Conectar
Type 1 diabetes is a chronic autoimmune disease, preceded by the presence of islet autoantibodies, a preclinical state defined as islet autoimmunity. Several environmental exposures have been associated with the initiation of islet autoimmunity but the triggers remain largely unknown. Rapid growth and weight gain during childhood are some of the exposures that have been proposed to promote islet autoimmunity. A high intake of protein and animal milks in early childhood is consistently associated with increased later obesity. Growth during early childhood is directly related to dietary intake and especially protein intake and this association has been linked to increased risk of islet autoimmunity and type 1 diabetes. The Intensive Dietary and Activity Counselling (IDAC) study aims to determine whether a healthy lifestyle counselling from age 3 months to age 2 years improves β-cell health in children with increased risk for islet autoimmunity.
The IDAC study is a randomised trial (1:1 allocation) with two parallel groups, aiming to enrol 1244 children at increased genetic risk of type 1 diabetes before the age of 4 months. Participants will be randomised to either the control or intervention group based on the child’s current breastfeeding status (currently breastfeeding or no longer breastfeeding). The intervention group will receive regular dietary and physical activity counselling. The primary outcome is β-cell health at 36 months, assessed by fasting and stimulated proinsulin-to-C-peptide ratio. Secondary outcomes include accelerated growth during infancy, overweight at 36 months, and time to development of persistent confirmed islet autoantibodies or type 1 diabetes. Growth measures, blood samples for serological markers, stool samples, dietary intake (nutrients and food group data) and questionnaire data will be collected regularly throughout the study period. Regression models will be used to estimate the effects of the intervention on the primary outcome.
The research protocol was approved by the Swedish Ethical Review Authority (dnr 2024-05217-01, 2024-08622-02, 2025-01759-02). Study findings will be presented at national and international conferences, submitted for publication in peer-reviewed journals, shared on social media and disseminated through patient-education materials.
To describe how persons with diabetes experience learning about self-care, with a particular focus on foot self-care.
Narrative, semi-structured interviews were conducted with persons diagnosed with Type 1 or Type 2 diabetes. Participants were recruited through an advertisement in a diabetes association magazine and through convenience and snowball sampling. Eleven participants aged 53–87 were interviewed between December 2024 and April 2025. Interviews were audio-recorded, transcribed verbatim and analysed using a phenomenological hermeneutic approach.
Learning about foot self-care emerged as a gradual, lived process shaped by bodily experiences, social relationships and access to support. Three themes were identified: the social landscape of self-care, the being of the feet and taking knowledge into your own hands. Learning was influenced by encounters with healthcare professionals, informal support from relatives and personal experiences over time. Bodily symptoms acted as driving forces for learning and self-care actions. Understanding why self-care mattered was essential for motivation, while seeking and evaluating knowledge became a strategy for control and participation in care.
Learning about foot self-care among persons with diabetes is an embodied, relational and ongoing process. That develops through interaction among lived bodily experiences, social support and personal responsibility rather than through information alone.
Healthcare professionals must integrate persons' experience-based knowledge and support dialogue, reflection and shared learning to strengthen foot self-care practices.
The study addressed the limited understanding of how persons with diabetes learn foot self-care. The results showed that learning is shaped by lived experience, relationships and meaning-making. The findings are relevant for persons with diabetes and healthcare professionals involved in diabetes care.
The study adhered to the COREQ criteria.
No patient or public contribution.
Research indicates various barriers to cervical cancer screening for transgender people, contributing to cancer inequities. Further research is required to better understand how these barriers affect experiences along the screening trajectory, from engaging with information, through invitation and testing, to receiving test results. Research exploring how transgender people navigate these barriers is also required.
To explore the experiences of cervical cancer screening in Sweden among transgender people who were assigned female at birth, and to identify touchpoints in need of improvement along the cervical cancer screening trajectory.
Qualitative interview study inspired by journey mapping.
Semi-structured interviews (n = 18) and interpretive description analysis.
