Swedish Medical Association

IntroductionVeterinary disciplinary boards (VDBs) evaluate complaints from animal owners regarding the healthcare of animals. It is important that these boards safeguard the quality of veterinary care, but how veterinarians are affected psychosocially is also relevant. The aim of this study was to explore perceptions, attitudes and experiences among veterinarians concerning the Swedish VDB, taking account of respondent characteristics.Materials and methodsA web-based questionnaire targeting veterinarians in current or former clinical practice was launched in 2024. There were 1,054 responses initiated and of these 819 were completed.ResultsHalf of the respondents had had complaints filed against them, but only 1 in 10 had received a sanction. Few veterinarians left clinical work because of VDB-related issues. Many veterinarians were relatively unaware about VDB processes and did not worry excessively about complaints being filed, respondents replying ‘cannot evaluate’ ranged 33–61% for these questions. However, 18% worried very much about having complaints filed. While veterinarians identified that VDB assessments increased record keeping and emphasis on communication, they generally felt that the VDB had relatively little effect on the patient outcomes for animals seen. Some animal owners who had previously submitted complaints would be denied access if veterinarians were aware of those complaints. Instituting operational oversight was considered a valuable adjunct to current regulation (43.7% ‘agreed completely’).DiscussionOverall, respondents found that the VDB performs an important task, while areas for improvement were identified, including transparency of procedures. One way to mitigate worries of complaints could be increased education and training in soft skills, including skills for communication and management of complaints.

ABSTRACT The paper explores possible similarities between falling ill after being infected by transmitted disease and the transformation that can occur after receiving a grain of something psychically foreign transmitted through human communication – whether it takes place in the primal situation of the mother/infant dyad, in the clinical situation of psychoanalytic treatment or in psychoanalytic training. The author argues that in order to gain transformative insight (learn), one must necessarily put oneself at risk, as there is no absolute way of knowing beforehand whether the incorporated aspects of the other embedded in interpretation and (enigmatic) messages also contain ‘pathogens’ and both analyst and analysand are exposed to this risk. The analogy is further used to highlight the specificity of psychoanalysis compared to other contemporary psychodynamic approaches and to make a plea for the preservation of the radicality of psychoanalysis in contemporary times.

To produce quicklime, high calcium carbonate rocks, including limestone, are burned in industrial kilns at 1100–1450 °C. As a consequence of the high temperatures, the carbonate rock can break and decrepitate into fine material, causing operational problems and material losses. In the present paper, an industrial case study on thermal decrepitation was performed on Boda Limestone from the Jutjärn quarry in Dalarna, Sweden. We analyzed 80 limestone samples for thermal decrepitation; furthermore, the correlation with chemical composition was statistically analyzed. The experiments were complemented by a detailed analysis of thermally-induced cracking at a range of temperatures (ambient, 500 °C, 800 °C, and 1150 °C) for two limestone samples with similar chemical compositions but with very different decrepitation behaviors. Decrepitation was analyzed by an in-house method, the chemical composition by XRF, and the thermally-induced cracking was investigated by SEM and image analysis. No strong correlation was found between thermal decrepitation and the chemical composition of the limestone. For the sample with low thermal decrepitation, a dense narrow network of fractures was found after full calcination; however, this network was not observed in the sample with high thermal decrepitation. A plausible explanation for the different decrepitation behaviors is that this fracture network releases internal stress and stabilizes the calcined rock. The obtained results can help in predicting limestone thermal decrepitation, enabling increased resource efficiency in quicklime production.

This paper reviews the overarching strategies, implementation rigour, achievements, strengths and weaknesses, and challenges and opportunities faced by Pakistan’s National Tuberculosis Control Program (NTP) during the period 2011-2020. NTP’s annual reports, Global Tuberculosis (TB) Report (2019 & 2020), peer-reviewed journal articles, NTP and NSP plans, along with voluminous programmatic data reviewed. Pakistan’s national and provincial tuberculosis control program has treated around four million people and gained more than 90% treatment success. Iterative planning, partnership with the private sector, strategic advocacy, communication, social mobilization, operational research, and increasing domestic funding are essential to improving case notification and treatment success. Lack of adequate political commitment, over-and under-reporting, lack of a systematic mechanism for sputum transport, and inefficient coverage from the private sector are the main areas for improvement. Local and national strategic planning in funding, program development, and implementation is imperative from a multisectoral perspective for ending TB. Ensuring universal health coverage, treating drug-resistant cases, maintaining and strengthening the national health information system, and upgrading the vital registration system is the cornerstone for ending TB.

