This chapter charts and critically analyses the ethical challenge of assessing how much (and what kind of) evidence is required for the justification of interventions in response antibiotic resistance (ABR), as well as other major public health threats. Our ambition here is to chart and briefly discuss main issues, and point to ways in which these need to be further advanced in future research. This will result in a tentative map of complications, underlying problems and possible challenges. This map illustrates that the ethical challenges in this area are much more complex and profound than is usually acknowledged, leaving no tentatively plausible intervention package free of downsides. This creates potentially overwhelming theoretical conundrums when trying to justify what to do. We therefore end by pointing out two general features of the complexity we find to be of particular importance, and a tentative suggestion for how to create a theoretical basis for further analysis.

On March 11, 2020, the World Health Organization declared the emerging COVID-19 threat a pandemic following the global spread of the virus. A year later, a number of governments are being handed the concluding reports of national public inquiries tasked with investigating responses, mishaps, and identifying lessons for the future. The present article aims to identify a set of learning obstacles that may hinder effective lessons drawing from the COVID-19 pandemic responses. The seven obstacles discussed in this article are: (1) retaining lessons and implementing them effectively, (2) effectively drawing lessons from other countries, (3) the potential for reforms to introduce unanticipated vulnerabilities elsewhere in the system, (4) political pressure, (5) drawing the conclusions from observations, (6) experts versus decision makers, and (7) reforms may not be related to the actual crisis. Exploring these obstacles will be central to future discussions concerning which kinds of responses will set precedent for future pandemics and global health crises. 

This paper presents the result of a survey study where representing members of the disability movement in Sweden have shared their experiences of living and acting during the first year of the Covid-19-pandemic. The aim was to identify crisis communication challenges and where additional communication material and methods are needed for supporting people in going from knowledge to taking action for achieving a higher level of crisis preparedness. The paper also includes a brief summary of a literature review of previous international research on disabilities and the Covid-19 pandemic. Three categories of crisis communication challenges were identified displaying a vulnerability in society and pointing towards several important knowledge gaps that ought to be addressed in order to achieve crisis preparedness among all people. The results indicate that there is a need for additional communication materials and methods that can be appropriated to individual needs, and dialogue methods between authorities and people in order to counteract normative assumptions in crisis communication aimed at different target groups.

This paper presents the result of a survey study where representing members of the disability movement in Sweden have shared their experiences of living and acting during the first year of the Covid-19-pandemic. The aim was to identify crisis communication challenges and where additional communication material and methods are needed for supporting people in going from knowledge to taking action for achieving a higher level of crisis preparedness. The paper also includes a brief summary of a literature review of previous international research on disabilities and the Covid-19 pandemic. Three categories of crisis communication challenges were identified displaying a vulnerability in society and pointing towards several important knowledge gaps that ought to be addressed in order to achieve crisis preparedness among allpeople. The results indicate that there is a need for additional communication materials and methods that can be appropriated to individual needs, and dialogue methods between authorities and people in order to counteract normative assumptions in crisis communication aimed at different target groups.

Residents’ perceived safety is key to improving livelihoods and reducing disparities between neighborhoods in Sweden. Neighborhood interventions may be more cost-effective than individual-level interventions in addressing major societal issues such as unequal levels of safety between neighborhoods. However, most studies investigating the impact of neighborhood characteristics on perceived safety suffer from either poor data quality, too few respondents per statistical unit, large units of analysis, or a lack of longitudinally collected data. This study aims to fill this gap by combining property-specific longitudinal sociodemographic data with customer satisfaction survey data (N = 147,965) collected between 2013–2014 and 2016–2021 in Gothenburg. Using two multilevel models, we examined the relationship between perceived safety and both property-level and area-level structural characteristics, testing three hypotheses. Consistent with prior research, we find that sociodemographic and urban environmental characteristics influenced perceptions of safety. The multilevel analyses reveal that proximity to the square is associated with lower levels of perceived safety, particularly among residents living within 0–100 m of the square in socioeconomically disadvantaged neighborhoods. Moreover, the results show that living in taller buildings of 10–16 floors is associated with lower levels of safety. 

BACKGROUND: Harnessing mobile health (mHealth) solutions could improve the delivery of mental health services and mitigate their impact in Uganda and similar low-resource settings. However, successful adoption requires that mHealth solutions have good usability. We have previously implemented a telephone service to provide mental health information and advice in English and Luganda, utilizing an automated interactive voice response (IVR) system linked to live agents, including mental health care workers and peer support workers. OBJECTIVE: This study aims to assess the usage and usability of this mental health telephone service. METHODS: We obtained usage data from the system’s call logs over 18 months to study call volumes and trends. We then surveyed callers to gather their characteristics and assess usability using the Telehealth Usability Questionnaire. Additionally, call recordings were evaluated for conversation quality by 3 independent health care professionals, using the Telephone Nursing Dialogue Process, and correlations between quality and usability aspects were investigated. RESULTS: Over 18 months, the system received 2863 meaningful calls (ie, calls that went past the welcome message) from 1125 unique telephone numbers. Of these, 1153 calls (40.27%) stopped at the prerecorded IVR information, while 1710 calls (59.73%) opted to speak to an agent. Among those who chose to speak with an agent, 1292 calls (75.56%) were answered, 393 calls (22.98%) went to voicemail and were returned in the following working days, and 25 calls (1.46%) were not answered. Usage was generally sustained over time, with spikes in call volume corresponding to marketing events. The survey (n=240) revealed that most callers were caregivers of patients with mental health issues (n=144, 60.0%) or members of the general public (n=46, 19.2%), while a few were patients with mental health issues (n=44, 18.3%). Additionally, the majority were male (n=143, 59.6%), spoke English (n=180, 75.0%), had postsecondary education (n=164, 68.3%), lived within 1 hour or less from Butabika Hospital (n=187, 77.9%), and were aged 25-44 years (n=160, 66.7%). The overall usability score for the system was 4.12 on a 5-point scale, significantly higher than the recommended target usability score of 4 (P=.006). The mean scores for usability components ranged from 3.66 for reliability to 4.41 for ease of use, with all components, except reliability, scoring higher than 4 or falling within its CI. Usability scores were higher for Luganda speakers compared with English speakers, but there was no association with other participant characteristics such as sex, distance from the hospital, age, marital status, duration of symptoms, or treatment status. The quality of call conversations (n=50) was rated at 4.35 out of 5 and showed a significant correlation with usability (Pearson r=0.34, P=.02). CONCLUSIONS: We found sustained usage of the mental health telephone service, along with a positive user experience and high satisfaction across various user characteristics. mHealth solutions like this should be embraced and replicated to enhance the delivery of health services in Uganda and similar low-resource settings. 

