Pro-Environmental Transformation of the Equine Sector-Facilitators and Challenges.

To improve horse welfare and ensure a sustainable equestrian future, we need to understand human behavior in relation to the challenges of the sector. The purpose of this paper is to map and analyze how individuals within the equine sector in Sweden and Norway define the environmental challenges they are faced with and how these are related to questions about horse welfare. A mixed-methods parallel design was used. The data consist of survey answers and semi-structured interviews. The survey, responded to by 697 Swedish and Norwegian participants, ensured statistical validity and power through a sample size calculation yielding approximately 385 participants. To deepen the understanding, 36 semi structured interviews with Swedish and Norwegian interviewees were conducted. An analysis of convergencies and divergencies between the data sets provided robust insights into the perceptions and behaviors within the equine sector in Sweden and Norway. The findings show that the equine sector has cultivated a stronger environmental commitment over the last 15 years (Svala, 2008). However, many participants express a perceived lack of influence on this transformation. The COM-B model (Michie, Van Stralen & West, 2011; Michie, Atkins & West, 2014) and previous research on 'thinking structures on climate delay' (Wormbs & Wolrath, 2023) are used to interpret the data. The analysis indicates that there is an overall capacity for change, and that skills and knowledge exist, but some individuals desire more information and a deeper understanding of the issues at hand. Higher barriers to change were found in the opportunity component, where physical constraints such as location, resources, and time seem challenging for individual actors to influence. Economic factors are also identified as impediments to transformation. Cultural norms related to orderliness within stables, although not directly addressing ecological nor ethical challenges, might serve as a foundation for promoting environmental initiatives that will also improve horse welfare.

Life satisfaction in cardiac arrest survivors: A nationwide Swedish registry study.

Introduction: Most cardiac arrest (CA) survivors report good health and quality of life. Life satisfaction on the other hand has not yet been studied in a large scale in the CA population. We aimed to explore life satisfaction as perceived by CA survivors with three research questions addressed: (1) how do CA survivors report their life satisfaction, (2) how are different domains of life satisfaction associated with overall life satisfaction, and (3) how are demographic and medical factors associated with overall life satisfaction? Methods: This registry study had a cross-sectional design. Life satisfaction was assessed using the 11-item Life Satisfaction checklist (LiSat-11). The sample included 1435 survivors ≥18 years of age. Descriptive statistics and binary logistic regression analyses were used. Results: Survivors were most satisfied with partner relation (85.6%), family life (82.2%), and self-care (77.8%), while 60.5% were satisfied with overall life. Satisfaction with psychological health was strongest associated with overall life satisfaction. Among medical and demographic factors, female sex and poor cerebral performance were associated with less overall life satisfaction. Conclusions: Generally, CA survivors seem to perceive similar levels of overall life satisfaction as general populations, while survivors tend to be significantly less satisfied with their sexual life. Satisfaction with psychological health is of special interest to identify and treat. Additionally, female survivors and survivors with poor neurological outcome are at risk for poorer overall life satisfaction and need special attention by healthcare professionals.

Health and Body Conditions of Riding School Horses Housed in Groups or Kept in Conventional Tie-Stall/Box Housing.

