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The use of codesign methods is becoming increasingly common practice to involve and engage research participants in health research. Through codesign, end-users and stakeholders can contribute their own perspectives and experiences to solve a common problem. This article describes how a 5-day codesign sprint can be used to find solutions to improve housing decisions of older adults. Based on case studies in Sweden and the Netherlands, we identified similarities, differences, and patterns across the two contexts. By sharing methodological experiences across projects, opportunities are created for other researchers to build on the method and to integrate a creative process into traditional health research methods. We conclude that a 5-day codesign sprint can effectively and efficiently engage older adults and people with dementia in creative housing decision solutions, and we provide recommendations for future codesign sprint projects. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Video is the most used tool for sport performance analysis as it provides a common reference point for the coach and the athlete. The problem with video is that it is a subjective tool. To overcome this, motion capture systems can used to get an objective 3D model of a person’s posture and motion, but only in laboratory settings. Unfortunately, many activities, such as most outdoor sports, cannot be captured in a lab without compromising the activity. In this paper, we propose to use an aerial drone system equipped with depth cameras, AI-based marker-less motion capture software to perform automatic skeleton tracking and real-time sports performance analysis of athletes. We experiment with off-the-shelf drone systems, miniaturized depth cameras, and commercially available skeleton tracking software to build a system for analyzing sports-related performance of athletes in their real settings. To make this a fully working system, we have conducted a few initial experiments and identified many issues that still needs to be addressed.

BACKGROUND: Universal coverage of evidence-based interventions for perinatal health, often part of evidence-based guidelines, could prevent most perinatal deaths, particularly if entire communities were engaged in the implementation. Social innovations may provide creative solutions to the implementation of evidence-based guidelines, but successful use of social innovations relies on the engagement of communities and health system actors. This proof-of-concept study aimed to assess whether an earlier successful social innovation for improved neonatal survival that employed regular facilitated Plan-Do-Study-Act meetings on the commune level was feasible and acceptable when implemented on multiple levels of the health system (52 health units) and resulted in actions with plausibly favourable effects on perinatal health and survival in Cao Bang province, northern Vietnam.

METHODS: The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided the implementation and evaluation of the Perinatal Knowledge-Into-Practice (PeriKIP) project. Data collection included facilitators' diaries, health workers' knowledge on perinatal care, structured observations of antenatal care, focus group discussions with facilitators, their mentors and representatives of different actors of the initiated stakeholder groups and an individual interview with the Reproductive Health Centre director. Clinical experts assessed the relevance of the identified problems and actions taken based on facilitators' diaries. Descriptive statistics included proportions, means, and t-tests for the knowledge assessment and observations. Qualitative data were analysed by content analysis.

RESULTS: The social innovation resulted in the identification of about 500 relevant problems. Also, 75% of planned actions to overcome prioritised problems were undertaken, results presented and a plan for new actions to achieve the group's goals to enhance perinatal health. The facilitators had significant roles, ensuring that the stakeholder groups were established based on principles of mutual respect. Overall, the knowledge of perinatal health and performance of antenatal care improved over the intervention period.

CONCLUSIONS: The establishment of facilitated local stakeholder groups can remedy the need for tailored interventions and grassroots involvement in perinatal health and provide a scalable structure for focused efforts to reduce preventable deaths and promote health and well-being.

BACKGROUND: Use of mobile applications (apps) are increasing during pregnancy but few of these are evidence-based or evaluated in research.

AIM: To examine the feasibility, including perceived usefulness and usability, and the preliminary effects of an app based on the Confident birth method.

METHODS: A mixed-method approach, including 48 women, was used to evaluate acceptability, usability and to test study design and procedures. iPhone-users (n = 24) tested the app during pregnancy while the remaining (n = 24) formed a control group. Background characteristics and outcome measurements were collected from all women at baseline. Women in the app group received two follow-up phone calls from a midwife concerning usefulness and ease of use of the app. A follow-up questionnaire after birth were used to measure preliminary effects of the intervention as well as system usability of the app.

RESULTS: Women using the app found the app exercises simple, understandable, and useful. System usability score showed a mean score of 85.3 indicating excellent system usability. Notes from phone calls resulted in four categories: positive feedback about the app, negative feedback about the app, partners involvement, and knowledge. Preliminary effects of labour experience showed no significant differences between the two groups, in terms of early labour or childbirth experience.

CONCLUSION: The app tested in this feasibility study, was perceived as useful and appreciated by women. Areas for improvement of the app were identified. The result shows promise for further efficacy testing in a forthcoming randomised controlled trial.

As part of a longitudinal research project on the transition from physical education teacher education (PETE) to school physical education (PE) in Sweden and exploring whether and how PETE matters, this article uses narrative inquiry to ‘represent’ a PE teacher’s professional journey from PETE to the induction phase of PE teaching. The study focuses on his use of, and reflections on, ‘assessment for learning’ (AfL) at different stages of his teaching experience. The purpose of the study is to contribute knowledge about how positive experiences of AfL during PETE can enable the use of AfL in school PE for a newly qualified teacher. This is done by analysing one male PETE student’s reflections on AfL in the context of a campus-based course on PE assessment, his use of and reflections on AfL during his practicum, and in school PE as a newly qualified teacher. The data generation consisted of recordings of a PETE seminar, a stimulated recall interview with the participant during his final school placement, and two interviews with him in his role as a newly qualified PE teacher at two different schools. Through the PE teacher’s tale, we show how the campus-based course on PE assessment in PETE and the student teacher’s positive experience of using AfL during his practicum seem to have inspired him in his later positions. The results are discussed in relation to the perspective of occupational socialisation theory. This narrative inquiry suggests that PETE can make a difference for student teachers who are prepared to face the challenges of the induction phase of PE teaching and are able to navigate between the barriers that get in their way. We conclude the paper with some considerations regarding the study’s potential strength (trustworthiness), sharing (transferability) and service (usefulness).

Initial harmonization has been found within nursing education in the European Union member states, but with a need for the establishment of further, well-defined standards. The aim of this study was to describe and analyze the main content of nursing education expressed in national guidelines in the Nordic countries, seen as comparisons between the countries and to the European Federation of Nurses Associations (EFN) Competency Framework. A qualitative deductive research method and content analysis were applied to analyze 20 documents, using the EFN Competency Framework as a theoretical framework and analysis matrix. The study was performed in line with the Standards for Reporting Qualitative Research (SRQR) checklist. Variations in structure between the included countries was seen and evident uniformity was lacking. There were differences, e.g. the number of European Credit Transfer and Accumulation System (ECTS) credits needed for a degree that needs to be further explored in relation to the quality of education and the competence of newly qualified nurses. There is a question of whether the EU Framework corresponds to the need for nursing competencies for today and the future. Homogenization of guidelines and structures might facilitate further development and deeper collaboration between the Nordic countries, thereby leading to enhanced patient safety and care quality.

Aim. Early intervention and detecting early signs are often cited as a goal by professionals working with children, butdetecting and describing early signs is not well explored. Thus, the study’s aim was to explore professionals’ experiences and challenges in the early identifcation of psychosocial concerns in children aged 0–16. Materials and Methods. Data were collected from semistructured interviews with 26 professionals (e.g., nurses, psychologists, social workers, teachers, principals, and managers) working with children. The participants engaged in a pilot cooperation model between preschools, schools, social services, and healthcare to reach out early to children in need of support. The interviews were analyzed using thematic network analysis. Results. Four organizing themes were created as follows: “The idea of promoting and preventing is the key to success,” “Identifying the children who need support and intervention,” “Identifying observable early signs,” and “Occupied with children needing immediate support.” The organizing themes were interpreted into one global theme as follows: “All want an early intervention but putting it into practice is challenging.” Conclusion. The study shows that it is difcult to identify children in need of psychosocial support at an early stage because the early signs are difficult to detect. Thus, our results suggest that both preventive interventions targeting all children and specifc interventions for those in need of support are needed to promote health and wellbeing.

Although a whole school approach (WSA) to sustainability has been described as one of the most meaningful education approaches, the concept of WSA has not yet been widely explored within the context of preschool education, where the play, learning, and care are preconditions for a wholeness in childhood. The concept of the WSA considers raising quality and standard across entire education institution (Henderson & Tilbury, 2004). This approach also emphasizes the needs for (pre)school to engage children, teachers, parents, and the wider community in sustainability (Mogren, Gericke & Scherp, 2019). The principals have important roles to play in reforming and prioritizing preschools activities towards sustainability (Borg & Vinterek, 2020). This paper explores 50 principals’ views and attitudes towards sustainability from a WSA perspective. Using randomized sampling, the principals were selected from 25 eco-certified and 25 non-eco-certified preschools in 25 municipalities in Sweden, out of 290. A questionnaire was utilized to collect demographic information about the preschools, number of children, number of qualified teachers, principals’ attitudes towards preschool’s activities with sustainability, and also an open-ended question about how the principals themselves integrate sustainability in their planning of preschool activities and what they actually do. The qualitative data was analyzed by using Wals and Mathie’s (2022) six component Whole School Approach Flower Model. The components are: 1. Vision, ethos, leadership and coordination; 2. Institutional practices; 3. Pedagogy and learning; 4. Curriculum; 5. Community connections; and 6. Capacity building. The components were adapted and operationalized within a preschool context. The quantitative data was analyzed by principal component analysis (PCA) in the SIMCA statistical software (Umetrics 2020). This study is a part of a project, “Eco-certified preschools and children’s learning for sustainability: Researching holistic outcomes of preschool education for sustainability (HOPES)” (Swedish Research Council, Dnr. 2018-04445). The analyses will be completed by June, 2023. 

