Kristianstad University

Contemporary creativity support tools (CSTs) primarily support divergent thinking, while often neglecting convergent thinking. Currently, research is limited concerning how these complementary aspects of creative thought could be integrated into a unified approach. This article theoretically conceptualizes the integration of artificial intelligence (AI) as a facilitator within CSTs to enhance design students' divergent and convergent thinking during ideation processes in higher education. The research employed the concept-driven design research methodology and conducted qualitative interviews with ten design students to evaluate and refine a theoretically underpinned design concept. The study identified four key themes that informed the crafting of a revised design concept: clarity and comprehension requirements, visualization of user journeys, the role of AI, and the balance between predictable and unpredictable interactions. Through iterative refinement, the research established a theoretically and empirically underpinned design concept that demonstrates how AI facilitation can support both divergent and convergent thinking while preserving student agency in creative processes. This research contributes to the theoretical grounding of AI-enhanced creativity support and provides practical insights for integrating AI facilitation in CTSs for design education.

Viral infections in the first year of life are associated with islet autoimmunity and type 1 diabetes risk. The Anti-Viral Action against Type 1 Diabetes Autoimmunity (AVAnT1A)- study is a clinical phase IV investigator initiated, randomised, controlled, multicentre, primary prevention trial conducted to determine whether vaccination against COVID-19 from 6 months of age reduces the cumulative incidence of islet autoantibodies or type 1 diabetes in children with elevated genetic risk. Additionally, it investigates the role of viral infections in the etiology of islet autoimmunity by intense surveillance within the first two years of life. Infants aged 3.00–4.00 months from Germany, Belgium, UK and Sweden are eligible if they have a >10 % expected risk to develop islet autoantibodies by age 6 years as determined by HLA DR/DQ genotype, polygenic risk score and family history of type 1 diabetes. A total of 2252 eligible children are randomized 1:1 to COVID-19 vaccine (Comirnaty® 3 μg Omicron XBB.1.5 or future new variants) or placebo (0.9 % Sodium Chloride) administered three times. Children are followed until the minimum age of 2.5 years and maximum age of 6 years. The intervention is accompanied by analyses of immune and metabolic parameters to determine changes induced by viral infections and to investigate mechanisms by which viral infection may lead to islet autoimmunity. The Sponsor is the Klinikum rechts der Isar, Technical University Munich. The study was approved by Clinical Trials Information System (CTIS, EU Trial number: 2023-507348-35-00) and by Integrated Research Application System (IRAS, IRAS-ID: 1009668).

Urine-metanephrines are used in the screening for pheochromocytomas in patients with adrenal incidentalomas, but their potential as markers for mortality in patients with adrenal adenomas has not been studied. A retrospective cohort study was designed to investigate if urine-metanephrines were associated with mortality in patients with adrenal adenomas. Participants where consecutively included between 2005 and 2015 at two endocrine centres in southern Sweden and followed until December 31st, 2022. The exposures were 24 h-urine (tU) metanephrine and normetanephrine analysed at inclusion. The endpoint was all-cause mortality. Outcome data were obtained from the Cause of Death Register. 879 adult (≥ 18 years) patients with an incidentally discovered adrenal adenoma were included in the study and followed for a median of 9.9 years. Median age of patients was 66.7 years, and 59.6% were women. 278 patients died during follow-up. tU-normetanephrine was associated with increased mortality, adjusted hazard ratio (HR) 1.47 (95% CI, 1.27–1.69) (HR for an increase of 100 μmol/mol creatinine). There was no significant association between tU-metanephrine and mortality, HR 0.96 (0.64–1.43). tU-normetanephrine seems to be a predictor for mortality in patients with adrenal adenomas. This widely available diagnostic test may be helpful in further risk-stratifying patients with adrenal adenomas.

