Objective: This study aims to examine the circumstances associated with patients’ tendencies to recommend a primary care centre, based on four hypotheses, the initial contact’s quality, care relationship continuity, treatment encounter responsiveness and whether the significance of encounter responsiveness differs depending on whether the patient has been seeing a nurse or physician. Design: The study is based on the patient’ self-reported responses, retrieved from the Swedish National Patient Survey. The design is cross-sectional, and data were analysed using a binary logistic regression. Setting: Data were collected from three primary healthcare centres in the region of Västra Götaland, Sweden. Participants: A total of 362 patients (62% females) having visited any of three publicly run healthcare centres in September 2010 constitute the analytical sample. Participants were fairly evenly distributed across all age groups. Main Outcome Measures: Recommendation was captured by patients’ binary responses to the question: Would you recommend the visited primary healthcare centre? Results: The hypotheses involving initial contact quality, care relationship continuity and treatment encounter responsiveness were supported by the analyses. The latter was strongly associated with patient tendency to recommend the primary healthcare centre. However, the profession (nurse or physician) involved in the treatment encounter made no difference for the predictive significance of encounter responsiveness for a patient’s tendency to recommend the healthcare centre. Conclusions: Striving for stable and responsive patient/staff relationships and an open approach towards patients are potentially successful strategies for primary healthcare centres seeking to attract new patients and maintain current ones. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)

Det övergripande syftet med denna rapport är att beskriva chefers etiska värderingar, dilemman och organisatoriska förutsättningar för att bedriva ett värdebaserat ledarskap i såväl kommunal som privat äldreomsorg.

Det empiriska materialet består av en omfattande enkätstudie till nästan 500 studerande inom ramen för den nationella ledarutbildningen för chefer inom äldreomsorgen vid Högskolan i Borås under perioden 2013 till 2015. Utbildningen gavs på uppdrag av Socialstyrelsen och omfattade 30 högskolepoäng med två års studier på kvartsfart. Samtliga studerande var yrkesverksamma som chefer och ledare inom kommunal eller privat äldreomsorg i södra Sverige. Metoder som använts i bearbetning och analys av materialet är deskriptiva, jämförande och analytiska med regressionsmodeller och SEM-analys.

Resultatet visar på att cheferna – oavsett utbildningsbakgrund, värderade följande etiska värden högst: att inte skada, respekt för individen och rätten till konfidentialitet. Värdedilemman i chefsarbetet är dock vanligt och sammanlänkat med andra utmaningar i arbetet, särskilt med utmaningar som rör hantering över organisationsnivåer (buffertproblem och containerproblem) och av olika ansvarsområden (logikkonflikter). Inom privat verksamhet skattade de medverkande cheferna värdekonflikter och andra utmaningar i lägre grad än chefer inom kommunal verksamhet.

De flesta chefer var nöjda med hur de kunde fullfölja sitt ansvar för utveckling av verksamheten avseende värdegrund, kvalitet, processer, dagligt arbete, brukarmedverkan, brukarsäkerhet och arbetsmiljö. De flesta skattade också att de arbetade i mycket hög grad med strukturering och utveckling av dessa frågor.

Stödresurser minskade upplevelsen av värdekonflikter, men det fanns skillnad i betydelsen relaterat till chefers grundprofession. Det organisatoriska stödet var också tydligare för chefer inom privat verksamhet. Organiserade stödresurser hade stor betydelse för hållbart integrerat och värdeskapande ledarskap samt för aktiva ledningsstrategier. Även sambandet mellan hållbart ledarskap och aktiva ledarstrategier modererades av grundprofession, där sambandet var moderat negativt för chefer med social grundutbildning. Det tycks således finnas ett utbildningsbehov bland äldreomsorgens chefer och behov av ett utvecklat stöd från arbets- HÖGSKOLAN BORÅS HÖGSKOLAN BORÅS 15 givaren då det varierar avseende omfattning, inriktning och nivå mellan kommunal och privat verksamhet.