The Cooking and Food Provisioning Action Scale (CAFPAS) is a 28-item validated tool for measuring food agency, a latent construct representing an individual's ability to make and achieve food-preparation and -provisioning goals. Here, key measurement parameters (targeting, threshold ordering, item fit, unidimensionality, differential item functioning, local dependency, and person reliability) of the CAFPAS are evaluated using a specific case of item response theory, Rasch analysis, on data from a development sample (N = 1853; 910 from Sweden; 943 from the US). Winsteps (v.5.1.7) is used for this analysis. The similarity of the Swedish version of the CAFPAS to the original is also assessed. Based on an iterative assessment of the measurement properties with different combinations of items in the development sample, ways to shorten the CAFPAS without jeopardizing construct validity or person reliability are examined. After removing items that do not fit the Rasch model, or that appear redundant in relation to other items, an 11-item version (CAFPAS-short) is suggested and tested using further Rasch analysis on both the development sample and an additional US-based validation sample (N = 1457). Scores of cooking confidence and attitudes are then modelled with measures from the CAFPAS and CAFPAS-short using frequentist and Bayesian analysis. Results suggest that the CAFPAS-short performs similarly to the full-length version, and potential future improvements to the CAFPAS are discussed. This study represents a successful application of item response theory to investigate and shorten a psychometric scale, reducing cognitive load on participants in studies using the CAFPAS whilst minimizing loss of data reliability. © 2023 The Author(s)

Om 10 år kommer primärvården ha andra kontaktvägar och högre tillgänglighet än idag. Patientens första kontakt är digital och i många fall kan ett digitalt beslutsstödssystem, vid behov kompletterat med hemtester, vara tillräckligt för att ge patienten den vård hen behöver. De digitala möjligheterna kommer att leda till ökad kunskap och egenförmåga hos patienten att ta större ansvar för sin egen hälsa. Personanpassade tjänster där individens behov styr kommer att erbjudas både från vården och andra aktörer. Relevant hälsodata kommer att finnas tillgänglig för de aktörer som behöver den och digitala lösningar integreras i hela vårdkedjan. På så sätt frigörs vårdresurser till de personer som verkligen behöver den.

Denna rapport illustrerar den nutida och framtida primärvården genom fem patientfall som tillsammans täcker in merparten av primärvårdens besök. Möt febrige femårige Arvid, Ahmed med risk för att utveckla livsstilsrelaterad kronisk sjukdom, deprimerade 14-åriga Sara, Erik som just haft en hjärtinfarkt och multisjuka Inga. Från nutid och 10 år framåt förväntas primärvårdens resurser förflyttas från fall av engångskaraktär som Arvid till att arbeta förebyggande med fall som Ahmed.

För att detta ska realiseras behöver vården säkerställa att patient- och kostnadsansvar följer individen och inte organisatoriska gränssnitt. Ett tydligt syfte med digitaliseringen och den avsedda effekten på verksamheten behöver definieras och hinder som möjliggör samlad vårdinformation som flödar mellan kommun och landsting behöver undanröjas.

Objectives. Exposure to hand-transmitted shocks is a widespread phenomenon in the workplace. Separate risk assessments for shocks do not exist in current international hand–arm vibration regulations, leading to potential underestimation of associated health risks. Methods. In a pilot study approach, eight healthy males were exposed to sets of 3 × 5 min of repetitive shocks and 1 × 5 min of random vibration, controlled at a weighted vibration total value of 10 m/s2. Baseline and post-exposure measurements of vibration perception thresholds, finger skin temperature, maximal grip/pinch force and the Purdue pegboard test were conducted. Muscle activity was monitored continuously by surface electromyography. Results. Shock exposures evoked a temporary increase of vibration perception thresholds with high examination frequencies. A decrease of skin temperature was hinted for shocks of 1 and 20 s–1. Electromyographical findings indicated an additional load on two forearm muscles during shock transmission. Maximum grip force and manual dexterity were not affected, and pinch force only partially reduced after the exposures. Conclusion. Physiological effects from shock exposure conform to those described for hand–arm vibration exposure in principle, although some divergence can be hypothesized. Randomized designs are required to conclusively assess the need of occupational health concepts specifically for hand-transmitted shocks.