Background During the COVID-19 pandemic, visitation restrictions in ICUs intensified psychological distress among family members, yet the long-term impact of psychosocial support on family resilience remains poorly understood. Objective To evaluate the experiences of family members during the COVID-19 pandemic, focusing on interactions with healthcare professionals and well-being 18th months after hospitalisation. Methods A qualitative descriptive study using semi-structured interviews with 14 families of patients admitted to the ICU in spring 2020.Data were analysed using inductive content analysis. Results Experiences were shaped by caring interactions with healthcare professionals, emotional disruption, and reliance on family support. Clear information and psychosocial support fostered trust but were also associated with stress and feelings of isolation. The experience caused profound emotional distress, with family members reporting lasting anxiety, while others described gratitude and personal growth. Support from Family were central to coping, although the responsibility as the primary contact person could increase emotional burden. Conclusions Families experienced significant psychological distress and long-lasting effects. The findings underline the need for improved communication, proactive support, and structured family-centred practices to address both immediate and long-term needs. Healthcare systems should implement strategies such as clear communication plans, follow-up counselling, support groups to reduce families’ emotional burden and improve well-being.

Purpose:Floorball, one of the most popular indoor team sports in Sweden, was the focus of this study, which aimed to explore floorball coaches' experiences of barriers to and opportunities for communicating about menstrual health with female adolescent athletes. Methodology:An exploratory qualitative study design based on interviews with eighteen floorball coaches coaching girls aged 10-18 years of age was conducted and analysed using thematic analysis. Participants were nine male and nine female coaches aged 31-69 years with experience coaching floorball ranging from 1 to 20 years. Findings:Coaches experienced inter-linked communicative, educational, and supportive barriers when addressing menstrual health. Many wished to expand their knowledge about menstruation, particularly male coaches who were considered to need greater understanding of the menstrual cycle. Menstruation was generally perceived as a challenging topic for communication due to persistent stigma. Coaches emphasized that while increased communication could help reduce stigma and normalize the subject, discussions about menstruation were still considered sensitive. There was a clear call for organisational support to strengthen education and provide structured guidance for addressing menstrual health. Future research should explore strategies to overcome communicative barriers and how menstrual health education can effectively be implemented in sports.

To describe critical care nurses' perceptions and experiences of the organ donation process. A systematic review with a literature search in CINAHL, PubMed, and PsycINFO was conducted between 2009–2024 and reported by the PRISMA guidelines. 14 qualitative studies were assessed for relevance and methodological quality. Data were extracted by two of the researchers. A quality appraisal was performed according to a review template, first individually and then discussed in the research group. The analysis followed an interpretative synthesis, in three steps: coding, developing descriptive themes and generating analytical themes. Four themes were identified: lack of knowledge, work environment, meeting with relatives and nurse's challenges. The nurses described that caring for a potential organ donor was complex. The nurses' general lack of knowledge about organ donation led to stress and feelings of uncertainty, which in turn created limitations in the donation process. Nurses identified several challenges with the organ donation process. The staff found the organ donation process challenging on various levels. There was a significant need for crisis processing for all professionals involved in the donation process. Addressing the knowledge gap through clear guidelines and internal training to enhance the organ donation process. Providing time for debriefing can help manage strain on professionals. This study highlights the critical need for improved education and emotional support for critical care nurses. Implementing these changes can lead to more efficient and compassionate organ donation processes.

Purpose: This study aimed to examine the impact of menstrual symptoms on sport participation and management strategies among adolescent girls playing floorball in Sweden. Methods: A cross-sectional study was conducted among floorball players aged 12–18 years (n = 545). Logistic regression was used to assess factors associated with menstrual-related symptoms and their impact on participation and absence from training sessions or matches. Results: Menstrual pain (89.6%) and mood swings (81.9%) were the most commonly reported symptoms. Symptoms such as menstrual pain, heavy menstrual bleeding, headache, fatigue, dizziness, and concentration difficulties were more prevalent among participants with early menarche (≤11 years) than those with later menarche. Overall, about 62.2% perceived that their menstrual symptoms affected their training and matches. Early menarche (≤11 years) was associated with nearly three times higher odds of refraining from training sessions or matches. Despite substantial impact, healthcare-seeking and communication with coaches were limited. Conclusions: Given the high prevalence of menstrual symptoms and their impact on sport participation and experiences, menstrual health should be recognised as a core component of athlete well-being in youth sport. Efforts are needed to improve menstrual health awareness, early identification of girls with high symptom burden, and supportive sport environments to promote gender equality in youth sport.