Five phases were identified comprising participants' cervical cancer screening journey, with touchpoints in each phase indicating key experiences, barriers, and strategies to navigate barriers. Experiences of touchpoints were affected by four interrelated dimensions: The embodied person—personal gender identity, relationship with own body, and transition process; System factors—policies, routines, and practices; Gender norms and transphobia; and Prior healthcare experiences. Significant barriers included a lack of trans-specific screening information; an invitation system that does not automatically invite male-registered individuals with a cervix; lack of trans competency among clinics and staff; female-centred clinics; gender dysphoria; anticipation or fear of being mistreated; distrust of healthcare authorities; and participant-staff power dynamics.
To make cervical cancer screening more equitable for transgender people, barriers need to be addressed by considering the four dimensions that affect these barriers.
Findings show that staff involved in policy and clinical practice can improve transgender people's experiences of cervical cancer screening by promoting agency and self-determination in each screening phase. This involves providing inclusive information, continuing invitations for male-registered individuals with a cervix, enhancing trans-competency, and addressing power dynamics in staff-participant interactions.
The Standards of Reporting Qualitative Research (SRQR).
Representatives from the Regional Cancer Centre Stockholm–Gotland were involved in the conceptualisation of this study. Representatives from trans and LGBTQI+ organisations, Regional Cancer Centres, and the National Board of Health and Welfare have provided feedback during the analysis and writing phases.
At-risk mothers experience disproportionately higher rates of antenatal depression and anxiety, which can hinder mother–infant bonding and adversely affect infant socioemotional development. Despite growing evidence on postpartum mental health, antenatal risk factors among psychosocially vulnerable mothers remain underexplored, particularly in multi-ethnic Asian settings.
To identify factors associated with antenatal depression, anxiety, and maternal–fetal bonding among at-risk mothers.
This cross-sectional observational study was nested within an ongoing randomised controlled trial. Two hundred at-risk mothers, defined as single, of low socioeconomic status, referred for psychosocial support, at risk of depression, with adverse childhood experiences, or with a fetus with a congenital malformation, were recruited from outpatient obstetric clinics between February and September 2024. Participants completed online self-administered questionnaires assessing antenatal depression, anxiety, perceived stress, social support, parenting self-efficacy, and maternal–fetal bonding. General Linear Models were used to analyse data and identify factors associated with depression, anxiety, and bonding.
Higher perceived stress was associated with increased depression (β = 0.28, p < 0.001) and anxiety (β = 1.28, p < 0.001) and poorer bonding (β = 0.08, p = 0.02), while greater social support predicted lower anxiety (β = −0.31, p < 0.001). Higher parenting self-efficacy was linked to stronger bonding (β = −0.09, p = 0.06). Younger mothers (β = −2.68, p = 0.025) and Indian mothers (β = 7.46, p = 0.017) were particularly vulnerable to anxiety, whereas post-secondary education was protective against depression (β = −1.44, p = 0.02). Model fit ranged from 0.14 to 0.65.
Perceived stress, social support, and parenting self-efficacy significantly influenced antenatal mental health and bonding in at-risk mothers. These findings underscore the need for culturally sensitive, nurse/midwife-led interventions that integrate early screening, stress reduction, and empowerment strategies within routine antenatal care to strengthen maternal mental health and early bonding outcomes.
(1) Nurses and midwives play a critical role in screening for antenatal depression and anxiety in mothers with risk profiles highlighted in this study. (2) Culturally responsive nursing practice that demonstrates sensitivity towards sociocultural pressures is needed to provide individualised care. (3) Integration of digital and community-based antenatal education programs could provide more equitable access to care for at-risk mothers who may face barriers to in-person care.
(1) Despite having a higher susceptibility for antenatal mental health conditions, risk factors for antenatal depression, anxiety, and maternal–infant bonding have been underexplored in at-risk mothers. (2) Antenatal stress and anxiety are universally associated with depression across risk groups, while maternal self-efficacy and perceived social support serve as key protective factors. (3) The findings from this study suggest the need for early screening and nurse-led interventions that support maternal parenting self-efficacy and stress management to improve maternal mental health outcomes among at-risk mothers.
STROBE reporting checklist.
No patient or public contribution.
Current evidence is unclear due to methodological limitations. We bridge critical knowledge gaps by quantifying the longitudinal changes in movement behaviours and their correlates from early childhood through adolescence.
Longitudinal observational cohort study.
