Clarifying the role of clinical research nurses working in Sweden, using the Clinical Trial Nursing Questionnaire - Swedish version.

AIM: To explore the role of CRNs in Sweden and differences in competences and tasks, using the Clinical Trial Nursing Questionnaire - Swedish version (CTNQ-SWE). DESIGN: A cross-sectional survey. METHODS: Participants were identified through strategic sampling. Data were analysed by descriptive and comparative statistics. RESULTS: The respondents were experienced nurses who felt proficient in their role, they felt more acceptance by the principal investigators than by nursing colleagues. A majority of CRNs are involved in all procedures specified in the CTNQ-SWE. The most often performed tasks, also rated as the most important by the CRNs, concerned informed consent and management of investigational products. The education was often informal: with a lack of job descriptions and professional development plans. Need of formal specialist education was expressed. CONCLUSIONS: Knowledge about the role description can be used by clinical research enterprise internationally and healthcare organizations aiming to support CRNs in their role.

Daily moderate-intensity physical activities and optimism promote healthy ageing in rural northern Sweden: a cross-sectional study.

The aim of our study was to explore the association between self-reported health factors and self-rated health (SRH) among an older rural population in northern Sweden and whether confounders optimistic outlook or daily moderate-intensity physical activity could moderate the association between self-reported health factors and SRH, controlling for age. The study is based on a sample (N = 1946) from the "Health on Equal Terms" Västernorrland survey 2018 aged 65-84. Prevalence and multivariate logistic regression analyses were performed. The results indicated most rural older people perceived very good or good SRH, though physical and mental health issues and impaired mobility increased with advanced age. Mental well-being exhibited a stronger association with poor SRH than physical health or impaired mobility. In addition, confounders optimistic outlook and daily moderate-intensity physical activity, separately and together could moderate the association between health factors and poor SRH. In conclusion, older people in a rural setting perceived good health, despite common physical and mental health issues. Promoting daily moderate-intensity physical activity and activities contributing to an optimistic outlook can protect against poor SRH in old age.

A nurse-led lifestyle intervention for adult persons with attention-deficit/hyperactivity disorder (ADHD) in Sweden.

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is associated with lifestyle-related diseases. Therefore, a nurse-led lifestyle intervention including interpersonal relationships, health education and cognitive support was developed to facilitate healthier lifestyle habits.Aim: The aim was to develop a lifestyle intervention and investigate its impact on mental and physical healthMethod: The 52-week intervention included 35 adults with ADHD. In a pre- and post-test design, symptoms of ADHD were measured with the Adult ADHD Self-Report Scale, quality of life was measured with the Adult ADHD Quality of Life scale and mental health was measured with the Hospital Anxiety and Depression scale. Lifestyle habits and dimensions of health were measured by the Lifestyle-Performance-Health Questionnaire and physical fitness was measured by the VO2 Max Test and calculations of waist circumference and body mass index. Result: Post-tests for a group of 25 persons showed positive changes following the intervention regarding weekly physical activity, quality of life and general and mental health. Lifestyle habit support was found to be important. The impact of the intervention should be confirmed in a long-term study with a control group.Conclusion: This intervention may be beneficial and may be implemented in a primary healthcare setting or in other open care units.

No Differences in Health Outcomes After Routine Inquiry About Violence Victimization in Young Women: A Randomized Controlled Study in Swedish Youth Health Centers.

