Eskilstuna Municipality

Timely discharge of patients who are clinically ready to be discharged from hospitals to the next point of care is a common health system challenge. Ensuring safe and effective discharge holds new urgency, given the backlogs and increased waiting times for inpatient services in many countries after the COVID-19 pandemic. The study aimed to identify policy options for addressing delayed discharges in six European countries (Denmark, France, Germany, the Netherlands, Norway, and Sweden), and to summarise available evidence on their effectiveness. Experts from the Health Systems and Policy Monitor (HSPM) network of the European Observatory on Health Systems and Policies and additional country experts identified relevant policies and initiatives up to November 2023. When evaluations were available, the experts also provided information on their findings. The data collection was followed by a qualitative, cross-country comparative analysis. A total of 17 policies or initiatives were identified in the study countries. Hospital-based initiatives included discharge planning and transitional care. Community and home care initiatives included municipal emergency beds, intensive home rehabilitation, and assisted discharge. Cross-sectoral initiatives ranged from coordination efforts at the regional and municipal levels to decision support systems and financial incentives. Several common factors or principles underpin many of the identified policies and initiatives. These include clarity of responsibility, effective planning and communication, resourcing of community-based capacity, possible unintended consequences of financial penalties, and the need to adopt a systemic approach.

Abstract Digital technologies offer great opportunities to increase efficiency and competitiveness in production. However, many manufacturing companies struggle to select and integrate digital technologies that generate both business and sustainability value. Research on digitalisation and sustainability has expanded rapidly, but the two areas are still often treated separately. As a result, decisions regarding digital technology selection and integration frequently prioritize technical performance or cost efficiency, while overlooking long-term social and environmental implications. The purpose of this paper is therefore to identify and categorize sustainability aspects affecting the selection and integration of digital technologies to achieve smart and sustainable production. Based on a literature review and workshops with industrial participants, the study synthesizes existing research on digitalization and sustainability and structures the findings based on two dimensions identified in literature. The first dimension is the data value chain, which includes data generation, communication, storage, processing, and usage. The second dimension are the three sustainability pillars: economic, social, and environmental sustainability. The resulting conceptual framework provides a holistic understanding of how the three sustainability pillars can be embedded in digitalization decisions throughout the data value chain. Moreover, the conceptual framework shows which sustainability aspects should be addressed during the selection of digital technologies and those that require attention during the integration. The paper contributes theoretically by linking sustainability perspectives with the data value chain and digital technology selection and integration literature, and practically by offering a structure for manufacturing companies to evaluate digital technologies beyond short-term efficiency gains.

ObjectivesThis study aimed to identify clinical and socioeconomic factors associated with treatment selection and survival in patients diagnosed with synchronous metastatic renal cell carcinoma (mRCC).Patients and MethodsThe Renal Cell Cancer Database Sweden (RCCBaSe2.0), linking the National Swedish Kidney Cancer Register with other national quality registers, was used to identify all patients with synchronous mRCC diagnosed 1 January 2014–1 July 2019 (n = 951); thus, it was performed during the tyrosine kinase inhibitor era. Logistic and Cox regression were used to evaluate associations with treatment selection, overall survival (OS) and cancer‐specific survival (CSS).ResultsUpfront cytoreductive nephrectomy (uCN) was the primary treatment in 56% of patients and was associated with larger primaries and treatment at university hospitals. Immediate systemic treatment (IST) was chosen in 32% and associated with multidisciplinary team (MDT) discussions, cN1 disease, more metastatic sites and higher comorbidity index. Gender, income, education level or marital status were not associated with upfront treatment. Patients selected for uCN had longer OS and CSS compared with those allocated to IST. This association remained when adjusting for selection factors. Socioeconomic factors were not linked to survival. Limitations include the retrospective design and the lack of detailed data on the International mRCC Database Consortium risk factors.ConclusionTumour‐related factors had significant effects on the choice to perform uCN or not. Patients with more advanced disease, higher comorbidity index and those discussed at MDT were more likely to be offered immediate systemic treatment. Socioeconomic status did not affect treatment allocation or survival, indicating equal healthcare access for Swedish mRCC patients.

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.

Energy systems around the world are undergoing immense transformations through many parallel developments. These changes across the energy landscape are introducing new security threats which require a degree of foresight to anticipate and subsequently mitigate the effects of. Therefore, through a systematic 3-round Delphi methodology, this study explores emerging threats to energy security from the political, economic, technological, socio-cultural, and environmental domains. Findings contribute with a broad picture of the emerging threat landscape in an increasingly renewable, integrated, and electrified post-modern energy system. Threats are ranked by the experts in terms of the most critical issues to non-issues, thereby offering insight for policy development. Political short-termism and tunnel vision and polarization are viewed as the most significant threats with a high degree of consensus amongst participating experts, followed by unambitious climate goals which increase environmental threats to energy security in the long-term. Based on these results, policy implications are derived throughout the reviewed domains to bolster long-term energy system resilience. Through its focus on Sweden, this study contributes with insights into the emerging context of countries at the forefront of energy transitions. • 33 threats are presented across a range of five domains. • The majority of threats stem from the political and technological domains. • The most significant threats are political. • Short-termism and tunnel vision are amongst the most critical threats. • Strong consensus across most critical threats.

