Linda Beckman

Background: Physical activity (PA) is central to healthy aging, yet interventions targeting older adults often report substantial attrition and variable adherence. Although digital and internet-based exercise programs broaden accessibility and flexibility, their ability to sustain engagement compared with traditional on-site formats remains unclear. Understanding how delivery mode influences attrition and adherence—and why participants persist or withdraw—is essential for designing inclusive and sustainable PA interventions. Objective: This pilot study evaluates the feasibility of delivering a 26-week PA intervention to older adults through 2 modes: online or on-site. Feasibility was assessed primarily by attrition, adherence, and participants’ experiences of factors influencing continued participation or withdrawal. Additionally, the study explores preliminary patterns in PA levels and physical and mental health outcomes to inform the design of a future definitive trial. Methods: This 26-week pragmatic pilot trial used an embedded convergent mixed methods design. Community-dwelling adults aged 60 years or older (N=35) from 3 residential areas in Sweden were cluster-randomized, without blinding, by site to an online (prerecorded video-based Otago exercises; n=12) or on-site (group-based, in-person Otago exercises; n=23) delivery mode. Feasibility outcomes included attrition and adherence. Exploratory outcomes included PA level (Godin-Shephard Leisure-Time Exercise Questionnaire), lower-body strength (Chair Stand Test), depressive symptoms (Geriatric Depression Scale), and health-related quality of life (EQ-5D-3L), assessed at baseline, midintervention (14 weeks), and postintervention (26 weeks). Exploratory quantitative analyses included t tests, chi-square tests, analysis of covariance, and mixed-design ANOVAs. We analyzed semistructured interviews with completers (n=17) and dropouts (n=7) using qualitative content analysis. Findings were integrated using the COM-B (Capability, Opportunity, Motivation-Behavior) framework. Results: The overall attrition rate was 37% (13/35), with no significant difference between delivery modes (P=.29). Most dropouts occurred within the first 2 weeks. Mean adherence appeared higher in the online delivery mode (mean 17.0, SD 6.7) than in the on-site delivery mode (mean 12.1, SD 10.1) but did not differ significantly (P=.15). Qualitative findings indicated that attrition was primarily driven by physical health issues and a perceived lack of fit, whereas adherence was supported by appeal and reward, routine and commitment, flexibility, feedback and PA overview, and (often) social presence. Mixed methods findings suggest that capability, opportunity, and motivation supported participation across both delivery modes. No intervention-related adverse events were reported. Conclusions: Both online and on-site delivery modes for PA interventions appeared feasible for many older adults. Although no statistically significant between-group differences were observed, the study was not powered to evaluate effectiveness. Feasibility may depend more on supporting capability, opportunity, and motivation than on delivery mode. Larger, adequately powered trials are needed to test effectiveness, identify optimal formats for different populations, and evaluate strategies to reduce early attrition. Trial Registration: ClinicalTrials.gov NCT05885308; https://clinicaltrials.gov/ct2/show/NCT05885308