Youth is a period in life when the risk of violence victimization is high and association between victimization and ill health is well established. Youth rarely reveal violence victimization to health professionals if not directly asked but favor health professionals asking about victimization. The study's primary aim was to examine health outcomes in young women being routinely asked about violence victimization and offered subsequent support, compared with controls, at 12-month follow-up. Secondary aims were to examine to what extent routine inquiry altered the consultation and re-victimization rates during the study period. A randomized controlled intervention study was conducted at Swedish youth health centers. Participants assigned to the intervention group were asked structured questions about violence. Victimized participants received empowering strategies and were offered further counseling. Participants in the control group completed questionnaires about victimization after the visit. Both groups answered questions about sociodemographics and health, constructed from validated instruments. A questionnaire was administered to all participants 12 months after baseline. Of 1,445 eligible young women, 1,051 (73%) participated, with 54% of the participants completing the 12-month follow-up. Lifetime violence victimization was reported by 53% in the intervention group and 60% in the control group, ns. There were no significant differences in health outcomes, between baseline and 12-month follow-up, within either group or between groups. Re-victimization rates were 16% in the intervention group and 12% in the control group, ns. Of victimized young women in the intervention group, 14% wanted and received further counseling. Routine inquiry about violence victimization and empowering strategies were feasible within ordinary consultations at youth health centers but did not demonstrate improved health outcomes at 12-month follow-up compared with controls. Questions about violence led to a high degree of disclosure, and 14% of victimized young women in the intervention group received further counseling as a result.

Translation and validation of the Clinical Trial Nursing Questionnaire in Swedish-A first step to clarify the clinical research nurse role in Sweden.

AIM AND OBJECTIVES: To translate the Clinical Trial Nursing Questionnaire (CTNQ) into Swedish and test it for face and content validity as well as internal consistency and reproducibility using test-retest procedures. INTRODUCTION/BACKGROUND: In many countries, as in Sweden, a registered nurse can be involved in research by becoming a clinical research nurse. The clinical research nurse plays a pivotal role in clinical studies as a part of the research team. Scales have been developed and used with the objective to clarify the role of clinical research nurses: one of them is the CTNQ. METHODS: A quantitative cross-sectional design with a test-retest procedure was applied to validate the translated questionnaire. By using a snowball sampling method, relevant participants were identified and 49 registered nurses working in the field of research as clinical research nurses answered the questionnaire on two occasions. An expert panel of three clinical research nurses evaluated the questionnaire for face and content validity. The STROBE checklist for observational research has been followed for presenting the research (see File S1). RESULTS: Face and content validity was agreed upon in the expert panel group. Tests for internal consistency of the CTNQ was calculated and showed a high Cronbach's alpha for both the frequency and importance subscales. The test-retest correlation analysis (reproducibility) also revealed a high correlation coefficient for both subscales. CONCLUSION: The CTNQ-SWE is a valid and robust instrument in a Swedish version. The instrument can be of importance in assessing the role of clinical research nurses in Sweden in future studies. RELEVANCE TO CLINICAL PRACTICE: Use of the CTNQ-SWE in future research can be of value for clarification and professional development of the clinical research nurse role in Sweden. The further use of the CTNQ in Sweden can be of value in understanding the process where licensed nurses make a transition into becoming a clinical research nurse, and to identify needs for customised education.

Motivational interviewing does not affect risk drinking among young women: A randomised, controlled intervention study in Swedish youth health centres.

AIM: The aim of this study was to analyse risk and binge drinking at 12-month follow-up in young women with risk drinking who received motivational interviewing compared with controls. METHODS: Young women attending Swedish youth health centres were randomised into intervention or control groups. The intervention group members were asked about their alcohol consumption by a midwife/social worker using the Alcohol Use Disorders Identification Test Consumption. A score of ⩾5 was used as the cut-off value for risk drinking. Participants with risk drinking in the intervention group received motivational interviewing within the same visit. Participants in the control group had a regular visit with a midwife/social worker and answered the same questions about alcohol consumption in a questionnaire after their visit. A questionnaire with the same questions was administered to participants 12 months after baseline. RESULTS: Of 1445 eligible young women, 1051 (73%) consented to randomisation and were enrolled in the study. The follow-up rate was 54%. There was a significant decrease in risk- and binge drinking, from baseline to follow-up, in both the intervention and the control groups. Generalised estimating equation analyses demonstrated no significant effect between groups. Of participants who did not have risk drinking at baseline, about 20% in both groups had developed high-risk drinking by the 12-month follow-up. CONCLUSIONS NO SIGNIFICANT DIFFERENCES IN RISK DRINKING BETWEEN YOUNG WOMEN WHO RECEIVED MOTIVATIONAL INTERVIEWING AND CONTROLS WERE FOUND THERE WAS A LARGE INTRA-INDIVIDUAL MOBILITY IN YOUNG WOMEN'S RISK DRINKING BEHAVIOUR THIS HIGHLIGHTS THE IMPORTANCE OF FINDING RELIABLE SCREENING TOOLS THAT CAN CAPTURE THE MOBILITY IN DRINKING BEHAVIOUR IN YOUTH MORE RESEARCH IS NEEDED BEFORE RECOMMENDATIONS CAN BE MADE.