We compared welfare measures of horses among Swedish riding schools (RS) during winter where horses were kept either in group housing (n = 8) or in tie-stalls/boxes (n = 8), Health data for six previous months were obtained for all horses at each RS from their records. Ten horses per RS were examined, with the exception of one where only 8 horses were examined. Health conditions and body condition score (BCS) using the Henneke scale were recorded and management factors were quantified (health check routines, feeding, housing-related risk factors, time outside). RS-recorded health data (for 327 horses in total) revealed that lameness was the most common issue in both systems. Respiratory problems and colic were significantly more common in tie-stall/box horses. The percentage of horses with respiratory problems (mean ± SEM) was 5.8 ± 1.4 in tie-stall/box systems and 1.1 ± 0.8 in group housing (F = 8.65, p = 0.01). The percentage with colic was 2.38 ± 0.62 in tie-stall/box systems and 0.38 ± 0.26 in group housing (F = 8.62, p = 0.01). Clinical examination of 158 horses revealed 207 conditions in these horses, the most common being minor skin injuries in areas affected by tack (i.e., saddle and bridle, including bit). Such injuries tended to be more prevalent in horses housed in tie-stalls/boxes (1.8 ± 0.6) than in group housing (0.5 ± 0.3) (F=3.14, p = 0.01). BCS was similar between systems (tie-stall/box 6.2 ± 0.1, group 6.3 ± 0.1), but the average BCS exceeded the level that is considered optimal (BCS 4⁻6). In conclusion, we found that Swedish RS horses are generally in good health, particularly when group-housed. However, 25%⁻32% were overweight. Riding schools would thus benefit from having an independent feeding expert performing regular body condition scoring of all horses and advising on feeding regimens.

Author Correction: Toxic fluoride gas emissions from lithium-ion battery fires.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Toxic fluoride gas emissions from lithium-ion battery fires.

Lithium-ion battery fires generate intense heat and considerable amounts of gas and smoke. Although the emission of toxic gases can be a larger threat than the heat, the knowledge of such emissions is limited. This paper presents quantitative measurements of heat release and fluoride gas emissions during battery fires for seven different types of commercial lithium-ion batteries. The results have been validated using two independent measurement techniques and show that large amounts of hydrogen fluoride (HF) may be generated, ranging between 20 and 200 mg/Wh of nominal battery energy capacity. In addition, 15-22 mg/Wh of another potentially toxic gas, phosphoryl fluoride (POF3), was measured in some of the fire tests. Gas emissions when using water mist as extinguishing agent were also investigated. Fluoride gas emission can pose a serious toxic threat and the results are crucial findings for risk assessment and management, especially for large Li-ion battery packs.

Ethical aspects of a predictive test for Huntington's Disease: A long term perspective.

BACKGROUND: A predictive genetic test for Huntington's disease can be used before any symptoms are apparent, but there is only sparse knowledge about the long-term consequences of a positive test result. Such knowledge is important in order to gain a deeper understanding of families' experiences. OBJECTIVES: The aim of the study was to describe a young couple's long-term experiences and the consequences of a predictive test for Huntington's disease. RESEARCH DESIGN: A descriptive case study design was used with a longitudinal narrative life history approach. PARTICIPANTS AND RESEARCH CONTEXT: The study was based on 18 interviews with a young couple, covering a period of 2.5 years; starting 6 months after the disclosure of the test results showing the woman to be a carrier of the gene causing Huntington's disease. ETHICAL CONSIDERATIONS: Even though the study was extremely sensitive, where potential harm constantly had to be balanced against the benefits, the couple had a strong wish to contribute to increased knowledge about people in their situation. The study was approved by the ethics committee. FINDINGS: The results show that the long-term consequences were devastating for the family. This 3-year period was characterized by anxiety, repeated suicide attempts, financial difficulties and eventually divorce. DISCUSSION: By offering a predictive test, the healthcare system has an ethical and moral responsibility. Once the test result is disclosed, the individual and the family cannot live without the knowledge it brings. Support is needed in a long-term perspective and should involve counselling concerning the families' everyday life involving important decision-making, reorientation towards a new outlook of the future and the meaning of life. CONCLUSION: As health professionals, our ethical and moral responsibility thus embraces not only the phase in direct connection to the actual genetic test but also a commitment to provide support to help the family deal with the long-term consequences of the test.

The shift from a medical to a nursing orientation: A comparison of Swedish nursing students' expectations when entering the nursing degree programme in 2003 and 2013.

