Abstract Introduction Progress toward operative autonomy is an important step in residency. This process is largely unexplored in Swedish residents. The aim was to analyse self-reported progression of operational autonomy in Swedish surgical and urology residents, and to explore a possible correlation with personality traits. Methods Applicants for positions at surgical departments at seven hospitals were invited to participate. A neutralized Big Five Personality Inventory was conducted. Questionnaires with background information and operative experience were carried out on recruitment, after one and three years. Descriptive statistics, Cochran’s Q test, McNemar’s test and Spearman’s rho correlation were used. Results Of 50 participants, 46 received employment, and 41 were still in a residency program after three years. A total of 28 participants had complete data for all tests and questionnaires. Descriptive statistics showed progression of autonomy in basic surgical procedures. Four individuals had noticeably higher or lower numbers compared to peers. Female gender and higher levels of neuroticism correlated with lower levels of autonomy (P < 0.05). No difference in autonomy was found between hospital types. Specialization correlated with levels of autonomy in the respective fields (P < 0.01). Discussion Residents at non-university hospitals are given opportunities to perform independent laparoscopic surgery more frequently than in university hospitals. Resident’s self-assessed operational autonomy did not significantly differ after three years of training. Our results indicate that high levels of neuroticism may affect operational autonomy progression. Discussion within the Swedish surgical society is called for to determine what levels of operative autonomy is expected at different stages of residency.

Does socially desirable responding produce exaggerated correlations between self-ratings of personality and positive psychology constructs? We operationalized social desirability as the tendency to react to evaluative content in questionnaire items and related one standard measure and one evaluatively neutralized measure of the Big Five to measures of five key positive psychology constructs (optimism, purpose in life, satisfaction with life, well-being and sense of coherence). Structural equation modelling (N = 439) revealed substantially different relationships between the Big Five and positive psychology constructs when the evaluative factor was accounted for. The results indicated that although the Big Five still predict the positive psychology constructs when the evaluative factor is accounted for, their influence is strongly reduced and the evaluative factor itself a major predictor. Arguably, this suggests that when the evaluative factor is not accounted for, the use of self-ratings invites social desirability to inflate the estimated relationships between personality traits and evaluatively loaded constructs in positive psychology. Alternative interpretations of the evaluative factor are discussed, as well as the importance of probing different solutions to measurement issues surrounding evaluative psychological constructs.

Background: Early-onset depression is an increasing concern, contributing to long-term disability and suicide. Diagnostic assessments are essential for effective treatment. However, research suggests that Child and Adolescent Psychiatry practices remain inadequate. Knowledge of healthcare processes is limited, with no consensus on conceptualising or measuring quality. This study aimed to investigate depression assessments in Swedish outpatient Child and Adolescent Psychiatry, including associations with predictors and diagnostic timeliness. Methods: Medical records (n = 284) from patients aged 8-17 with depression were collected from 10 services. Quality indicators for depressive symptoms, suicidality, comorbidities, and functioning were developed from guidelines. Indicator occurrences were assessed, summarised into components, and analysed using regression and correlations. Results: Indicator occurrences ranged from 8% to 84%, averaging 49%. Documentation varied considerably for risk aspects (57%). Distinct depressive characteristics (63%) occurred nearly twice as often as subtler symptoms (35%). Comorbidities (13%-22%) were rarely documented, whereas functioning and life situation (69%) were well-recorded. Predictors explained up to 28% of variance, with unidentified service-related factors explaining 10%. Better documentation weakly correlated with earlier diagnoses. Conclusions: Findings indicate the need for guideline implementation and further investigation into assessment inequities. Improving quality might promote earlier diagnoses. The indicators may be applicable in similar settings.

