To Örebro University

PURPOSE: Studies have shown that men with Peyronie's disease often suffer from psychological problems, but the psychiatric burden of this disorder remains largely unknown. We assessed risks of a range of psychiatric outcomes in a population-based, Swedish cohort comprising 3.5 million men.

MATERIALS AND METHODS: We conducted a longitudinal cohort study based on Swedish national registers. A total of 8,105 men diagnosed with Peyronie's disease and 3.5 million comparison subjects from the general Swedish population were selected, and followed-up for diagnosed psychiatric outcomes, including substance use disorder, alcohol misuse, anxiety disorder, depression, and self-injurious behaviors. Risks of psychiatric outcomes were estimated with Cox regressions, and additionally adjusted for birth year.

RESULTS: Men with Peyronie's disease had increased risks of being diagnosed with substance use disorder; hazard ratio (HR) 1.4, 95% confidence interval (CI) 1.1-1.9, no excess risk of alcohol misuse; HR 0.9, CI 0.8-1.1, but elevated risks of anxiety disorder; HR 1.9, CI 1.6-2.2, depression; HR 1.7, CI 1.5-2.0, self-injurious behaviors; HR 2.0, 95% CI 1.7-2.3, as well as any psychiatric outcomes; HR 1.4, 95% CI 1.2-1.5. The risk estimates were slightly decreased when adjusted for birth year. A limitation of the study was that we had no information about Peyronie's disease diagnoses assigned before year 1997.

CONCLUSIONS: Men with Peyronie's disease are at increased risk of being diagnosed with adverse psychiatric outcomes. Health care providers should ensure that men with Peyronie's disease have a documented mental health status assessment.

Background: Managing mass casualty or disaster incidents is challenging to any person or organisation. Therefore, this paper identifies and describes common challenges to managing such situations, using case and lessons learned reports. It focuses on sudden onset, man-made or technologically caused mass casualty or disaster situations.

Methods: A management review was conducted based on a structured search in the PubMed andWeb of Science databases.

Results:The review included 20 case—and lessons learned reports covering natural disasters, man-made events, and accidents across Europe, the United States of Amerika (USA), Asia and the Middle East. Five common challenges were identified: (1) to identify the situation and deal with uncertainty, (2) to balance the mismatch between the contingency plan and the reality, (3) to establish a functional crisis organization, (4) to adapt the medical response to the actual and overall situation and (5) to ensure a resilient response.

Conclusions: The challenges when managing mass casualty or disaster events involved were mainly related to the ability to manage uncertainty and surprising situations, using structured processes to respond. The ability to change mind set, organization and procedures, both from an organizational- and individual perspective, was essential. Non-medical factors and internal factors influenced the medical management. In order to respond in an eective, timely and resilient way, all these factors should be taken into consideration.

Women with pre-gestational diabetes face additional challenges after birth as they struggle with breastfeeding and managing unpredictable blood glucose levels. The aim of this study is to validate the Diabetes and Breastfeeding Management Questionnaire (DBM-Q). In total, 142 mothers with type 1 diabetes mellitus answered the questionnaire, which initially consisted of 11 items. The response rate was 82.5% (n = 128) at two months, and 88.4% (n = 137) at six months postpartum. The measurement properties of the Diabetes and Breastfeeding Management Questionnaire were tested according to the Rasch measurement theory (RMT). One item showed both disordered thresholds and several model misfits and was removed. Two items showed disordered thresholds which were resolved by collapsing response categories. This resulted in a 10-item questionnaire with all the fit residuals within the range of +2.5, minor significant dierential item functioning, well-targeted items and a person separation index of 0.73. Evaluating the DBM-Q according to the RMT is a strength, as it evaluates data against strict measurement criteria. This study provides an initial validation of the questionnaire. The DBM-Q shows good measurement properties for measuring diabetes and breastfeeding management postpartum in women with pre-gestational diabetes. Further studies are needed to identify cutos for when professional support is needed.

The aim of the study was to evaluate if an intervention including theater in school sex education affects students' knowledge, attitudes, and behavior regarding condom use in Sweden. The study was a cluster randomized controlled trial. The intervention group got a play, value exercises, chlamydia games, condom school, and interactive replay with professional actors and staff from a youth guidance center. The control group got standard sex education from school staff. Students in both groups answered web surveys on knowledge, attitudes, and behavior regarding condom use. Posteducation, knowledge on condom use, chlamydia, and protection had increased in both groups. However, students in the intervention group showed higher levels of knowledge, improved attitudes, and less risky behavior in regard to condom use compared to the control group. The intervention titled SAFETY seemed to be a beneficial supplement to standard sex education and more effective with regard to knowledge of condom use.

This study describes the attitudes to risk behaviour among patients diagnosed with a chlamydia infection at a sexually transmitted infection (STI) clinic. Qualitative interviews were conducted face to face with 18 participants, aged 18–30 years, with a confirmed diagnosis of chlamydia infection. An interview guide was used and participants described the behaviour that had led to their infection. Qualitative content analysis was performed on the theme of risk. A common denominator among participants was risky behaviour in sexual relations when using alcohol, while very few participants took unnecessary risks in life in general. Of the 18 participants, 16 had been tested for STIs previously, and 10 had previously had an STI.

Introduction: The primary aim of this study was to investigate midwives' and obstetricians' views on how many ultrasound examinations should be part of standard care during pregnancy in Norway.