General healthy child and adolescent sample in Singapore.
Growing Up in Singapore Towards healthy Outcomes study participants.
We used wrist-worn accelerometry and proxy-reported data to examine movement behaviours (sleep, inactivity, light physical activity (PA; LPA) and moderate-to-vigorous PA (MVPA) and screen-viewing) at ages 5.5, 8, 10 and 12 years and the sociodemographic and maternal lifestyle-related correlates using linear regression models with generalised estimating equations.
Among 837 children, sleep, LPA and MVPA declined by 3% (from 9.1 to 8.8 hours/day), 24% (from 5.8 to 4.4 hours/day) and 44% (from 71.3 to 40.1 min/day), respectively, while inactivity and screen viewing increased by 26% (from 8.0 to 10.1 hours/day) and 155% (from 1.8 to 4.6 hours/day), respectively, from ages 5.5 to 12 years. The greatest annual increase in inactivity (0.6 hour/annum) and screen-viewing (0.8 hour/annum) and decrease in LPA (0.3 hour/annum) and MVPA (10.4 min/annum) occurred from ages 8 to 10 years. Girls of Malay ethnicity and lower socioeconomic status, and whose mothers had less favourable movement behaviours, had significantly less sleep, higher inactivity and screen-viewing and/or lower PA. Maternal PA levels and/or sitting time were associated with children’s sleep, inactivity and MVPA up to age 8 years, while maternal sitting and screen-viewing behaviours were associated with children’s screen-viewing at all ages.
Using contemporaneous datasets relevant to the present day, we confirmed that children become less physically active and have longer screen-viewing as they transition into adolescence and highlighted characteristics to be prioritised in future interventions.
Digital documentation in patients’ electronic medical records (EMRs) places new demands on perioperative nurses, increasing workload and cognitive strain, with subsequent technostress. While new EMR systems are implemented, they are not always adapted to users’ needs.
This study aimed to explore how perioperative nurses and nursing assistants describe their experiences with electronic documentation during surgery and its impact on their work environment. Additionally, it examined the emotional reactions these experiences triggered, and the adaptive strategies used to manage their effects.
A qualitative study was conducted. Data were analysed using Braun and Clarke’s thematic analysis.
Two university hospitals and one county hospital in Sweden were included.
15 women and 5 men, including 9 specialist nurses in anaesthesia care, 9 nurses in operating room (OR) care and 2 nursing assistants in OR care in Sweden participated.
Two main themes emerged: A—Introducing digital systems without a clear aim undermines work performance and B—Digital systems were embraced when automation and comfort were present. Subthemes included leadership and management, possibilities to develop and influence digital systems and EMRs not adapted to clinical needs. Automation from digital systems made work easier, and digital systems within one’s comfort zone were appreciated. However, frustration and stress arose when aforementioned preconditions were not fulfilled, leading to adjustments to manage these challenges.
Digital documentation is appreciated when fundamental conditions are met. A lack of clarity on how, what and why to document, along with insufficient training and limited ability to have an influence, triggers negative emotional reactions and unhealthy coping strategies. To enhance digital literacy, a standardised process of digital systems including digital documentation through educational efforts in which knowledge control in educational purposes is included could be tested as a potential solution.
To explore peer volunteers' experiences of delivering online support through SMART to at-risk mothers during the perinatal period, to inform future improvements to mobile-health-application (mHealth app) based peer-support interventions.
Descriptive qualitative research.
The study was conducted between February 2024 and June 2025 in a tertiary public healthcare institution in Singapore. Twenty peer volunteers were recruited via convenience and snowball sampling and participated in individual semi-structured interviews. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.
Four themes were identified: (a) Giving and receiving: the inner world of peer volunteers; (b) Navigating relational complexity in digital peer support; (c) Facilitating connection and continuity in digital peer support; and (d) Building better connections through supportive ecosystems.
Peers reported experiencing reciprocal benefits, such as a sense of fulfilment and achievement, while supporting mothers. Shared experiences and psychosocial vulnerabilities enhanced relatability, reassurance and rapport, which sustained supportive relationships. Challenges encountered by peers highlighted the need for strengthening both intervention design and peer training.
