Umeå University's logo

Background: Problem drinking and illicit drug use among healthcare workers (i.e., physicians and nurses) may impair their attention and cognitive functioning, thereby increasing the risk of medical errors and diminishing the quality of patient care.

Objective: To investigate the association between healthcare workers' problem drinking and illicit drug use with subsequent self-rated quality of care provided.

Design: A two-wave longitudinal observational study.

Methods: Panel data were drawn from the Longitudinal Occupational Health Survey in Healthcare Sweden (LOHHCS), collected in 2022 (baseline) and 2023 (follow-up), encompassing a sample of 3280 healthcare workers. Questionnaires included problem drinking, illicit drug use (cannabis and stimulants), and self-rated quality of care they provide to patients. Logistic regression models analysed relationships between the study variables.

Results: At baseline, the prevalence of problem drinking was 3.8 %, and illicit drug use was 1.3 %. Both problem drinking (OR = 1.93, 95 % CI = 1.28–3.02) and illicit drug use (OR = 2.07, 95 % CI = 1.00–4.29) were significantly associated with lower self-rated quality of care provided at follow-up, after adjustment for confounding variables.

Conclusions: This novel longitudinal study shows that healthcare workers reporting substance use at baseline were about twice as likely to report providing poor quality of care one year later. These findings are of clinical relevance and highlight the need for targeted preventive measures and interventions to safeguard the health and well-being of healthcare workers while maintaining quality standards in patient care.

Background: Research suggests a comorbidity between illicit drug use and mental health conditions. However, it remains unclear whether illicit drug use serves as a risk factor for, or a consequence of, mental health conditions in healthcare workers (HCWs). This study aimed to 1) examine the prevalence of illicit drug use among HCWs in Sweden and 2) investigate the bidirectional relationship between illicit drug use and mental health conditions(i.e., depression and burnout).

Methods: Data from the 2022 and 2023 Longitudinal Occupational Health Survey in Healthcare Sweden (LOHHCS) were used. The data included 3280 HCWs (50.3 % physicians and 49.7 % nurses). Questionnaires assessed illicit drug use frequency, burnout complaints (BAT-12), and depression (SCL-CD6). Cross-lagged panel models (CLPMs) were used to examine the reciprocal relationships over the two studied time-points between illicit drug use and mental health conditions.

Results: The prevalence of illicit drug use in 2022 was 1.3 %, which increased slightly to 1.6 % one and a half years later, in 2023. Using two-wave panel data, results revealed a bidirectional effect between illicit drug use and burnout. However, while depression was associated with subsequent illicit drug use, the reversed association was not observed.

Conclusions: These findings suggest that illicit drug use plays different roles in relation to burnout and depression among healthcare workers. This highlights the importance of integrated treatment strategies and preventive measures that address both illicit drug use and mental health conditions—especially burnout—simultaneously.

Aim: This study aimed to explore how patients with chronic obstructive pulmonary disease (COPD) experience continuity of care through their encounters with a specialised asthma/COPD Registered Nurse in primary care.

Design: An inductive qualitative study using interpretive description.

Methods: Data were collected through semi-structured individual interviews with 13 purposively sampled patients with COPD from four regions in Sweden. The audiotaped interviews were conducted over a 5-month period (September 2024–January 2025) via telephone, transcribed verbatim and analysed using interpretive description.

Results: Three themes describe the results. Meaningful care when encountering a dedicated nurse, which patients describe when encountering the same trusted nurse. Being acknowledged and listened to highlights the patient’s appreciation for the nurse’s knowledge and competence, both regarding the patient and the disease. Feeling trust in the relationship, a personal but not overly private relationship that fosters trust, which is essential since COPD can be a shameful disease. Some patients haven’t shared their diagnosis with loved ones, making the nurse a vital and comforting point of contact.

Conclusion: Patients with COPD value continuity of care with a specialised asthma/COPD Registered Nurse. Trust and a non-judgmental relationship are essential for continuity to be experienced positively. Continuity is more than repeated encounters; it requires quality interactions that empower patients and address the stigma associated with COPD.

Reporting Method: Consolidated Criteria for Reporting Qualitative Research guidelines.

Background: Healthcare workers are frequently exposed to workplace violence (including threats and physical aggression), which may increase the risk of burnout complaints through maladaptive coping behaviours such as harmful alcohol use. Leadership climate may buffer these adverse effects by fostering psychological safety and supportive supervisor–employee interactions. This study examined whether leadership climate moderates the association between violence and harmful alcohol use, whether the indirect association between violence and subsequent burnout via harmful alcohol use depends on leadership climate, and whether these pathways differ between physicians and nurses.

Methods: Two-wave panel data were drawn from the Longitudinal Occupational Health Survey in Healthcare Sweden (LOHHCS). The sample included 2446 healthcare workers. Violence, harmful alcohol use, and leadership climate were assessed at Time 1, while burnout was measured at Time 2. Moderated mediation analyses were conducted using the PROCESS macro.