References

Borg, F., & Vinterek, M. (2020). Principals´ Views on and Descriptions of Preschool Education for Sustainable Development. Journal of Applied Technical and Educational Sciences, 10(2), 18-40. doi:10.24368/jates.v10i2.170

Henderson, K., & Tilbury, D. (2004). Whole school approaches to sustainability: An international review of sustainable school programs. Report prepared by Macquarie University for the Australian Government Department of the Environment and Heritage. Sydney.

Mogren, A., Gericke, N., & Scherp, H.-Å. (2019). Whole school approaches to education for sustainable development: a model that links to school improvement. Environmental Education Research, 25(4), 508-531. https://doi:10.1080/13504622.2018.1455074  

Umetrics. (2020). SIMCA-P+. In (Version 16.0) [Computer software]. Sartorius Stedim Inc. https://www.sartorius.com/en/products/process-analytical-technology/data-analytics-software/mvda-software/simca?gclid=Cj0KCQiAvvKBBhCXARIsACTePW-oD9sm_Ng1dgNBivHH9GFSApdp5wo2G0EDOydryNnzZQ-20Xoj_vIaApIwEALw_wcB  

It is well established that students in higher education need to develop evaluative skills in order to become effective learners (Guest & Riegler 2022). Assessment for Learning (AfL) is a model for assessment that strengthens learning in schools as well as in higher education (Black et al 2002). This is also the case in physical education teacher education (PETE) (Eather et al 2017, Macken et al 2020) and in school physical education (Leirhaug 2016). One of the key learning strategies in AfL is to activate peers as resources for learning, often operationalised as peer assessment. In PETE, peer assessment (or peer-assisted learning in a broader meaning) has proven to strengthen learning for both the observer and the observed (Lamb et al 2012). 

One dimension of peer assessment, that has only scarcely been covered in the PETE context (Macken et al 2020) but that is more highlighted in research of peer assessment in general teacher education (see e.g. Kilic 2016, Tait-McCutcheon & Bernadette Knewstubb 2018), is the tensions inherent in giving feedback to peers on their work, peers who might also often be friends. According to Kilic (2016, 137) preservice teachers “do not feel comfortable when critiquing another student” and Tait-McCutcheon and Knewstubb (2018, 773) argues that “peer assessment could reflect friendships more than learning outcomes”. 

Research demonstrates a complexity with regards to the potential for peer assessment in PETE. On the one hand, preservice teachers have expressed that giving feedback to peers creates a positive, safe, equal and relaxed learning environment (Lamb et al., 2012) and peer assessment has been reported to improve competence, confidence and self-efficacy among preservice teachers (Eather et al., 2017). On the other hand, a study by Macken et al. (2020) reported that preservice teachers believe their students would be mean to each other if implementing peer assessment during their school placement practice in PETE.

In this paper, we aim to further explore the complexity involved in peer assessment in PETE to get a deepened and more differentiated picture of this phenomenon. Our overall aim is to contribute to more knowledge about how to involve  preservice teachers in PETE and students in school physical education as resources for learning without risking to cause harm. Drawing on the call from Scanlon et al. (2022) for more studies on how assessment is taught in PETE, our specific aim in this paper is to investigate preservice teachers’ views on what as well as how peer assessment is taught in PETE, to be used in school physical education. We will use Pierre Bourdieu’s (1990) concept of capital, as well as the work of Hay and Penney (2013) on how accountability mechanisms functions in assessment, in order to analyse what is assigned value in peer assessment. The two questions that will guide our analysis in this paper reads: What mechanisms are assigned value in peer assessment according to preservice teachers in PETE? And: How do the mechanisms that are assigned value in peer assessment in PETE function according to preservice teachers? More knowledge about the what and the how in teaching of assessment practices in PETE can improve these practices within school physical education.

Methodology

The study presented in this paper is conducted as part of a greater project with the aim of exploring how PETE matters for school physical education. In the overall project we have recruited preservice teachers, with physical education as one of their subjects, during their last year in teacher education. During this last year, one campus-placed course in assessment and one school placement course, constituted the contexts from which we collected empirical material to this study (Authors 2021).  

The participants in this study were 21 preservice teachers from two different PETE institutions in Sweden (10 from uni A and 11 from uni B). The empirical material analysed in this study compriced of: 

1.      Three audio-recorded seminars (90-120 min each) from the campus-based assessment courses (one seminar from uni A and two from uni B) conducted before the preservice teachers’ school placement studies. 

2.      Seven individual semi-structured interviews (40-70 min each) (Kvale 1996) conducted during visits at the preservice teachers’ school placement studies (all from uni A). 

3.      Five individual Stimulated Recall (SR)-interviews conducted during visits at the preservice teachers’ school placement studies (one from A, four from B). 

4.      Two audio-recorded and semi-structured group interviews (40-60 min each) (Kvale 1996) from the campus-based assessment courses (both from A) conducted after the school placement studies. 

After having had the empirical material transcribed by an external part, a thematic content analysis was initiated by a process of familiarisation in which all four researchers were engaged (Braun et al 2017). Inspired by an abductive approach (Alvesson & Sköldberg 2017), we allowed ourselves to be open to alternative theories that could help explain the empirical material. The choice of research object was initiated by the impression from the interviews that giving feedback to peers is surrounded by a complexity, both in PETE and in school physical education. The identification of social relationships and certain types of bodies and movements as assigned with value when giving feedback to peers guided our attention towards Bourdieu-inspired interpretations of the social capital (Beames & Atencio 2008) and the physical capital (Redelius & Hay 2010).   

Educational challenges following when ‘the what’ is reflected in ‘the how’

The findings indicate that when the what-aspect of ‘social relationships’ is to be implemented into an how-aspect, the preservice teachers calls for continuous interaction ‘over time’ in order to build a safe and an allowing climate for learning. While this interaction can be implemented in PETE and in school physical education, allowing for school children to build social capital (Beames & Atencio 2008), a result from this study that calls for further discussion is how PETE can make continuous interaction between preservice teachers and school students possible during school placement studies. 

When the what-aspect of ‘articulating what to learn’ is mirrored in relation to the how-aspect of giving ‘correct feedback’ in peer assessment, this displays that physical capital in school physical education is strongly connected to standards of excellence and norms of right and wrong movement technique (Redelius & Hay 2010). These golden norms seem to be upheld by the displayed lack a common language for learning (Larsson & Redelius 2008). A question following from this study is what resources preservice teachers are offered within PETE to embody a language for learning in school physical education? 

This study also made visible that ‘the emphasis of certain forms of knowledge ’ is highly valued when preservice teachers are to give feedback to their peers, to their students (during school placement) or when they engage students to give feedback to each other.  The preservice teachers claim to handle this ‘what-aspect’ of peer assessment by focus their attention on ‘managing the sensitivity’ arising when themselves or their students are to comment on each others’ bodies in movements. 

In conclusion, the combination of social and physical capital decides what is possible to say to whom when preservice teachers and students are to give feedback to peers in PETE and in school physical education.

References

Alvesson M and Sköldberg K (2017) Tolkning och Reflektion. Vetenskapsfilosofi och Kvalitativ Metod [Interpretation and Reflection. Philosophy of Science and Qualitative Method]. Lund: Studentlitteratur. [In Swedish.]

Beames, Simon and Atencio, Matthew (2008)'Building social capital through outdoor education', Journal of Adventure Education & Outdoor Learning,8:2,99 — 112

Black, P., C. Harrison, C. Lee, B. Marshall, and D. Wiliam. 2002. Working Inside the Black Box. Assessment for Learning in the Classroom. London: GL Assessment

Bourdieu, P. (1990). The logic of practice. (Richard Nice, Trans.). Cambridge, MA: Polity Press.

Eather, N., Riley, N., Miller, D., Jones, B. (2017) Evaluating the Effectiveness of Using Peer-Dialogue Assessment for Improving Pre-Service Teachers' Perceived Confidence and Competence to Teach Physical Education. Australian Journal of Teacher Education, 

Guest J & Riegler R (2022) Knowing HE standards: how good are students at evaluating academic work?, Higher Education Research & Development, 41:3, 714-728

Hay, P. J., and D. Penney. 2013. Assessment in Physical Education. A Sociocultural Perspective. London: Routledge.

Kilic, D. (2016) An Examination of Using Self-, Peer-, and Teacher-Assessment in Higher Education: A Case Study in Teacher Education, Higher Education Studies, 6(1), 136-144. 

Kvale, Steinar (1996). Interviews. An Introduction to Qualitative Research Interviewing. California: Sage Publications.