Regular check-ins by programme facilitators, alongside clear information, flexible guidelines and reassurance, can improve peer volunteers' motivation and resilience, thereby ensuring consistent and sustainable support for at-risk mothers.
Examined peer volunteers' experiences in providing online perinatal support to mothers with diverse psychosocial vulnerabilities. Peers offered emotional, informational and practical support, while mothers benefited from learning how peers had coped with their psychosocial vulnerabilities. Shared experiences fostered confidence and reassurance among mothers that they, too could overcome similar adversities. Valuable in providing both medically accurate perinatal information and meaningful social support to perinatal mothers.
The reporting of the study adheres to the standards outlined in the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
Mothers and peer volunteers contributed valuable insights and suggestions that helped in the design of the intervention.
To explore existing research regarding how nurses' unclear responsibilities influence their professional role development in hospital settings.
A scoping review was conducted according to Arksey and O'Malley.
The Population Exposure Outcome framework was used to identify eligible inclusion and exclusion criteria and search terms. The included articles have been thematically analysed in guidance by Braun and Clarke.
Twenty-six studies conducted between 2016 and 2024 were identified in CINAHL, PubMed and Scopus.
The roles of nurses were highly adaptable within hospital settings and healthcare teams, requiring nurses to assess both organisational shortcomings and colleagues' needs. These assessments depended on the nurses' competence and motivation for professional growth.
There was a clear need to strengthen organisational structures and frameworks to support the evolving role of nurses. Basic nursing education must be better at preparing nurses for their upcoming leadership role.
Increasing complexity and unclear responsibilities contribute to role ambiguity among nurses. The review highlights the importance of recognising nurses as visible and accountable leaders. There is also a need to support nurses' adaptability through improved basic education, which may have implications for both clinical practice and education.
The PRISMA Scoping Review checklist was used during the review process. The PRISMA flowchart was used to report the database searches.
This study did not include patient or public involvement in its design, conduct, or reporting.
To identify and address ethical challenges in doctoral supervision within nursing and health sciences and propose strategies to overcome them.
Following PRISMA guidelines, this mixed-method systematic review synthesises findings from quantitative, qualitative and mixed-methods studies published in English between 2014 and 2025. Studies were included if they examined ethical challenges in doctoral supervision and strategies to address them within nursing and health sciences. Exclusion criteria encompassed reviews, books, editorials, opinion papers, conference papers, studies unrelated to nursing or health sciences or published before 2014.
A systematic search was conducted in CINAHL, Education Source, ERIC, PubMed, Scopus and Web of Science Core Collection, yielding 1100 citations.
The methodological quality of included studies was assessed using the STROBE checklist for quantitative studies and the COREQ framework for qualitative studies. The findings were then synthesised and thematically organised.
Eleven studies met the inclusion criteria: four quantitative, four qualitative and three mixed methods. Ethical challenges in doctoral supervision emerged at three levels: individual (e.g., misaligned expectations, inadequate feedback, student adjustment difficulties), institutional (e.g., high student–supervisor ratios, limited support structures), and cultural (e.g., differing norms around autonomy and academic authority). Supervisors also reported role conflicts. Strategies to address these challenges included improved communication, supervision agreements, institutional support and targeted training.
Ethical challenges in supervision are shaped by individual, institutional and cultural factors. Addressing them requires multi-level strategies, including clear expectations, feedback mechanisms, structured training and culturally sensitive supervision practices. Applying ethical principles fosters a transparent and supportive academic environment that enhances doctoral outcomes.
Universities should adopt multi-level strategies, including supervisor training, mentorship structures and culturally informed policies, to strengthen the ethical integrity and effectiveness of doctoral supervision.
What problem did the study address?: This study synthesises ethical challenges in doctoral supervision within nursing and health sciences, focusing on communication barriers, institutional constraints and the transition from clinical practice to academia. What were the main Findings?: Misaligned expectations between supervisors and students, inadequate feedback and structural limitations, negatively impact the quality of supervision. Doctoral students struggle to adapt to academic expectations, while supervisors face challenges in balancing multiple roles. Effective communication, institutional support and targeted training programmes are essential for improving supervisory experience. Where and on whom will the research have an impact?: The research will inform universities and institutions offering doctoral education in nursing and health sciences. It will benefit doctoral students, supervisors and academic administrators by providing insights and strategies to enhance supervision quality and promote ethical practices.
