Center for Clinical Research Dalarna

The bowel-bladder interaction is well established, as is the fact that constipation can lead to daytime incontinence and/or recurrent urinary tract infections. However, the link between constipation and enuresis is less clear. The bowel's influence on enuresis is possibly important even though fecal disimpaction by itself will not make the child dry at night. Furthermore, parents and patients may be unaware of the child's constipation until the enuresis is evaluated. The same should apply to healthy children. The hypothesis that a full bowel affects bladder function appears to be logical; however, this may not be applicable in enuresis. A crucial question is if constipation is more common among children with enuresis than in the general population. To evaluate the prevalence of constipation in children with enuresis as compared to children without bladder problems. In this case-control study the former group was recruited from a pediatric clinic and the latter from the general population in the same geographic area. All children had their horizontal rectal diameter measured via abdominal ultrasound. Their bowel movements over two weeks and bladder function over two days were recorded at home. We recruited 66 children with enuresis and 58 healthy controls. The ages ranged from 6 to 11 (mean 7.3 ± 1.3) years and 50 (40 %) of them were girls. The groups had no difference in rectal diameter (28.9 ± 7.7 vs 28.2 ± 10.1 mm, P = 0.672) and they had a similar prevalence of constipation according to the Rome IV criteria. The children with enuresis had fewer bowel movements per two weeks (11.2 ± 4.1 vs 14.8 ± 6.9, P < 0.001) than controls, but they had no more constipation symptoms. However, bladder diaries showed that children with enuresis had smaller voided volumes (87.1 ± 31.8 vs 127.5 ± 44.5 % of expected bladder capacity; P < 0.001) than controls. We did not find support for constipation being more prevalent among children with enuresis than controls. But we did find decreased functional bladder capacity in patients with enuresis which may be an indirect sign of detrusor overactivity.

To explore how cancer survivors experience work-related well-being and aspects influencing their experience of it, one year after cancer treatment. During the development of a work-related intervention, cancer survivors (n = 22, 67% was female, age md 56years) were interviewed using purposive sampling one year post chemo-/radiotherapy for breast, prostate or colorectal cancer. Inductive content analysis was applied. The first year after treatment was described as a transition period in which cancer survivors strove to regain their general well-being but were able to experience work-related well-being even when their general well-being was limited. Their work-related experiences were characterised by a balance between personal readiness for work participation and workload. Daily life and working life were described as interdependent, requiring strategies to maintain balance. There was a vulnerability in handling the demands of work. Both general well-being and work-related well-being were promoted by the absence of side effects and the availability of guidance and responsiveness from caregivers and employers. One year after treatment, cancer survivors considered participation in work life to be important for their well-being. At the same time, the need for enhanced preparation was expressed for balancing work and private life, managing remaining side effects, and navigating ongoing rehabilitation. Our results suggest that the interplay between personal preparedness and work-related stress is central to work-related well-being, highlighting the importance of addressing work-related aspects early in treatment. The findings also indicate that available resources in cancer rehabilitation are underused relative to patients' individual needs. Cancer survivors desired a more holistic rehabilitation, as both general well-being and work-related well-being encompass life after illness as well as the process of returning to work. Strengthening and clearly defining the role of contact nurses regarding work-related issues, and establishing early collaboration between thecancer survivor, employer, and rehabilitation coordinators, can improve support for return to work. Further research is needed to investigate how these discussions and support efforts can be structured and how models and theories can be applied to contribute to increased focus on issues related to work-related well-being after cancer.

We aimed to 1) investigate associations between leisure time physical activity level cumulated over 20 years and multiple plasma proteins and 2) explore if proteins significantly associated with physical activity are also associated with risk of imminent myocardial infarction (MI), long-term MI and mortality. In the cohort Uppsala Longitudinal Study of Adult Men (ULSAM), leisure time physical activity was self-reported at ages 50, 60, and 70. At age 70, 720 plasma proteins were analyzed in 782 participants with up to 19.3 years of follow-up for MI and 26.3 years follow-up for mortality. In the nested case-cohort study Markers of Imminent Myocardial Infarction (MIMI), plasma proteins were measured in disease-free individuals from six European cohorts. Cases (n=420) were those with acute MI within 6 months of a blood draw, with up to four cohort representatives per case (n=1,598). A higher level of leisure time physical activity level was inversely associated with 12 plasma proteins after adjusting for age, education, smoking and established cardiovascular risk factors (Bonferroni corrected p<0.000069). Of these 12 proteins, IL-6 was associated with increased incidence of imminent MI (HR 1.22 95%CI [1.09-1.37]), TNFRSF11A was associated with increased long-term MI incidence (HR 1.22 [1.01-1.48]) and 11 proteins were associated with increased mortality (HR 1.14-1.30 [1.01-1.42]). These findings confirm and extend our understanding of how physical activity could assert its beneficial effect on cardiovascular health through proteins involved with modulating inflammatory, immune and metabolic pathways. Further research is needed to explore the causal mechanisms behind these associations.