Lamb P Lane K & Aldous D (2012) Enhancing the spaces of reflection: A buddy peer-review process within physical education initial teacher education, European Physical Education Review 19(1) 21–38

Larsson H & Redelius K (2008) Swedish physical education research questioned—current situation and future directions, Physical Education and Sport Pedagogy, 13:4, 381-398, DOI: 10.1080/17408980802353354

Leirhaug 2016 Exploring the relationship between student grades and assessment for learning in Norwegian physical education, European Physical Education Review, 22(3) 298–314

Macken S, MacPhail, A & Calderon, A (2020) Exploring primary pre-service teachers’ use of ‘assessment for learning’ while teaching primary physical education during school placement, Physical Education and Sport Pedagogy, 25:5, 539-554

Redelius, K. & Hay, P. (2010) Defining, acquiring and transacting cultural capital through assessment in physical education, European Physical Education Review, 5(3):275–294:

Scanlon D, MacPhail, A Walsh C & Tannehill D (2022): Embedding assessment in learning experiences: enacting the principles of instructional alignment in physical education teacher education, Curriculum Studies in Health and Physical Education, epub ahead of print

Tait-McCutcheon S & Knewstubb, B. (2018) Evaluating the alignment of self, peer and lecture assessment in an Aotearoa New Zealand pre-service teacher education course, Assessment & Evaluation in Higher Education, 43:5, 772-785

Introduction

Chronic musculoskeletal pain is a highly prevalent, complex and distressing condition that may negatively affect all domains of life. In view of an active inference framework, and resting on the concept of allostasis, human movement per se becomes a prerequisite for health and well-being while chronic pain becomes a sign of a system unable to attenuate an allostatic load. Previous studies on different subgroups of chronic pain conditions have demonstrated alterations in gait kinematics and muscle activity, indicating shared disturbances in the motor system from long-term allostatic load. We hypothesise that such alterations exist in heterogenous populations with chronic musculoskeletal pain, and that exposure to acute and controlled exercise may attenuate these alterations. Therefore, the main aim of this study is to investigate the acute effects of exercise on gait kinematics and activity of the back and neck muscles during diverse walking conditions in patients with chronic musculoskeletal pain compared with a reference sample consisting of healthy participants.

Methods and analysis

This two-sample two-armed parallel randomised controlled laboratory trial will include 40 participants with chronic musculoskeletal pain (>3 months) and 40 healthy participants. Participants will be randomly allocated to either 30 min of aerobic exercise or rest. Primary outcomes are gait kinematics (walking speed, step frequency, stride length, lumbar rotation, gait stability) and muscular activity (spatial and temporal) of the back and neck during diverse walking conditions. Secondary outcomes are variability of gait kinematics and muscle activity and subjective pain ratings assessed regularly during the trial.

Ethics and dissemination

The study has been approved by the Regional Ethics Review Board in Uppsala, Sweden (#2018/307). Findings will be disseminated via conference presentations, publications in peer-reviewed journals and engagement with patient support groups and clinicians.

Trial registration number

NCT03882333.

Background: Methoxyflurane (MTX) is an inhalation agent that has several potential benefits for limiting various types of pain in ambulance care.

Aim: To elucidate how ambulance nurses experience the characteristics of MTX in an ambulance care setting.

Method: This cross-sectional study applied a mixed-methods approach, using a questionnaire together with complementary interviews. The questionnaire survey was analyzed using descriptive statistics (10-point Likert scale and question index values [Q-IV], range: 0-1.0). The interviews were analyzed using directed content analysis. Study results were reported following the STROBE statement.

Results: The ambulance nurses' overall general satisfaction with the MTX concept had a median of 7.0 (IQR 5-8), corresponding to a mean Q-IV of 0.84 (very good experience). The qualitative part was divided into three categories: sense of security, patient participation, and general usefulness. The results revealed varying experiences of usefulness, including pain-relieving effect and the possibility of patient participation. The perceived strong odor of MTX seemed to concern the ambulance nurses and their patients.

Conclusion: In general, MTX was experienced as a safe and effective analgesic. However, the experiences of the overall usefulness varied, particularly since the product had a perceived strong odor. Increasing knowledge of using MTX, could likely increase the overall usefulness.

This article presents a theoretical approach and an analytical toolbox for researchers on reflections in PE and PETE. Its purpose is to provide an approach to analyzing how reflections are composed. Previous research mainly asks how teachers and student teachers (STs) reflect and use different theoretical concepts to describe the way in which they reflect. The use of the analytical toolbox, as described in this paper, examines how the reflections of teachers and STs have different parts that are influenced by the direction – within a given context – of their gaze and focus on teaching. Their experiences and reflections are affected by the contexts, which influence the forward-moving spiral of the development of their professional judgment. Using a recontextualized version of Wackerhausen’s (2009) theory as an analytical toolbox in research, as proposed in this article, can contribute to more nuanced descriptions of teachers’ and STs’ reflections on teaching in PE.

OBJECTIVES: Our aim was to describe the time and costs used during the implementation of a more person-centred care (PCC) approach as part of ordinary practice.

DESIGN: A case study with embedded units.

SETTING: Region Dalarna, Sweden.

PARTICIPANTS: The Department for Development (DD) staff who provided a central support function in the implementation and six healthcare units: nephrology, two geriatric care and rehabilitation units, two psychiatry units and primary care.

INTERVENTIONS: More PCC.

PRIMARY AND SECONDARY OUTCOME MEASURES: Working days and related salary costs reported by categories indicating costs for implementation strategies, service delivery, and research/development costs.

RESULTS: The healthcare units logged on average 5.5 working days per staff member. In the healthcare units, 6%-57% of the time reported was used for implementation strategies, 40%-90% for service delivery and 2%-12% for research/development. Of the time reported by the DD, 88% was assigned to implementation strategies. Costs associated with reported time indicated 23% of costs for this implementation occurred in the DD. Using the budgeted cost, this proportion increased to 48%. The budget for the DD corresponded to SEK 2.30 per citizen per year and 0.009% of the total healthcare budget of the region.

CONCLUSIONS: The study found that a large part of resources used for this implementation of more PCC occurred in the DD, although at least half of the costs occurred in the healthcare units. Moreover, the cost of providing a central support function corresponds to a tiny proportion of the total health budget.

One of the current main public health problems is the prevalence of obesity in children. Unhealthy lifestyle behaviors such as poor dietary habits, high sedentary screen time (SST), and low levels of physical activity (PA) have a strong tendency to track from childhood into adulthood. The aim of this manuscript is to assess the association between meeting or not meeting the PA and SST recommendations and the consumption of different food groups.

Data were obtained from a sample of European adolescents from the multicenter cross-sectional HELENA study. In all, 1448 adolescents from 8 cities were included. PA was objectively measured by accelerometry and dietary intake by 24-hour dietary records. Adolescents were grouped according to PA and SST recommendations.

In both sexes, intake of savory snacks was higher in those groups who did not meet any of the recommendations (p < 0.05). For males, those who met both recommendations were more likely to drink/eat milk, yogurt, and water (p < 0.05). Those not meeting recommendations were more likely to drink sugar-sweetened beverages (p < 0.05). For females, those not meeting recommendations were less likely to eat fruits and vegetables and more likely to have a higher intake of fats and oils (p < 0.05).

Those adolescents meeting PA and SST recommendations had a higher intake of healthy foods, like fruit and vegetables and dairy products. However, the negative relationship unhealthier food and SST is stronger in males independently of PA. More studies assessing the combined effect of both PA and SST regarding dietary habits in children and adolescents are needed.

BACKGROUND: We aimed to compare absolute plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and growth differentiation factor 15 (GDF-15) obtained by a conventional immunoassay with the corresponding relative concentrations from a proximity extension assay (PEA) and compare the prognostic impact of the protein levels obtained from these assays.

METHODS: We evaluated 437 patients with peripheral arterial disease (PAD) and a population-based cohort of 643 individuals without PAD. Correlations were calculated using Spearman's rank correlation coefficients (rho). The discriminatory accuracy of the protein levels to predict future cardiovascular events was analyzed with Cox regression and presented as time-dependent areas under the receiver-operator-characteristic curves (tdAUCs).

RESULTS: For NT-proBNP, the two assays correlated with rho 0.93 and 0.93 in the respective cohort. The PEA values leveled off at higher values in both cohorts. The corresponding correlations for GDF-15 were 0.91 and 0.89. At 5 years follow-up, the tdAUCs in the patient cohort were similar for NT-proBNP and GDF-15 regardless of assay used (0.65-0.66). The corresponding tdAUCs in the population-based cohort were between 0.72 and 0.77.

CONCLUSION: Except for the highest levels of NT-proBNP, we suggest that PEA data for NT-proBNP and GDF-15 reliably reflects absolute plasma levels and contains similar prognostic information.

BACKGROUND: Stress-related biomarkers have the potential to provide objective measures of whether interventions directed at people with dementia (PWD) and their family caregivers (FCG) are successful. The use of such biomarkers has been limited by logistical barriers to sample collection.

OBJECTIVE: Explore saliva concentration of steroid hormones in dementia care dyads during a music intervention.

METHODS: Consecutive PWD attending a memory evaluation center and their FCG were allocated to either an intervention-with-music or a non-intervention control group. All were living at home. Stress biomarkers, salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S) samples were collected by the PWD and their FCG, in the morning and evening, 5 days a week, for 8 consecutive weeks. Biomarker concentrations of the intervention and the control groups were compared at week 8, in an intention-to-treat approach with adjustment for baseline value.

RESULTS: Twenty-four PWD in the intervention group and 10 in the control group, and their FCG were included in the analyses. The mean number of morning saliva collections was similar in the intervention and the control groups, ranging from 4.3 to 4.9 per participant weekly during the first 7 weeks, declining to 3.3 during week 8. Median log morning cortisol (pg/mL) among caregivers was lower in the intervention group than in the control group (8.09 vs. 8.57, P = 0.0133).

CONCLUSION: This study demonstrates that music intervention was associated with lower morning saliva cortisol concentrations for FCGs.

INTRODUCTION: Persons with dementia experience time-related problems, but there is a lack of instruments evaluating their time processing ability and daily time management. This study aimed to evaluate the psychometric properties of the instruments KaTid®-Senior measuring time processing ability, and Time-S© Senior and Time-Proxy© measuring daily time management for persons with dementia.