Results: Violence was positively associated with harmful alcohol use, with this association weakened under stronger leadership climate. The conditional indirect prospective association between violence and later burnout through harmful alcohol use was evident primarily under weaker leadership conditions (b = 0.007, 95% CI [0.001, 0.016]) and nonsignificant under moderate or strong leadership. Formal tests did not indicate statistically significant differences between professional groups.

Conclusions: A supportive leadership climate may play a modest protective role in the associations between violence and harmful alcohol use and subsequent burnout. Despite small effect sizes and limited causal inference, consistency with theory suggests that leadership climate may play a meaningful protective role in violence-exposed healthcare environments.

Registration: Swedish Occupational and Education Registries

Aim: To explore Registered Nurses' experiences of continuity of care for patients with chronic obstructive pulmonary disease in primary care.

Design: An inductive, descriptive qualitative study.

pled Registered Nurses of varying levels of experience from eight regions in Sweden. The audiotaped interviews were conducted over a 5-month period (December 2023–April 2024), transcribed verbatim and analysed using interpretive description.

Results: Registered Nurses' experiences of continuity of care for patients with chronic obstructive pulmonary disease are described by three themes (seven subthemes): Patient continuity (Building personal relationships: Being accessible and enabling trust and confirmation), Collaborator continuity (Having a colleague to lean on: Colleagues can lean on me: Feeling alone with my expertise) and Continuity with myself (Trusting my own competence: Carrying a burden alone).

Reporting Method: Consolidated Criteria for Reporting Qualitative Research Guidelines.

Conclusion: This study provides an understanding of Registered Nurses' experiences of continuity of care in primary care. The results may help improve future care since nurses play an essential role in the care of chronic obstructive pulmonary disease within primary care.

Implications for the Profession and Patient Care: To enhance continuity of care for patients with chronic obstructive pulmonary disease, the relationship between the nurse and the patient is important, as is collaboration with colleagues. This collaborative approach allows these nurses to maintain continuity with both the patients and themselves, fostering a more stable and effective care environment.

Impact: This study offers valuable insights into the experiences of Registered Nurses in maintaining continuity of care within primary care, particularly for patients with chronic obstructive pulmonary disease. By highlighting the critical role of Registered Nurses in managing these patients, the study underscores the importance of strong nurse–patient relationships and effective collaboration among healthcare professionals. Patient or Public

Contribution: No Patient or Public Contribution.

In 2010, a Cryptosporidium hominis outbreak resulted in 27,000 clinical cryptosporidiosis cases (45% of the population) in Östersund, Sweden. Long-term abdominal and joint symptoms are common following cryptosporidiosis in adults, and it can affect the development of children in low-income countries. We investigated the potential consequences for children in a high-income setting. In 2011, we prospectively surveyed 600 randomly selected children aged 0-5 years from Östersund. Cases were defined as respondents reporting new episodes of diarrhoea during the outbreak. After 10 years, respondents received a follow-up questionnaire about long-term symptoms (n = 423). We used X2 and Mann-Whitney U tests to assess between-group differences in demographics and the mean number of symptoms. Logistic regressions adjusted for sex, age, and prior issues with loose stools were used to examine associations between case status and symptoms reported at follow-up. We retrieved data on healthcare visits from patient records. In total, 121 cases and 174 non-cases responded to the follow-up questionnaire (69.7%). Cases reported 1.74 (median 1.00, range 0-14) symptoms and non-cases 1.37 (median 0.00, range 0-11) symptoms (p = 0.029). Cases were more likely to report joint symptoms (aOR 4.0, CI 1.3-12.0) and fatigue (aOR 1.9, CI 1.1-3.4), but numbers were generally low. We found no between-group differences in abdominal symptoms, healthcare utilization, or disease diagnoses. Children aged 0-5 years from high-income countries may experience long-term symptoms after cryptosporidiosis, but may not be affected to the same extent as adults or their peers living in low-income countries.

Aims: Problem drinking in healthcare workers (HCWs) is highly relevant to study as it could result in personal suffering, as well as inefficiencies in health service delivery. This study aims to investigate the prevalence of nondrinking, drinking, and problem drinking and to investigate the comorbidity between drinking alcohol and mental illness (burnout and depression) among HCWs in Sweden.

Methods: This cross-sectional study draws on the 2022 Longitudinal Occupational Health survey in Healthcare Sweden of physicians, nurses, and nurse assistants in Sweden (N = 5966). Measures include levels of alcohol use assessed by the Cut, Annoyed, Guilty, and Eye Opener questionnaire, the 12-item Burnout Assessment Tool, and the Symptom CheckList–Core Depression. Multinomial Logistic regressions were used to investigate the likelihood of reporting nondrinking and problem drinking compared to drinking.