Introduction: Survivors of critical illness commonly experience physical, cognitive, and psychological impairments. Early rehabilitation may mitigate these impairments; however, how rehabilitation practices are perceived and implemented by healthcare professionals in intensive care unit (ICU) remains insufficiently described. This study aimed to describe healthcare professionals' perceptions of rehabilitation activities in the ICU and to explore their self-reported estimates of the time devoted to these activities in Scandinavian ICUs. Methods: A cross-sectional survey was conducted among healthcare professionals working in ICUs in Denmark, Norway, and Sweden. Using convenience sampling, data were collected on rehabilitation activities, time allocation, timing of initiation, and availability of post-ICU rehabilitative services. Results: In total, 518 healthcare professionals participated. Rehabilitation was described as a multidimensional practice encompassing cognitive, sensory stimulation, physical, and social rehabilitation activities, as well as patient participation in personal care. Activities were typically performed daily throughout the ICU stay. Respondents reported spending a median of 40% of their working time on rehabilitation, and most patients were considered eligible. Commonly reported activities included verbal interaction, sitting on the edge of the bed, family visits, and participation in personal care. Conclusion: Rehabilitation is an established component of ICU care in Scandinavia and is integrated into routine clinical practice. Activities span multiple domains, with physical and social rehabilitation activities being most prominent. Further research is needed to clarify optimal timing and prioritisation of rehabilitation activities. Editorial Comment: This survey study presents perceptions from ICU personnel of how rehabilitation activities tend to be implemented in their workplace. Through different means, rehabilitation efforts are described as established in ICU practice in the three Scandinavian countries which were sampled.

OBJECTIVE:To describe healthcare professionals' perception of current early rehabilitation practices and their preconditions, focusing on functional and cognitive stimulation facilitated by nurses and other healthcare professionals in Scandinavian intensive care units (ICUs). DESIGN:Cross-sectional electronic survey administered to healthcare professionals. The survey was developed in Danish, translated into Norwegian and Swedish, and delivered using Google Forms. The qualitative data were analysed using the framework method. SETTING:Scandinavian ICUs. RESULTS:Practices facilitated by nurses and other healthcare professionals in the ICU often began with weaning from the ventilator and reducing sedation. This was followed by increased mobilisation and building physical strength. There was attention to optimising nutrition, swallowing function, and oral intake. Enabling communication and employing cognitively stimulating activities and bodily stimulation to engage the patient's mind were also framed as rehabilitation. To avoid delirium and overexertion, it was important to balance rest and activity and to shield the patient from unnecessary stimulation. Furthermore, it was important to support the patient's will to live and to involve the family in rehabilitation. Post-discharge rehabilitation activities included reaching out to patients discharged to wards and homes. CONCLUSION:Rehabilitation was described as progressing from passive to active as patients gained consciousness and strength. Weaning, balancing rest and activity, supporting the patient's life courage and will to recover, open visitation policies, and multi-professional collaboration were important prerequisites for rehabilitation. IMPLICATIONS FOR PRACTICE:All aspects of patient care can function as important opportunities for physical and cognitive rehabilitation. Balancing rest and activity is important for conserving the patient's energy for rehabilitation.

Menstrual-related symptoms such as menstrual pain and heavy bleeding impact individuals’ health, quality of life and can limit the ability to engage in daily life activities, including school. Menstrual-related symptoms thus risk reinforcing existing gender inequalities in health among young people, making it an issue of equal rights and public health concerns. No previous study has estimated the prevalence of menstrual-related symptoms and subsequent school absences in Sweden by using population-based data. The study aimed to estimate the prevalence of menstrual-related symptoms and school absence among young people aged 16–29 in Sweden, and to examine associations between symptoms, absence, and sociodemographic factors. A sample (n = 5,483) of individuals aged 16–29 was drawn from a population-based cross-sectional study which used stratified random sampling. We used logistic regression to test sociodemographic factors associated with school absence due to menstrual-related symptoms. Menstrual-related symptoms were reported by most of the respondents (91.43

