Eva von Strauss

The purpose of this study was to describe the psychosocial experience of the International Federation of Red Cross and Red Crescent Societies’ nurses upon their return from deployment at an Ebola Treatment Center during an Ebola virus disease outbreak in Kenema, Sierra Leone, between 2014 and 2015. The following three psychosocial aspects related to pre-, during, and postdeployment were explored: stress management, sociocultural exposure, and attitudes from others. This is a descriptive qualitative study with a cross-sectional design. Questionnaires were administered to 50 nurses, of which 44 responded. Eight themes were identified in relation to the three psychosocial aspects of interest: professional- and self-confidence, pragmatism, wellness activities, human contact, cultural competency, professionalism, pariah, and/or hero. One of the most important findings in this article relates to the essential mental health support pre- and during deployment with an emphasis upon return when the risk of isolation and stigmatization is greater. In conclusion, more research is needed about the psychosocial challenges met by nurses to prepare and support them as increasing threat of emerging infectious diseases puts pressure on global health systems.

Violence against women is an acknowledged public and global health problem which has adverse consequences for women’s health. Education, especially higher education, has long been identified as an important arena for addressing the problem and promoting gender equality. Two measures recently put in place in the Swedish higher education have brought the role of the sector into focus. The first is the inclusion of gender equality as a measurable outcome in quality assurance in higher education. The second measure is the amendment of the Swedish Higher Education Ordinance to include mandatory knowledge of VAW in the degree programme of seven selected relevant professional groups. The potentials of both measures to positively contribute to the gender equality discourse, as well as improving capacity building for the public health workforce who encounter VAW, are discussed.

There is an urgent need to train public health professionals at undergraduate level who can face global challenges that are due to longstanding conflicts, increasing number of displaced people, natural disasters, and growing inequalities between and within countries. Future public health professionals will lead activities ranging from national and international community planning, strategic work geared towards integration of migrants and crisis management of refugees, and humanitarian services. Consequently, the need for public health professionals with deep and wide theoretical and practical competencies in global contexts has become most relevant. In response to this need, The Swedish Red Cross University College has created such a programme leading to a Bachelor degree in Public Health Science, specialization Global Health.

Det föreligger ett akut behov att utbilda folkhälsovetare på grundnivå och som kan möta de globala utmaningarna. Hälsoutmaningarna förändras i takt med långvariga konflikter, människor på flykt, stora katastrofer och en ökande ojämlikhet mellan och inom länder, i en omvärld som är i ständig rörelse. Dagens och morgondagens folkhälsovetare ska kunna arbeta med olika aktörer på skilda arenor; med hälso- och sjukdomsprevention kommunalt, regionalt, nationellt (regering, myndigheter) och internationellt (europeiskt och globalt). Det innefattar även integrationsarbete, internationellt biståndsarbete och humanitärt arbete. Behovet av professionella folkhälsovetare med breda och djupa teoretiska och praktiska kompetenser i globala sammanhang har därför blivit högst relevant. Därför agerar nu Röda Korsets Högskola och startar ett folkhälsovetenskapligt program på kandidatnivå med global inriktning.

Background: Nurses are on the forefront and play a key role in global disaster responses. Nevertheless, they are often not prepared for the challenges they are facing and research is scarce regarding the nursing skills required for first responders during a disaster situation. Objectives: To investigate how returnee nursing staff experienced deployment before, during and after having worked for the Red Cross at an Ebola Treatment Center in Kenema, West Africa, and to supply knowledge on how to better prepare and support staff for viral haemorrhagic fever outbreaks. Methods: A descriptive, cross-sectional approach. Questionnaires were administered to nurses having worked with patients suffering from Ebola in 2014 and 2015. Data collection covered aspects of pre-, during and post-deployment on clinical training, personal health, stress management, leadership styles, socio-cultural exposure and knowledge transfer, as well as attitudes from others. Data was analysed using both quantitative and qualitative methods. Results: Response-rate was 88%: forty-four nurses from 15 different countries outside West Africa answered the questionnaire. The respondents identified the following needs for improvement: increased mental health and psychosocial support and hands-on coping strategies with focus on pre- and post-deployment; more pre-deployment task-oriented clinical training; and workload reduction, as exhaustion is a risk for safety. Conclusions: This study supplies knowledge on how to better prepare health care staff for future viral haemorrhagic fever outbreaks and other disasters. Participants were satisfied with their pre-deployment physical health preparation, whereas they stressed the importance of mental health support combined with psychosocial support after deployment. Furthermore, additional pre-clinical training was requested.