BACKGROUND: The focus of education in nursing has changed over time with a decreased focus on biomedicine and an increased focus on nursing science. It is therefore important to investigate whether these changes are also reflected in the students' conceptions and expectations of the programme over time. OBJECTIVES: The aim of the study was to describe and compare two cohorts of students entering the nursing programme with 10year in between (2003 and 2013), regarding their demographic background, reasons for wanting to become a registered nurse, expectations of the programme and perceptions of the nursing profession. DESIGN AND SETTING: The study was a descriptive cross-sectional cohort study carried out at a university in southern Sweden. PARTICIPANTS: In all, 177 nursing students participated in the study, 89 from the 2003 cohort and 88 from the 2013 cohort. METHODS: Data were collected at the start of the programme using a questionnaire consisting of predefined and open-ended questions. The responses were statistically analysed and compared. RESULTS: The students' reasons for wanting to become a registered nurse remained stable over the 10-year period. The main reason stated by the students in both cohort was humanitarian, i. e wanting to help others. The students' expectations regarding both the programme and the nursing profession had, however, changed significantly from a biomedical to a nursing orientation in the 10-year perspective. CONCLUSIONS: The change in the students' preconceptions of the nursing education towards increasing importance of nursing science indicates the beginning of a paradigm shift.

The use of drama to support reflection and understanding of the residents' situation in dementia care: a pilot study.

BACKGROUND: One key aspect of person-centredness is striving to understand both the patients' experiences and behaviours from their perspective. These aspects are precisely those that staff in dementia care highlight as causing them most difficulty because the people in their care have major problems expressing themselves. There is thus a need to develop a method to help the staff to achieve interpretation through reflection. AIM: The aim of this study was to explore the use of drama as a tool to support reflection among staff working in the residential care of people with dementia. DESIGN: A qualitative evaluation of a programme consisting of three drama sessions with staff working in residential care (n = 10 nurse assistants). METHODS: Data comprised observations and tape recordings of the sessions, the researchers' reflections after each session and a focus-group interview with the participants. The texts were analysed using qualitative content analysis. RESULTS: The analysis showed that: (i) the exercises stimulate reflection about daily caring practice; (ii) the participants must receive extensive information about the purpose of the sessions; (iii) the research team must secure the defined frames and conditions and have practical knowledge about caring for people with dementia and (iv) the management needs to be stable, committed and supportive. CONCLUSION: Drama seems to be a valid tool to aid reflection, but several adjustments are needed concerning both the content of the sessions and the methodology. When designing a larger intervention study, it would be preferable to the sessions to be combined with staff support to effect changes in care provision resulting from their increased awareness of the residents' situation and experience. IMPLICATIONS FOR PRACTICE: Our results showed that drama can be a means to enhance reflection among staff in residential care for people with dementia. Further research is however needed concerning the effects for the staff's situation and nursing care quality.

Nursing students' experiences of assessment by the Swedish National Clinical Final Examination.

The Swedish National Clinical Final Examination (NCFE) was established in 2007 in order to examine nursing students' clinical competence upon completing their Bachelor's degree in nursing. The NCFE constitutes an innovative method of examination, divided into two parts: a written and bedside test. The aim of this study was to evaluate nursing students' experiences of being assessed by means of the NCFE, in order to obtain information that could be used to improve the examination. A survey was conducted using a questionnaire with open-ended questions concerning the written and the bedside part of the NCFE. The answers from 577 third-year nursing students were analysed using content analysis. The nursing students regarded the NCFE as promoting further learning and as an important means of quality assurance. Its comprehensive nature was perceived to tie the education together and contributed to the students' awareness of their own clinical competence. The strengths of the NCFE especially highlighted were its high degree of objectivity and the fact that it took place in a natural setting. However, the students felt that the NCFE did not cover the entire nursing programme and that it caused stress. It thus appears to be important to reconsider the written theoretical part of the examination and to standardise the bedside part.

Ethical aspects of undergoing a predictive genetic testing for Huntington's disease.

The aim of this study was to describe the experiences of undergoing a presymptomatic genetic test for the hereditary and fatal Huntington's disease, using a case study approach. The study was based on 18 interviews with a young woman and her husband from the decision to undergo the test, to receiving the results and trying to adapt to them, which were analysed using a life history approach. The findings show that the process of undergoing a presymptomatic test involves several closely connected ethical and medical questions, such as the reason for the test, the consequences of the test results and how health-care services can be developed to support people in this situation.