Background Universal access to sexual and reproductive health and rights (SRHR) is fundamental to achieving the Sustainable Development Goals due to its impact on gender equality as well as women’s health and survival. In the Democratic Republic of Congo, there are many civil society organizations (CSOs) that are involved in raising awareness of SRHR issues and providing SRHR services to young people. Objective: The aim of this study was to explore the challenges and enabling factors CSOs experience regarding the delivery of SRHR services to young people. Methods We conducted a qualitative study via focus group discussions with CSOs in Kinshasa. Two focus groups comprising women and two comprising men, with approximately 10 participants in each group, were held. The interview transcripts were subjected to an inductive thematic analysis. Results Young people’s barriers to SRHR information and services were described as multi-layered, linked to individual, community, societal, institutional, and health system levels. The most common barrier in delivering SRHR information was the widespread view of sexuality as a taboo subject in communities and churches as well as in young people’s families. Despite the obstacles that CSOs faced, the results also demonstrate that CSOs have found creative ways to reach out and offer SRHR information to young people. Conclusion It is essential to acknowledge the role of CSOs in the advancement of gender equality, and it is important to put policies into place that can overcome cultural, religious, and familial barriers to young people’s access to SRHR information.

Enabling civil society organizations (CSOs) in sub-Saharan Africa to develop research ensures equitable scholarly representation and addresses local problems in sexual and reproductive health. To this end, a transnational research collaboration was formed to evaluate abortion services and develop the research capacity of two CSOs in the Democratic Republic of Congo (DRC). The team included Karolinska Institutet, Partners for Reproductive Justice (IPAS) and the National Midwives’ Association (SCOSAF). The objective of this article is to discuss the context of the partnership, including research capacity-building inputs, processes, outputs, and outcomes, as well as lessons learned and recommendations. Activities were tailored to the research capacities of each CSO and the research team of clinical care providers over the two-year project period. Research capacity-building resulted in increased opportunities for team members to conduct research and manage research projects outside of academia. Overall, there were improvements in midwives’ capacity to design and conduct research, and in the midwives’ association’s capacity for research management and project administration. Recommendations for others include pragmatic incorporation of gender considerations, approaches to organizational and individual research capacity-building, and baseline CSO capacity assessments for research management. Health research conducted in a non-academic setting, specifically within CSOs, can be a pathway to research equity. In DRC, it strengthened health professionals in their capacity to generate evidence to influence local abortion policy and health services in Kinshasa, DRC.

Sexual violence is a critical and preventable global threat to public health, sexual and reproductive health and rights, and gender equality. Studies have shown that sexual violence among young people in Sweden is prevalent, with lesbian, gay, and bisexual individuals facing greater exposure than their heterosexual peers do. Research has also indicated that nonbinary youth report high levels of sexual violence. However, population-based studies in Sweden on sexual violence across gender identities and sexual orientations among those aged 16 to 29 years remain limited. This study aims to investigate the lifetime prevalence of forced penetration, physical assault during sex, online sexual abuse and nonconsensual sharing of sexual content and their associations with gender identities and sexual orientations among young people in Sweden. This study also aims to examine the categories of perpetrators of sexual violence reported by young people. A population-based, cross-sectional survey using stratified random sampling (response rate = 23.7%) yielded a sample of 9,430 respondents. The survey data were complemented with national register data from Statistics Sweden. Statistical analyses included chi-square tests and logistic regression analyses. Young women and nonbinary individuals reported higher levels of all four types of violence compared to young men, with the categories of perpetrators differing by type of violence. Compared to heterosexual men, bisexual and heterosexual women were more likely to experience the four types of sexual violence. Additionally, lesbian women, along with gay and bisexual men, faced higher odds of exposure to three types of violence compared to heterosexual men. Our results indicate that, compared to nearly all groups, bisexual women are particularly vulnerable, showing the highest prevalence of all forms of sexual violence. In summary, our study reveals inequities in lifetime exposure to four types of sexual violence across gender identities and sexual orientations, revealing insights into the vulnerability of bisexual, lesbian, and heterosexual women, gay and bisexual men, as well as nonbinary individuals. To eliminate sexual violence in Sweden, measures involving stakeholders at all levels are needed, focusing on tailored prevention efforts and inclusive policies that address the vulnerabilities of these groups while promoting equity for all young people.