Feasibility of the subgroup criteria included in the treatment-strategy-based (TREST) classification system (CS) for patients with non-specific low back pain (NSLBP).

BACKGROUND: The new treatment-strategy based (TREST) classification system (CS) is in its exploratory phase with potential to impact clinical decision-making in the management of non-specific low back pain (NSLBP). OBJECTIVE: To evaluate the feasibility of subgroup criteria included in TREST subgroups: pain modulation, stabilization exercise, mobilization, and training. METHODS: An observational cross-sectional investigation involving a secondary analysis of data from 128 examinations of NSLBP patients, categorized individually by four examiners into one of the TREST subgroups. Four separate multivariate logistic regression analyses in two models were applied to identify how examiners applied judgments on pain intensity, disability and predetermined signs and symptoms to categorize patients into subgroups. RESULTS: Associations were found between the presence of "neurological signs and symptoms" (OR 5.5, 95% CI 1.9-16), "irritability" (OR 3.0, 95% CI 3.2-20) and disability (ODI) >30 (OR 8.5, 95% CI 3-20) and the subgroup pain modulation; between the presence of "bilateral spinal signs" (OR 5.6, 95% CI 1.1-29) and the subgroup stabilization exercise; between the presence of "specific segmental signs" (OR 4.0, 95% CI 1.2-14) and ODI ≤30 (OR 0.2, 95% CI 0.1-0.6) and the subgroup mobilization; between the presence of "neurological signs and symptoms" (OR 0.2, 95% CI 0.1-0.4) and the subgroup training. CONCLUSIONS: Findings preliminary support feasibility of TREST subgroup criteria: neurological deficits, irritability, bilateral spinal signs, segmental signs and disability in the categorization of NSLBP patients. Further validation of the TREST classification system is required to establish its value in clinical reasoning and impact on patient outcomes.

Violence victimisation-a watershed for young women's mental and physical health.

PURPOSE: The association between victimisation and adverse health in children is well established but few studies have addressed the effect of victimisation, especially multiple victimisations, in older adolescents and young adults. The aim of this study was to assess self-reported health in young women (15-22 years) victimised to one or more types of violence, compared with non-victimised. METHODS: Young women visiting youth health centres in Sweden answered a questionnaire constructed from standardised instruments addressing violence victimisation (emotional, physical, sexual and family violence), socio-demographics, substance use and physical and mental health. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and attributable risk (AR) were assessed. RESULTS: Of 1051 women (73% of eligible women), 25% were lifetime victims of one type of violence and 31% of two or more types of violence. Sexual-minority young women were more victimised than heterosexual women. Violence victimisation increased the risk for adverse health outcomes, especially evident for those multiply victimised. Victims of two or more types of violence had AOR 11.8 (CI 6.9-20.1) for post-traumatic stress symptoms, 6.3 (CI 3.9-10.2) for anxiety symptoms and 10.8 (CI 5.2-22.5) for suicide ideation. The AR of victimisation accounted for 41% of post-traumatic stress symptoms, 30% of anxiety symptoms and 27% of suicide ideation. Stratified analyses showed that lower economic resources did not influence health negatively for non-victimised, whereas it multiplicatively reinforced ill-health when combined with violence victimisation. CONCLUSION: Violence victimisation, and particularly multiple victimisations, was strongly associated with mental ill-health in young women, especially evident in those with low economic resources.