Identifying hazardous alcohol use among patients with psychiatric disorders is important for improving treatment outcomes. This study aimed to describe the prevalence of hazardous alcohol use across 20 psychiatric diagnoses using phosphatidylethanol (PEth) blood sampling. We conducted a cross-sectional analysis of PEth samples collected between 2017 and 2023 from a regional Swedish healthcare database, linked to clinician-assessed psychiatric diagnoses. Participants were adults (≥18years) with a psychiatric disorder (N = 18,240). Hazardous alcohol use was defined as a PEth concentration>0.30µmol/L (∼210 µg/L). Marginal risk ratios (RR) were estimated using logistic regression adjusted for sex, age, comorbidity, season, and healthcare setting. In the sample (mean age: 40years; 58.7% female), 7.4% screened positive for hazardous use. The highest prevalence was observed in patients with substance use disorder (12%, RR: 1.87, 95% CI: 1.57-2.23) and panic disorder (8.8%, RR: 1.43, 95% CI: 1.19-1.70). Lower prevalence was seen in patients with exhaustion syndrome (5.4%), ADHD (5.0%), and obsessive-compulsive disorder (4.2%). Panic disorder remained significantly associated with hazardous use after adjustment. Male sex (RR: 1.79, 95% CI: 1.58-2.02) and age, with the highest risk observed around 60years, were both strongly associated with increased risk. Hazardous alcohol use is prevalent among patients with psychiatric disorders when assessed with PEth. Targeted screening, especially among older men and patients with panic disorder, may improve identification and intervention.

PurposeFalls pose a significant health risk to older adults, often resulting in adverse outcomes. Despite the recognition of effective interventions, the psychological aspect of fear of falling (FoF) remains under-addressed. The Fear of Falling Questionnaire-Revised (FFQ-R) (15 and 6-item) was developed to assess FoF. However, no Swedish version is available, necessitating its translation and evaluation of psychometric testing. This study aimed to translate the FFQ-R (15 and 6-item) and examine the psychometric properties of the Swedish versions in healthy community-dwelling adults aged ≥ 60 years.Patients and MethodsThis study used a cross-sectional design to translate and assess the psychometric properties of the FFQ-R(S) (15 and 6-item) for healthy community-dwelling older adults. Translators, experts, and community-dwelling older adults participated in the process. Confirmatory factor analysis was used to assess the fit of the model. Scale reliability was measured with ordinal α.ResultsThe translation resulted in minor changes and demonstrated satisfactory content validity. Confirmatory factor analysis showed that the FFQ-R(S) model, with four latent factors and 15 items, was not analyzable due to non-convergence. For the two-factors and six items, FFQ-R(S), the ordinal α values for the scales’ harm outcome (HO) and degree of threat (DT), measuring reliability, were 0.70 and 0.88, respectively. The confirmatory factor analysis yielded mixed fit indices, where values of standardized root mean square residual, comparative fit index, and Tucker–Lewis index suggested a good fit of the model to the sample, whereas the χ2 test and the value of root mean square error of approximation indicated a lesser good fit.ConclusionThe Swedish version of the 6-item FFQ-R demonstrates acceptable psychometric properties. Moreover, the six items align with the two factors, DT and HO. Based on these findings, we recommend using the Short FFQ-R(S) (6-item) to assess FoF in primary fall prevention efforts for community-dwelling older adults.

BackgroundMalaria in pregnancy (MiP) poses significant risks in sub-Saharan Africa. Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) is a key WHO-recommended intervention. However, its implementation faces challenges, particularly in fragile, diverse malaria transmission settings like Somalia, where data on uptake is limited. Critically, a substantial majority of recently pregnant women in Somalia do not access formal antenatal care (ANC) at all, with only ~ 31% attending one or more visits, severely limiting the primary platform for IPTp-SP delivery. This study aimed to identify factors associated with reported use of any sulfadoxine-pyrimethamine (SP/Fansidar) during pregnancy in Somalia, and specifically, factors associated with its uptake within antenatal care (ANC) services, contextualized by the low ANC attendance rates.MethodsThis study analysed data from the 2020 Somalia Demographic and Health Survey (SDHS) to identify factors associated with the self-reported use of SP/Fansidar during women’s most recent pregnancy in the preceding 5 years. This cross-sectional study analysed data from 7124 women aged 15–49 with a live birth in the preceding 5 years, using the 2020 Somalia Health and Demographic Survey (SDHS). The outcome was self-reported use of any SP/Fansidar during the last pregnancy (Yes/No), acknowledging this measure does not quantify dose number or adherence to WHO guidelines. To provide a more nuanced understanding of programmatic uptake, the analysis was stratified by ANC attendance (at least one visit vs. no visits). Multilevel logistic regression models were employed to assess associations with individual, household, and community-level factors, accounting for data clustering.ResultsOverall reported SP/Fansidar use was extremely low at 6.3%. A striking 69.0% of women reported no ANC visits during their last pregnancy, while 22.0% reported 1–3 visits, and only 9.0% reported 4 + visits. Reported SP/Fansidar use was highest among women with 1–3 ANC visits (e.g., 10.5%), significantly lower in those with 4 + visits (e.g., 4.2%), and lowest among those with no ANC visits (e.g., 1.8%). Multilevel analysis revealed that nulliparous women had significantly lower odds of reported SP use (AOR = 0.6; 95% CI 0.4–0.9) compared to women with 1–3 children. Women attending 4 or more ANC visits had significantly lower odds of reported SP use (AOR = 0.38; 95% CI 0.25–0.58) compared to those with no ANC visits. Women whose husbands had no education also had lower odds (AOR = 0.68, 95% CI 0.51–0.91), while women whose husbands were unemployed had higher odds (AOR = 1.6, 95% CI 1.32–2.1). Compared to the poorest, women in the fourth wealth quintile had lower odds (AOR = 0.51, 95% CI 0.29–0.89). Nomadic women had higher odds than rural women (AOR = 3.7, 95% CI 2.2–6.4). Profound regional disparities were observed, with significantly lower reported SP use in many regions compared to Awdal. Community-level factors explained 7.4% of the residual variance (ICC = 7.4%) in the overall model.ConclusionThe overall reported use of SP/Fansidar in Somalia is critically low, indicative of significant gaps in maternal healthcare delivery and falling far short of WHO coverage goals. This is fundamentally driven by the very low overall ANC attendance rate (31.0%) and further exacerbated by paradoxical findings, such as lower reported SP use among those who do attend, despite higher ANC attendance, which suggest severe systemic barriers and potential issues with service quality or SP availability. Interventions are needed to improve both initial access to ANC and the quality of ANC delivery, ensure SP availability and administration during visits, address regional inequities, and strengthen the health system to protect pregnant women and newborns from malaria.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12936-025-05673-3.