Objectives: The PROMISE project (person-centered eHealth for treatment and rehabilitation of common mental disorders) applied a person-centered eHealth intervention as an add-on to usual care to improve the health of patients with common mental disorders (CMDs). This study aimed to evaluate the cost-utility of this intervention compared to usual care alone among patients with CMDs in Western Sweden. Methods: An open randomized controlled trial was conducted from February 2018 to June 2020 with 100 study participants in the intervention group and 106 in the control group. In the intervention group, patients received person-centered eHealth services through telephone and a web-based digital platform, in addition to the usual care, while the control group received usual care alone. Data were collected using questionnaires, extracted from national and regional databases and registers, and translated to costs using national statistics. The incremental cost-effectiveness ratio (ICER) was determined using quality-adjusted life-years (QALYs) and costs from a societal perspective. The analysis followed the intention-to-treat principle over a one-year time horizon. Results: The add-on person-centered eHealth intervention resulted in an average incremental cost per patient of SEK -20,296 and an average incremental gain in QALYs of 0.0054 compared to usual care. This resulted in an ICER value of -3,776,895, which, in sensitivity analyses, exhibited a 76.3% probability of being cost-effective. Conclusion: Add-on person-centered eHealth interventions improves upon the usual care only for patients on sick leave for CMDs. This approach has proven to be cost-effective in managing CMDs and supporting better outcomes for patients on sick leave.

Background Parkinson’s disease (PD) is a neurodegenerative disorder associated with substantial costs that escalate as the disease progresses. Previous research has explored the relationship between disease progression, motor symptoms, and the economic burden of PD. However, there is a lack of studies focusing on the relationship between costs and non-motor symptoms (NMS). Objective To examine the association between societal costs and NMS in individuals with PD in Sweden. Methods Persons with idiopathic PD in the Swedish Parkinson’s disease registry from the region of Skåne with registrations of non-motor symptoms questionnaire (NMSQ) were included. Identified subjects were linked to administrative health care data registries, to estimate annual costs. A generalized linear model was used to assess the relationship between NMS and costs. Results NMS were present in 74% (n = 703) of the study population, with a mean of 6.9 symptoms per observation. The number of NMS increased with disease duration, and costs were higher for those with a greater number of symptoms. Formal care costs were 3.8 times higher in observations with at least 10 NMS. Experiencing hallucinations and/or delusions was associated with an 80–94% increase in total costs, corresponding to an additional SEK 107,000–121,000 per patient year. Conclusions Presence of NMS in PD is associated with substantial societal costs. Findings from this study highlight the necessity for comprehensive management strategies that address both motor and non-motor symptoms to potentially alleviate the burden on patients and the healthcare system.

Background: Surgical site infection (SSI) following orthopedic surgery impacts patient outcomes. Airborne transmission is one potential route of infection. Despite their high cost and resource demands, modern ventilation systems have shown limited efficacy in reducing SSI rates. This trial investigated the effectiveness of a low-cost air purifier in reducing SSI rates after orthopedic surgery. Methods: In a nationwide, multicenter, double-blind, cluster-randomized crossover, placebo-controlled superiority trial, we included all patients undergoing orthopedic surgery during the trial period. The intervention group underwent surgery in operating rooms with active Novaerus NV800 air purifiers, while the control group underwent surgery in operating rooms with the same air purifiers that were inactive. The primary end point was SSI within 12 weeks post surgery, defined as a postsurgery infection marker (PSIM), a custom composite outcome based on registry codes for prescribed antibiotics, diagnoses, and surgical procedures. Logistic regression was performed to evaluate the primary outcome. Results: Of the 40,547 patients analyzed, 19,869 were in the intervention group and 20,678 in the control group. The PSIM rate was 9.2% in the invention group, and 9.4% in the control group, with an odds ratio of 0.98 (95% confidence interval, 0.91 to 1.05) for the intervention group. This finding remained consistent across various subgroups based on diagnoses, hospital levels, and ventilation types. Conclusions: In modern operating rooms equipped with standard, midrange airflow ventilation systems, the addition of wall-mounted plasma air purifiers did not reduce the PSIM rate after orthopedic surgery. (Funded by the Swedish Research Council; grant number, 2017-00198; ClinicalTrials.gov number, NCT02695368.).

This study explored factors influencing ChatGPT adoption among higher education students in five Nordic countries (Sweden, Finland, Denmark, Norway, and Iceland) and the USA. The unified theory of acceptance and use of technology 2 (UTAUT2) framework was employed and extended to incorporate personal innovativeness. Data was collected from 586 students recruited through Prolific and analyzed using partial least squares structural equation modeling (PLS-SEM). The findings revealed varying patterns of relationships between different factors and behavioral intention in each region. In the Nordic countries, performance expectancy, hedonic motivation, and habit demonstrated positive relationships with behavioral intention. In the USA, the results revealed positive relationships between behavioral intention and performance expectancy, social influence, habit, and personal innovativeness. Performance expectancy emerged as the strongest predictor of behavioral intention in both regions. In both the Nordic countries and the USA, habit and behavioral intention emerged as the only predictors of ChatGPT use behavior. Behavioral intention demonstrated a marginally stronger influence on use behavior in both regions. These findings offer insights for educators and policymakers regarding AI integration in academic settings by highlighting common drivers and differences in AI adoption patterns.