Material and methods: This study is a part of a larger study, the CROss-Country Ultrasound Study (CROCUS), an international investigation of midwives' and obstetricians' experiences of and views on the use of ultrasound. We distributed 400 questionnaires to respondents in all five health regions in Norway: 40 to municipal midwives, 180 to midwives working in hospitals and 180 to obstetricians. The questionnaire included specific questions about the appropriate number of examinations during pregnancy, examinations without medical indication, non-medical ultrasound, commercialisation and safety.

Results: The response rate was 45%. Of the respondents, 58% reported satisfaction with the offer of one scheduled ultrasound examination during pregnancy, as recommended in the Norwegian guidelines. Health care professionals who used ultrasound themselves were significantly more likely to want to offer more ultrasound examinations: 52% of the ultrasound users wanted to offer two or more ultrasound examinations vs. 16% of the non-users (p < .01). The majority of obstetricians (80%) reported that pregnant women expect to undergo ultrasound examination, even in the absence of medical indication.

Conclusion: The majority of Norwegian health care professionals participating in this study supported the national recommendation on ultrasound in pregnancy. Ultrasound users wanted to offer more ultrasound examinations during pregnancy, whereas non-users were generally content with the recommendation. The majority of respondents thought that commercialisation was not a problem at their institution, and reported that ultrasound is often performed without a medical indication. The ultrasound users thought that ultrasound is safe.

Background: The impact of sexual violence in any community is extremely devastating and women in the Eastern part of the Congo are no exception. Sexual violence not only affects the health of women, but it impacts their social life within the community too.

Objective: The study aims to investigate the experiences of female victims of sexual violence in accessing medical care in North Kivu.

Design: An interpretive, phenomenological approach was used for this inductive and qualitative study. In-depth informant interviews were the main data collection tool. Open-ended questions were used during the interviews in order to garner more information from the interviewees. Heidegger’s approach was utilized in analyzing the collected data.

Results: The analyzed and interpreted results of the data indicated that survivors of sexual violence are engaged in an ongoing struggle. The victims demonstrated immense resilience despite the lack of comprehensive medical care and have continued to reassemble their broken lives. In order to present the outcomes of the research in a succinct and coherent manner, the outcomes are categorized into five sub-themes: managing worries and shame; regaining happiness; healing and restoration; the need for professional assistance and struggles in daily life.

Conclusion: The study provides an understanding of the recovery processes of survivors of sexual violence in North Kivu, with important insights into dimensions that rehabilitation programs should take into consideration.

Aims: To report results from and explore use of a multicentre, parallel-group, unblinded, randomized controlled trial testing the effectiveness in terms of well-being and diabetes management of a person-centred, web-based support programme for women with Type 1 diabetes, in pregnancy and postpartum.

Methods: Between 2011 and 2014, 174 pregnant women with Type 1 diabetes were randomly allocated (1:1) to web-based support and standard care (intervention group, n=83), or standard care (control group, n=91). The web-based support consisted of evidence-based information; a self-care diary for monitoring of daily activities; and peer support in a discussion forum. The primary outcomes (mean difference, measured at 6 months after childbirth) were well-being and diabetes management.

Results: No differences were found with regard to the primary outcome measure scores for general well-being [1.04 (95% CI -1.28 to 3.37); P= 0.68] and self-efficacy of diabetes management [0.076 (95% CI -0.123 to 0.275); P= 0.75], after adjustment for baseline differences in the insulin administration method, nor with regard to the secondary outcome measures.

Conclusions: At 6 months after childbirth, the web-based support plus standard care was not superior to standard care in terms of general well-being or self-efficacy of diabetes management. This might be explained by the low number of participants who had a high activity level. Few simultaneously active participants in the web-based programme and stressors in motherhood and diabetes postpartum were the main barriers to its use. Further intervention studies that offer web-based support are needed, with lessons learned from the present study.

Background: Nursing practice requires application of knowledge, skills and values in various combinations and has undergone substantial changes the last decades. An increased focus on inter-professional collaboration and possible new and more independent roles for nurses are described. A variety of programs have been developed in order to educate registered nurses (RN) to meet the changes and demands in health and nursing care throughout the world.

Aim: The aims were to 1) describe nurses' self-assessment of clinical competence and need for further training, and 2) explore possible differences between nurses in specialist vs master's programs.

Methods: A cross-sectional survey design was applied. 97 nurses in postgraduate programs from five countries responded (response rate 45%). A revised version of the Professional Nurse Self-Assessment Scale of clinical core competencies (PROFFNurseSASII) was used for data collection. Independent student t-test and regression analyses were carried out.

Results: The respondents rated their competence highest in taking full responsibility, cooperation with other health professionals and in acting ethically. Items where they considered themselves needing further training most were competence on medications, interaction and side effects and differential diagnoses. For all items, nurses in master's programs rated their competence higher than nurses in the specialist programs. Nurses in specialist programs rated their need for more training for all items higher than nurses in master's degree programs, and for 47 out of the 50 items these differences were statistically significant.

Conclusion: Even though the nurses rated their competence high for important competence aspects such as taking responsibility and cooperation with other health professionals, it is worrying that their need for further training was highest for effects and interaction of various types of medications. Further studies are needed to conclude if and how master's education improves patient outcome.