Sammanfattningsvis har chefer i äldreomsorgen många olika värden, på olika nivåer och utifrån olika perspektiv att förhålla sig till i sitt ledarskap. Att hantera och utveckla förståelse för dessa är utmanande i chefskapet och värdedilemman är vanliga. Majoriteten av cheferna i denna studie beskriver dock generellt en aktiv och god hantering och organisering av dessa. Konstateras att en integrerad förståelse och hantering, samt goda organisatoriska stödresurser tycks bidra till mer hållbart och värdeskapande ledarskap.

OBJECTIVE: Investigate hearing function and headphone listening habits in nine-year-old Swedish children.

DESIGN: A cross-sectional study was conducted and included otoscopy, tympanometry, pure-tone audiometry, and spontaneous otoacoustic emissions (SOAE). A questionnaire was used to evaluate headphone listening habits, tinnitus, and hyperacusis.

STUDY SAMPLE: A total of 415 children aged nine years.

RESULTS: The prevalence of a hearing threshold ≥20 dB HL at one or several frequencies was 53%, and the hearing thresholds at 6 and 8 kHz were higher than those at the low and mid frequencies. SOAEs were observed in 35% of the children, and the prevalence of tinnitus was 5.3%. No significant relationship between SOAE and tinnitus was found. Pure-tone audiometry showed poorer hearing thresholds in children with tinnitus and in children who regularly listened with headphones.

CONCLUSION: The present study of hearing, listening habits, and tinnitus in nine-year old children is, to our knowledge, the largest study so far. The main findings were that hearing thresholds in the right ear were poorer in children who used headphones than in children not using them, which could be interpreted as headphone listening may have negative consequences to children's hearing. Children with tinnitus showed poorer hearing thresholds compared to children without tinnitus.

People with sleep-onset problems often experience neuroticism. To what extent the one problem leads to the other is unknown. We used self-reported data from a Swedish longitudinal project to examine developmental links between neuroticism and sleep-onset problems. A sample of 212 people, followed from birth to midlife, was part of a cohort study spanning 37 years. Adolescent neuroticism was measured at age 16 with the High School Personality Questionnaire (HSPQ, Form A) and in midlife at age 37 with the Eysenck Personality Questionnaire (EPQ). Sleep-onset problems were measured at ages 15 to 17, 25, and 37 with items developed for the Solna Project. Adolescent neuroticism failed to predict sleep-onset problems. Instead, sleep-onset problems in adolescence and young adulthood predicted midlife neuroticism. We found that sleep-onset problems during adolescence were a direct risk for midlife neuroticism, as well as, an indirect risk through continuance of sleep-onset problems into adulthood. This study provides longitudinal support for adolescent sleep-onset problems as a potent risk factor for heightened neuroticism in midlife. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract)

Chefer kan ha stor betydelse för anställdas hälsa, stress, engagemang i arbetet och prestation. Få tidigare studier har undersökt vilket stöd chefer behöver för ett hållbart och bra ledarskap. Artikeln presenterar resultat från en prospektiv studie om betydelsen av chefers stödresurser för hållbart ledarskap. I studien, som är en del av Chefios-projektet, ingår chefer i kommunal vård och omsorg (n=344). Data från enkätstudier med instrumentet ”Gothenburg Manager Stress Inventory” har analyserats. Resultatet visar att ett stödjande privatliv och en personlig inställning till chefsuppdrag har stor betydelse för chefers hållbarhet över tid. Chefens kontrollspann och erfarenhet som chef påverkade betydelsen av stödresurser. För chefer med kortare chefserfarenhet eller fler underställda (>30) har även stöd från ledning, chefskollegor och externt stöd betydelse.