BackgroundIntegrated occupational safety and health and patient safety management are essential for addressing the challenges faced by healthcare services today. Developing and evaluating tools that support this work is crucial. This project aims to assess the effectiveness of a structured method for systematic and integrated occupational safety and health and patient safety management systems (SIOHPS). Additionally, the project includes embedded economic and process evaluation. This article presents the overall design of the SIOHPS-project, with a specific focus on the design and evaluation of the (cost-)effectiveness study.MethodsThe project is guided by the Medical Research Council (MRC) framework for complex interventions and is coproduced with key stakeholders. The intervention is designed to support systematic occupational health and patient safety management systems, incorporating both Safety I and Safety II perspectives. It is grounded in safety culture theory and knowledge about team debriefing for learning. The intervention consists of several core components, including targeted education, end-of-shift team debriefings, and support for systematic management. The intervention is supported by a digital tool. A program theory guides the evaluation. A pragmatic stepped-wedge cluster-controlled design (p-SWD) is used, with hospital healthcare units as clusters. The p-SWD includes three steps, with at least four clusters transitioning from the control to the intervention group at each step. A minimum of twelve healthcare units from two different regions in Sweden will participate. The intervention effect will be evaluated using sick leave and quality of care as primary outcomes. Secondary outcomes include safety climate, work environment factors, healthcare worker health, performance, patient safety and quality of nursing care. Primary and secondary analyses are conducted based on intention-to-treat approach. Cost-effectiveness will be assessed using cost-benefit and cost-consequence analyses.DiscussionThe need of methods that integrate systematic occupational safety and health and patient safety management has been emphasized by different stakeholders worldwide. The SIOHPS study has strong potential for nationwide implementation in Sweden to help healthcare organizations address current challenges. Additionally, the project will contribute to existing safety culture theory by exploring the integration of these domains.Trial registrationClinicalTrials.gov Identifier: NCT06398860. Registration date: 2024-04-30.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13537-4.

IntroductionAs care and rehabilitation poststroke are increasingly moving into persons’ home environment, the importance of support from social networks in self-management and rehabilitation has emerged as an important topic for research and practice. While there are instruments used to assess social support and collective efficacy, a clearer scope of the availability and quality of these instruments is needed. This clarification will enable the development of interventions integrating social network perspectives in poststroke rehabilitation.Methods and analysisTo assess the availability and quality of instruments assessing social support and collective efficacy, a scoping review will be conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews guidelines (PRISMA-ScR). Literature searches conducted between 14 November 2024 and 15 November 2024 in the CINAHL and PubMed/Medline databases resulted in 4631 articles potentially eligible. After removing duplicates, 4121 articles’ titles and abstracts were initially screened. Full-text screening, searches of reference lists and data extraction started in June 2025. Starting August 2025, two reviewers will assess the full texts against the inclusion criteria in Covidence using a coding template. Identified instruments will be appraised following the COSMIN (Consensus-based Standards for the selection of health Measurement INstruments guidelines) and analysed using a narrative descriptive method. Results will be reported in February 2026 according to PRISMA-ScR guidelines.Ethics and disseminationEthical approval is not required for this scoping review, as it does not involve primary data. However, this review follows established ethical guidelines and best practices, and included studies will be reviewed to ensure that they received ethical approval and included informed consent. Results from the review will be disseminated through an article in a scientific journal, at relevant conferences and surmised to stroke organisations. A policy brief will be developed for health and social care professionals and policy makers.