BACKGROUND Physical activity (PA) is central to healthy aging, yet interventions targeting older adults often report substantial attrition and variable adherence. Although digital and internet-based exercise programs broaden accessibility and flexibility, their ability to sustain engagement compared with traditional on-site formats remains unclear. Understanding how delivery mode influences attrition and adherence—and why participants persist or withdraw—is essential for designing inclusive and sustainable PA interventions. OBJECTIVE This pilot study evaluates the feasibility of delivering a 26-week PA intervention to older adults through 2 modes: online or on-site. Feasibility was assessed primarily by attrition, adherence, and participants’ experiences of factors influencing continued participation or withdrawal. Additionally, the study explores preliminary patterns in PA levels and physical and mental health outcomes to inform the design of a future definitive trial. METHODS This 26-week pragmatic pilot trial used an embedded convergent mixed methods design. Community-dwelling adults aged 60 years or older (N=35) from 3 residential areas in Sweden were cluster-randomized, without blinding, by site to an online (prerecorded video-based Otago exercises; n=12) or on-site (group-based, in-person Otago exercises; n=23) delivery mode. Feasibility outcomes included attrition and adherence. Exploratory outcomes included PA level (Godin-Shephard Leisure-Time Exercise Questionnaire), lower-body strength (Chair Stand Test), depressive symptoms (Geriatric Depression Scale), and health-related quality of life (EQ-5D-3L), assessed at baseline, midintervention (14 weeks), and postintervention (26 weeks). Exploratory quantitative analyses included t tests, chi-square tests, analysis of covariance, and mixed-design ANOVAs. We analyzed semistructured interviews with completers (n=17) and dropouts (n=7) using qualitative content analysis. Findings were integrated using the COM-B (Capability, Opportunity, Motivation-Behavior) framework. RESULTS The overall attrition rate was 37% (13/35), with no significant difference between delivery modes (P=.29). Most dropouts occurred within the first 2 weeks. Mean adherence appeared higher in the online delivery mode (mean 17.0, SD 6.7) than in the on-site delivery mode (mean 12.1, SD 10.1) but did not differ significantly (P=.15). Qualitative findings indicated that attrition was primarily driven by physical health issues and a perceived lack of fit, whereas adherence was supported by appeal and reward, routine and commitment, flexibility, feedback and PA overview, and (often) social presence. Mixed methods findings suggest that capability, opportunity, and motivation supported participation across both delivery modes. No intervention-related adverse events were reported. CONCLUSIONS Both online and on-site delivery modes for PA interventions appeared feasible for many older adults. Although no statistically significant between-group differences were observed, the study was not powered to evaluate effectiveness. Feasibility may depend more on supporting capability, opportunity, and motivation than on delivery mode. Larger, adequately powered trials are needed to test effectiveness, identify optimal formats for different populations, and evaluate strategies to reduce early attrition. CLINICALTRIAL ClinicalTrials.gov NCT05885308; https://clinicaltrials.gov/ct2/show/NCT05885308

Oral Health in Persons With Mental Illness: Persons with mental illness often have poor oral health due to irregular routines, insufficient hygiene, dental anxiety, poor dietary habits, and prolonged medication use, thereby increasing the risk of oral diseases. Inadequate oral health may worsen physical conditions like diabetes, stroke, and cardiovascular and respiratory diseases. Insights from these individuals’ experiences can support the integration of oral health discussions into routine psychiatric visits, helping mental health professionals recognize and respond to oral health needs that might otherwise remain unaddressed. This study aimed to explore how persons with mental illness understand, navigate, and manage their oral health as part of their mental and overall health. Semistructured Interviews on Oral Health: Semistructured interviews were conducted with 12 individuals receiving psychiatric care for mental illness to explore how they understand, manage, and navigate their oral health in relation to their mental and overall health. The interviews took place between September 2022 and June 2023. Data were analyzed using inductive qualitative content analysis. The findings illustrate how informants made sense of and managed their oral health in everyday life. The findings were structured into three categories: (1) self‐insight to navigate oral health, (2) social and societal factors shaping oral health self‐management, and (3) healthcare encounters that support or challenge daily management of mental and oral health. Together, these three categories include personal factors, where routines and daily habits play a crucial role; the influence of relationships with professionals and significant others, which can transform a person’s situation and immediate environment; and societal‐level factors that facilitate access to subsidized dental care. Conclusions: Promoting oral health among persons with mental illness requires a holistic approach that acknowledges how everyday life, mental well‐being, and access to both dental and mental healthcare are interconnected. Effective support needs to be continuous, flexible, and grounded in collaboration between dental, psychiatric, and social services, enabling individuals to better understand, manage, and navigate their oral health needs.