Results: The prevalence of problem drinking among Swedish HCWs was 3.7%. Only sex differences were observed for those with a problem drinking, with male nurses and nurse assistants being more likely to report problem drinking. Comorbidity was found between problem drinking and depression but not between problem drinking and burnout.

Conclusions: This study demonstrated that ~3.7% of Swedish HCWs had problem drinking and that those also had a higher likelihood of reporting depression but not burnout. Results contribute to new knowledge about the use of alcohol and comorbidities with depression and burnout among HCWs in Sweden. Findings could benefit employers in implementing preventive and tailored strategies to preserve the psychosocial well-being of HCWs.

Objective: To explore rural general practitioners’ (GPs’) experiences of providing care in rural community hospitals (CHs) in northern Sweden.

Design: An interview study, using qualitative content analysis.

Setting: The study was conducted in Norrbotten and Västerbotten counties in Sweden and included eight rural CHs.

Participants: Semi-structured interviews were conducted in 2018 with 15 rural GPs.

Results: Two themes were identified: ‘Being the hub in the patient’s healthcare pathway’ and ‘Offering person-centred care far from hospital’. CHs are suitable for elderly, multimorbid and end-of-life patients, emphasising proximity, familiarity and discharge planning. They serve as primary care and intermediate hospital care hubs, collaborating with general hospitals and municipal caregivers. The rural GPs interviewed, as generalists, value holistic hospital patient care, and benefit from longitudinal patient knowledge. They highlighted these advantages and the cost-effectiveness of the CH model, arguing that it should be extended to urban regions. The rural GPs described their work situation as stimulating, but role conflicts in tight-knit communities, geographical distances and limited medical resources pose rural-specific ethical dilemmas.

Conclusions: Rural GPs value the holistic generalist perspective of CH care and emphasise the high-quality care that the CH setting enables them to provide. Despite rural-specific ethical dilemmas, they value the CH model and are concerned about its closures.

Purpose: App-based treatment of urgency (UUI) and mixed (MUI) urinary incontinence has proved to be effective. To further improve treatment, it will be beneficial to analyze baseline and treatment-related factors that are associated with satisfaction.

Methods: A secondary analysis was conducted of data from a randomized controlled trial (RCT) assessing an app for UUI or MUI treatment, encompassing 98 women for whom there was long-term treatment satisfaction data. All participants completed a short-term (15 weeks) and a long-term (15 months) follow-up questionnaire after being given access to treatment. The outcome was a 3-item question on current treatment satisfaction at the long-term follow-up. Factors potentially associated with the outcome were analyzed using the chi-square test, Student’s t test or logistic regression.

Results: At the long-term follow-up, 58% of the women were satisfied with the treatment. The most important baseline variable associated with satisfaction was incontinence-related quality of life (International Consultation on Incontinence Questionnaire (ICIQ) − Lower Urinary Tract Symptoms Quality of Life Module) (OR 0.91, 95% CI 0.58–0.97). Short-term follow-up variables associated with long-term treatment satisfaction were improvement in the ability to endure urgency (OR 4.33, 95% CI 1.43–13.12), and confidence in pelvic floor contraction ability (OR 2.67, 95% CI 1.04–6.82).

Conclusion: App-based treatment for UUI and MUI may be an alternative first-line treatment that is satisfactory to many women over the long-term. Furthermore, short-term treatment that focuses on improving the ability to endure urgency, and confidence in pelvic floor contraction ability, can also be recommended for long-term satisfaction.

Introduction: The present article aimed to investigate 1) if mental health problems (depression and burnout including the dimensions; emotional exhaustion, mental distance and cognitive and emotional impairment) differed between nurses and physicians in Sweden, 2) if any differences were explained by differences in sex compositions, and 3) if any sex differences were larger within either of the two professions.

Method: Data were derived from a representative sample of nurses (n = 2903) and physicians (n = 2712) in 2022. Two scales were used to assess burnout (KEDS and BAT) and one to assess depression (SCL-6). The BAT scale has four sub-dimensions. Descriptive statistics and logistic regression were used to analyse each scale and dimension separately.

Results: Results showed that 16–28 % of nurses and physicians reported moderate to severe symptoms of burnout. The prevalence differed between occupations across the scales and dimensions used. Nurses reported higher scores on KEDS while physicians reported higher scores on BAT including the four dimensions. Also, 7 % of nurses' and 6 % of physicians' scores were above the cut-off for major depression. The inclusion of sex in the models changed the odds ratios of differences between doctors and nurses in all mental health dimensions except mental distance and cognitive impairment.

Limitations: This study was based on cross-sectional survey data which has some limitations.

Conclusion: Our study suggests that the prevalence of mental health problems is prominent among nurses and physicians in Sweden. Sex plays an important role in the difference in the prevalence of mental health problems between the two professions.