Aim to assess the importance of managerial support from superior, colleagues, external, employees and private life and its importance for managers’ health- related sustainability Background. Managers and leadership can have a great importance for employees’ health related sustainability. Few published studies, have investigate what kind of support managers need to sustain in their position with preserved health. Design. A prospective cohort study with data collection 2009 and 2011. Methods. All first and second line managers for public health care in seven Swedish municipalities were included (n=344). Managers’ health related sustainability and support resources were measured with Gothenburg Manager Stress Inventory. Analysis with structured equation modeling with a crossed-lagged panel design. Results. All of the studied sources of support were cross-sectional associated with sustainable health, but only support from private life predicted health related sustainability across time. Stratified analyses revealed further prospective associations. First, among less experienced managers, all of the studied sources of support predicted at least some aspect of health-related sustainability. Second, among managers with a large span of control (>30 subordinates), external support and support through good cooperation with subordinates predicted health-related sustainability. Conclusion. It is important to provide health care mangers with adequate support, but only support through private life predicted health-related sustainability. Socializing as well as organisational support was strongly predicting sustainable health among managers new in their role and managers with a large span of control.

Objective To investigate whether a dance intervention for adolescent girls reduces stress-related symptoms. Methods This was a randomized controlled trial of an after-school intervention. Participants were 112 girls aged 13 to 18 years with stress-related somatic symptoms and emotional distress. The intervention comprised twice-weekly dance sessions for 8 months with a focus on enjoyment and socialization. A questionnaire was administered at baseline and after 8, 12 and 20 months. Participants rated the frequency with which they had experienced somatic symptoms and emotional distress during the previous 3 months. Results After the intervention, there was a significantly greater reduction in somatic symptoms and emotional distress in the dance intervention group than in the control group. The difference in the mean score change on a 5-point scale was 0.26 (95% confidence interval [CI]: 0.04 to 0.47) for somatic symptoms and 0.30 (95% CI: 0.04 to 0.58) for emotional distress. Conclusion Dance interventions may reduce somatic symptoms and emotional distress in adolescent girls, and may constitute a nonpharmacological complement to school health services. However, continued participation is needed for long-term sustainable results. Additional randomized studies are required to further evaluate the effect of this type of intervention in different settings. This study was registered with ClinicalTrials.gov. Study name: ‘Influencing Adolescent Girls With Creative Dance Twice Weekly’. 

Patients in intensive care suffer from severe illnesses or injuries and from symptoms related to care and treatments. Environmental factors, such as lighting at night, can disturb patients' circadian rhythms. The aim was to investigate whether patients displayed circadian rhythms and whether a cycled lighting intervention would impact it. In this pilot study (N=60), a cycled lighting intervention in a two-bed patient room was conducted. An ordinary hospital room functioned as the control. Patient activity, heart rate, mean arterial pressure and body temperature were recorded. All data were collected during the patients' final 24h in the intensive care unit. There was a significant difference between day and night patient activity within but not between conditions. Heart rates differed between day and night significantly for patients in the ordinary room but not in the intervention room or between conditions. Body temperature was lowest at night for all patients with no significant difference between conditions. Patients in both conditions had a natural circadian rhythm; and the cycled lighting intervention showed no significant impact. As the sample size was small, a larger repeated measures study should be conducted to determine if other types of lighting or environmental factors can impact patients' well-being.

Aims

To investigate how job demands and resources interact with each other to predict intention to leave among assistant nurses and Registered Nurses.

Design

Longitudinal study.

Methods

Questionnaire data were collected yearly during three years (October 2012-December 2014) from Registered Nurses (RN) and assistant nurses (N = 840) employed in Swedish hospitals. Associations and interaction effects of demands and resources were assessed with correlation analyses and regression models.

Results

Job demands predicted assistant nurses’ intentions to leave, while resources predicted RNs’ intention to leave. For RNs, several resources were functional in moderating the associations between demands and intention to leave: social support, vertical trust, and humanity moderated work pace and workflow moderated emotional demands. For assistant nurses, organizational clarity and interprofessional collaboration moderated emotional demands. None of the resources had a moderating effect on the associations between quantitative demands or illegitimate tasks and intention to leave.

AIM:

The aim of this study was to investigate how restricted decision making autonomy and conflicting demands impact operational managers' work performance and health.

BACKGROUND:

Managers at operational level (first and second-line managers') in health care organizations are commonly exposed to strain in their work situation with high demands and a challenging work context. Although they play an important role, the knowledge about the causal associations between stressful job demands and their consequences is limited.