Recent advancements in dental implant materials, designs, and surgery have increased their use, especially for challenging local conditions. As guidelines for individualized risk assessment are increasingly emphasized, implant treatment has become available to patients with diverse medical backgrounds. However, clinical research with large patient groups is needed to investigate the effects of patient-related factors associated with early implant failure. This paper investigates patient factors in two patient cohorts associated with early implant complications and failures. The collected data were analyzed and presented in two studies. Both studies followed the same data collection methodology and compared cohorts treated in 2007 and 2017. The same patient-level dataset was analyzed, although the second study included additional analyses of diseases and allergies. Data were analyzed univariately (p < 0.20) to select variables for the multivariable logistic regression model (p < 0.05), with early implant failures and complications as dependent variables. In total, 1875 patients with 4670 implants were included. There were 74 (3.7%) dropouts, mainly due to lack of data. The 2007 cohort comprised 799 patients with 2473 implants, and the 2017 cohort comprised 1076 patients with 2287 implants. Differences were observed between the two cohorts for the number of implants per patient, exposed implant threads, and preoperative antibiotics. In the 2007 cohort, 23 (2.9%) patients had early implant failure. In the 2017 cohort, 40 (3.7%) had early implant failure (p > 0.30). Significantly more implants failed in the 2017 cohort (n = 56, 2.4%) than in the 2007 cohort (n = 26, 1.1%) (p < 0.001). Early complications were reported for 56 (7.0%) patients in 2007 and 145 (13.5%) patients in 2017 (p < 0.001). Three patient-related variables were associated with an increased risk of early failure-food allergy, exposed implant threads, and increased number of implants. Seven variables were related to an increased risk of complications: smoking, exposed threads, no preoperative antibiotics, number of implants, sinus perforations, food allergy, and metal allergy. This study identified three factors associated with early implant failure and seven associated with early complications.

Abstract Background Kinesiophobia (fear of movement) is prevalent after a myocardial infarction and in atrial fibrillation (prevalence 20% and 70%, respectively) and may impede the ability to be physically active as recommended in guidelines. Purpose To evaluate the feasibility of an 8-week digital program (MOVE-IT) regarding changes in kinesiophobia, cardiac anxiety, self-rated health, and to explore patient´s experiences of the program. Methods The MOVE-IT program, based on problem-based learning and cognitive behavioural therapy, was digitally delivered to base-groups supervised by a nurse or physiotherapist. The primary outcome was a change in kinesiophobia, i.e., score of ≥ 37 using the Tampa Scale of Kinesiophobia Swedish Version for the Heart (TSK-SV Heart). Changes in scores on the Cardiac Anxiety Questionnaire (CAQ) and the EuroQol-VAS (EQ-VAS) were also assessed. Individual semi-structured interviews were analysed by conventional qualitative content analysis. Preliminary results: Nine participants, mean age 73 years, 78% female, 89% atrial fibrillation and 11% myocardial infarction. The majority of the participants engaged in physical activity (&amp;gt; 30 minutes) on two days or fewer per week. At baseline, the mean score of TSK-SV Heart was 43.6 (SD 4.4), and 8-weeks (end of program), and 3-month follow-up, the mean scores were 34.8 (SD 3.5) and 25.9 (SD 4.0), respectively. This represents a reduction of 8.8 points (20%) by the end of the study and a reduction of 17.7 points (26%) at the 3-month follow-up compared to baseline. For CAQ, the mean values at baseline, 8-weeks, and follow-up, were 37.4 (SD 9.4), 25.2 (SD 5.2), and 19.8 (SD 5.7), respectively. This corresponds to reductions of 11.9 points (32%) and 17.6 points (47%) at the 8-weeks and 3-month follow-up, respectively. At baseline, the mean value on EQ-VAS was 60.9 (SD 18). At 8 weeks, the score had increased by 11.1 points to 72 (SD 20.6), and at 3 months, it had risen by 17.4 points to 78.3 (SD 13.6). Compared to baseline, this represents an increase of 18% and 28%, respectively. At 8 weeks, none of the participants’ scores decreased, and the change in scores varied from 0 to 20 points (0% to 67%). The qualitative findings showed an initially restrictive existential fear for death concerning physical activity. However, the base-group’s authentic and genuine support was existentially comforting. The tutor was confident, guiding and supportive in an invaluable way. The program felt challenging and strengthening despite initial digital obstacles. The kinesiophobia was relieved or gone. This promoted the participants to be physically active and to plan future goals. Conclusions The MOVE-IT program indicates promising results in a small group of participants, showing a considerable decrease in kinesiophobia and cardiac anxiety, as well as improved self-rated health after the program and three months later. More participants will be enrolled in this pilot study for it to be completed.