Achieving menstrual health is fundamental to gender equality, human rights, and the well-being of all people who menstruate. We undertook a scoping review to map the extent and range of qualitative studies on menstrual health in the Nordic countries and applied an intersectional lens in reporting the findings. The specific research questions we aimed to answer were (1) what types of menstrual health experiences were researched, (2) whose experiences and voices were being researched, and (3) what gaps exist in understanding the experiences and challenges encountered by diverse groups. Four databases were searched for peer-reviewed articles published between 2011 and 2023. Searches yielded 2733, and 22 articles met our inclusion criteria. Included studies were undertaken in Denmark (n = 5), Iceland (n = 1), Norway (n = 3), and Sweden (n = 13). The samples included menstruating people, healthcare professionals, and/or other professionals. Most of the included studies reported on menstrual experiences related to menstrual pain and disorders such as endometriosis. Studies focusing on understanding menstrual health experiences among people in vulnerable situations in the Nordic countries are lacking. We found that menstrual health experiences of menstruating people with the following identities were under-researched: people with disabilities, non-Nordic ethnicities, refugees, gender-diverse people, people experiencing homelessness, and young adolescents. The findings suggest that we have little knowledge and understanding of the experiences and challenges that might be faced by these groups in the Nordic countries. Findings of this scoping review can be used to inform future research directions and policy programming.

In the Democratic Republic of Congo (DRC) unsafe abortion claims thousands of lives every year. Under the 2018 Maputo protocol ratification, officials are implementing abortion services, yet abortion stigma contributes to delays in access to care. A recognized approach, person-centred care, can improve the quality and access to care in DRC. The aim of this study was to understand the experiences of women who received an abortion with midwives, nurses or physicians recently trained in comprehensive abortion care (CAC) using person-centred approaches in the capital city of Kinshasa. A qualitative design with semi-structured interviews captured the complexity and richness of twenty-five women who accessed CAC with trained healthcare providers. Participants were interviewed two weeks post-abortion. The analysis was thematic and applied person-centred abortion care frameworks. Participants emphasized the importance of emotional and psychological support from healthcare providers, and care that was empathetic, informative, reassuring and rapport building over time. They valued services tailored to their needs including care delivered virtually or outside of traditional clinical settings before, during, and after the abortion process. Relational continuity across the care journey, was central to their experiences and helped reduce feelings of isolation and stigma. Person-centred abortion care approaches can be expanded to explore how the care process, particularly the nexus between healthcare provider and client, shapes the overall experience. In DRC this includes prioritizing programs to support continuity of healthcare provider, and community-based care including the option for abortion self-management.

BACKGROUND:Both hospitalised (H) and non-hospitalised (NH) individuals may have different symptoms and impairments after COVID-19. We aimed to explore symptoms, mental and physical health after initial COVID-19 for both groups of individuals and the association between physical and mental impairments in relation to self-rated health status and to identify different cluster profiles. METHODS:Participants were recruited between June 2020 until December 2022 at the Karolinska University Hospital, Sweden. Data was collected at first assessment after COVID-19 and consisted of demographics, medical history, symptoms and results from physical function tests and self-reported questionnaires. RESULTS:Here we show that among 931 participants, the H-group are older (mean age 56.7 years) and predominantly male (72%), while the NH-group are younger (mean age 44.4 years) and mostly female (84%). Fatigue, dyspnoea, joint pain, paraesthesia, and chest pressure are common symptoms reported across all participants. Physical function is lower than predicted in both groups and the NH-group have higher prevalence of depression and fatigue. These impairments together with dyspnoea, number of symptoms and sick leave are also associated with reduced self-rated health. Four specific cluster profiles have been identified, and 66.4% of the participants have severe to moderate impairments. CONCLUSIONS:Regardless of the initial level of care approximately two-thirds of the participants exhibit various physical and mental impairments associated to self-rated health after COVID-19. We propose that defining specific cluster profiles is crucial for tailoring management of post-COVID sequelae. Further long-term studies are needed to understand recovery trajectories to optimise targeted interventions.