METHODS:

A prospective design with questionnaire data collected at two points in time, one year apart, from a sample of operational managers (N = 162) at five Swedish hospitals was used to conduct a structural equation model (SEM) analysis with cross-lagged paths.

RESULTS:

Restricted decision making autonomy was negatively associated with both the managers' health and their managerial work performance over time.

CONCLUSIONS:

Health care managers' work performance and health may be sustained by the top management allowing them a higher degree of autonomy in their decision making.

IMPLICATIONS FOR NURSING MANAGEMENT:

This study suggests that nursing leaders should create the circumstances for operational managers' to have higher levels of autonomy in their area of responsibility and the freedom to prioritize their managerial workload. 

The potential importance of psychological aspects in relation to risk factors for fractures and preventing unhealth behaviour has rarely been investigated in the field of osteoporosis. This study explores some psychological aspects and health behaviour of people detected to have osteoporosis at the time of a forearm fracture. Moreover, it aims at revealing subgroups within this population with clinical relevance for managing secondary prevention actions. Data collection was based on questionnaires and physical tests. Eighty-five individual were analysed. The results confirm earlier research on a similar population having relatively good self-reported health behaviour. The individuals reported high quality of life, high amount of physical activity and low alcohol intake. A majority reported good osteoporosis knowledge, a high sense of coherence (mean = 74) and high activity-specific balance confidence (mean = 81). Furthermore, hierarchical cluster analysis indicated a typology of two subgroups where 75% matched a health-resilient group while 25% matched a health-vulnerable group. The vulnerable group had a significantly lower sense of coherence SOC (p = 0.02) and activity-specific balance confidence, ABC (p = 0.001). This pattern was confirmed from behavioural aspects but only regarding one traditional risk factor namely the history of fractures. The health-vulnerable group achieved a significantly weaker physical profile, less reported time spent outdoors and lower quality of life. The differences found between the subgroups indicate that this typology, as a complement to models based upon relative risk like FRAX, can be relevant for widening perspectives in future research and clinical practice of fracture prevention in osteoporosis.

Sleep duration and sleeping difficulties among adolescents: exploring associations with school stress, self-perception and technology use

Sleeping problems are increasing among adolescents worldwide. This study aimed to describe the prevalence of self-reported sleep duration and sleeping difficulties, as well as to explore their associations with school stress, self-perception, that is how adolescents perceive their appearance and happiness, and technology use among adolescents. Data were collected in 2015 using a questionnaire. A total of 937 ninth grade adolescents, 15–16 years, from a city in western Sweden participated, resulting in a response rate of 83%. The result showed that 55% of the adolescents slept less than the recommended 8 hours per night and 11% had sleeping difficulties. School stress and technology use were associated with short sleep duration. School stress and self-perception were associated with sleeping difficulties. The girls had worse outcomes for sleeping difficulties, school stress, self-perception and technology use than the boys. Based on the results, there is a need for school nurses to implement preventive measures to improve adolescents’ sleep.

I syfte att predicera sjukfrånvaron på 38 vårdenheter i Västra Götalandsregionen användes enhetschefernas självrapporterade uppgifter om arbetsmiljö och arbetsrelaterad hälsa. Data analyserades med hjälp av binär logistisk regression. Utfallsvariabeln baserades på klusteranalyser av sjukfrånvaroincidens för perioden 2013-2016, där varje sjukvårdsenhet representerades av antingen en gynnsam eller en ofördelaktig trend. Analyser utfördes separat för undersköterskor och sjuksköterskor och för kombinationen av båda yrkesgrupperna inom tre olika sjukfrånvarointervall (0-7 dagar/år; 8-27 dagar/år; ≥ 28 dagar/år). Resultaten gav få belägg för att chefers arbetssituation predicerar sjukfrånvaro på hela vårdenheter. Dock fanns vissa indikationer på att chefers burnout möjligen har en sådan effekt.