This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
No patient or public involvement.
To examine the perinatal experiences of at-risk mothers and their engagement with mobile-health-based care.
A qualitative descriptive study.
One-to-one semi-structured interviews were conducted with 30 at-risk mothers, defined as those who were single, had low income, were at risk of depression, had adverse childhood experiences, gave birth to a baby with congenital disorders, or had a history of mental health conditions. Participants were purposively sampled at 6 months postpartum from a tertiary public hospital in Singapore between February and September 2024. Interviews continued until data saturation was achieved, were audio-recorded, transcribed verbatim and analysed using thematic analysis.
The study identified four overarching themes: (a) Me and my baby versus the world, (b) navigating vulnerability and strength in motherhood, (c) generational tensions in modern parenting and (d) reimagining perinatal care for every mother. Across the perinatal period, both intervention and control group mothers reported social isolation, emotional and physical strain and challenges balancing traditional family expectations with modern parenting practices. While mothers in the intervention group described receiving holistic support through the SMART program, those in the control group relied on ad hoc sources of support, such as social media platforms.
At-risk mothers experienced significant challenges during the perinatal period, and those who used a mobile-health-based perinatal intervention felt supported through its peer support and multimedia educational resources.
Mobile-health-based interventions can be integral aspects of standard nursing care. Future researchers must ensure that support rendered to at-risk mothers is culturally compatible and specific to the psychosocial vulnerabilities they experience. Increased contact and funding are vital, whereas artificial intelligence, multiple shared access and health monitoring trackers can shape future perinatal interventions.
A mobile-health-based perinatal intervention can have an enormous positive impact on the psychological well-being of vulnerable mothers worldwide.
This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
This study did not include patient or public involvement in its design, conduct or reporting.
ClinicalTrials.gov (Registration ID: NCT06363019). Registered 4/12/23, first recruitment on 26/02/2024.
To explore health professionals’ perspectives on the barriers and enablers of healthcare access for older adults in Cambodia.
A qualitative study based on semi-structured interviews conducted in Khmer, recorded, transcribed, translated into English and analysed using an abductive thematic analysis approach.
Phnom Penh, Cambodia.
A purposive sample of 11 health professionals serving in diverse roles and sectors participated in the study.
Three key barriers emerged: (1) institutional barriers, (2) patient-specific access barriers and (3) communication barriers. However, four key enablers were also identified: (1) supportive healthcare environment, (2) reaching out to improve access to health services, (3) peer and community engagement and (4) government direct support to access healthcare. Despite previous policy efforts, gaps in the implementation of healthcare services for older adults persist across all health facilities. Health professionals identified that improving healthcare access for older adults in Cambodia requires a multifaceted strategy involving proactive outreach, health promotion, financial assistance and stronger community and family support.
Effective policy implementation requires collaboration among stakeholders and the active involvement of older adults in programme design to enhance dignity and well-being in Cambodia’s ageing population.
The aim of this study was to analyse associations between crowded housing and children’s indoor living environment, respiratory and allergic disorders and general health.
A cross-sectional study.
Sweden, using data from the Swedish National Environmental Health Survey 2019.
The study sample included 48 512 children (aged 6–10 months, 4 years and 12 years). We also investigated associations in vulnerable subgroups, such as children with asthma and those living under unfavourable socioeconomic conditions.
Primary outcomes in the living environment were at least one sign of mould, poor indoor air quality, unpleasant odours, too warm indoors in summer and too cold indoors in winter. Primary outcomes for children’s health were asthma, airway problems, breathing difficulties, rhinitis symptoms, mould and mites allergy, pollen allergy, furred pet allergy and good general health.
About one in five children lived in an overcrowded home. Factors from the indoor living environment such as perceived poor indoor air quality and mould were significantly associated with crowded housing. Moreover, children who lived in overcrowded conditions were less likely to report good general health than children in non-crowded households (OR 0.64, 95% CI 0.54 to 0.76). This association was even stronger in children with asthma (OR 0.51, 95% CI 0.34 to 0.77). Few significant associations were, however, observed with the respiratory and allergic health outcomes.