Purpose This study aims to explore the experiences of care, psychosocial support, and psychosocial wellbeing among patients treated for COVID-19 in intensive care 12 to 18 months after discharge. Methods This study used a qualitative approach with a descriptive design. Semi-structured interviews were performed with 20 adult patients treated for COVID-19 12 to 18 months after being discharged from a university hospital in Sweden. Data were analysed using qualitative content analysis. Findings The participants were severely affected by COVID-19 both during the hospital stay and afterwards. They experienced overwhelming fears and uncertainties related to their wellbeing and possibility to recover. The care was described chaotic with staff that were stressed; however, the efforts of the staff during this strenuous circumstance were still positively acknowledged. Difficulties to stay in touch with family and friends due to visiting restrictions affected the patient’s psychosocial wellbeing. Conclusion Contracting COVID-19 in the beginning of the pandemic was a stressful event. Being seen and heard is of importance as it has the possibility to create a feeling of security and being cared for despite unclarities about treatment and illness trajectory. Accordingly, healthcare staff play an important role for the psychosocial wellbeing of patients treated for COVID-19.

BackgroundMenstrual health is a recognised important public health issue and is essential for the realisation of gender equality and the achievement of Sustainable Development Goals. This study aimed to explore the menstrual health experiences of young people in Sweden and how the menstrual cycle affects their health and lives. The study also aimed to identify the facilitators and barriers to achieving menstrual health.MethodsWe conducted a qualitative study in Sweden. Sixteen young people aged 18-28 who have experienced the menstrual cycle participated in individual interviews. Purposeful sampling combined with snowball sampling was applied to recruit the participants. The data were analysed using reflexive thematic analysis.ResultsParticipants viewed menstruation as a sign of having a healthy and functioning body. Menstruation was linked to becoming a woman and fostered a sense of community and sisterhood, which was viewed as positive among cis women. Further, the results showed that physical and emotional symptoms related to the menstrual cycle limited the participants' everyday lives and social relationships and had a negative effect on their sexual and mental health. While managing their emotional discomfort and other menstrual complaints, they also had to deal with the public stigma and norms about menstruation contributing to shame and worries. Barriers to menstrual health included stigma and norms related to menstruation, which led to the adoption of expected behaviours, such as avoiding participation in social activities. The normalisation of menstrual complaints also contributed to delays in seeking healthcare, despite having symptoms that had a negative effect on their health. An important factor promoting menstrual health and quality of life is access to prompt treatment to mitigate and decrease symptoms that limit everyday life.ConclusionsThe results indicate that menstrual stigma and related norms create challenging situations limiting menstruating people's everyday lives and reluctance to seek healthcare despite needing to. To promote the menstrual health of menstruating young people in Sweden, organised and systematic screening of menstrual cycle-related symptoms should be provided within student health services at schools and universities, and primary healthcare. Policymakers should consider integrating stigma-reducing efforts into public health interventions to improve general awareness and promote gender equality.

BACKGROUND:Conflicts with patients and relatives occur frequently in intensive care units (ICUs), driven by factors that are intensified by critical illness and its treatments. A majority of ICU healthcare professionals have experienced verbal and/or physical violence. There is a need to understand how healthcare professionals in ICUs experience and manage this workplace violence. METHODS:A qualitative descriptive analysis of four hospitals in Sweden was conducted using semi-structured focus-group interviews with ICU healthcare professionals. RESULTS:A total of 34 participants (14 nurses, 6 physicians and 14 other staff) were interviewed across the four hospitals. The overarching theme: "The paradox of violence in healthcare" illustrated a normalisation of violence in ICU care and indicated a complex association between healthcare professionals regarding violence as an integral aspect of caregiving, while simultaneously identifying themselves as victims of this violence. The healthcare professionals described being poorly prepared and lacking appropriate tools to manage violent situations. The management of violence was therefore mostly based on self-taught skills. CONCLUSIONS:This study contributes to understanding the normalisation of violence in ICU care and gives a possible explanation for its origins. The paradox involves a multifaceted approach that acknowledges and confronts the structural and cultural dimensions of violence in healthcare. Such an approach will lay the foundations for a more sustainable healthcare system.