(1) Background: Both employees and organizations benefit from a work environment characterized by work engagement and job satisfaction. This study examines the influence of work-group social capital on individuals’ work engagement, job satisfaction, and job crafting. In addition, the mediating effect of job crafting between social capital on the one side and job satisfaction and work engagement on the other side was analyzed. (2) Methods: This study used data from 250 health-care employees in Sweden who had completed a questionnaire at two time points (six to eight months apart). Analyses of separate cross-lagged panel designs were conducted using structural regression modeling with manifest variables. (3) Results: Social capital was predictive of both job satisfaction and work engagement over time. The results also indicated that higher degrees of social capital was predictive of more cognitive and relational, but not task-related job crafting over time. There was no clear evidence for a mediating effect of job crafting for social capital to work engagement or job satisfaction. (4) Conclusion: It would be beneficial for the health-care sector to consider setting up the organizations to promote social capital within work groups. Individual workers would gain in well-being and the organization is likely to gain in efficiency and lower turnover rates.

The predictive effects of peer victimization and harsh parenting on deliberate self-harm were examined. As derived from the experiential avoidance model, the study also tested whether these links were moderated by individual self-regulation approaches. Data were collected at two points in time from 880 junior high school students (mean age = 13.72) in Sweden. Analyses using structural equation modeling revealed that Peer Victimization was predictive of self-harm. Although Harsh Parenting was not predictive of self-harm, this link was moderated by adolescents' gender. No moderating effect of self-regulation was revealed. The study concludes that the high prevalence of deliberate self-harm recently found in community samples of adolescents cannot be prevented without attending to environmental psychosocial factors. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract)

The authors, with Swedish elementary school students (N = 201), 9–12 years old, examined the potential significance to self-perceived academic competence of students' cross-ethnic friendship ties and prosocial behavior to better understand education's minority achievement gap. A crossed-lagged panel model was tested to investigate potential relationships between these variables over time, while controlling for temporal associations. The results revealed that higher levels of prosocial behavior were related to more positive academic performance six months later. However, higher levels of cross-ethnic friendship did not. The findings further establish the predictive influence of prosocial behavior on academic competence, indicating that this over-time relation is applicable also in the North European context, with its increasingly diverse ethnicity.

Four specific schemas of cognitive structures that adolescents may hold concerning interpersonal disagreements with their parents were identified, each reflecting an authoritative, authoritarian, indulgent, or a neglecting parenting style. To examine the occurrence of such schemas across high and low levels of psychosocial adjustment, 120 Swedish adolescents (50 boys, 70 girls) (mean age = 14.76 years) indicated how their parents usually approach six potential situations involving parent-adolescent conflict. Findings show that the authoritative conflict schema (compliance as a result of mutual respect) occurred more often among well-adjusted adolescents, whereas authoritarian and indulgent conflict schemas were particularly associated with low levels of psychosocial adjustment. The concept of conflict schemas may contribute to the understanding of how various parenting styles are linked to certain developmental outcomes for the adolescent. 

Two samples (pairwise matched in terms of sex of child, age of child, and fathers’ education) of fathers from Sweden (n = 50) and the US (n = 50) respectively were interviewed about their use of parental discipline when in conflict with their 38–66-month-olds. The results show that, compared with US fathers, Swedish fathers display a range of disciplining approaches from punitive reprimands (i.e., behaviour modification and physical punishment) to restrictive control approaches (i.e., verbal control and physical restraint). No difference was found between Swedish and US fathers in terms of their general tendency to assert compliance when their children misbehave. Copyright © 2002 John Wiley & Sons, Ltd.

Objectives

The study examined the possibility that a mediating role of positive and negative emotional expressivity may contribute to understanding the associations between social loneliness and its previously identified predictors (i.e. health, age, sex, and social living situation).

Method

Self-reported assessments were collected from community-dwelling Swedish residents (aged 65 and above) in job retirement. Structural equation modeling with manifest variables was applied to cross-sectional data (N = 601) to analyze two competing models; one main-effect regression model, examining the predictive effect of emotional expressivity (along with health and sociodemographics) on social loneliness, and one mediation model, examining the mediating effect of emotional expressivity (using the bootstrapping technique provided in Mplus).

