and abnormal cholesterol levels. Home/work tries to nudge us (who sit too much) to move a little bit more in our everyday life. The objects are inspired by climbing holds, crash pads and bouldering. The project questions the concept of ergonomics and its inherent positive connotation

Home/Work : Möbler för att bryta stillasittande

Home/work: objekt för hemmet att interagera, leka och träna med. I Sverige sitter vi i genomsnitt 10h/dag, vilket är associerat med en lång rad risker, så som kardiovaskulära sjukdomar, högt blodtryck, högt blodsocker, övervikt, onormala kolesterolnivåer etcetera. Home/work är ett försök att knuffa i gång oss som sitter för mycket att få in mer rörelse i vardagen. Objekten är inspirerade av klättergrepp, crashpads och bouldering. Projektet ifrågasätter begreppet ergonomi och dess inneboende positiva konnotation. Home/work: piece of furniture for the home to interact, play and exercise with. In Sweden we sit in average 10H/day. This is associated with a lot of risks, such as cardiovascular diseases, increased blood pressure, high blood sugar, excess body fat and abnormal cholesterol levels. Home/work tries to nudge us (who sit too much) to move a little bit more in our everyday life. The objects are inspired by climbing holds, crash pads and bouldering. The project questions the concept of ergonomics and its inherent positive connotation

Samverkan i distansutbildning, från fristående kurser till examen i folkhälsovetenskap

Att främja jämlik hälsa är komplext och kräver inte bara mångvetenskap utan också tvärvetenskap för att få en ökad insikt och förståelse om dagens hälsoproblem. Distansundervisning gör det möjligt för studenterna att vara rums- och tidsoberoende så väl som ortsoberoende. I denna artikel redo-visas en folkhälsoutbildning som leder till kandidatexamen. Utbildningen är en samverkan mellan två lärosäten i Sverige, Högskolan i Halmstad och Mittuniversitetet i Sundsvall. Utbildningen är på it-distans och börjar med A- och B-kurser på Högskolan i Halmstad med inriktning i hälsa och livs-stil med fortsättning sedan på Mittuniversitetet i Sundsvall med utbildnings-fokus på projektplanering och projektledning för att kunna genomföra strategiska insatser för bättre folkhälsa på organisations- och samhälls-nivå. Utbildningen avslutas med en kandidatexamen i Folkhälsovetenskap.To promote equity in health is complex and requires not only multidisciplinary methods but also interdisciplinary studies to get a better insight and under-standing of today’s health problems. Distance learning makes it possible for students to be room-and-time-independent as well as local independent. In this article we present, a public health education leading to a Bachelor’s degree. The programme is a collaboration between two universities in Sweden, Halmstad University and Mid Sweden University in Sundsvall. The training is at it-distance and begins with basic courses at Halmstad Univer-sity with a specialization in health and lifestyle. Further, the students starts at the Mid Sweden University in Sundsvall with focus on project planning and project management to implement strategic actions for better health at the organizational and societal level. The programme ends with a Bachelor’s degree in Public Health