METHODS: Persons with dementia (n = 53) and their significant others (n = 49) participated in the study. Rasch analyses were used to evaluate the instruments' rating scale functioning; internal scale validity; person-response validity; unidimensionality; person-separation reliability; and internal consistency. Versions excluding items with poor fit to the Rasch model were also evaluated.

RESULTS: Overall, the Rasch analyses showed acceptable psychometric properties. All instruments met the criteria for unidimensionality and the reliability was good. More challenging items should be added in KaTid-Senior for better targeting of persons with mild dementia. Person-response validity issues in Time-S Senior need to be addressed.

CONCLUSION: The instruments can validly and reliably be used to assess time processing ability and daily time management in persons with dementia in clinical research and healthcare settings. In turn, this can contribute to the development of methods to compensate for impaired time processing ability and daily time management. The assessments can also increase the possibility of early detection of impaired time processing ability and daily time management, thereby facilitating adequate timing of interventions and enhanced occupational performance.

The purpose of this study is to report on the validation process of a questionnaire that explores health science students’ attitudes towards women’s childbirth experiences. This questionnaire can help inform education programs to enhance the quality of woman-professional interactions, and to improve women’s experiences of childbirth. A standardized procedure for the development and validation of the questionnaire included: item development and psychometric pre-validation, Cronbach’s Alpha coefficient calculation, test–retest and item-total correlation for the reliability analysis. Content validity was undertaken by Delphi method with sixteen panelists over two rounds. We determined the factor structure and refined and validated the questionnaire according to the responses of a cohort of 560 students using principal components factor analysis with varimax rotation. Confirmatory factor analysis was undertaken. A 52-items questionnaire CAVE-st: (acronym for cuestionario de actitudes sobre vivencias y experiencias en el parto) was developed and validated. The results of the factor analysis finally revealed four latent dimensions. The questionnaire CAVE-st is a valid and reliable tool to assess health science students’ attitude towards women’s childbirth experiences. Further work to translate and adapt the instrument in other cultures and languages will be undertaken. © 2021, The Author(s).

BACKGROUND: In a critical obstetric situation, the time interval between the decision of performing a caesarean section (CS) and delivery can influence maternal and newborn outcomes. In Somaliland, consent for surgical procedures, such as CS needs to be sought from family members.

OBJECTIVE: To determine the association between a delay in performing a CS and severe maternal and newborn outcomes in a national referral hospital in Somaliland. The type of barriers leading to delayed performance of CS after a doctor's decision were also explored.

METHODS: Women were followed from the time of decision to perform CS until discharge from the hospital between 15 April 2019 and 30 March 2020. No delay was defined as < 1 hour and delayed CS was defined as 1-3 hours and >3 hours from decision of CS to delivery. Information was collected on barriers leading to delayed CS and maternal and newborn outcomes. Data was analysed using binary and multivariate logistic regression.

RESULTS: Overall, 1255 women were recruited from a larger cohort of 6658 women. A delay in CS >3 hours was associated with higher odds of severe maternal outcomes (aOR 1.58, 95% CI [1.13-2.21]). On the contrary, delay in performing a CS >3 hours was associated with lower odds of stillbirth (aOR 0.48, 95% CI [0.32-0.71]) compared to women without delay. Further, family decision-making for consent was the most important barrier leading to delays of >3 hours as compared to financial factors and barriers related to healthcare providers (48% vs 26% and 15%, respectively, p < 0.001).

CONCLUSIONS: In this setting, delay in performing CS >3 hours was associated with higher risk of severe maternal outcomes. A standardised system of performing a CS by primarily addressing the barriers associated with family decision-making, financial aspects and healthcare providers is needed.

Background: Concerns have been raised whether exposure to endocrine-disrupting chemicals (EDCs) can alter reproductive functions and play a role in the aetiology of infertility in women. With increasing evidence of adverse effects, information on factors associated with exposure is necessary to form firm recommendations aiming at reducing exposure. Objective: Our aim was to identify associations between lifestyle factors including the home environment, use of personal care products (PCP), and dietary habits and concentrations of EDCs in ovarian follicular fluid. Methods: April-June 2016, 185 women undergoing ovum pick-up for in vitro fertilisation in Sweden were recruited. Correlation analyses were performed between self-reported lifestyle factors and concentration of EDCs analysed in follicular fluid. Habits related to cleaning, PCPs, and diet were assessed together with concentration of six per- and polyfluoroalkyl substances (PFASs) [PFHxS, PFOA, PFOS, PFNA, PFDA and PFUnDA], methyl paraben and eight phthalate metabolites [MECPP, MEHPP, MEOHP, MEHP, cxMinCH, cxMiNP, ohMiNP, MEP, MOHiBP]. Spearman’s partial correlations were adjusted for age, parity and BMI. Results: Significant associations were discovered between multiple lifestyle factors and concentrations of EDCs in ovarian follicular fluid. After correcting p values for multiple testing, frequent use of perfume was associated with MEP (correlation ρ = 0.41 (confidence interval 0.21–0.47), p < 0.001); hens’ egg consumption was positively associated with PFOS (ρ = 0.30 (0.15–0.43), p = 0.007) and PFUnDA (ρ = 0.27 (0.12–0.40), p = 0.036). White fish consumption was positively associated with PFUnDA (ρ = 0.34 (0.20–0.47), p < 0.001) and PFDA (ρ = 0.27 (0.13–0.41), p = 0.028). More correlations were discovered when considering the raw uncorrected p values. Altogether, our results suggest that multiple lifestyle variables affect chemical contamination of follicular fluid. Impact statement: This study shows how lifestyle factors correlate with the level of contamination in the ovary by both persistent and semi-persistent chemicals in women of reproductive age. Subsequently, these data can be used to form recommendations regarding lifestyle to mitigate possible negative health outcomes and fertility problems associated with chemical exposure, and to inform chemical policy decision making. Our study can also help form the basis for the design of larger observational and intervention studies to examine possible effects of lifestyle changes on exposure levels, and to unravel the complex interactions between biological factors, lifestyle and chemical exposures in more detail. © 2023, The Author(s).

IMPORTANCE: Procrastination is prevalent among university students and is hypothesized to lead to adverse health outcomes. Previous cross-sectional research suggests that procrastination is associated with mental and physical health outcomes, but longitudinal evidence is currently scarce.

OBJECTIVE: To evaluate the association between procrastination and subsequent health outcomes among university students in Sweden.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was based on the Sustainable University Life study, conducted between August 19, 2019, and December 15, 2021, in which university students recruited from 8 universities in the greater Stockholm area and Örebro were followed up at 5 time points over 1 year. The present study used data on 3525 students from 3 time points to assess whether procrastination was associated with worse health outcomes 9 months later.

EXPOSURE: Self-reported procrastination, measured using 5 items from the Swedish version of the Pure Procrastination Scale rated on a Likert scale from 1 ("very rarely or does not represent me") to 5 ("very often or always represents me") and summed to give a total procrastination score ranging from 5 to 25.

MAIN OUTCOMES AND MEASURES: Sixteen self-reported health outcomes were assessed at the 9-month follow-up. These included mental health problems (symptoms of depression, anxiety, and stress), disabling pain (neck and/or upper back, lower back, upper extremities, and lower extremities), unhealthy lifestyle behaviors (poor sleep quality, physical inactivity, tobacco use, cannabis use, alcohol use, and breakfast skipping), psychosocial health factors (loneliness and economic difficulties), and general health.

RESULTS: The study included 3525 participants (2229 women [63%]; mean [SD] age, 24.8 [6.2] years), with a follow-up rate of 73% (n = 2587) 9 months later. The mean (SD) procrastination score at baseline was 12.9 (5.4). An increase of 1 SD in procrastination was associated with higher mean symptom levels of depression (β, 0.13; 95% CI, 0.09-0.17), anxiety (β, 0.08; 95% CI, 0.04-0.12), and stress (β, 0.11; 95% CI, 0.08-0.15), and having disabling pain in the upper extremities (risk ratio [RR], 1.27; 95% CI, 1.14-1.42), poor sleep quality (RR, 1.09, 95% CI, 1.05-1.14), physical inactivity (RR, 1.07; 95% CI, 1.04-1.11), loneliness (RR, 1.07; 95% CI, 1.02-1.12), and economic difficulties (RR, 1.15, 95% CI, 1.02-1.30) at the 9-month follow-up, after controlling for a large set of potential confounders.

CONCLUSIONS AND RELEVANCE: This cohort study of Swedish university students suggests that procrastination is associated with subsequent mental health problems, disabling pain, unhealthy lifestyle behaviors, and worse psychosocial health factors. Considering that procrastination is prevalent among university students, these findings may be of importance to enhance the understanding of students' health.