Multiple violence victimisation associated with sexual ill health and sexual risk behaviours in Swedish youth.

OBJECTIVES: To address the associations between emotional, physical and sexual violence, specifically multiple violence victimisation, and sexual ill health and sexual risk behaviours in youth, as well as possible gender differences. METHODS: A cross-sectional population-based survey among sexually experienced youth using a questionnaire with validated questions on emotional, physical, and sexual violence victimisation, sociodemographics, health risk behaviours, and sexual ill health and sexual risk behaviours. Proportions, unadjusted/adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS: The participants comprised 1192 female and 1021 male students aged 15 to 22 years. The females had experienced multiple violence (victimisation with two or three types of violence) more often than the males (21% vs. 16%). The associations between multiple violence victimisation and sexual ill health and sexual risk behaviours were consistent for both genders. Experience of/involvement in pregnancy yielded adjusted ORs of 2.4 (95% CI 1.5-3.7) for females and 2.1 (95% CI 1.3-3.4) for males, and early age at first intercourse 2.2 (95% CI 1.6-3.1) for females and 1.9 (95% CI 1.2-3.0) for males. No significantly raised adjusted ORs were found for non-use of contraceptives in young men or young women, or for chlamydia infection in young men. CONCLUSIONS: Several types of sexual ill health and sexual risk behaviours are strongly associated with multiple violence victimisation in both genders. This should be taken into consideration when counselling young people and addressing their sexual and reproductive health.

Assessing the Construct Validity and Reliability of School Health Records Using the 'Health Dialogue Questionnaire' in the Eleventh Grade.

BACKGROUND AND AIMS: The aim for this study was to assess the construct validity and reliability of the Health Dialogue Questionnaire (HDQ©) for eleventh grade in school through comparison of the HDQ© with Paediatric Quality Of Life Inventory (PedsQL™), Local monitoring of youth policy questionnaire (LUPP®), Health behaviour in Swedish school-aged children (HBSC©), Equal health (EH©) and The Swedish Survey Youth on Alcohol Consumption (SSYAC©). METHODS: Cross-sectional samples of eleventh graders from the academic year 2009/2010 was used from the HDQ© (n = 2752), the HBSC© (n = 2090), the PedsQL™ (n = 666), the "LUPP®" questionnaires (n = 2400), EH© (n = 258), and SSYAC© (n = 1748) in the academic year 2009/2010. A comparison between HDQ© and the different proxies was done. Exploratory and confirmatory factor analyses were performed as well as a Multitrait-Multimethod Matrix (MTMM), in order to evaluate the construct validity and reliability of HDQ©. RESULTS: An average disagreement between HDQ© and proxies with 10 percentages was found. Exploratory factor analysis of HDQ© on the 2009/2010 sample suggested a four factor solution (girls factor solution 65% of total variance explained, and in the boys' solution 59% of total variance explained). A second sample 2010/2011 of eleventh graders were used for the confirmatory solution. Almost perfectly similar four factor solutions with were found (girls 58% of total variance explained and boys 56% of the total variance explained). Using MTMM the reliability was generally high and HDQ© and showed agreeable validity. DISCUSSION AND CONCLUSIONS: The HDQ© questionnaire is a reliable and valid instrument for measuring eleventh graders self-reported-health in school.

Higher risk of violence exposure in men and women with physical or sensory disabilities: results from a public health survey.