Background Health-promotive interventions targeting older persons are important for active and healthy ageing. Hence, physical group exercises for community-dwelling older persons are arranged by various stakeholders via meeting places within the municipalities. Increased knowledge of how group exercises via meeting places can be arranged to promote health for the older population is needed. Therefore, the aim was to explore involved stakeholders’ experiences of group exercises for older persons arranged via meeting places in municipalities in relation to health promotion. Methods Six focus group interviews were conducted online with 25 stakeholders from seven municipalities in Sweden. The stakeholders were managers of prevention units, municipal coordinators for physical activity, group exercise leaders, stakeholders from study associations, sports associations and private stakeholders, and non-profit stakeholders who arranged group exercises via the meeting places. The data was analysed using focus group methodology, where the focus of the analysis was to obtain the stakeholders’ collective understanding of the topic. Findings The analysis resulted in two main themes and seven categories. In the main theme Strategies to strengthen empowerment and exercise habits among older persons, the stakeholders highlighted strategies on an individual level. Strategies of importance to attract new participants and supporting them in maintaining their exercise habits, empowering them through social belonging, adapting to older persons through responsiveness and evaluation, facilitating participation in decision-making, and enabling older persons to lead group exercises. The other main theme, Strategies to strengthen the arrangement of group exercises over time, highlighted strategies on an organisational level concerning financial resources, supportive environments, the importance of human resources, competence development as well as collaboration. Conclusions Person-centredness emerges in health-promoting strategies both at the individual and organisational level. The study contributes to an understanding of how person-centredness is significant when working with health-promotive interventions for healthy ageing. Thus, a potential implication is to use a person-centred approach in the encounter with older persons and in the organisation when arranging group exercises for community-dwelling older persons.

Background Digital interventions for supportive care during cancer treatment incorporating electronic patient-reported outcomes (ePROs) can enhance early detection of symptoms and facilitate timely symptom management. However, economic evaluations are needed. Objective This study aims to conduct a cost-utility analysis of an app for ePRO and interactive support from the perspective of the payer (Region Stockholm Health Care Organization) and to explore its impact on patient health care utilization and costs. Methods Two open-label randomized controlled trials (RCTs) were conducted, including patients undergoing neoadjuvant chemotherapy for breast cancer (B-RCT; N=149) and radiotherapy for prostate cancer (P-RCT; N=150), recruited from oncology clinics at 2 university hospitals in Stockholm, Sweden. EORTC QLQ-C30 scores were mapped to EQ-5D-3L to calculate quality-adjusted life years (QALYs). Intervention and implementation costs and health care costs, obtained from an administrative database, were used to calculate incremental cost-effectiveness ratios (ICERs) in 3 ways: including all health care costs (ICERa), excluding nonacute health care costs (ICERb), and excluding health care costs altogether (ICERc). Nonparametric bootstrapping was used to explore ICER uncertainty. Health care costs were analyzed by classifying them as disease-related or acute. Results In both RCT intervention groups, fewer QALYs were lost compared with the control group (P<.001). In the B-RCT, the mean intervention cost was €92 (SD €2; €1=US $1.03). The mean cost for the intervention and all health care was €36,882 (SD €1032) in the intervention group and €35,427 (SD €959) in the control group (P<.001), with an ICERa of €202,368 (95% CI €152,008-€252,728). The mean cost for the intervention and acute health care was €3585 (SD €480) in the intervention group and €3235 (SD €494) in the control group (P<.001). ICERb was €49,903 (95% CI €37,049-€62,758) and ICERc was €13,213 (95% CI €11,145-€15,281); 22 out of 74 (30%) intervention group patients and 24 out of 75 (32%) of the control group patients required acute inpatient care for fever. In the P-RCT, the mean intervention cost was €43 (SD €0.2). The mean cost for the intervention and all health care was €3419 (SD €739) in the intervention group and €3537 (SD €689) in the control group (P<.001), with an ICERa of –€1,092,136 (95% CI –€3,274,774 to €1,090,502). The mean cost for the intervention and acute health care was €1219 (SD €593) in the intervention group and €802 (SD €281) in the control group (P<.001). ICERb was €745,987 (95% CI –€247,317 to €1,739,292) and ICERc was €13,118 (95% CI –68,468 to €94,704). As many as 10 out of the 75 (13%) intervention group patients had acute inpatient care, with the most common symptom being dyspnea, while 9 out of the 75 (12%) control group patients had acute inpatient care, with the most common symptom being urinary tract infection. Conclusions ePRO and interactive support via an app generated a small improvement in QALYs at a low intervention cost and may be cost-effective, depending on the costs considered. Considerable variability in patient health care costs introduced uncertainty around the estimates, preventing a robust determination of cost-effectiveness. Larger studies examining cost-effectiveness from a societal perspective are needed. The study provides valuable insights into acute health care utilization during cancer treatment. Trial Registration ClinicalTrials.gov NCT02479607; https://clinicaltrials.gov/ct2/show/NCT02479607, ClinicalTrials.gov NCT02477137; https://clinicaltrials.gov/ct2/show/NCT02477137 International Registered Report Identifier (IRRID) RR2-10.1186/s12885-017-3450-y