Feeling a sense of belonging at school is associated with important positive outcomes for youth and requires youth to engage in positive social relationships. Yet there is a limited understanding of the social factors most associated with youths' school belonging and limited evidence about whether correlates of school belonging vary for marginalized groups like newcomers compared to majority groups. Sweden provides an important context for investigation of these issues because, over the past two decades, the country has experienced an influx of asylum seekers and educational reforms that have altered the composition and functioning of Swedish secondary schools. This study addresses these gaps by (1) investigating which of eight social factors are associated with school belonging among diverse Swedish youth, and (2) examining whether newcomer status moderates the relationship between social factors and school belonging. Hierarchical regression and moderation analyses were used to analyze data from 14 to 19 year-old (n = 233) newcomers and non-newcomers in Sweden. An exploratory factor analysis revealed that the school belonging measure contained two factors: positive perceptions and negative perceptions (reverse coded). For both, stronger school belonging was associated with lower perceived ethnic discrimination. Positive perceptions of school belonging were also associated with more prosocial behaviours and lower emotional problems. Negative perceptions of school belonging were associated with more peer problems. Notably, quantity and quality of peer relationships were not associated with school belonging. There was no consistent evidence of newcomer status moderating the relationship between social factors and school belonging. These results highlight factors associated with school belonging which are modifiable and amenable to intervention or impact by policy-ethnic discrimination, prosocial behaviour, and emotional and peer problems. The absence of moderation by newcomer status suggests that school belonging interventions or related policies are likely to affect newcomer and non-newcomer students similarly.

OBJECTIVES: To assess the feasibility, acceptability and the impact of an online parenting programme for forcibly displaced parents of adolescents. DESIGN: The study was a single-arm feasibility study using pre-intervention post-intervention and follow-up assessments. SETTING: Participants were recruited from municipality-based activities for refugee parents in a small city in the south of Sweden. PARTICIPANTS: Participants were forcibly displaced parents (n=23; 47.8% maternal figures) of youth (n=23; 8-17 years old; 26.1% female) from Syria, Afghanistan and Somalia participating in an online parenting programme (eConnect). INTERVENTION: eConnect is an attachment-based and trauma-informed parenting intervention and was delivered over the course of 10 weekly sessions. PRIMARY AND SECONDARY OUTCOME MEASURES: Feasibility was assessed by programme enrolment, attendance, completion and acceptability of the online platform and cultural fit of the programme. Primary outcome measures were programme impact on youth mental health problems. Secondary outcome measures were programme impact on family functioning and parent-child attachment insecurity. RESULTS: The eConnect programme was highly feasible in terms of overall enrolment (100%), attendance (89.6%) and retention rates (100%). The online platform was acceptable, with mixed feedback primarily related to the access and usage of technology. Cultural fit of the programme was acceptable. Youth mental health problems (η2=0.29) and family functioning significantly improved (η2=0.18) over the course of the programme. Unexpectedly, parent reports of youth attachment insecurity significantly worsened (η2=0.16). CONCLUSIONS: The findings suggest that the online delivery of Connect was a promising way to reduce barriers to service access and improve mental health problems and family functioning among forcibly displaced parents and their children during COVID-19. Future research is needed to explore the acceptability and impact of this programme post-COVID-19, and to develop culturally tailored and psychometrically sound measures for parent and youth reports of attachment. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

While Bangladesh has made gains in maternal health provisions, there are still gaps and unmet need for services. Bangladesh has trained over 7 000 midwives, and many more midwifery educators are needed to serve the country’s population of 140 million with midwifery services. In April 2016 the first nursing faculty teaching midwifery students at nursing institutes across Bangladesh were enrolled in a blended online and onsite master’s programme with the Dalarna University, Sweden. The programme content focused the subject sexual, reproductive and perinatal health and was the first of its kind in Asia. The graduating faculty members were expected to be in a position to deliver higher quality education to the midwifery students (1, 2). To date, the team of teachers from Dalarna University has trained 150 midwifery educators (3). The current proposal from the University is that an equivalent to the Swedish Master's programme should be established in Bangladesh. While Bangladesh has made gains in education of midwives, there are still gaps and unmet need for educators with skills and knowledge in the subject of midwifery. During a period of transition, open seminars will be held at Dalarna University for all alumni who want to attend, with the hope on the part of the team of Dalarna university teachers being that they provide inspiration for high-quality midwifery education in Bangladesh. © 2023, South Asian Midwives Association (SAMA). All rights reserved.

WHO implemented the Rapid Assistive Technology Assessment in 2021. This is a household survey on self-reported use, need and barriers for accessing AT in 35 countries globally. In order to obtain comparable data, all surveys followed guidelines developed by WHO, including national two-stage random sampling of households. The 2021 rATA survey included 32 of a total of 140 LMICs globally. Around 40 % of the total respondents (all countries) estimated travel distance to be <5 km, varying from less than 10 % to almost 60 % among the countries. Around 15 % had to travel more than 50 km, varying from 1.3 % to 37.5 %. More individuals living in rural as compared to urban areas had to travel more than 25 km to get their main assistive product. Gender differences were marginal. By far the most prevalent barrier to access assistive products was "Cannot afford", amounting to 39.9% and varying from 6.7 % to 79.1 % among countries. This was followed by "No support" with 14.3 %, varying from 2.3 % to 36.9 %, and "Not available" with 8.1 %, varying from 1 % to 21.5 %. More barriers were reported in rural than urban areas and women report more barriers than men. Variation between countries in both travel time and barriers is substantial and country-specific service development is needed to guide service development.

BACKGROUND: As people grow old, they pass through various life courses. Thus, it is important to realize aging in the context of each of these stages, as aging is not only physiological and psychological processes. To understand the lifeworld experiences of the phenomenon "being an elderly person" from the individual perspective was important, in this study, within day-to-day life in Metropolitan cities of northwestern Ethiopia.

OBJECTIVE: The aim of this study was to describe the lifeworld of elderly persons living in Bahir Dar and Gondar Cities, Northwest Ethiopia.

METHODS: A community based qualitative study conducted from October 29, 2021 to November 6, 2021. A purposive sampling technique and in-depth interviews were used for sampling and data collection, respectively. To explore the life experience /life-world/ of the elderly, a descriptive phenomenological study was conducted among 15 elderly persons. The audio records were transcribed and the field notes incorporated. Transcribed texts were translated into the English language, and a descriptive phenomenological analysis was done.

RESULTS: In this study, the essence of the phenomenon, being an elderly person, means, in an ebb and flow motion, balancing a life change characterized by changing perspective, ambiguity to body functions, and preparing for being released. The elderly experienced physical, mental, and psychosocial changes. They had encountered positive and negative situations throughout their life span. They also expressed that their time was over and wished to prepare for God's Kingdom.

CONCLUSION: The use of phenomenology for this research provided an opportunity for a deeper understanding of the experiences of elderly persons. With knowledge from this study, nurses and other health professionals can understand and support the elderly from an individual point of view.

BACKGROUND: A global trend is to move rehabilitation closer to people's neighborhoods and homes. Still, little attention has been given to how the built environment outside the hospital setting might impact rehabilitation and recovery for stroke survivors.

OBJECTIVE: The overarching objective of this project is to develop conceptual models of built environments that support stroke rehabilitation and recovery outside the hospital setting. Specifically, the project will explore factors and characteristics of the built environment that support people with stroke and their families and identify innovative built environments that can be designed for local health care. The project will examine facilitators and obstacles for implementing built environmental solutions and evaluate the potential benefits, feasibility, and acceptability.

METHODS: The project uses a mixed methods design approach with 3 phases. In phase 1, factors and characteristics of the built environment for rehabilitation will be identified. Based on the results from phase 1, phase 2 will involve co-designing prototypes of environments to support the rehabilitation process for people with stroke. Finally, the prototypes will be evaluated in phase 3. Qualitative and quantitative methods will include a literature review, a concept mapping (CM) study, stakeholder interviews, prototype development, and testing. The project will use multidimensional scaling, hierarchical cluster analysis, descriptive statistics for quantitative data, and content analysis for qualitative data. Location analysis will rely on the location-allocation model for network problems, and the rule-based analysis will be based on geographic information systems data.

RESULTS: As of the submission of this protocol, ethical approval for the CM study and the interview study has been obtained. Data collection is planned to start in September 2023 and the workshops later in the same year. The scoping review is ongoing from January 2023. The CM study is ongoing and will be finalized in the spring of 2024. We expect to finish the data analysis in the second half of 2024. The project is a 3-year project and will continue until December 2025.

CONCLUSIONS: We aim to determine how new environments could better support a person's control over their day, environment, goals, and ultimately control over their recovery and rehabilitation activities. This "taking charge" approach would have the greatest chance of transferring the care closer to the patient's home. By co-designing with multiple stakeholders, we aim to create solutions with the potential for rapid implementation. The project's outcomes may target other people with frail health after a hospital stay or older persons in Sweden and anywhere else. The impact and social benefits include collaboration between important stakeholders to explore how new environments can support the transition to local health care, co-design, and test of new conceptual models of environments that can promote health and well-being for people post stroke.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52489.

BACKGROUND: Older adults experiencing disabilities such as loss of autonomy face the decision of whether to stay at home or move to a healthcare facility such as a nursing home. Thus, they may need support for this difficult decision.

OBJECTIVE: We assessed Canadian older adults' intention to use an electronic decision aid (eDA) for making housing decisions and identified the factors that influenced their intention.

METHODS: We conducted a cross-sectional study using an online survey targeting older adults across the 10 Canadian provinces and 3 territories. We included respondents from an online panel who were aged 65 years or older, understood English or French, had access to an electronic device with an internet connection and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the online survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents' intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence and facilitating conditions). We also assessed e-Health literacy using subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify factors influencing the intention to use the eDA.