Results

The results indicated that the mediation model fit the data considerably better than the main-effect regression model (Δχ2 [Δdf = 8] = 72.69, p < 0.00001), and demonstrated a good fit on its own, with CFI = 0.986 and RMSEA = 0.030. This suggests that emotional expressivity contributes to the understanding of the connection between social loneliness and its previously identified predictors.

Conclusion

Recognizing the significance of emotional expressivity has the potential to enhance our understanding of loneliness in older adults, both in theory and in practice.

It is known that intimate partner violence (IPV) negatively affects both parental capacity and children’s well-being, but few studies have focused on the experiences of those taking part in family interventions focused on IPV. In this study, 26 parents (16 mothers and 10 fathers) with a history of IPV participated in focus groups concerning their attachment-based group intervention experience in the program Parenting and Violence. The transcripts, subjected to thematic analysis, showed that participants experienced the intervention as supportive and confirming of their role as parents. Parents described feeling more in control, more self-confident, more skilled in communicating, and more able to provide security for their children. However, they also expressed a need for continuing support to maintain their improved parenting strategies.

A crossed-lagged regression model was tested to investigate relationships between friendship support, bullying involvement, and its consequences during adolescence. Students, 12–16 years ( N = 880), were administered questionnaires twice, one year apart. Using structural equation modeling, a model was specified and higher levels of support from friends were related to lower levels of bullying and victimization one year later. Additionally, a bidirectional relationship between victimization and depression was found, and greater property crimes commission was related to higher levels of future bullying. These findings support the ‘friendship protection hypothesis’ and suggest the quality of support in friendships can protect against bullying victimization and perpetration. Prior research has shown that friendships can protect against victimization; however this is one of the few longitudinal studies to focus on the quality of friendship, rather than other characteristics of the friends. It is suggested that interventions should focus on increasing perceptions of support within existing friendships.

Research has indicated that social and emotional learning (SEL) programs can offer benefits to students and school environments. However, students’ experiences of participation in such programs have not received as much attention. This focus group study describes elementary students’ (N = 23) experiences of and beliefs about participation in a school-based SEL program commonly used in Sweden, Life Skills Training. The results suggest questionable acceptability of the program by the students, indicating a clear belief that the school’s implementation of the program was due to their problematic behavior. Although students experienced the program content as predictable, consistent, and structured, there was great variation in their attitudes toward the program: Both strong negative and positive attitudes were revealed. The students also expressed discomfort with the personal nature of the discussions promoted by the program and uncertainty about its place in the school setting. These findings can inform SEL program implementation.

A good school climate can promote children's development in school as well as in life in general. To create good conditions for all students requires resources and in-depth knowledge regarding a variety of factors; here, sociocultural diversity is in focus.

Titled The Whole School: school and social services based integration work, the Whole School Project consisted of integration work in a multicultural school environment. Two therapeutic social workers worked actively on these issues for one year among students in grades 1–6 at Byttorpskolan, City of Borås, and their parents during 2013–2014. The Public Health Agency of Sweden funded the project as a development project focusing on support to children and families. The project was conducted in collaboration between the City of Borås and FoU Sjuhärad Välfärd.

The overall project objective was to develop and test a school-based work- ing model with children and parents to increase social integration (i.e., students’ tendency to have friends of a different ethnic background). To examine whether increased integration contributes to the improvement of students’ academic achievement and prosocial behavior (i.e. rule-following and the propensity to be a ”good friend”) was also a goal. The project also developed and quality-assessed a survey instrument for children regarding the project’s three quantitative foci: social integration, school performance, and prosocial behavior.

FoU Sjuhärad Välfärd participated initially in the development of the pro- ject and then had the task of evaluating the same. The evaluation consisted of a quantitative main study and five qualitative studies. The main study was a survey in which elementary school students at the project school (Byttorpskolan) and

14 Utvärdering av projektet Hela Skolan

a comparison school (Hestra Midgårdskolan, another F-6 school in the City of Borås) answered questions about the evaluation’s three main areas on four diffe- rent occasions. The qualitative studies consisted of interviews and focus groups with students, parents, and school staff based on their experiences of The Whole School Project. A process evaluation of project implementation and compliance was based on document studies, participant observation, and interviews.