The World Health Organization has declared that violence is a global public health problem. The prevalence of violence exposure among adults with intellectual and unspecific disabilities has been demonstrated in several studies, whereas only a few articles on people with sensory disabilities have been published. The aim of this study was to investigate the prevalence and risk for exposure to physical violence, psychological offence, or threats of violence in people with physical and/or sensory disabilities, compared with people with no such disabilities, controlling for socioeconomic data. Data from a public health survey were analyzed. A nationally representative sample of women and men aged 16 to 84 years had answered a questionnaire. In the present study, the whole sample, comprised of 25,461 women and 21,545 men, was used. Women with auditory disabilities were generally more often violence exposed than non-disabled women, whereas men with physical disabilities were more often violence exposed than non-impaired men. Some age groups among both women and men with visual disabilities had higher prevalence rates than women and men without disabilities. The adjusted odds ratios (ORs) were significantly higher among the auditory impairment group for exposure to physical (OR = 1.4, confidence interval [CI] = [1.1, 1.9]) and psychological (OR = 1.4, CI = [1.1, 1.8]) violence among women. Men with physical disabilities had raised odds ratios for physical violence (OR = 1.7, CI = [1.2, 2.4]) and psychological violence (OR = 1.4, CI = [1.0, 2.0]) compared with the non-disabled group. Both men and women with a physical or sensory disability showed higher odds of being exposed to violence than men and women without a disability. The results indicated that socioeconomic situation, smoking, and hazardous drinking strengthened the association between impairment and violence.

Transitions in the Swedish school system and the impact on student's positive self-reported-health.

BACKGROUND: To explore three school based transitions and their impact on positive self-reported-health (SRH), pre-school to elementary school (6-10 y), elementary school to junior high school (10-13 y), and junior high school to upper secondary school/high school (13-16 y), in a long-term longitudinal population based study. METHODS: The study followed three cohorts through one school transition each. A longitudinal study with data from 6693 Health Dialogue questionnaires were used. Data were collected in the middle of Sweden during 2007-2012 with school children age 6-16 years old. RESULTS: Several significant factors were identified with an impact for a positive self-reported-health among children age 6-16 y; not feeling sad or depressed, afraid or worried, positive school environment (schoolyard and restrooms), not bullied, good sleep, daily physical activity and ability to concentrate. There was no single factor identified, the factors differed according to gender and age. CONCLUSION: The study have identified several gender and age specific factors for successful school transitions relevant for a positive SRH. This is valuable information for school staff, parents and school children and provides a possibility to provide support and assistance when needed.

Strong association between earlier abuse and revictimization in youth.

BACKGROUND: Violence victimization among youth is recognized as a public health problem. The objective was to analyze the risk pattern of emotional, physical, and sexual abuse during the past 12 months by gender, sociodemographic factors, health risk behaviors, and exposure to abuse before the age of 15, among young men and women attending youth health centers in Sweden. METHODS: A cross-sectional survey was conducted using a nationally representative sample of youth health centers. A total of 2,250 young women and 920 young men aged 15-23 completed a self-administered questionnaire. Odds ratios (OR) and adjusted odds ratios (AOR) with 95% CI were calculated. RESULTS: A consistent and strong association was noted between exposure to all types of violence during the past year and victimization before the age of 15 for all types of violence for both women and men. The only exceptions were childhood sexual victimization and sexual violence during the past year for men. Younger age was associated with all violence exposure for the women and with emotional violence for the men. For the women, drug use was associated with all types of violence, while the association with hazardous alcohol use and not living with parents was restricted to physical and sexual violence exposure, present smoking was restricted to emotional and physical violence exposure, and partnership and living in urban areas were restricted to sexual violence. For men, not being partnered, hazardous alcohol consumption, and drug use meant increased risk for physical violence, while smoking and living in urban areas were associated with sexual violence. After adjustment, immigration had no association with violence exposure. CONCLUSIONS: Violence victimization in young men and women is often not a single experience. Findings underline the importance of early interventions among previously abused youth.

A Life Course Model of Self-Reported Violence Exposure and Ill-health with A Public Health Problem Perspective.