BACKGROUND: The benefit of the ICU for older patients is often debated. There is little knowledge on subjective impressions of excessive care in ICU nurses and physicians combined with objective patient data in real-life cases.RESEARCH QUESTION: Is there a difference in treatment limitation decisions and 1-year outcomes in patients < 75 and >= 75 years of age, with and without concordant perceptions of excessive care by two or more ICU nurses and physicians?STUDY DESIGN AND METHODS: This was a reanalysis of the prospective observational DISPROPRICUS study, performed in 56 ICUs. Nurses and physicians completed a daily questionnaire about the appropriateness of care for each of their patients during a 28-day period in 2014. We compared the cumulative incidence of patients with concordant perceptions of excessive care, treatment limitation decisions, and the proportion of patients attaining the combined end point (death, poor quality of life, or not being at home) at 1 year across age groups via Cox regression with propensity score weighting and Fisher exact tests.RESULTS: Of 1,641 patients, 405 (25%) were >= 75 years of age. The cumulative incidence of concordant perceptions of excessive care was higher in older patients (13.6% vs 8.5%; P < .001). In patients with concordant perceptions of excessive care, we found no difference between age groups in risk of death (1-year mortality, 83% in both groups; P > .99; hazard ratio [HR] after weighting, 1.11; 95% CI, 0.74-1.65), treatment limitation decisions (33% vs 31%; HR after weighting, 1.11; 95% CI, 0.69-2.17), and reaching the combined end point at 1 year (90% vs 93%; P 1/4 .546). In patients without concordant perceptions of excessive care, we found a difference in risk of death (1-year mortality, 41% vs 30%; P < .001; HR after weighting, 1.38; 95% CI, 1.11-1.73) and treatment limitation decisions (11% vs 5%; P < .001; HR, 2.11; 95% CI, 1.37-3.27); however, treatment limitation decisions were mostly documented prior to ICU admission. The risk of reaching the combined end point was higher in the older adults (61.6% vs 52.8%; P < .001).INTERPRETATION: Although the incidence of perceptions of excessive care is slightly higher in older patients, there is no difference in treatment limitation decisions and 1-year outcomes between older and younger patients once patients are identified by concordant perceptions of excessive care. Additionally, in patients without concordant perceptions, the outcomes are worse in the older adults, pleading against ageism in ICU nurses and physicians.

BACKGROUND:The benefit of the ICU for older patients is often debated. There is little knowledge on subjective impressions of excessive care in ICU nurses and physicians combined with objective patient data in real-life cases. RESEARCH QUESTION:Is there a difference in treatment limitation decisions and 1-year outcomes in patients < 75 and ≥ 75 years of age, with and without concordant perceptions of excessive care by two or more ICU nurses and physicians? STUDY DESIGN AND METHODS:This was a reanalysis of the prospective observational DISPROPRICUS study, performed in 56 ICUs. Nurses and physicians completed a daily questionnaire about the appropriateness of care for each of their patients during a 28-day period in 2014. We compared the cumulative incidence of patients with concordant perceptions of excessive care, treatment limitation decisions, and the proportion of patients attaining the combined end point (death, poor quality of life, or not being at home) at 1 year across age groups via Cox regression with propensity score weighting and Fisher exact tests. RESULTS:Of 1,641 patients, 405 (25%) were ≥ 75 years of age. The cumulative incidence of concordant perceptions of excessive care was higher in older patients (13.6% vs 8.5%; P < .001). In patients with concordant perceptions of excessive care, we found no difference between age groups in risk of death (1-year mortality, 83% in both groups; P > .99; hazard ratio [HR] after weighting, 1.11; 95% CI, 0.74-1.65), treatment limitation decisions (33% vs 31%; HR after weighting, 1.11; 95% CI, 0.69-2.17), and reaching the combined end point at 1 year (90% vs 93%; P = .546). In patients without concordant perceptions of excessive care, we found a difference in risk of death (1-year mortality, 41% vs 30%; P < .001; HR after weighting, 1.38; 95% CI, 1.11-1.73) and treatment limitation decisions (11% vs 5%; P < .001; HR, 2.11; 95% CI, 1.37-3.27); however, treatment limitation decisions were mostly documented prior to ICU admission. The risk of reaching the combined end point was higher in the older adults (61.6% vs 52.8%; P < .001). INTERPRETATION:Although the incidence of perceptions of excessive care is slightly higher in older patients, there is no difference in treatment limitation decisions and 1-year outcomes between older and younger patients once patients are identified by concordant perceptions of excessive care. Additionally, in patients without concordant perceptions, the outcomes are worse in the older adults, pleading against ageism in ICU nurses and physicians.