The Whole School Project developed and evaluated a variety of interventions with different target groups, two in particular: a group activity with a focus on values directed at students and network meetings with parents. The results of the evaluation indicate that the network meetings, a structured form of parent meet- ings, can contribute to the promotion of integration between parents with and without an immigrant background and increase engagement in Swedish schools, particularly among parents with an immigrant background.

The project has developed a working model related to issues of integration and the well-being of children in school. The Whole School Project also deve- loped a survey instrument for school children in a multicultural environment that addresses social integration, school performance, and prosocial behavior. In some other respects, the project was less successful. The project's interventions showed no clear benefits for the children, and changes in social integration could not be linked to changes in school performance and prosocial behavior over time. To some extent, this may have to do with the project’s purpose and goals in rela- tion to its resources and very limited timeframe. 

To explore young adolescents’ negotiation of their national identity in an educational context, we individually interviewed nine students (ages 10–14) with different backgrounds attending an ethnically diverse school in Sweden. The transcribed interviews were thematically and qualitatively analyzed. Results show that students negotiated their national identity as being quantifiable, often as sized portions of a whole or percentages, and dichotomous (Swedish vs. non-Swedish). Their national identity negotiation further related to feelings of belonging as well as to birthplace, appearance, and language. Results suggest that national identity is more complex for youth with immigrant backgrounds and that the status conferred by being part of the majority group is recognized in ethnically diverse and segregated contexts. These findings on young adolescents’ national identity negotiations can inform future research or educational practices as well as curricula to support national identity development or feelings of belonging in diverse school settings. 

BACKGROUND AND AIM:

Health status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling.

METHODS:

Using computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007-2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit.

RESULTS:

The measurement model yielded a reasonable fit to the data, χ2=110.93, df=38; CFI=0.97; RMSEA=0.047, with 90% C.I.=0.037-0.058. The model fit for the conceptual model was acceptable; χ2=271.64, df=39; CFI=0.91; RMSEA=0.084, with 90% C.I.=0.074-0.093. SES itself was not a direct predictor of HS (β=0.13, p=0.059) but it was a predictor of HS either through affecting PA (β=0.31, p<0.001) or I (β=0.57, p<0.001).

CONCLUSION:

Socioeconomic status appeared to influence health status, not directly but through mediating some behavioral and self-confidence aspects including physical activity and independence in ADL.

BACKGROUND AND AIM: Health status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling.

METHODS: Using computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007-2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit.

RESULTS: The measurement model yielded a reasonable fit to the data, χ2=110.93, df=38; CFI=0.97; RMSEA=0.047, with 90% C.I.=0.037-0.058. The model fit for the conceptual model was acceptable; χ2=271.64, df=39; CFI=0.91; RMSEA=0.084, with 90% C.I.=0.074-0.093. SES itself was not a direct predictor of HS (β=0.13, p=0.059) but it was a predictor of HS either through affecting PA (β=0.31, p<0.001) or I (β=0.57, p<0.001).

CONCLUSION: Socioeconomic status appeared to influence health status, not directly but through mediating some behavioral and self-confidence aspects including physical activity and independence in ADL.

BACKGROUND: Patients who call for an ambulance but only have primary care needs do not always get appropriate care. The starting point in this study is that such patients should be assigned to as basic of care as possible, while maintaining high levels of patient trust and patient safety.

AIM: To evaluate patient trust and patient safety among low-priority ambulance patients referred to care at either the Community Health Centre (CHC) or the Emergency Department (ED).

METHODS: This randomized controlled trial pilot study compared the level of patient trust and patient safety among low-priority ambulance patients who were randomized into two groups: CHC (n = 105) or ED (n = 83).