ABSTRACT The distinguishing feature of psychoanalytic treatment, compared to other forms of treatment, is that it offers the opportunity to go through experiences and thereby develop to become a more psychologically experienced person. The aim of this paper is first of all to try to clarify, with the help of the philosophy of Hegel, Heidegger and Gadamer, what it means to ‘go through an experience’, to ‘learn from experience’ and to ‘become experienced’. Next, and on the basis of the clarification of the concept of experience, the aim is to develop an understanding of the clinical challenges psychoanalysis is facing when it tries to offer a kind of contact that will enable the patient, in the best case scenario, to go through the experiences that she/he has never before permitted her/himself to go through.

Background: The situation of mental health globally is alarming particularly in developing countries. In Somaliland/Somalia, every third person may be suffering from some sort of mental illness according to the World Health Organization. Major barriers to improve mental health include stigma and lack of skilled human resources. Objectives: The aim was to explore the feasibility of organizing integrated community-based mental, epilepsy and mother and child health services delivered by trained female community health workers (FCHWs) in three urban sites (Borama, Baki and Dila) in the Awdal Region, Somaliland. Methods: After selection of the 3 project sites and recruitment and training of project staff, a baseline survey was carried out. First, the sites were properly mapped based on existing geographical administrative sectors and sub-sectors of the sites. Then a representative sample of 2,722 households was randomly selected from all the 3 sites. The female head of each of those households were then interviewed using a questionnaire containing 22 questions on the target groups. The questionnaire responses were coded, and data analysed using Statistical software program, SPSS. After the baseline survey, the FCHWs were deployed in the sites assigning a specified area to each female worker. The FCHWs worked 6 hours per day 6 days per week and were required to visit 6 families each day including follow-ups. Their activities included identification of patients with severe mental illness (SMI) or with epilepsy, counselling, distribution of medications, follow-up of patients already on medication, referral, stigma reduction and documentation of their daily activities in logbooks. Results: The baseline study showed that 12% of the households were taking care of at least one person with SMI each, while 7% had one person with epilepsy each. Of the patients with SMI, 18% were on chains. During the project period (2015-2019), the number of people with SMI or with epilepsy who benefited from the project was 2.225 and 738 respectively and their families empowered through increased mental health awareness. Among the patients with SMI, 237 were on chains before intervention and 85% of them were successfully released from their shackles. Conclusions: This project has shown that deployment of trained and supported FCHWs can be used to reduce the mental health care gap in Somaliland. It is suggested as a model project which could, hopefully, be replicated and tested in other similar settings.

Background: The prevalence of smoking has decreased in the general population and is nowadays around 7% in Sweden. The Swedish National Airway Register (SNAR) gives a unique opportunity to study obstructive lung diseases and related factors such as smoking habits. Aim: To provide a survey of data registered in SNAR and to report the prevalence of smoking and offered smoking cessation support among patients with asthma and COPD. Methods: In 2019, registrations of new patients and follow-up visits from primary and secondary care included 3845 adolescents with asthma (aged 12-17yr), 43721 adults with asthma, and 29945 with COPD with complete data about smoking habits. Smoking cessation support was defined as offered nicotine replacement therapy or motivational interviewing. The registrations were performed manually by healthcare professionals, or directly transmitted from medical records to a web-based platform. Results: The proportion of current smokers was 1.7% among adolescents with asthma (girls 2.4% vs. boys 1.1% p=0.003), 12.3% among adults with asthma (women 12.9% vs. men 11.3%, p Conclusion: In Sweden, a substantial proportion of patients with diagnosed asthma or COPD continue to smoke, with room for improvment for smoking cessation support.

ObjectivesThe present study aimed to evaluate the iLead intervention and to investigate whether or not transfer of training can be supported by contextualising the intervention (recruiting all managers from one branch of the organisation while focusing on one implementation case, as well as training senior management).DesignA pre-evaluation–postevaluation design was applied using mixed methods with process and effect surveys and interviews to measure the effects on three levels.SettingHealthcare managers from Stockholm’s regional healthcare organisation were invited to the training.Participants52 managers participated in the iLead intervention. Group 1 consisted of 21 managers from different organisations and with different implementation cases. Group 2, representing the contextualised group, consisted of 31 managers from the same organisation, working on the same implementation case, where senior management also received training.InterventioniLead is an intervention where healthcare managers are trained in implementation leadership based on the full-range leadership model.Primary outcome measuresReactions, knowledge and implementation leadership are measured.ResultsQuantitative and qualitative analyses indicate that iLead was perceived to be of high quality and capable of increasing participants’ knowledge. Mixed effects were found regarding changes in behaviours. The contextualisation did not have a boosting effect on behaviour change. Hence, group 2 did not increase its active implementation leadership in comparison with group 1.ConclusionsiLead introduces a new approach to how implementation leadership can be trained when knowledge of effective leadership for implementations is combined with findings on the importance of environmental factors for the transfer of training. Even though managers reported general positive effects, transfer was not facilitated through the contextualisation of the intervention. There is a need to further develop approaches to help participants subsequently apply the learnt skills in their work environment.