Swedish nursing students' experience of aspects important for their learning process and their ability to handle the complexity of the nursing degree program.

The aim of the study was to explore nursing students' experiences of aspects important for their learning process and their ability to handle the complexity of the nursing degree program. The study was longitudinal and qualitative based on interviews with nursing students, six women and two men aged 20-36, during their three years of education. In all, seven patterns were found embracing aspects of importance for the students' learning: Having a clear goal, being able to re-evaluate one's ideas, being acknowledged, when the abstract becomes tangible, using one's own experiences as a tool for learning, hovering between closeness and distance regarding one's future profession and handling theory and practice in relation to one another. The results show the importance of providing clinical courses, strongly connected to the theoretical parts of the program and to use reflection and experience-based learning in the nursing program.

The transition from rookie to genuine nurse: narratives from Swedish nurses 1 year after graduation.

This article describes nurses' experiences during their first year after graduation, based on the qualitative content analysis of eight interviews. The results show that the nurses experienced a transition from "being a rookie," including being accepted as a member of the team and respected as a colleague, to "becoming a genuine nurse," including the feeling of being able to shoulder responsibility, prioritize tasks, and convey confidence to patients. This transition seems to occur regardless of support, and it is important to be aware of nurses' level of maturity and to adjust the degree of responsibility given to them because they may not be comfortable revealing their limitations to others.

The nursing programme in the rear-view mirror. Interviews with Swedish nurses one year after their graduation.

In order to increase the understanding of how students assimilate the knowledge they need to carry out their professional duties, knowledge about the experience of the nursing education in the light of the first year of employment is important. The aim of this study was to describe nurses' views of their education, one year after their graduation. Interviews with eight nurses, aged 24 to 40 years, were analysed using manifest qualitative content analysis. The results show that, when viewing their education in the rear-view mirror, they emphasised the importance of the applied courses but had started to acknowledge the importance of training in scientific methods, which during their education was seen as less important. They also stated that their training in medical science had been sufficient, although during their education they expressed doubts about whether this level of knowledge would be enough. The nurses also realised that knowledge concerning the subject of nursing science afforded them both opportunities and the potential possibilities to influence nursing care provision. The study indicates that nursing education gives the students the tools they need to perform their assignments as registered nurses, even if clinical experience is required to internalise and consolidate the knowledge.

Study circles improve the precision in nutritional care in special accommodations.

BACKGROUND: Disease-related malnutrition is a major health problem in the elderly population, but it has until recently received very little attention, especially are management issues under-explored. By identifying residents at the risk of undernutrition (UN), appropriate nutritional care can be provided. OBJECTIVE: To investigate if study circles and policy documents improve the precision in nutritional care and decrease the prevalence of low or high body mass index (BMI). DESIGN: Pre and post-intervention study. SETTING: Special accommodations (nursing homes) within six municipalities were involved. PARTICIPANTS: In 2005, 1,726 (90.4%) of 1,910 residents agreed to participate and in 2007, 1,526 (81.8%) of 1,866 residents participated. INTERVENTION: Study circles in one municipality, having a policy document in one municipality and no intervention in four municipalities. MEASUREMENTS: RISK OF UN WAS DEFINED AS INVOLVING ANY OF: involuntary weight loss; low BMI; and/or eating difficulties. Overweight was defined as high BMI. RESULTS: In 2005 and 2007, 64% and 66% of residents, respectively, were at the risk of UN. In 2007, significantly more patients in the study circle municipality were accurately provided protein and energy enriched food (PE-food) compared to the no intervention municipalities. There was a decrease between 2005 and 2007 in the prevalence of low BMI in the study circle municipality, but the prevalence of overweight increased in the policy document municipality. CONCLUSIONS: Study circles improve the provision of PE-food for residents at the risk of UN and can possibly decrease the prevalence of low BMI. It is likely that a combination of study circles and implementation of a policy document focusing on screening and on actions to take if the resident is at UN risk can give even better results.