Background: Recent studies suggest that trends in cardiovascular risk may result in a decrease in age-specific prevalence of dementia. Studies in rural areas are rare. Objectives: To study cohort effects in dementia prevalence and survival of people with dementia in a Swedish rural area. Methods: Participants were from the 1995-1998 Nordanstig Project (NP) (n = 303) and the 2001-2003 Swedish National study on Aging and Care in Nordanstig (SNAC-N) (n = 384). Overall 6-year dementia prevalence and mortality in NP and SNAC-N were compared for people 78 years and older. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for dementia occurrence using the NP study population as the reference group. Cox regression models were used to analyze time to death. Results: The crude prevalence of dementia was 21.8% in NP and 17.4% in SNAC-N. When the NP cohort was used as the reference group, the age- and gender-adjusted OR of dementia was 0.71 (95% CI 0.48–1.04) in SNAC-N; the OR was 0.47 (0.24–0.90) for men and 0.88 (0.54–1.44) for women. In the extended model, the OR of dementia was significantly lower in SNAC-N than in the NP cohort as a whole (0.63; 0.39–0.99) and in men (0.34; 0.15–0.79), but not in women (0.81; 0.46–1.44). The Cox regression models indicated that the hazard ratio of dying was lower in the SNAC-N than NP population. Conclusions: Trends toward a lower prevalence of dementia in high-income countries seem to be evident in this Swedish rural area, at least in men.

The aim of the study was to examine 1) the incidence of disability in Activities of Daily Living (ADL), in persons 78 years and older 2) explore whether being physical active earlier is a significant predictor of being disability free at follow-up and 3) describe the amount of informal and formal care in relation to ADL-disability. Data were used from a longitudinal community-based study in Nordanstig (SNAC-N), a part of the Swedish National Study on Aging and Care (SNAC). To study objectives 1) and 2) all ADL-independent participants at baseline (N = 307) were included; for objective 3) all participants 78 years and older were included (N = 316). Data were collected at baseline and at 3- and 6-year follow-ups. ADL-disability was defined as a need for assistance in one or more activities. Informal and formal care were measured using the Resource utilization in Dementia (RUD)-instrument. The incidence rates for men were similar in the age groups 78-81and 84 years and older, 42.3 vs. 42.5/1000 person-years. For women the incidence rate for ADL-disability increased significantly from the age group 78–81 to the age group 84 years and older, 20.8 vs.118.3/1000 person-years. In the age group 78–81 years, being physically active earlier (aOR 6.2) and during the past 12 month (aOR 2.9) were both significant preventive factors for ADL-disability. Both informal and formal care increased with ADL-disability and the amount of informal care was greater than formal care. The incidence rate for ADL-disability increases with age for women and being physically active is a protective factor for ADL-disability. The incidence rate for ADL-disability increases with age for women, and being physical active is a protective factor for ADL-disability.

The concepts of target efficiency can be used to assess the extent to which service provision is in line with the needs of the population. Horizontal target efficiency denotes the extent to which those deemed to need a service receive it and vertical target efficiency is the corresponding extent to which those who receive services actually need them. The aim of this study was to assess the target efficiency of the Swedish eldercare system and to establish whether target efficiencies differ in different geographical areas such as large urban, midsize urban and rural areas. Vertical efficiency was measured by studying those people who received eldercare services and was expressed as a percentage of those who received services who were functionally dependent. To measure horizontal target efficiency, data collected at baseline in the longitudinal population study SNAC (Swedish National study on Aging and Care) during the years 2001–2004 were used. The horizontal efficiency was calculated as the percentage of functionally dependent persons who received services. Functional dependency was measured as having difficulty with instrumental activities of daily living (IADL) and/or personal activities of daily living (PADL). Services included long-term municipal eldercare services (LTC). Horizontal target efficiency for the public LTC system was reasonably high in all three geographical areas, when using dependency in PADL as the measure of need (70–90 %), but efficiency was lower when the less restrictive measure of IADL dependency was used (40–50 %). In both cases, the target efficiency was markedly higher in the large urban and the rural areas than in the midsize urban areas. Vertical target efficiency showed the same pattern—it was almost 100 % in all areas for IADL dependency, but only 50–60 % for PADL dependency. Household composition differed in the areas studied as did the way public long-term care was provided to people living alone as compared to those co-habiting.

Background: Administration of medication to care recipients is delegated to home‐care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home‐care assistants have practical administration skills, but lack formal medical knowledge.Aim: The aim of this study was to explore how home‐care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care.Methods: Four focus groups consisting of 19 home‐care assistants were conducted. Data were analysed using qualitative content analysis.Results: According to home‐care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home‐care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality.Conclusions: Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home‐care recipients.Implications for practice: This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients’ best interest and to ensure patient safety.