Mid Sweden University

Background: Problem drinking and illicit drug use among healthcare workers (i.e., physicians and nurses) may impair their attention and cognitive functioning, thereby increasing the risk of medical errors and diminishing the quality of patient care. Objective: To investigate the association between healthcare workers' problem drinking and illicit drug use with subsequent self-rated quality of care provided. Design: A two-wave longitudinal observational study. Methods: Panel data were drawn from the Longitudinal Occupational Health Survey in Healthcare Sweden (LOHHCS), collected in 2022 (baseline) and 2023 (follow-up), encompassing a sample of 3280 healthcare workers. Questionnaires included problem drinking, illicit drug use (cannabis and stimulants), and self-rated quality of care they provide to patients. Logistic regression models analysed relationships between the study variables. Results: At baseline, the prevalence of problem drinking was 3.8 %, and illicit drug use was 1.3 %. Both problem drinking (OR = 1.93, 95 % CI = 1.28–3.02) and illicit drug use (OR = 2.07, 95 % CI = 1.00–4.29) were significantly associated with lower self-rated quality of care provided at follow-up, after adjustment for confounding variables. Conclusions: This novel longitudinal study shows that healthcare workers reporting substance use at baseline were about twice as likely to report providing poor quality of care one year later. These findings are of clinical relevance and highlight the need for targeted preventive measures and interventions to safeguard the health and well-being of healthcare workers while maintaining quality standards in patient care. 

Background: Research suggests a comorbidity between illicit drug use and mental health conditions. However, it remains unclear whether illicit drug use serves as a risk factor for, or a consequence of, mental health conditions in healthcare workers (HCWs). This study aimed to 1) examine the prevalence of illicit drug use among HCWs in Sweden and 2) investigate the bidirectional relationship between illicit drug use and mental health conditions(i.e., depression and burnout). Methods: Data from the 2022 and 2023 Longitudinal Occupational Health Survey in Healthcare Sweden (LOHHCS) were used. The data included 3280 HCWs (50.3 % physicians and 49.7 % nurses). Questionnaires assessed illicit drug use frequency, burnout complaints (BAT-12), and depression (SCL-CD6). Cross-lagged panel models (CLPMs) were used to examine the reciprocal relationships over the two studied time-points between illicit drug use and mental health conditions. Results: The prevalence of illicit drug use in 2022 was 1.3 %, which increased slightly to 1.6 % one and a half years later, in 2023. Using two-wave panel data, results revealed a bidirectional effect between illicit drug use and burnout. However, while depression was associated with subsequent illicit drug use, the reversed association was not observed. Conclusions: These findings suggest that illicit drug use plays different roles in relation to burnout and depression among healthcare workers. This highlights the importance of integrated treatment strategies and preventive measures that address both illicit drug use and mental health conditions—especially burnout—simultaneously. 

Introduction: Prolonged labour pain is a challenging aspect of childbirth. This study examined how a woman's job affects her prolonged labour pain experience in India's diverse healthcare and socioeconomic landscape. Methods: The National Family Health Survey 5, a nationwide study conducted in India investigated the correlation between occupation and prolonged labour pain among 176,385 women aged 15–49 with a 97% survey response rate. Information on labour pain duration and intensity, alongside demographic factors was collected through structured interviews, medical records, and self-reporting. Occupation, age, education, religion, and wealth index were analyzed as predictor variables using cross-tabulation, chi-square tests and multivariate logistic regression. Results: Certain occupations in India, such as clerical, services/household, and agricultural, were linked to increased labour pain compared to women who were not employed. Among these, clerical workers reported the highest level of labour pain at 55.2%. The age group of 20–24 years demonstrated the highest prevalence of prolonged labour pain at 42.4%, and those aged 45–49 exhibited the lowest prevalence at 30.6%. Women with secondary education reported higher pain levels (41.6%) compared to others, this association did not remain significant in the multivariate analysis. Particularly, Hindu (41.9%), and Muslim women (37.6%), experienced more pain compared to other religions, while both the richest (41.7%) and middle-class (41.4%) women reported higher pain levels than other categories. Conclusion: The research unveiled a correlation between occupation and prolonged labour pain. Policymakers can utilize these current findings to enhance preventive planning strategies. It's imperative to give due consideration to the factors identified in the study that are linked with prolonged labour pain. More in-depth primary studies are warranted to explore this issue further. 