Violence has probably always been part of the human experience. Its impact can be seen, in various forms, in all parts of the world. In 1996, WHO:s Forty-Ninth World Health Assembly adopted a resolution, declaring violence a major and growing public health problem around the world. Public health work centers around health promotion and disease prevention activities in the population and public health is an expression of the health status of the population taking into account both the level and the distribution of health. Exposure to violence can have many aspects, differing throughout the life course - deprivation of autonomy, financial exploitation, psychological and physical neglect or abuse - but all types share common characteristics: the use of destructive force to control others by depriving them of safety, freedom, health and, in too many instances, life; the epidemic proportions of the problem, particularly among vulnerable groups; a devastating impact on individuals, families, neighborhoods, communities, and society. There is considerable evidence that stressful early life events influence a variety of physical and/or psychological health problems later in life. Childhood adversity has been linked to elevated rates of morbidity and mortality from number of chronic diseases. A model outlining potential biobehavioural pathways is put forward that may be a potential explanation of how exposure to violence among both men and women work as an important risk factor for ill health and should receive greater attention in public health work.

Long-term health consequences of violence exposure in adolescence: a 26-year prospective study.

BACKGROUND: Violence victimization represents a serious risk factor for health related symptoms, for both men and women. The aim of this study was to evaluate the long-term effects of violence exposure in late adolescence and early adulthood on adult health, physical as well as mental, using a long-term prospective population-based study, with a follow up of 9, 19, and 26 years. METHODS: The primary data source is a longitudinal panel from one of the longest running social science surveys in the world, the Swedish Level-of-Living surveys (LNU). We analyzed three cohorts, individuals aged 15-19 in 1974 and 1981, and individuals aged 18-19 in 1991 which were followed up 2000. Structured interviews on childhood, family relationships, life-events, living conditions, health history and status, working conditions, behavioral, psychosocial, and demographic variables were repeatedly used in all cohorts. RESULTS: Multivariate models of violence exposures in adolescence in the 1974-91 cohorts as predictors of adult health in 2000 are reported for both men and women. Women exposed to violence had raised odds ratios for ill health, measured as heavy illness burden, and poor self rated health, after controlling for possible confounders. No such associations were found for men. CONCLUSIONS: This study's findings provide additional empirical support for the importance of policies and practices to identify and prevent violence exposure in adolescence and young adulthood and to supply treatments for adolescence exposed to violence and above all the young women.

Inter-examiner reliability of a proposed decision-making treatment based classification system for low back pain patients.

Evolving evidence has shown increased clinical outcomes, when low back pain (LBP) patients are classified and receive matched physical treatment. The present study aimed to examine the inter-examiner reliability of a proposed new decision-making classification system for non-specific LBP patients, using a mixed simultaneous and independent examiner design. With minimal familiarization, two pairs of experienced physiotherapists trained in Orthopedic Manual Therapy (OMT) at two different out-patient clinics in primary care, examined and classified 64 consenting consecutive patients. Further, inter-examiner reliability on five examination items was examined. The agreement between examiners was expressed by percentage of agreement (%) and by the un-weighted (κ) or weighted (κ(w)) kappa coefficient. The overall % agreement, categorizing patients into one of four classifications was 80% and κ = 0.72. For each classification, pain modulation, stabilization exercise, mobilization and training, agreement was 90%, 83%, 58% and 89% (κ = 0.77, 0.67, 0.11 and 0.75), respectively. Agreement on five individual examination items was; irritability 82% (κ(w) = 0.41), specific movement pattern 68% (κ = 0.38), specific segmental signs 67% (κ = 0.28), uni- or bilateral signs 62% (κ = 0.42), and neurological signs and symptoms 92% (κ = 0.84). This study demonstrated that this new classification system had substantial inter-examiner reliability when used by clinically experienced OMT-trained physiotherapists. Agreement within classification was substantial, except for mobilization which was poor. Inter-examiner reliability for the individual examination items varied from fair to almost perfect. Further studies are needed to investigate utility and validity of this new classification system.