This study addresses the impact of witnessing different types of school bullying on Turkish school students who are bystanders. The primary aim is to investigate how the type of bullying (direct/indirect; ostracism/devaluation) affects the perception of bullying and the roles witnesses take. Additionally, we explore whether gender, global state self-esteem, and identification with one’s school account for variability in the dependent variables. Using an experimental vignette design, 378 Turkish students (mean age 15 years, 59

Abstract Background Few scales designed to assess factors that facilitate and/or impede the uptake of guidelines in routine care are valid, reliable, and cover multiple domains. The Barriers and Facilitators Assessment Instrument (BFAI) measures barriers on four scales: Innovation, Provider, Patient, and Context and is one of few evaluated for psychometric properties, primarily in the context of adult health care. This study aimed to contribute to the development and cross-validation of the BFAI by examining a Swedish version as part of a larger depression guideline implementation across child and adolescent mental health services (CAMHS). The study also explored the relationship between attitudes toward evidence-based practice, as measured by the Evidence-Based Practice Attitude Scale (EBPAS), and perceived barriers to guideline implementation. Methods The BFAI was translated, adapted, and completed by 440 CAMHS clinicians (52% response rate) across Sweden. Items were tested and scales’ internal consistency and dimensionality were examined using Cronbach alpha and exploratory factor analyses. Results Items satisfied criteria set by developers. The internal consistency and dimensionality of the four scales were supported. The Patient and Innovation scales had the best psychometric properties, while the Context scale had some issues due to the intra- and interdomain correlations. Correlations between BFAI and EBPAS scales were in the expected direction (negative) but weak. Conclusion The Swedish version of the BFAI exhibited acceptable psychometric properties; single items can be used for tailoring local strategies in implementation programs. The BFAI scales might also be suitable for research by providing more specific information about guideline implementation challenges than the EBPAS.

The Sensory Processing Measure, second edition (SPM-2), is an American assessment guiding person-centered sensory processing interventions, but it lacks Swedish adaptation for occupational therapists. In eight phases, this study translated the SPM-2 into Swedish and assessed its face validity and preliminary psychometric properties, including internal consistency and inter-scale/item correlations. The findings suggest the Swedish SPM-2 is valid and reliable, although the Social Participation scale showed weak internal consistency. A larger normative study (N = 130) is needed before clinical use.

Abstract Background Implementation of evidence-based practice (EBP) in child and adolescent mental health services (CAMHS) is a priority to improve service delivery and outcomes. Clinicians’ EBP attitudes are likely to play a crucial role in implementation but are poorly understood. This study aimed to assess variation in EBP attitudes in a large national sample of CAMHS clinicians in Sweden, and to compare these findings to findings from the United States of America (USA). Methods CAMHS clinicians (n = 799; 60% response rate) completed the Evidence-Based Practice Attitude Scale (EBPAS) and items from the Organizational Readiness for Change Scale (ORC) ahead of an EBP for depression implementation effort across Sweden. EBPAS scores were compared with the USA study. Predictors of global and specific attitudes (gender, age, working years, education, profession, perceived benefit of diagnosis and organizational readiness and type of service) were examined using simple and multiple linear regressions. Results Clinicians had positive attitudes towards EBP on the four-dimensional subscales of the EBPAS, somewhat more so than their American counterparts. Clinician and organizational characteristics were related to at least one attitudinal dimension in both models, with perceived utility of diagnosis being the strongest and most consistent predictor across dimensions and models. Conclusions Results from this large-scale national study underscore the need to consider cultural, contextual, and individual variations in attitudes towards EBP when planning implementation efforts. Such efforts may need to be tailored to the working contexts, needs, and values of CAMHS clinicians, particularly their views on the utility of diagnosis.

The forced-choice response format is often considered superior to the standard Likert-type format for controlling social desirability in personality inventories. We performed simulations and found that the trait information based on the two formats converges when the number of items is high and forced-choice items are mixed with regard to positively and negatively keyed items. Given that forced-choice items extract the same personality information as Likert-type items do, including socially desirable responding, other means are needed to counteract social desirability. We propose using evaluatively neutralized items in personality measurement, as they can counteract social desirability regardless of response format.