Introduction: The United States has a high rate of maternal mortality compared to similar countries. Following the overturning of Roe v. Wade and federal protections to abortion, multiple US states have adopted new policies related to legal abortion access. No published scoping or systematic reviews have comprehensively examined existing literature related to state-level abortion policy and maternal mortality in the United States. This study seeks to assess the extent of evidence on the relationship between state-level abortion policy and maternal mortality in the United States. Methods: The scoping review is guided by the Joanna Briggs Institute (JBI) methodology and had no publication date restriction to capture pre- and post-Roe v. Wade studies. Results: Ten articles met inclusion criteria, with years of analysis from 1959 to 2020. Studies consistently found that restrictive abortion policies are associated with increases in maternal mortality at the state level. Limitations with the ability to compare findings across studies should be considered. Conclusion: Across published studies, policies that restrict access to abortion are consistently associated with increases in maternal mortality, underscoring the significant impact of policy decisions on maternal health outcomes. Future research with updated policy and health outcomes data is needed as the policy landscape evolves.

Older adults were particularly vulnerable to the COVID-19 pandemic, necessitating significant efforts to avoid contamination. This extraordinary situation posed an increased risk of mental pressure, and the ability to handle stressful situations is affected by several aspects. Therefore, this study aims to explore the coping strategies employed by older adults during the early months of the COVID-19 pandemic. A sample of 41 Swedish older adults aged 70–85 participated in phone interviews regarding their experiences with social distancing due to COVID-19. The interviews were conducted between April and May 2020, with nine follow-up interviews conducted in November and December 2020. The findings revealed results that despite the challenging circumstances, the participants demonstrated a strong mindset and resilience. Strategies utilised to improve their wellbeing and manage the situation included following recommendations, accepting the situation and maintaining a positive outlook. The influence of previous experiences on their coping strategies was evident. Additionally, the participants expressed a longing for their relatives and a need to adopt new technologies to manage their everyday lives. The follow-up interviews indicated no significant changes in worry or behaviour; if anything, participants were less worried at the beginning of the pandemic. This study contributes to the ongoing discussion on vulnerability among older adults by highlighting the diverse range of coping strategies employed during a prolonged crisis such as the COVID-19 pandemic. It demonstrated that though they are medically vulnerable, they are situationally resilient and, in many ways, well set to handle a challenging situation. During crises, older adults might need practical assistance. On the other hand, they can be a resource regarding mental preparedness during crises. Further research should explore the possibilities of balancing the needs of older adults and, at the same time, viewing them as a resource during long-time crises.

Eczema is a common chronic disease that affects both children and adults, and may have an adverse impact on school performance, as it is characteristically pruritic, and hence may lead to poor concentration and inadequate sleep. The aim of this study was to elucidate the relationship between eczema and self-reported difficulties keeping up with school education. The study was based on cross-sectional questionnaire data collected in schools among all 9th graders (15–16 years old) within a Swedish county. Logistic regression analyses were used to assess the association between having eczema and self-reported difficulties keeping up with school education. A total of 2,620 pupils participated (50.1% female). An increased odds ratio (OR) of self-reported difficulties keeping up with school education was found in adolescents with eczema compared with those without eczema after adjustment for sex and family residence (OR 2.13, 95% confidence interval (95% CI) 1.32–3.44), and with additional adjustment for sleeping problems, attention-deficit hyperactivity disorder, allergy, rhinitis, asthma, and alcohol consumption (adjusted OR 1.78, CI 1.05–3.00). Eczema may be a relevant risk factor for difficulty keeping up with school education in adolescents. However, studies that can assess temporality, based in different settings with objective reports of both eczema and self-reported difficulties at school, are needed to confirm these findings.