OBJECTIVE: Community paramedicine services (CPSs) may alleviate the increasing pressure on emergency medical services (EMSs) but lack the capacity for patient transport. The study aims to determine whether a municipality implementing the CPS between periods (CPSREGION) compared with a control municipality (CTRREGION) served by EMS only affected patient flow and safety in a rural Norwegian setting. DESIGN: A quasi-experimental study evaluating patient flow and safety before and after the introduction of CPS in one of two rural municipalities. SETTING: Two rural Norwegian municipalities that were served by EMS from nearby municipalities before the study started. PARTICIPANTS: Before and after the introduction of CPS, a total of 604 and 650 patients, respectively, were included in CPSREGION, and 367 and 408 patients, respectively, in CTRREGION. INTERVENTIONS: CPS was introduced in CPSREGION between the two data collection periods, whereas CTRREGION continued to be served by EMS. OUTCOME MEASURES: The outcome of patient flow was assessed by the number of admissions to nearby hospitals, the number of patient contacts and the location for delivery and treatment. The outcome for safety was assessed as the need for medical recontact within 7 days and 30-day mortality. RESULTS: Hospital admission rates increased over the two study periods, being insignificant in CPSREGION (+4.7%, p=0.373) and significant in CTRREGION (+23.2%, p<0.001). EMS recontacts within 7 days and 30-day mortality rates were both unchanged (p≥0.119). CONCLUSIONS: Introducing CPS resulted in fewer hospital admissions, with more patients being treated locally. No safety concerns with respect to medical recontacts and 30-day mortality were observed. We conclude that CPS can alter patient flow towards more local treatment without compromising safety. This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine

Objectives The aim of this study was to explore physicians' experiences of the process leading up to their sick leave due to exhaustion disorder (ED).Design A qualitative study with a narrative approach was conducted.Setting The study was conducted in Sweden. Interviews with physicians were conducted face-to-face during the Spring and Autumn of 2022. Each interview lasted between 35 and 60 min.Participants Purposive sampling was employed to recruit physicians on long-term sick leave for ED. We used an interview guide with open-ended questions.Results 12 physicians shared their experiences of the process leading to their ED-related sick leave. Four themes related to different phases of the process: Theme 1. Strongly motivated to become a physician, Theme 2. Demands delivering best practice, Theme 3. Symptoms of ill health and Theme 4. Managing symptoms of ED. The narrative analyses showed a holistic understanding of the personal consequences for the physicians and their families as well as the consequences in working life.Conclusions Politicians and leaders at different healthcare levels must take responsibility for strengthening the working environment, which is important for creating long-term and sustainable healthcare services.

Objective This study aimed to explore the predictive value of severe burnout complaints, symptom dimension of burnout and depressive symptoms for subsequent all-cause medically certified sickness absence (ACMCSA) during the pandemic among physicians in Sweden. Design A 1 year follow-up panel cohort observational study - the Longitudinal Occupational Health Survey for HealthCare in Sweden. At baseline (February-May 2021), a representative sample of 6699 physicians was drawn from the Swedish occupational register and invited to participate in the study. At follow-up (March-May 2022), the full sample (excluding those who died, retired, stopped working as a physician or migrated, n=94) was invited to answer the survey. Setting Swedish primary and specialist healthcare. Participants At baseline, the response rate was 41.3% (n=2761) of which 1575 also answered at follow-up. Primary and secondary outcome measures ACMCSA data came from the Swedish Social Insurance Agency. The Burnout Assessment Tool (BAT-23) was used to measure burnout, including a burnout total score and scores for the four symptom dimensions of exhaustion, mental distance, emotional impairment and cognitive impairment. Depressive symptoms were assessed using the Symptom Checklist-core depression (SCL-CD6). Associations between baseline burnout and depressive symptoms and subsequent ACMCSA were estimated with logistic regression analyses. Results ACMCSA was found in 9% of the participating physicians. In the sample, 4.7% had severe burnout complaints, and 3.7% had depressive symptoms. Burnout (OR=2.57; 95% CI=1.27 to 5.23) and the burnout symptom dimensions emotional impairment (OR=1.80; 95% CI=1.03 to 3.15) and cognitive impairment (OR=2.52; 95% CI=1.12 to 5.50) were associated with a higher likelihood of subsequent ACMCSA. Depressive symptoms were not associated with ACMCSA when adjusted for severe burnout complaints and other covariates. Conclusion This study demonstrates the distinction between burnout and depressive symptoms, particularly in predicting future ACMCSA. Early intervention targeting exhaustion and burnout may mitigate symptom development and reduce the risk of ACMCSA. 