BACKGROUND:Despite efforts to promote guideline use, guideline adoption is often suboptimal due to failure to identify and address relevant barriers. Barriers vary not only between guidelines but also between settings, intended users, and targeted patients. Multi-professional guidelines are often used in child and adolescent mental health services (CAMHS), making the implementation process more difficult. Despite this, there is a lack of knowledge about which barriers to consider or if barriers vary by profession. The aim of this study was to address these gaps by examining barriers to adopting a multi-professional depression guideline in the context of a nationwide implementation study. METHODS:440 CAMHS clinicians across Sweden (52%) completed the Barriers and Facilitators Assessment Instrument (BFAI) ahead of an implementation endeavour. BFAI is a widely used and validated measure of guideline implementation on four scales: Innovation, Provider, Context, and Patient. Barriers were calculated at scale and at item levels. ANOVA and chi-square tests were used to analyse differences by profession and effect sizes were calculated. RESULTS:Overall, clinicians were optimistic about guideline uptake, particularly about guideline characteristics and their own adoption ability. Barriers were related to the patient and the context domains, as well as to individual clinician knowledge and training. Perceptions differed across professions; psychiatrists were most, and counsellors were least positive about guideline embeddedness. CONCLUSION:This large-scale quantitative study suggests that CAMHS clinicians have an overall favourable attitude towards guideline adoption but highlights the need for adaptations to certain patient groups. Strategies to improve guideline use should primarily address these patient issues while securing proper support to the implementation. Implementation efforts, particularly those targeting staff knowledge, training, and involvement, may benefit from being tailored to different professional needs. These findings may inform implementation projects in CAMHS and future research.

Introduction360-degree evaluations are used as an assessment in order to identify strengths and weaknesses of, or as a continuous evaluation for, residents. The aim of this study was to investigate the relationship between personality and ratings on 360-degree evaluations among surgical residency applicants. A secondary aim was to describe the personality profile of applicants for a surgical residency position.MethodsDoctors interviewed for a residency or locum position in general, urology, or pediatric surgery were included. Participants rated their personality on the Neutralized Big Five Inventory. A 360-degree assessment was conducted. Scores from two laparoscopic simulators were used as a measure of technical ability. Univariate analyses were used to assess the results. Student's t-test was used to compare personality and Pearson correlations between 360-degree assessment and personality.ResultsFifty doctors participated: data were complete for 38. Personality profiles showed higher emotional stability, agreeableness, conscientiousness and openness ratings than the norm. Correlations revealed a significant relationship between extraversion and higher scores on the 360-degree assessments. Significant univariate correlations were found between extraversion and the 360-degree assessments, and two of the correlations held up after adjustment for multiple tests. No correlations with performance when using laparoscopic simulators were found.ConclusionsApplicants for surgical residency rated significantly higher than the norm in four personality domains. Extraversion correlated with overall higher scores in 360-degree assessments by coworkers. Higher scores were not related to objective measures of technical skill, highlighting the importance of using objective measures for assessment.

Background: Knowing whether interventions addressing everyday life as a whole can affect work readiness for people with severe mental health issues would be important for how to develop support. Objective: To compare two groups of people with mental health problems, receiving either of two types of 16-week activity-based interventions, Balancing Everyday Life (BEL) or Care as Usual (CAU), regarding work readiness in terms of perceived worker role and satisfaction with recent work experience. Changes from baseline (T1) to completed intervention (T2) and a six-month follow-up (T3) and variables of potential importance to changes were also explored. Methods: This cluster RCT recruited participants for BEL (n = 133) and CAU (n = 93) from specialized and community-based psychiatry. Questionnaires addressing work readiness and potentially influencing variables (sociodemographic, clinical, type of intervention, work experience, non-work activity factors, social interaction and self-esteem) were used. Mixed model regression analyses were employed. Results: Positive changes occurred for both groups in one worker role aspect (resources for a future worker role) and in satisfaction with recent work participation. Satisfaction with non-work everyday activities, having valued activities, and self-esteem were important for change in the work readiness variables, whereas intervention type, age, sex or general activity level were not. Conclusion: Both interventions yielded equally positive work readiness outcomes. Support that emphasizes engagement in satisfying and valued everyday activities and boosts self-esteem would be a potential way to help people with mental health issues develop work readiness in terms of the worker role and satisfaction with work participation.