Crowded housing is associated both with a poor indoor environment and with poorer general health in children. Children with asthma may experience even poorer general health.
To explore how frail older patients experience their stay and nursing care during boarding time at the emergency department.
A qualitative explorative interview study.
Purposive sampling was used, with a two-step selection process: (1) Patients 65 years or older spending at least 4 h at the emergency department waiting for a hospital bed, referred to as boarding time, were (2) screened for frailty using the FRail Elderly Support researcH group screening instrument. If screening identified a patient as frail, they were eligible for an interview. Individual semi-structured interviews (n = 19) were conducted during patients' boarding time at the emergency department. Data was collected between March and April 2019. The theoretical Fundamentals of Care framework shaped the interview guide. Interviews were transcribed and an inductive latent content analysis was performed.
The findings resulted in four main categories: Frail older patients felt disregarded, defenceless, and resigned during boarding time at the emergency department, yet also hopeful. The experience of hope resulted from confidence in the nurses, good nursing care, patience towards one's situation, and hope in emergency care.
The frail older patient experienced boarding time in the emergency department through an overarching theme: ‘being left in no-man's land in the emergency department but still feeling hopeful’. A trusting nurse–patient relationship, integrating the provision of fundamental care, is a favourable factor for the well-being of the frail older patient.
The study addressed the increased number of older adults with complex health needs, coupled with overcrowded emergency departments. Frail older patients perceive the boarding time as being left in a ‘no-man's-land’, addressing unclear information and lack of caregiver responsibility. This highlights the need for tailored guidelines and care practices that promote person-centred care and ensure safety for this vulnerable group in emergency settings.
Not applicable.
The use of direct oral anticoagulants (DOACs) as stroke prophylaxis in patients with non-valvular atrial fibrillation (NVAF) has increased steadily since the introduction in 2011. In Sweden today, more patients are treated with DOACs than with warfarin. However, it is not shown that an increased proportion of DOAC prescriptions correlates to lower event rates of stroke and systemic embolism.
This study aims to investigate whether the increased prescription of DOACs in Sweden correlates with lower event rates for all-cause stroke, systemic embolism and bleeding complications, using real-life data for the whole NVAF population.
Nationwide retrospective register study.
Data were obtained from the Swedish National Patient Registry, covering patients aged 18 years or older with NVAF, between 1 January 2014, and 31 December 2017. Exposure to oral anticoagulants was determined based on pharmaceutical data, calculating treatment duration by the number of pills dispensed and the prescribed daily usage rate. Baseline characteristics and endpoints were collected from hospital administrative registers using International Classification of Diseases, 10th edition (ICD-10) codes.
All patients with NVAF were identified using ICD-10 codes during the study period. Entry criteria included having a first recorded atrial fibrillation diagnosis after 1 January 2014 or being previously diagnosed with atrial fibrillation before 2014 but still receiving care after this date.
The outcomes were event rates (per 100 person-years) of ischaemic stroke, systemic embolism, all-cause stroke, major bleeding and intracranial bleeding (including haemorrhagic stroke). Event rates were calculated and compared across the study period using Cox proportional hazard models.
In the total NVAF population, the proportional decrease in event rates (per 100 treatment years) in 2017 compared with 2014 was ischaemic stroke 24% (1.70–1.30), all-cause mortality 4% (9.40–9.00), all-cause stroke 24% (2.10–1.60) and all-cause stroke and systemic embolism 23% (2.20–1.70). During the same time, the proportion of major bleeding and intracranial bleeding rates, including haemorrhagic stroke, also decreased: 5% (2.00–1.90), 6% (0.68–0.64) and 17% (0.30–0.25), respectively. DOACs use increased from 4.1% to 28.3% in the total population and from 22.7% to 60.9% in newly diagnosed patients.
In the initial years following the introduction when DOAC uptake in the population was high, an increasing proportion of Swedish NVAF patients receiving DOACs was accompanied by lower event rates of all-cause stroke and systemic embolism, ischaemic stroke and all-cause mortality, intracranial bleeding and major bleeding, highlighting the improved risk-benefit balance of DOACs in stroke prophylaxis.
FreshRSS 