Aims: Problem drinking in healthcare workers (HCWs) is highly relevant to study as it could result in personal suffering, as well as inefficiencies in health service delivery. This study aims to investigate the prevalence of nondrinking, drinking, and problem drinking and to investigate the comorbidity between drinking alcohol and mental illness (burnout and depression) among HCWs in Sweden. Methods: This cross-sectional study draws on the 2022 Longitudinal Occupational Health survey in Healthcare Sweden of physicians, nurses, and nurse assistants in Sweden (N = 5966). Measures include levels of alcohol use assessed by the Cut, Annoyed, Guilty, and Eye Opener questionnaire, the 12-item Burnout Assessment Tool, and the Symptom CheckList-Core Depression. Multinomial Logistic regressions were used to investigate the likelihood of reporting nondrinking and problem drinking compared to drinking. Results: The prevalence of problem drinking among Swedish HCWs was 3.7%. Only sex differences were observed for those with a problem drinking, with male nurses and nurse assistants being more likely to report problem drinking. Comorbidity was found between problem drinking and depression but not between problem drinking and burnout. Conclusions: This study demonstrated that similar to 3.7% of Swedish HCWs had problem drinking and that those also had a higher likelihood of reporting depression but not burnout. Results contribute to new knowledge about the use of alcohol and comorbidities with depression and burnout among HCWs in Sweden. Findings could benefit employers in implementing preventive and tailored strategies to preserve the psychosocial well-being of HCWs.

Globally, self-employed people were among the hardest hit by the repercussions of the COVID-19 pandemic and faced hardships such as financial decline, restrictions, and business closures. A plethora of financial support measures were rolled out worldwide to support them, but there is a lack of research looking at the effect of the policy measures on self-employed people. To understand how different governmental financial support measures enhanced the resilience of the self-employed and improved their ability to manage the pandemic, we conducted a mixed-method study using policy analysis and semi-structured interviews. The documents described policies addressing governmental financial support in Sweden and Canada during the pandemic, and the interviews were conducted with Swedish and Canadian self-employed people to explore how they experienced the support measures in relation to their resilience. The key results were that self-employed people in both countries who were unable to telework were less resilient during the pandemic due to financial problems, restrictions, and lockdowns. The interviews revealed that many self-employed people in hard-hit industries were dissatisfied with the support measures and found them to be unfairly distributed. In addition, the self-employed people experiencing difficulties running their businesses reported reduced well-being, negatively affecting their business survival.

Patient participation is legislated for internationally and leads to improved patient satisfaction, quality in health services, trust in health professionals, and self-management of disease. Patient participation involves health personnel sharing power, thus empowering the patient. To involve and empower patients is important for achieving several Sustainable Development Goals: Good health and well-being (3) and Reduced equality (10). Patient participation is complex, and the aim of this study is to develop a comprehensive model to understand and improve patient par ticipation in health services and research. Based on 27 qualitative primary studies about patient participation in non-communicable diseases analysed by meta-ethnography, four themes were defined: frame factors, interactions, level of involve ment, and clinical context. Including frame factors adds a new dimension to the understanding of patient participation. Frame factors have been underestimated and frame factor theory may be useful to understand and reveal the complexity of patient participation in clinical practice and research. 

This chapter deals with visually impaired individuals’ experiences of learning and participation in education and working life. Health literacy is important at an individual and organisational level aiming at eliminating barriers and promoting equal opportunities for the visually impaired (SDG 10: Reduced inequality within and among countries). This study reveals that visually impaired individuals experi ence outsiderness in education and working life. The study also demonstrates the challenges and opportunities in participating in education and working life for the visually impaired in the future. The study provides important knowledge on how to strengthen good health and well-being (SDG 3: Good health and well-being) and promote quality education and life-long learning opportunities for the visually impaired (SDG 4: Quality education).