RESULTS: Of the 11,972 eligible panellists, 1,176 met the eligibility criteria and 1,000 (85%) respondents completed the survey. The mean age was 72.5 ± 5.59 years. Most respondents were male (54.8%), white (90.6%), English-speakers (62.9%) and living in Ontario or Quebec (62.8%) in urban areas (85%). Mean scores for subjective e-Health literacy were 27.8 ± 5.88 out of 40 and for objective e-Health literacy, 3.00 ± 0.97 out of 5. In our sample, the intention score was 4.74 ± 1.7 out of 7. Mean scores of intention constructs out of 7 were 5.63 ± 1.28 for facilitating conditions, 4.94 ± 1.48 for performance expectancy, 5.61 ± 1.35 for effort expectancy and 4.76 ± 1.59 for social influence. In the final model, factors associated with intention included mother tongue (β = .30; P <.001), objective e-Health literacy (β = -.06; P =.03), performance expectancy (β = .55; P <.001), social influence (β = .37; P <.001) and facilitating conditions (β = .15; P <.001).

CONCLUSIONS: Findings from this pan-Canadian online survey suggest that Canadian older adults' intention to use an eDA to make housing decisions are similar to findings in other studies using UTAUT. Factors identified as influencing intention were mother tongue, objective e-Health literacy, performance expectancy, social influence and facilitating conditions. These will guide future strategies for implementing the eDA.

BACKGROUND: Epidemiological studies have shown that impaired lung function is common and associated with increased risk of cardiovascular disease. Increased levels of several inflammatory and cardiovascular disease-related plasma proteins have been associated with impaired lung function. The aim was to study the association between plasma proteomics and forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and FEV₁/FVC ratio.

METHODS: We used a discovery and replication approach in two community-based cohorts, EpiHealth and the Malmö Offspring Study (total n=2874), to cross-sectionally study 242 cardiovascular disease- and metabolism-linked proteins in relation to FEV₁, FVC (both % predicted) and FEV₁/FVC ratio. A false discovery rate of 5% was used as the significance threshold in the discovery cohort.

RESULTS: Plasma fatty acid-binding protein 4, interleukin-1 receptor antagonist, interleukin-6 and leptin were negatively associated with FEV₁ and paraoxonase 3 was positively associated therewith. Fatty acid-binding protein 4, fibroblast growth factor 21, interleukin-1 receptor antagonist, interleukin-6 and leptin were negatively associated with FVC and agouti-related protein, insulin-like growth factor-binding protein 2, paraoxonase 3 and receptor for advanced glycation end products were positively associated therewith. No proteins were associated with FEV₁/FVC ratio. A sensitivity analysis in EpiHealth revealed only minor changes after excluding individuals with known cardiovascular disease, diabetes or obesity.

CONCLUSIONS: Five proteins were associated with both FEV₁ and FVC. Four proteins associated with only FVC and none with FEV₁/FVC ratio, suggesting associations mainly through lung volume, not airway obstruction. However, additional studies are needed to investigate underlying mechanisms for these findings.

Introduction: Little is known about the impact of the coronavirus on sexual behavior, function, and satisfaction.

Aim: The aim of the present study was to systematically review people’s sexual function and behaviors and their changes in sexual activities during the COVID-19 pandemic.

Methods: Comprehensive searches in PubMed, Web of Science, and Scopus were conducted with keywords in accordance with MeSH terms: COVID-19, SARS-CoV-2, coronavirus, sexual health, sexual function, sexual dysfunctions, sexuality, sexual orientation, sexual activities, and premarital sex. Two reviewers independently assessed full-text articles according to predefined criteria: original design, English studies, and investigating either the general population or sexual minorities.

Results: Risk of bias in the studies was assessed by the Newcastle-Ottawa Scale, and data were pooled via random effects meta-analyses. We utilized the standardized mean difference to evaluate the effects of the COVID-19 pandemic on sexual activity, functioning, and satisfaction. We included 19 studies in the analysis and 11 studies in the meta-analysis, with a sample size of 12 350. To investigate sexual activity changes, a sample size of 8838 was entered into the subgroup analysis, which showed a significant decrease in both genders (5821 women, P < .033; 3017 men, P < .008). A subgroup meta-analysis showed that the sexual function of men and women during the COVID-19 pandemic significantly declined (3974 women, P < .001; 1427 men, P < .001). Sexual desire and arousal decreased in both genders, though mainly in women. In investigating sexual satisfaction changes during the COVID-19 pandemic, a meta-analysis with a sample size of 2711 showed a significant decrease (P < .001). The most indicative changes in sexual behaviors during the pandemic were the increase in masturbating and usage of sex toys. Greater COVID-19 knowledge was associated with lower masturbation, oral sex, and vaginal sex. The more protective behaviors were associated with less hugging, kissing, cuddling, genital touching, watching porn with a partner, and vaginal sex.

Conclusion: The COVID-19 pandemic led to increased challenges and changes for individuals’ sexual behaviors. Efforts for preventive strategies should therefore be concentrated between pandemics, while ensuring that there is information available to the population during a pandemic for help in times of psychological distress or crisis.

Objective: To investigate the relationship between head impact characteristics and the levels of blood biomarkersassociated with brain injury, neurofilament light (NfL) and glial fibrillary acidic protein (GFAP).Methods: Four elite amateur Muay Thai athletes were equipped with impact monitoring mouthguards, collectinglinear and rotational acceleration data during a period of eight weeks. Capillary blood samples were collectedafter each period of sparring sessions to analyse the levels of NfL and GFAP.Results: On a group level, mean GFAP levels were negatively correlated to mean impacts per session (p < 0.05).Two athletes had significant correlations between head impact characteristics and the levels of NfL and/or GFAP.Conclusions: The results indicate that NfL and GFAP might responded differently to linear and rotational accelerationsand/or that the effect of different types of accelerations on brain tissue integrity is individual. Themethods used could be useful to monitor brain health in different impacts sports.

Bariatric surgery is the most medically and cost-effective treatment for adults with obesity and type 2 diabetes mellitus (T2DM). Our findings suggest initial improvements in health-related quality of life that may decline as support from follow-up care ends. How patients experience long-term support is not well described. This study therefore aimed to investigate how adults with previous T2DM perceived different sources of support 2 years after bariatric surgery. In this qualitative study, individual interviews were conducted with 13 adults (10 women) 2 years after surgery. Using thematic analysis, one overarching theme (compiling complementary elements of support after gastric-bypass surgery), four themes and nine subthemes emerged. The results show that support was given and received from various sources, support needs varied over time depending on where the patient was in the process and that the sources of support were complementary. To conclude, our results show that support needs change in adults who have undergone bariatric surgery. Long-term professional and day-to-day support from family and other networks are essential and complementary elements of support. Healthcare staff should consider these findings, especially during the early follow-up period.

This article focuses on the stock of accommodation service units for people with psychiatric disabilities in Sweden and the classification of supported accommodation. We examined 122 units in 12 municipalities in Sweden and classified them according to the Simple Taxonomy for Supported Accommodation (STAX-SA). We found an obvious variation in the field and a movement into a recovery-oriented direction and towards individuality. There is an emphasis on Move-On that seems to expand into and beyond floating outreach support, and there is a relaxation of service units’ boundaries concerning commitment and target groups. The correspondence to STAX-SA was quite low (48%), and the applicability to ‘real world’ services was not satisfactory. When capturing variation and change in a rich dataset, STAX-SA is too reductive. However, STAX-SA was a successful point of departure in the analysis that opened up for identifying diversities and movement. We suggest some adjustments to increase its applicability.

BACKGROUND: The Government of India has committed to educate 90,000 midwives functioning in midwifery-led care units (MLCUs) to care for women during labour and birth. There is a need to consider local circumstances in India, as there is no 'one size fits all' prescription for MLCUs.

AIM: To explore contextual factors influencing the implementation of MLCUs across India.

METHOD: Data were collected through six focus group interviews with 16 nurses, midwives, public health experts and physicians, representing six national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis.

FINDINGS: Four generic categories describe the contextual factors which influence the implementation of MLCUs in India: (i) Perceptions of the Nurse Practitioner in Midwifery and MLCUs and their acceptance, (ii) Reversing the medicalization of childbirth, (iii) Engagement with the community, and (iv) The need for legal frameworks and standards.

CONCLUSION: Based on the identified contextual factors in this study, we recommend that in India and other similar contexts the following should be in place when designing and implementing MLCUs: legal frameworks to enable midwives to provide full scope of practice in line with the midwifery philosophy and informed by global standards; pre- and in-service training to optimize interdisciplinary teamwork and the knowledge and skills required for the implementation of the midwifery philosophy; midwifery leadership acknowledged as key to the planning and implementation of midwifery-led care at the MLCUs; and a demand among women created through effective midwifery-led care and advocacy messages.