BACKGROUND:For many children, public playgrounds represent environments that are playful and important in developing good health. Without efforts to facilitate climate change adaptation of outdoor playgrounds there may be a negative impact on children's health and well-being. AIM:With a special focus on play value, to explore the reasoning and described strategies among professionals responsible for development, planning and solutions concerning outdoor playgrounds in the context of climate change. MATERIALS AND METHODS:Eight semi-structured interviews were held with purposefully selected interviewees. Analysis was conducted with manifest content analysis. RESULTS:Four themes with supporting categories; 1: a new design paradigm for outdoor play environments, 2: a need for updated regulation- and security guidelines for outdoor play environments, 3: nature-based play environments are more climate change resilient, and 4: maintenance and construction of nature-based outdoor play environments. The findings showed an overall awareness and a will to use innovative and nature-based strategies and planning to deal with climate change implications for outdoor play environments. CONCLUSIONS AND SIGNIFICANCE:The findings suggest that the strategies employed lean towards implementation of increased ecosystem services and natural elements. Ensuring strengthened resilience against hazardous climate change effects may positively facilitate diverse play activities with high play value.

Recently, it has been suggested that gender disparity in Occupational Therapy has to do with segregated gendered job norms that position female dominated professions as a ‘step down’ for many males. Interestingly, this suggestion was not underpinned by experiences of males in the profession. Thirteen male Occupational Therapists with a variety of backgrounds were invited to this Round Table research, focussing on the broader issue of the existing gender imbalance in Occupational Therapy. Two themes emerged: ‘The core values of the profession’, and ‘Broadening the scope of the profession’; none of them suggesting that male/female imbalance was necessarily the most pressing issue. A gender-unrelated approach to everyday problem-solving was put forward to achieve increased diversity in Occupational Therapists’ backgrounds, better reflecting the people they serve. By broadening the scope and the way the profession is presented, and encouraging innovative and more entrepreneurially driven approaches, diversity in the workforce could be further facilitated. These findings are discussed within the context of ‘The mutual constitution of cultures and selves’ model. Diversity in the Occupational therapy workforce could be further facilitated with a shift in focus away from the male/female perspective to an intersectional approach.

Background: The technical skills of a surgeon influence surgical outcome. Testing technical aptitude at point of re-cruitment of surgical residents is only conducted in a few countries. This study investigated the impact of visuo-spatial ability (VSA), background factors, and manual dexterity on performance in two different laparoscopic surgical simulators amongst applicants and 1st year surgical residents.Method: Applicants from general surgery, pediatric surgery, and urology were included from seven hospitals in Sweden between 2017 and 2021. Some 73 applicants were invited and 50 completed. Participants filled out a background form, and were tested for manual dexterity, and visuospatial ability. Two laparoscopic simulators were used, one 2D video box trainer and one 3D Virtual Reality Simulator.Results: A significant association was found between the visuospatial ability test and 2D video box laparoscopic performance (95 % CI: 1.028-1.2, p-value <0.01). For every point on the visuospatial test the odds of accomplishing the task increased by 11 %. No association was found between VSA and performance in a laparo-scopic VR simulator using 3D vision. No other background factors were associated with performance in the two laparoscopic simulators. Conclusion: Visuospatial ability in applicants to surgical residency positions is associated to performance in a 2D video box trainer. Knowledge of a resident's visuospatial ability can be used to tailor individualized laparoscopic training programs, and in the future might function as a selection tool concerning laparoscopic ability. Key message: Visuospatial ability differs greatly amongst applicants for surgical residency and is associated to lap-aroscopic simulator performance. Testing applicants' visuospatial ability could possibly be used to tailor individ-ualized laparoscopic training programs or in the future as a selection tool concerning laparoscopic ability.(c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

The purpose of the study was to explore employees’ appraisals and coping responses to workplace incivility in the foodservice industry. Five group interviews with foodservice workers were conducted. 13 different types of experienced or witnessed incivility were identified. Positive-benign, irrelevant, and negative appraisals were found, as well as four major coping themes. These were active, passive, and proactive coping as well as reappraisal, encompassing twelve forms of coping behaviors. Additionally, workplace incivility was described as a daily stressor which can be expressed as a part of the workplace culture in the foodservice industry.