Purpose: Spiritual care is a multifaceted and integral part of holistic health within the medical standard of care, and it is a crucial component of healthcare providers' (HCPs) job descriptions. This study aimed to investigate Zambian HCPs' professional competence and practice of spiritual care in maternal healthcare settings, with a comparative focus on nurses. Methods: A cross-sectional design was applied among 311 maternal HCPs using an online survey with two validated instruments: Professional Competence in Spiritual Care (PCSC) and the Nurse Spiritual Care Therapeutics Scale (NSCTS). Results: Most participants were females (63.0%) and nurses or midwives (25.1% each). The mean PCSC score was 135.4 (SD = 26.5), indicating excellent competence in spiritual care. The mean NSCTS score was 24.5 (SD = 14.2), indicating that HCPs seldom provide spiritual care. No significant differences were found in PCSC scores across different HCPs (p = 0.065). However, midwives and medical practitioners scored significantly higher on NSCTS compared to nurses (p < 0.001). Conclusions: Zambian HCPs demonstrate excellent competence in spiritual care but seldom provide it. Nurses appear to provide inadequate spiritual care compared to other HCPs. These findings highlight the need for further investigation to identify barriers preventing nurses from delivering comprehensive spiritual care.

Background Several cancer types have increased PFKFB3, a glycolytic enzyme for which potent inhibitors have been found. Inhibition of PFKFB3 impairs DNA repair after irradiation of cancer cells, making it a possible radiosensitization target. The SweBCG91RT trial, in which breast cancer patients were randomized to postoperative radiotherapy or not, was used to investigate PFKFB3 as a clinical marker of sensitivity to adjuvant radiotherapy. Methods Nuclear protein levels of PFKFB3 were assessed with immunohistochemistry in primary breast tumors (n = 970) and whole-cell RNA levels with microarray gene expression (n = 765). Multivariable competing risks regression analysis was employed for the effect of radiotherapy on incidence of ipsilateral breast tumor recurrence (IBTR), depending on PFKFB3 levels. Results Tumors with high levels of nuclear protein and RNA had the largest effect on incidence of IBTR of adjuvant radiotherapy, however without evidence of an interaction. PFKFB3 RNA correlated with subtype, as high levels were more common among the human epidermal growth factor receptor 2 (HER2) positive and Luminal A subtypes than Luminal B and triple negative tumors. Conclusion High PFKFB3 is associated with a larger reduction of IBTR after radiotherapy but PFKFB3 cannot reliably be used as a predictive marker of sensitivity to adjuvant radiotherapy in breast cancer. PFKFB3 expression differed with subtype, indicating that it may be a better marker among Luminal A and HER2 positive tumors, but this is yet to be investigated. Trial registration The trial has been retrospectively registered at clinicaltrials.gov 2024-10-03 (NCT06637202).

The article discusses the development and application of the so-called “stigma engagement strategy (SES)” in interviews with stigmatized study populations, drawing on an interview study with Swedish men who have paid for sex. SES is a qualitative methodological approach that utilizes external sources of stigmatizing narratives, such as newspaper articles and columns, as textual probes within interviews with stigmatized individuals. This strategy can help researchers to 1) concretize public discourse on stigmatized behaviors, 2) bring the broader societal context into the interview setting, 3) create a degree of separation between stigmatizing societal narratives and the interaction between interviewer and interviewee, and 4) contrast different narratives (societal versus personal). As such, this strategy assists in the exploration of how individuals manage stigmatization, enabling researchers to gain a comprehensive understanding of their experiences and perspectives. The article contributes to the existing body of studies on the value of deploying material methods in interview research by elucidating how these texts facilitated the data collection and analysis.