Background: Three evidence-based midwife-led care practices: dynamic birth positions (DBP), immediate skin-to-skin contact (SSC) with zero separation between mother and newborn, and delayed cord clamping (DCC), were implemented in four sub-Saharan African countries after an internet-based capacity building program for midwifery leadership in quality improvement (QI). Knowledge on costs of this QI initiative can inform resource mobilization for scale up and sustainability. Methods: We estimated the costs and intermediate outcomes from the implementation of the three evidence-based practices under the midwife-led care (MIDWIZE) framework in a single facility in Kenya through a pre- and post-test implementation design. Daily observations for the level of practice on DBP, SSC and DCC was done at baseline for 1 week and continued during the 11 weeks of the training intervention. Three cost scenarios from the health facility perspective included: scenario 1; staff participation time costs ($515 USD), scenario 2; staff participation time costs plus hired trainer time costs, training material and logistical costs ($1318 USD) and scenario 3; staff participation time costs plus total program costs for the head trainer as the QI leader from the capacity building midwifery program ($8548 USD). Results: At baseline, the level of DBP and SSC practices per the guidelines was at 0 % while that of DCC was at 80 %. After 11 weeks, we observed an adoption of DBP practice of 36 % (N = 111 births), SSC practice of 79 % (N = 241 births), and no change in DCC practice. Major cost driver(s) were midwives’ participation time costs (56 %) for scenario 1 (collaborative), trainers’ material and logistic costs (55 %) in scenario 2(collaborative) and capacity building program costs for the trainer (QI lead) (94 %) in scenario 3 (programmatic). Costs per intermediate outcome were $2.3 USD per birth and $0.5 USD per birth adopting DBP and SSC respectively in Scenario 1; $6.0 USD per birth adopting DBP and $1.4 USD per birth adopting SSC in Scenario 2; $38.5 USD per birth adopting DBP and $8.8 USD per birth adopting SSC in scenario 3. The average hourly wage of the facility midwife was $4.7 USD. Conclusion: Improving adoption of DBP and SSC practices can be done at reasonable facility costs under a collaborative MIDWIZE QI approach. In a programmatic approach, higher facility costs would be needed. This can inform resource mobilization for future QI in similar resource-constrained settings. © 2023

OBJECTIVES: The emergence of the COVID-19 pandemic led to multiple preventive actions as primary interventions to contain the spread of the virus. Globally, countries are facing enormous challenges with consequences for use of social, economic and health services. The Democratic Republic of Congo (DRC) was among the African countries implementing strict lockdown at the start of the pandemic, resulting in shortages and decreased access to services. The adverse effects of the pandemic had unpleasant consequences for the country. This study aimed to examine the association between COVID-19 pandemic-related factors, sociodemographic factors, and the need to visit healthcare facilities, including family planning services, among women aged 15-49 years in the DRC.

METHODS: We conducted a secondary analysis of a performance monitoring for action (PMA) cross-sectional COVID-19 phone survey in Kinshasa, DRC, which had a response rate of 74.7%. In total, 1325 randomly selected women aged 15-49 years from the Kinshasa province who had previously participated in the PMA baseline survey participated in the survey. Bivariate and multivariate logistic regressions were used to assess associations.

RESULTS: The COVID-19 pandemic and related factors affected 92% of women in the Kinshasa province socioeconomically. A majority were highly economically dependent on their partner or some other sources for their basic needs to be met, and even more worried about the future impact of the pandemic on their household finances. Over 50% of women did not attempt visiting a health service, with some of the top reasons being fear of being infected with COVID-19 and not being able to afford services. We found a significant association between age groups and contraceptive use. The need for and use of contraceptives was higher among women aged 25-34 years than those aged 15-24 or 35-49 years.

CONCLUSION: Effective social/economic support to women and girls during pandemics and in crises is essential as it can have lasting beneficial effects on many domains of their lives, including their ability to access health services and the contraceptives of their choice.

BACKGROUND: Persons with dementia encounter time-related problems and significant others often need to provide support in daily time management and use of time assistive technology (AT). Further research has been requested on how time AT for persons with dementia affects the situation of significant others. Moreover, there are a few previous qualitative studies on the experiences of time AT by persons with dementia. This study explores the experiences of persons with dementia and significant others in daily time management and their perceptions on how time AT affects everyday life.

METHOD: Semi-structured interviews with persons with mild to moderate dementia (n = 6) and significant others (n = 9) were conducted three months after receiving prescribed time AT. Interviews were analysed using qualitative content analysis.

RESULTS: A main category "Support by significant others is always part of daily time management", and three categories "Facing new challenges", "Using strategies to handle changes", and "Time assistive technology in daily life" illustrated that significant others provided support for daily time management in all phases of dementia. This support was often embedded in other kinds of support for emerging challenges. Support in time management was needed from an early stage in dementia, and responsibility for time management was gradually transferred to significant others. Time AT could support time orientation and were important for sharing the time management conducted by others but did not enable independent time management.

CONCLUSIONS: Time-related assessments and interventions should be offered at an early stage of dementia to increase the possibility of maintaining daily time management skills. Using time AT to communicate time might increase agency and participation in daily occupations for persons with dementia. Given the central role of significant others for daily time management, the society needs to adequately support persons with dementia lacking support from significant others.

BACKGROUND: Accessibility is acknowledged as a key to inclusion in the Convention of Rights for People with Disabilities. An inaccessible design can result in exclusion from eHealth and cause disability among people who have impairments. OBJECTIVE: This scoping literature review aimed to investigate how eHealth services have been developed and evaluated regarding accessibility for people with impairments. METHODS: In line with Arksey and O'Malley's framework for scoping studies and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we conducted a search in 4 databases (PubMed, Scopus, IEEE, and Web of Science) in October 2020 and an update of the search in June 2022. The search strategy was structured according to the PICO model as follows: Population/Problem, digital accessibility for users with impairment; Intervention, health care delivered by any digital solution; Comparison, not applicable; Outcome, use of and adherence to (1) Web Content Accessibility Guidelines (WCAG), (2) other accessibility guidelines, and (3) other means, for designing or evaluating accessibility in eHealth services. A Boolean search was conducted by combining terms related to accessibility and eHealth. All authors participated in screening abstracts according to the eligibility criteria. Each publication, containing a potentially relevant abstract, was read (full text) and assessed for eligibility by 2 authors independently and pairwise. Publications deemed eligible were read by all authors and discussed for consensus. RESULTS: A total of 8643 publications were identified. After abstract screening, 131 publications remained for full-text reading. Of those, 116 publications were excluded as they did not meet the eligibility criteria. Fifteen publications involving studies of 12 eHealth services were included in the study. Of the 15 publications, 2 provided a definition of accessibility, 5 provided an explanation of accessibility, and 8 did not provide any explanation. Five publications used the WCAG to evaluate accessibility when developing eHealth services. One publication used International Organization for Standardization (ISO) 29138, ISO 2941, and ISO/International Electrotechnical Commission (IEC) 30071-1 standards together with the Spanish Association for Standardization (UNE) 139803 standard. Eleven publications used other means to address accessibility, including text-level grading; literature review about accessibility; user tests, focus groups, interviews, and design workshops with target groups of patients, relatives, and health care professionals; and comparative analysis of existing technical solutions to provide information about useful requirements. CONCLUSIONS: Although a clear definition of accessibility can enhance operationalization and thus measurability when evaluating accessibility in eHealth services, accessibility was insufficiently defined in most of the included studies. Further, accessibility guidelines and standards were used to a very limited extent in the development and evaluation of eHealth services. Guidelines for developing complex interventions that include guidance for accessibility are motivated to ensure that accessibility will be considered systematically in eHealth services. ©Marika Jonsson, Stefan Johansson, Dena Hussain, Jan Gulliksen, Catharina Gustavsson. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.08.2023.

BACKGROUND: Type 2 diabetes mellitus (DM) in older people is a heterogeneous condition that exhibits differential characteristics in comparison with younger adults. DM increases the risk of disability, is associated with dementia and loss of function, and cognition may often be interrelated and more pronounced in older patients with DM than in those without.

AIMS: Our aim was to evaluate the incidence of functional and/or cognitive impairment in older adults with and without DM, and its associated factors in DM participants.

METHODS: A 2-year prospective analysis was conducted in a European multicenter prospective cohort (SCOPE study). Older community-dwelling adults (aged ≥ 75 years) underwent a comprehensive geriatric assessment. New functional and/or cognitive decline was explored.

RESULTS: Of 1611 participants, 335 (22.0%) had DM at baseline. The percentage of participants scoring at least one ADL impairment and/or cognitive impairment (MMSE < 24) was similar in both groups (9.6%). Factors associated with any new disability in participants with DM in the multivariate analysis were female sex (OR 3.28, 95% CI 1.42-7.56), history of stroke (OR 4.58, 95% CI 1.64-12.7), and greater IADL dependency (OR 1.08 95% CI 1.02-1.15).

DISCUSSION: Association between DM and cognitive or functional decline in outpatients of 75 years and older was not found, but factors such as female gender, history of stroke, and IADL dependency could be related.

CONCLUSION: Decline in functional and cognitive status of community-dwelling older adults with DM was similar to participants without DM in a short period of 2 years of follow-up, though several clinical factors may increase its risk in this population.

BACKGROUND: From a nursing perspective, tasks that are not carried out, and the consequences of this, have been studied for over a decade. The difference between Registered Nurses (RNs) and nurse assistants (NAs) regarding qualifications and work tasks, and the profound knowledge around RN-to-patient ratios, warrants investigating missed nursing care (MNC) for each group rather than as one (nursing staff).

AIM: To describe and compare RNs and NAs ratings of and reasons for MNC at in-hospital wards.

METHODS: A cross-sectional study with a comparative approach. RNs and NAs at in-hospital medical and surgical wards for adults were invited to answer the MISSCARE Survey-Swedish version, including questions on patient safety and quality of care.

RESULTS: A total of 205 RNs and 219 NAs answered the questionnaire. Quality of care and patient safety was rated as good by both RNs and NAs. Compared to NAs, RNs reported more MNC, for example, in the item 'Turning patient every 2 h' (p < 0.001), 'Ambulation three times per day or as ordered' (p = 0.018), and 'Mouth care' (p < 0.001). NAs reported more MNC in the items 'Medications administered within 30 min before or after scheduled time' (p = 0.005), and 'Patient medication requests acted on within 15 min' (p < 0.001). No significant differences were found between the samples concerning reasons for MNC.