Although most individuals consider gambling to be an innocent and fun activity, when it develops into problem gambling, it can have detrimental outcomes to one's life, such as over-indebtedness. This cross-sectional study explores the role of maladaptive personality traits and gender in both problem gambling and over-indebtedness, in an online sample of 1479 adult gamblers (65% males) in Sweden. Participants were administered the Problem Gambling Severity Index (PGSI), the Personality Inventory for DSM-5-Brief Form (PID-5-BF), and questions addressing subjective over-indebtedness and other risk factors. Quasi-Poisson loglinear models and logistic regression analyses demonstrated that Disinhibition (OR = 1.38, 95% CI [1.24, 1.53]), and Antagonism (OR = 1.23, 95% CI [1.14, 1.34]) showed the strongest associations to problem gambling, and that only Disinhibition (OR = 1.72, 95% CI [1.22, 1.43]) and Antagonism (OR = 2.00, 95% CI [1.52, 2.66]) were significantly related to over-indebtedness. The prevalence of problem gambling and over-indebtedness was more common among women, and gender moderated the univariate relationships of Negative Affectivity, Disinhibition and Psychoticism to problem gambling. These findings call for future research addressing maladaptive personality traits, problem gambling and over-indebtedness, and highlight the need for tailored interventions and prevention strategies, particularly for women who may be at higher risk.

Abstract: Personality is usually measured by means of self-ratings. Despite some drawbacks, the method is here to stay, and improving on it, particularly regarding social desirability, is essential. One way to do this is evaluative neutralization, that is, to rephrase items such that it is less obvious to the respondent what would be a desirable response. We present a 120-item evaluatively neutralized five-factor inventory and compare it to the IPIP-NEO ( Goldberg et al., 2006 ). Psychometric analyses revealed that the new inventory has high factor homogeneity, relatively independent facets with acceptable homogeneity and normally distributed ratings, and relatively evaluatively neutral ratings (as indicated by the level of item popularity). In sum, this new inventory captures the same personality variance as other five-factor inventories but with less influence from individual differences in evaluative responding, resulting in less correlation between factors and a factor structure more in line with the simple structure model than many other five-factor inventories. Evaluatively neutralized inventories should be particularly useful when the factor structure is central to the research question and focuses on discriminant validity, such as identifying theoretically valid relationships between personality traits and other concepts.

Background The aim of the present study is to explore whether (experienced and witnessed) workplace incivility is a risk factor for (experienced and witnessed) workplace bullying. An additional aim is to explore whether experienced workplace incivility is associated with psychological well-being above and beyond the influence of (experienced and witnessed) workplace bullying on well-being. Methods A survey was distributed via e-mail to a panel of Swedish engineers. The survey was administered at three time points over one year. In total, N = 1005 engineers responded to the survey. Of these, N = 341 responded to more than one survey, providing longitudinal data. N = 111 responded to all three surveys. Results The results showed that the likelihood of being targeted by workplace bullying was higher for those who had previously experienced incivility, even when taking previous bullying exposure into account. There was also partial support for a higher likelihood of witnessing bullying at a later time point for those that had previously witnessed incivility. Additionally, the results showed that experienced workplace incivility was negatively related to psychological well-being over time, even when controlling for previous levels of experienced and witnessed workplace bullying and well-being. However, this result was only found over one of the two time lags. Conclusion The findings of the present study suggests that workplace incivility can be a risk factor for future bullying. In addition, the findings suggest that experienced workplace incivility exerts a unique negative effect on psychological well-being, even when accounting for exposure to workplace bullying.

Experience sampling often makes use of items that are similar to personality questionnaire items. Arguably, this opens up for item-popularity effects, where some respondents react to the items’ level of evaluative phrasing, causing a separate factor. Gauging the risk of item popularity effects in experience sampling is important since the multifactorial aspect of the responses to the items may cause spurious correlations. We investigate this in one original study and two existing datasets. The results reveal that evaluativeness in experience sampling items creates the same type of problems as in self-rating inventories. We conclude that personality researchers need to be aware that the experience sampling method is not vaccinated against socially desirable responding, and that careful phrasing of items promotes purer personality measures. This allows for more optimal testing of theoretical models of personality, as the fit between data and model will not concern variance in socially desirable responding but in the relevant constructs.