BackgroundReablement has a health promotive perspective. The goal is to enhance or maintain health and functional ability and, thereby, the ability of older adults to live in their own homes. The intervention described in this study was introduced so the older person would remain at home and be given the opportunity to regain or maintain functional ability physically, mentally, and socially to live independently and have optimal health and well-being. This paper aims to report the measured effects of reablement among the older adults in terms of bio-psycho-social health that emerged in the randomized controlled trial (RCT).MethodsA sample of older adults (65+) was studied, consisting of those who applied for homecare in the municipal home service (n = 237), those who received intensive home reablement (IHR) carried out by an interprofessional team, and a control group who received home-based care as usual. Data were collected at three different occasions with validated instruments: at inclusion, after completion of IHR, and 3 months after completed intervention.ResultsBoth groups improved significantly at the post-measurement, and this improvement was maintained at the 3-month follow-up regarding: global quality of life (HACT); general health (EQ-5D-5 L); the self-estimates for mobility, hygiene, daily activities, pain/discomfort, anxiety/depression (EQ-5D-5 L); subjective well-being (GP-CORE); self-assessed capacity to perform physical activities as well as satisfaction with performance (COPM); measures of physical activity capacity regarding lower extremities (SPPB); upper extremities (hand dynamometer test). No between group differences were statistically significant. At the 3-month follow-up, the average number of homecare hours was slightly lower in the group that underwent IHR than in the group receiving usual homecare and rehabilitation interventions, but the difference was not statistically certain.ConclusionsIn this RCT with a relatively short follow-up period, IHR was equivalent to traditional homecare regarding older people’s self-reported health, physical activity ability and number of homecare hours.Trial registrationClinicalTrials.gov (https://clinicaltrials.gov/study/NCT03565614?intr=Reablement&rank=4) Registration number: NCT03565614. Registered on 1 January 2016.

Purpose Manufacturing companies still struggle to integrate additive manufacturing (AM) technologies with existing traditional manufacturing technologies. This paper explores AM technology integration into a global manufacturing company from an operational capability perspective. Design/methodology/approach The research was conducted using a single case study in collaboration with a global heavy-duty vehicle manufacturer. Data were collected through a focus group and interviews representing management and engineering roles. Additional data were collected from meetings, company documents, field notes and observations. Subsequently, the collected data were analyzed thematically. Findings The findings reveal that, despite the company embarking on its AM technology integration journey, it encountered challenges, including cognitive fixation, manufacturing fixation, situational awareness, ambiguous ownership and the make-or-buy dilemma. Furthermore, the findings showed that the company developed operational capabilities – such as developing proficiency in AM know-how, continuous use of AM technology, operational practices for AM technology, cross-collaboration for AM initiatives and business cases for AM technology – to address these challenges. A facilitation model was developed, outlining essential actions prioritized for the short-term, mid-term and long-term. These actions leverage the operational capabilities to address challenges in AM technology integration. Originality/value This paper offers an in-depth exploration of AM technology integration in a global heavy-duty vehicle manufacturer. It introduces a novel application of operational capability theory and proposes a facilitation model for managers and academics in pursuit of achieving AM technology integration.

AimTo assess the prevalence of overweight among Swedish 4 year olds in 2018, 2020 and 2022, taking socioeconomic variables into account.MethodsAggregated regional data on children's body mass index were collected. The socioeconomic Care Need Index (CNI), foreign background, low education, being a single parent, low income and childhood poverty, were assessed. The differences in overweight, including obesity, were tested for Sweden and for regions.ResultsData were available for 303 843 children, representing 87% of children born in 2014, 2016 and 2018. Overweight or obesity were found in 11 177 (11.4%) of children in 2022, decreasing from 2020 (13.3%, p < 0.001) but at the same level as in 2018. Regional low CNI, low level of foreign background, education and income as well as being a single parent were associated with a higher prevalence of overweight or obesity in all cohorts (p < 0.001). In regions with high levels of childhood poverty, overweight or obesity were more prevalent during (p = 0.009) and after the pandemic (p < 0.001).ConclusionThree national cohorts demonstrate that the increase in overweight during the COVID‐19 pandemic has returned to pre‐pandemic levels, but the inequalities in health associated with socioeconomic vulnerability of the regions remained.