CONCLUSION: This study demonstrated that RNs' and NAs' ratings of MNC to a large extent differed between the groups. RNs and NAs should be viewed as separate groups based on their different knowledge levels and roles when caring for patients. Thus, viewing all nursing staff as a homogenous group in MNC research may mask important differences between the groups. These differences are important to address when taking actions to reduce MNC in the clinical setting.

BACKGROUND: Sustainable and effective eHealth requires accessibility for everyone. Little is known about how accessibility of eHealth is perceived among people with various impairments. The aim of this study was to compare use and perceived difficulty in the use of eHealth among people with and without impairment, and how different types of impairment were associated with perceived difficulty in the use of eHealth.

METHODS: This study used data collected in a nationwide survey in Sweden. Snowball sampling was used to recruit participants with self-reported impairment, from June to October 2019. In February 2020, the survey was posted to people in the general population who were matched to the participants with impairment by age, gender and county of residence. Multiple logistic regression was used to analyse the use of four eHealth services, and perceived difficulty in the use of six eHealth services.

RESULTS: In total, 1631 participants with, and 1084 participants without impairment responded to the survey. Participants with impairment reported less use and more difficulty in the use of all eHealth services as compared to participants without impairment. When comparing types of impairment, booking healthcare appointments online was least used and most avoided by participants with communication, language and calculation impairments (adjusted odds ratio (aOR) use 0.64, 95% confidence interval (95%CI) 0.49-0.83; aOR avoid 1.64, 95%CI 1.19-2.27), and intellectual impairments (aOR use 0.28, 95%CI 0.20-0.39; aOR avoid 2.88, 95%CI 1.86-4.45). The Swedish national web-portal for health information and services, 1177.se, was reported difficult to use the most among participants with communication, language and calculation impairments (aOR 2.24, 95%CI 1.50-3.36), deaf-blindness (aOR 11.24, 95%CI 3.49-36.23) and hearing impairment (aOR 2.50, 95%CI 1.17-5.35).

CONCLUSIONS: The results confirm the existence of an eHealth disability digital divide. People with impairment were not one homogeneous group, but differed in perceived difficulties in regard to eHealth. Based on a purposeful subgrouping of impairments, we showed that people with communication, language and calculation impairments, and intellectual impairments, reported least use and most difficulty in using eHealth. The findings can guide further research in creating eHealth that is accessible for all, including those with the most significant difficulties.

Understanding the capacity of child welfare (CW) organisations to deal with child abuse is complex, and dependent on the specific CW context. Sweden occupies a unique position in trying to balance high demands for CW and protection with a strong family support focus, which carries a risk of overlooking children who need protection. Drawing on an understanding of social service organisations as street-level bureaucracies, this article explores discretion in child abuse cases by examining conditions affecting discretion and strategies for investigating child abuse, including police reporting. Thematic analysis of interviews with Swedish supervising social workers showed that staff’s conceptions of the CW system influenced the exercise of discretion, leading to different strategies for dealing with child abuse. This resulted in different practices and potentially unequal access to child protection and support, highlighting the wide margin of discretion. This article concludes that the interplay between knowledge and governance is central to equal child protection. This article contributes to the discussion of discretion in CW organisations by underlining the importance of being particularly vigilant about discretion when both children and parents are considered clients, as the child risks being lost as a subject with individual needs and rights.

The Timed Up-and-Go (TUG) test has been combined with different verbal/cognitive tasks (i.e., TUG dual task [TUGdt]) as a form of motor-cognitive testing. However, it is still unclear how different TUGdt conditions affect gait among older adults. Thirty community-dwelling older adults, with mean age of 73 years, participated in the study. Data were collected using marker-free video recordings. Gait parameters were extracted using a semiautomatic deep learning system. Comparisons of execution time and gait parameter outcomes were made under TUG and three types of TUGdt test conditions: TUGdt-naming animals, TUGdt-months backwards, and TUGdt-serial 7s. Statistical analyses were based on mean values of the gait parameters for each participant and TUG condition, including TUGdt gait cost, that is, the relative difference between TUGdt and TUG. All the investigated TUGdt conditions resulted in varying degrees of gait parameter changes. Under TUGdt conditions, participants took shorter and slower steps, with TUGdt-serial 7s causing the largest interference.

AIMS: Back pain and neck/shoulder pain are common among nurses. The aim of this study was to investigate the association between nurses' exposure to a demanding psychosocial work environment during the first three years after graduation and the occurrence of severe back pain and neck/shoulder pain in the longer term, 11-15 years later.

METHODS: The Longitudinal Analysis of Nursing Education (LANE) study (nursing graduates from 26 Swedish universities in the years 2002, 2004 and 2006) was used to create two risk cohorts of nurses not reporting severe back pain (n=1764) or neck/shoulder pain (n=1707). Nurses exposed to a demanding psychosocial work environment for one, two or three of the first three years in their career were compared to nurses not having a demanding psychosocial work environment for any of these three years regarding the incidence of severe back pain or neck/shoulder pain at follow-up, 11-15 years later. Relative risks (RR) with 95% confidence intervals (CI) were calculated using binomial regression.

RESULTS: The RR (95% CI) of having severe back pain for nurses who had a demanding psychosocial work environment for one of the three years was 1.36 (0.82-2.28) and 2.08 (1.21-3.57) for two of the three years and 2.82 (1.43-5.55) for all three years. Corresponding RRs (95% CIs) for severe neck/shoulder pain were 1.35 (0.87-2.10), 1.49 (0.88-2.51) and 1.41 (0.62-3.20), respectively.

CONCLUSIONS: Nurses who were repeatedly exposed to a demanding psychosocial work environment early in their career reported severe back pain to a higher extent in the longer term.

BACKGROUND: Pregnant women in early labour have felt excluded from professional care, and their partners have been restricted from being involved in the birthing process. Expectant parents must be better prepared to deal with fear and stress during early labour. There is a need for evidence-based information and digital applications that can empower couples during childbirth.

OBJECTIVE: To develop and identify requirements for a practice-based mobile health (mHealth) application for Digital Early Labour Support.

METHODS: This research started with creating an expert group composed of a multidisciplinary team capable of informing the app development process on evidence-based practices. In consultation with the expert group, the app was built using an agile development approach (i.e., Scrum) within a continuous software engineering setting (i.e., CI/CD, DevOps), also including user and security tests.

RESULTS: During the development of the Early Labour App, two main types of challenges emerged: (1) user challenges, related to understanding the users' needs and experience with the app, and (2) team challenges, related to the software development team in particular, and the necessary skills for translating an early labour intervention into a digital solution. This study reaffirms the importance of midwife support via blended care and the opportunity of complementing it with an app. The Early Labour App was easy to use, the women needed little to no help, and the partner's preparation was facilitated. The combination of the app together with blended care opens up awareness, thoughts and feelings about the method and provides good preparation for the birth.

CONCLUSION: We propose the creation of the Early Labour App, a mHealth app for early labour support. The preliminary tests conducted for the Early Labour App show that the app is mature, allowing it to be used in the project's Randomised Control Trial, which is already ongoing.

BACKGROUND: In many low-income countries, including Ethiopia, neonatal mortality remains a major concern. For every newborn that dies, many more neonates survived (near-miss neonates) the first 28 days after birth from life-threatening conditions. The generation of evidence on neonatal near-miss determinants could be a critical step in reducing neonatal mortality rates. However, studies causal pathway determinants are limited in Ethiopia. This study aimed to investigate the Neonatal Near-miss determinants in public health hospitals in Amhara Regional State, northwest Ethiopia.

METHOD: A cross-sectional study was conducted on 1277 mother-newborn pairs at six hospitals between July 2021 and January 2022. A validated interviewer-administered questionnaire and a review of medical records were used to collect data. Data were entered into Epi-Info version 7.1.2 and exported to STATA version 16 in California, America for analysis. The paths from exposure variables to Neonatal Near-Miss via mediators were examined using multiple logistic regression analysis. The adjusted odds ratio (AOR) and ß-coefficients were calculated and reported with a 95% confidence interval and a p-value of 0.05.

RESULTS: The proportion of neonatal near-misses was 28.6% (365/1277) (95% CI: 26-31%). Women who could not read and write (AOR = 1.67,95%CI:1.14-2.47), being primiparous (AOR = 2.48,95% CI:1.63-3.79), pregnancy-induced hypertension (AOR = 2.10,95% CI:1.49-2.95),being referred from other health facilities (AOR = 2.28,95% CI:1.88-3.29), premature rupture of membrane (AOR = 1.47,95% CI:1.09-1.98), and fetal malposition (AOR = 1.89,95% CI:1.14-3.16) were associated with Neonatal Near-miss. Grade III meconium stained amniotic fluid partially mediated the relationship between primiparous (ß = 0.517), fetal malposition (ß = 0.526), pregnant women referred from other health facilities (ß = 0.948) and Neonatal Near-Miss at P-value < 0.01. Duration of the active first stage of labour partially mediated the relationship between primiparous (ß = -0.345), fetal malposition (ß = -0.656), premature rupture of membranes (ß = -0.550) and Neonatal Near-Miss at P- value <0.01.It had also a significant indirect effect (ß = 0.581, P<0.001) on NNM with variables (primiparous, fetal malposition, and premature rupture of membranes).

CONCLUSIONS: The relationship between fetal malposition, primiparous, referred from other health facilities, premature rupture of membrane, and Neonatal Near miss were partially mediated by grade III meconium stained amniotic fluid and duration of the active first stage of labour. Early diagnosis of these potential danger signs and appropriate intervention could be of supreme importance in reducing NNM.