Background: A lack of patient safety is a significant global public health challenge and is one of the leading causes of death and disability, entailing significant financial and economic costs. However, patient safety can be improved and patients can avoid being harmed if more knowledge could be gained about what it is that impacts patient safety. Patient safety when receiving telephone advice is an important issue given the increase in digitalization in healthcare services.Aim: The aim of this study was to explore district nurses’ (“telenurses”) experiences and perceptions of patient safety when providing health advice over the phone.Methods: Data collection was performed using semi-structured interviews and analyzed using qualitative content analysis. The participants (n = 12) were telnurses in primary care.Results: The theme “Being able to make the right decision” was formed based on two categories: “Communication” and “Assessment”. Through effective communication with the right conditions to make an assessment, the correct decision can be made when a patient calls, and the district nurse feels that their telephone advice is safe for the patient.Conclusions: Patient safety can be challenged when receiving telephone advice, particularly when they feel stressed due to organizational factors. There is a need to shift from the individual to the organization. Further, while computerized knowledge support generally results in safe decisions, there may also be problems. Hence, it is imperative to develop computerized knowledge support as a part of improved patient safety in telephone advice.

Listening to the voices of adolescents and young adults regarding their lived experiences could be a way to identify important skills and abilities for adaptive and positive behaviour that will enable youth to deal effectively with the demands and challenges of everyday life. Hence, the aim with the current study is to explore the experiences and understandings of the life situation among adolescents and young adults of today, by making their voices heard in regards to mental health and help-seeking behaviour. A total of 6 group interviews were conducted with 22 adolescents and young adults (13 girls and 9 boys) ages 17–25 (M = 18.6 years). Data analysis was conducted using qualitative content analysis and resulted in two categories and five subcategories. The first category, Life challenges, included views on the sources of mental health, how to manage different types of relationships, and thoughts on accepted ways to express mental health problems. The second category, The need of present adults, highlighted important aspects for seeking help, such as an expressed need to be seen and heard by adults including parents, school staff, and other professionals as well as a need for adults’ increased availability. The challenges to students’ well-being and mental health are many, and there are no simple solutions. Based on the results in this study, life skills training should include elements to enhance the development of individual coping strategies, to be applied when life feels tough and when the body is experiencing stress reactions. Further, to minimize the risk of self-stigma and the internalization of negative stereotypes and self-blame, life skills training should include elements to increase knowledge of structural factors that have effects on the life situation as well as parents, school personnel, and other important adults.

Professionals who meet and work with adolescents hold important information and perspectives on adolescents’ mental health that, in addition to the adolescents’ voices, can shed light on complex issues. The aim was to explore professionals’ views on what challenges they face and how they can strengthen today’s adolescents’ mental health. This study involves four group interviews, conducted in March and October of 2020, including professionals with different working backgrounds. Data were analyzed with a qualitative content analysis. Two categories emerged: navigating life arenas and support for mental health. The first category included the demanding aspects of school, the challenges of social media, and the professionals’ thoughts on which pieces of mental health knowledge adolescents are lacking. The second category included what the professionals thought today’s parents need to develop and do to best support their children. Moreover, self-critical views were expressed on which aspects the professionals could do better to improve adolescents’ mental health. In conclusion, listening to professionals working with adolescents talk about adolescents’ mental health gives important insights. According to the professionals, both adolescents and their parents need improved life skills, including a strengthened and empowered self-esteem as well as improved mental health literacy.

Sweden has a large population of both recent and established immigrants with high prevalence of risk factors for ill health. Here, we aimed to explore the prevalence of chronic severe sleep problems (CSSP) among non-Nordic-born persons, and to evaluate the risk for CSSP when fully adjusted for covariates. Our additional hypothesis was that lengthier time since immigration would reduce the risk for CSSP. We used data from a large-population postal survey covering life and health issues among inhabitants in mid-Sweden. Relationship between different countries of birth and CSSP was assessed in logistic analyses for more severe and longstanding pain, sex, employment, mental disability, gastrointestinal problems, and length of stay (short, middle time, and up to ten years of stay). Persons of non-Nordic birth reported significantly more often CSSP, regardless of short or long-term stay. Our findings indicate that non-Nordic birth, regardless of residence time and covariates, was an independent and significant predictor for CSSP. The findings may contribute to increasing awareness in healthcare personnel to recognize chronic sleep problems among immigrant patients. Thus, our study might contribute to developing strategies to enhance health for minorities.