Physical and psychological symptoms and learning difficulties in children of women exposed and non-exposed to violence: a population-based study.

OBJECTIVES: To analyse the association between violence against mothers and the health of their children as reported by the mothers. METHODS: The data originate from a multistage sampling health-questionnaire survey, distributed to a representative sample of women in Sweden. The health of 283 children (aged 0-18 years), as reported by women who had been exposed to violence at home or outside home during the past 12 months, was compared with that of 4,664 children of non-exposed mothers. RESULTS: Odds ratios regarding most registered physical symptoms showed that children of violence-exposed mothers had a significant higher risk of ill health than children of non-exposed mothers. Regarding psychological symptoms and learning difficulties, the odds were raised for girls for most symptoms, but not for boys. A twofold increase in health-care utilisation and an overall general increase in the risk of pharmaceutical consumption were shown for both girls and boys of exposed mothers. CONCLUSIONS: This population-based study shows an increased risk of poorer health amongst boys and girls aged 0-18 years, as reported by mothers exposed to violence.

Did a health dialogue matter? Self-reported cardiovascular disease and diabetes 11 years after health screening.

OBJECTIVE: To study the potential impact of health screening, with or without a motivational health dialogue, on the risk and morbidity of cardiovascular diseases (CVD) and diabetes (DM). DESIGN: Two cross-sectional studies with an interval of 11 years. SETTING: The community of Härnösand, Sweden. SUBJECTS: In the first study, 402 men born in 1934, 1944, or 1954 underwent health screening for CVD prevention in 1989. In the second study, 415 men (of the same ages) completed a questionnaire in 2000 (11 years later). MAIN OUTCOME MEASURES: Odds ratio (OR) for self-reported CVD and DM. RESULTS: The odds ratio of self-reported CVD and DM was more than doubled among participants in the health screening without a health dialogue (OR 2.5; 95% CI 0.8-7.4) and threefold for those not participating (OR 3.0; 95% CI 1.0-8.8) compared with those who reported participation in health screening that included a structured health dialogue. CONCLUSIONS: Health screening for the prevention of CVD and DM benefits from inclusion of a structured, motivational health dialogue.

Waiting for surgery; living a life on hold--a continuous struggle against a faceless system.

This interpretive-phenomenological study examined the lived experience of being on the waiting list for arthroplastic surgery of the knee or hip. Interviews reveal that respondents experience suffering in different ways: illness-, caring- and life-suffering. Suffering leads to a struggle in order to have their caring needs met and the struggle is often fruitless-against a faceless enemy-"the system". No one is there to answer their plea or the frustration they experience. This in combination with their present life situation may lead to a disrupted self-image. Finding or creating meaning in suffering appears to be a crucial issue in the struggling process. Respondents who are able to preserve or create meaning in life are able to reformulate their life-world and live a full life, in spite of severe pain and disability.

[Consequences of violence--a public health issue. Strong connection between violence/threat and illness in both women and men]. / Våldets följder--en fråga om folkhälsa. Starkt samband mellan våld/hot och ohälsa hos både kvinnor och män.

Earlier studies have indicated that patients with chronic pain often have experienced physical abuse, but only a small number of population studies have demonstrated an association between abuse and chronic pain. During 1997 a population study was made in northern Sweden. Close to 15,000 people from 18-85 years of age answered a questionnaire about public health issues, including four questions about physical abuse and threats. In the present study the association between answers to these four questions and the other health questions were analyzed for men and women from 18-44 years. Almost 8% of the women and 10% of the men had been subjected to violence or threats during the past year, with higher figures for younger men and women. A strong association between violence/threats and most of the other health issues was found for both men and women. The association remained after controlling for various socioeconomic variables as well as smoking, although with somewhat lower odds ratios.