While the notion of liminality has improved our understanding of individuals going through transition, its widespread use in a variety of organizational contexts has led to a dilution of the concept’s analytical precision. By analysing ‘liminoid’ transitions we simultaneously widen our field of vision and narrow down the precise meaning of the twin terms liminal and liminoid. Following Turner’s original understanding, ‘liminality’ focuses on a pre-planned change of an individual within a conventional organizational structure, whereas liminoid addresses individuals seeking to make changes to the structure itself from ‘outside’. Through an ethnographic study of individuals in a UK-based social venture incubator, we address the question: what practices do individuals engaged in a liminoid transition adopt? Our analysis suggests venturers deploy five practices: detaching and reorienting, exploring, structuring, compromising, and self-evaluating. We make three contributions. First, our empirical account of individuals’ practices provides a deeper insight into the specific social dynamics that unfold in a liminoid transition. Second, we contribute greater analytical precision and conceptual grounding for theorising liminoid transition processes and practices by detailing their distinguishing features from liminal transitions in terms of motivation, context, and conditions. Third, we contribute by discussing how different degrees of detachment from conventional organizational structures may impact the possibilities for social change and the personal lives of the transitioning individual.

This literature review aims to highlight the themes and the developments of public sector accounting (PSA) research over the last five decades (1970–2019), analyzing 2187 papers though a combination of bibliometric (co‐word) analysis and qualitative insights into the selected papers. The review shows that PSA scholarship has grown in significance over the last few decades giving rise to a vibrant and variegated scientific community, flourishing at the intersection among but also increasingly spanning across, different disciplines. Moreover, it reveals that traditional themes such as budgeting, performance measurement, and accountability remained at the core of the literature across most of the decades, attracting attention from multiple communities and journals. Other themes, such as accruals accounting, accounting standards, reporting, and auditing experienced varied interest over the decades and reflected the interests of more specialized, or “niche” communities of scholarship. By looking at the trends of PSA over time, the paper shows how accounting systems and calculative practices have come to reflect and affect the multiple values and the need for quantifying techniques of an ever‐evolving public sector. A call for more attention toward accounting for multiple and plural values is advanced, with suggestions for future research avenues.

Background Infant feeding tools available in the literature lack comprehensiveness and inclusiveness to infants of different ages. This study aimed to pilot test a newly developed infant feeding descriptive questionnaire. Methods This study utilized a cross-sectional design. The questionnaire developed had two main sections; the first section included questions relative to sociodemographic characteristics, birth and clinical history, and infant food history in the first year. The second section incorporated a 22-item design to stipulate a comprehensive description of infant feeding practices (IFP) and Infant Feeding Beliefs (IFB). A convenient sampling technique was used to collect data from six health centers located in Muscat and Al-Sharqia North. The infant feeding practices and beliefs variables were dichotomized to either meeting the recommendations (1) or not meeting the recommendations (0), based on the WHO guidelines. Results The data analysis encompassed a cohort of 203 participants. Most mothers aged between 26 and 35 years (58.6%). Among the mothers, 67% practiced exclusive breastfeeding in the first six months, 89.2% were breastfeeding in the first year, and 44.9% initiated infant formula feeding at six months of age or later. Moreover, 64% of the mothers introduced solid food (e.g., rice, vegetables, fruits) at six months, while (87.2%) started feeding meat, chicken, or fish at six months. For feeding egg white, fresh milk, and bee honey, 43.4%, 84.7%, and 78.4%, respectively, met the recommendation of waiting until the child ages 12 months. The mean IFP score was 8.09 (SD 1.75), while the mean IFB score was slightly higher (m = 8.90, SD = 1.45). The Pearson correlation analysis signified a positive relationship between IFP and IFB (r = 0.53, p < 0.001). Mothers who received infant feeding counseling had higher IFP scores compared to the mothers who did not. Additionally, mothers with at least a baccalaureate degree and a family income of at least 1000 OMR had better IFB recommendation scores (p < 0.05). Conclusion Data generated from the newly developed infant feeding practices and beliefs questionnaire shall assist in determining the risks associated with multiple nutrition-related morbidities in children, contributing to a comprehensive infant feeding assessment.