RESULTS: There was a high level of trust in the care received, regardless of whether the patient received care at CHC or ED. Overall 31% fulfilled one or more of the given criteria for potentially jeopardizing patient safety.

CONCLUSION: Patient selection for the trial indicated a potential limit in patient safety. There was a high level of trust in the care received regardless of whether the patient received care. The accuracy of patient selection for the new care model needs to be further improved with the intention to enhance patient safety even further.

Rationale aims and objectives: The objective of this study was to develop a questionnaire measuring the level of trust and its constituents in patients calling the Emergency Medicak Services (EMS) for suspected acute primary healthcare problems. The questionnaire is called the Patient Trust Questionnaire (PTQ). The following frontline service providers were involved: 1) The Dispatch Centre, 2) the Emergency Medical Services and 3) the recieving unit (the Emergency Department/Healthcare Centre)

Method: Cross-sectional data were collected repeately and redundant items were discarded using a step-by-step approach. Based on litterature review, the PTQ was developed in line with the folowing 4-step procedure: 1) item construction, 2) a face-to-face evaluation of separate items, 3) an emerical pre-evaluation targeting each separate frontline service provider and 4) an emperical full-scale evaluation. The inclusion criteria for participating were that the patient must be 18 years of age or older and suspected having a suspected acute primary care problem when calling the EMS. In the finale full-scale evaluation of the questionnaire, 427 patients were included.

Results: A set of 8 items with good phsycometric properties remained through the developing procedure. Two constituents of trust emerged (labelled credibility and accessibility), witch were robust across all fronline service providers.

Conclusion: A new measuring instrument has been developed for this particular healthcare chain, for patients with suspected acute primary care problem calling the EMS. Althought not yet validated, the PTQ is a potentially usefull tool in future healthcare research with reference to the concept of patient trust.

Objective: Mothers who have negative breastfeeding experiences due to initial breastfeeding difficulties are indemanding existential situations. Therefore, it is important for healthcare professionals to identify and addresssuch breastfeeding problems. The aim of this study was to develop an instrument designed to assess existentialaspects of mothers’ initial breastfeeding difficulties and evaluate its psychometric properties.

Methods: This study reports on the development of a new instrument and was carried out in three steps: (1) aquestionnaire about various existential aspects of initial breastfeeding difficulties, based on 66 items derivedfrom two phenomenological studies, was developed; (2) information was collected using the questionnaire; (3)and the resulting data were statistically analysed. Spearman’s correlation coefficient was used to assess comparativevalidity; exploratory factor analysis with principal axis factoring and varimax rotation were used toassess construct validity; and Cronbach’s alfa was used to assess internal consistency and reliability. Threehundred and nine Swedish-speaking mothers aged 20–46 participated in the study.

Results: Correlation and factor analysis of the 66 items revealed that 16 of the items were of psychometric valueand valid. Factor analysis generated three factors that accounted for 62.9% of the total variance: Mother-Child Interdependency, Exposure and Vulnerability and Security and Trust. The instrument shows adequate sensitivity toidentify existential aspects of mothers’ initial breastfeeding difficulties.

Conclusion: The instrument satisfactorily assesses existential aspects of initial breastfeeding difficulties and canbe used as a sensitive tool by healthcare professionals to screen for and identify mothers who have negativebreastfeeding experiences.

This study examined the effects that re-occurring episodes of child transgression have on Swedish parents' use of discipline strategies. Mothers and fathers from 84 two-parent families were interviewed about their responses to first- and second-time episodes of hypothetical transgressions committed by their 3-6-year-olds. The results showed that when their children did not respond to initial discipline, parents exchanged their use of verbal control for the strategies of coercion and behaviour modification and thereby increased the pressure on their children to comply. However, this finding was valid only for serious transgressions. For mild transgressions, parents' behaviour was consistent across first- and second-time episodes. The conclusion that is drawn is that parents appear to be willing to follow up initial disciplining attempts. The Swedish corporal punishment ban, which has been in force since 1979, therefore appears not to have influenced parents to become permissive in their attitudes toward their children's misconduct. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract)