Aim To investigate how immigrants from the Balkan region experienced their current life situation after living in Sweden for 30 years or more. Materials The study was designed as a qualitative study using data from interviews with informants from five Balkan countries. The inclusion criteria were informants who were immigrants to Sweden and had lived in Sweden for more than 30 years. Five groups comprising sixteen informants were invited to participate in the study, and they all agreed. Results The analysis of the interviews resulted in three main categories: "from someone to no one", "labour market", and "discrimination". All the informants reported that having an education and life experience was worth-less, having a life but having to start over, re-educating, applying for many jobs but often not being answered, and finally getting a job for which every in-formant was educated but being humiliated every day and treated separately as well as being discriminated against. Conclusion Coming to Sweden with all their problems, having an education and work experience that was equal to zero in Sweden, studying Swedish and re-reading/repeating all their education, looking for a job and not receiving answers to applications, and finally getting a job but being treated differently and discriminated against on a daily basis was experienced by all the in-formants as terrible. Even though there are enough similar studies in Sweden, it is always good to write more to help prospective immigrants and prospective employers in Sweden.

Objectives. The purpose of this study was to determine whether fear and prejudice in relation to organ donation and the transplantation of organs may influence the decision to become an organ donor. Materials and Methods. Data were collected through four group interviews using open-ended questions and qualitative content analysis. Forty participants, 16 males and 24 females from seven countries, participated in the focus group interviews. Results. The analysis resulted in three main categories, and nine subcategories. Fears and prejudice caused by tradition and customs, approval of organ donation by family members, perception of the body as a gift from parents, the influence of religious leaders, knowledge about the religious understanding of organ donation, influence of social ambience on respondents, knowledge of the donation process in the healthcare system, including knowing about life after eventual organ donation, were some of predictors in the decision to agree to organ donation. Conclusion. More education on the factors that influence organ donation, more information in schools, health institutions and through the media, as well as more research with the aim of “dispelling” fears and prejudice about organ donation would significantly improve the current situation and result in a larger number of potential organ donors.

Introduction Inflammation can arise as a consequence of both extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) treatments. Alterations in inflammatory parameters may serve as indicators of kidney injuries and the ensuing inflammation. This study aims to investigate the effects of ESWL and URS procedures on inflammatory parameters for proximal ureteral stone treatment. Materials and methods A prospective interventional study comprised 120 patients with confirmed stones measuring less than 10 mm in the upper half of the proximal ureter. These patients were randomly assigned to either the ESWL or URS treatment groups. Laboratory analyses encompassed interleukin-6 (IL-6), leukocyte count, fibrinogen levels, and erythrocyte sedimentation rate (ESR), which were assessed prior to the intervention, on the first postoperative day, and six months later. IL-6 levels in the serum were determined using a chemiluminescence immunoassay (CLIA). Results There was no significant difference in IL-6 levels between pre-intervention and the first post-intervention day in patients treated with ESWL (1.8 (1.4-2.59) pg/mL vs. 2.33 (1.22-3.19) pg/mL). However, for patients treated with URS, the pre-intervention IL-6 value was 2.9 (1.9-3.34) pg/mL, and it increased significantly to 7.1 (3.85-28.07) pg/mL on the first post-intervention day (p<0.001). On the first post-intervention day, levels of IL-6, CRP, leukocyte count, and ESR were significantly higher in patients treated with URS compared to ESWL (p<0.001; p<0.001; p=0.03; p=0.03, respectively). Conclusion Our research findings suggest that monitoring IL-6 levels can offer valuable insights into the degree of inflammation and tissue damage during and following observed procedures, particularly among patients undergoing URS, even within the initial days post-procedure.

Background: The Lung adenocarcinoma, a subtype of non-small cell lung cancer, exhibits diverse histopathological patterns, impacting prognosis and therapeutic outcomes. Objective: This study explores the correlation between smoking habits and the prevalence of different histopathological subtypes in invasive lung adenocarcinoma (IAC). Methods: A single-center, cross-sectional study included 140 patients with surgically treated, histopathological verified lung adenocarcinoma. The patients were classified based on the World Health Organization’s (WHO) histopathological patterns, and smoking status data were collected from medical records. Descriptive and inferential statistical analyses were performed using SPSS software. Results: The predominant histopathological subtypes were acinar (47.9%) and solid (30.7%) IAC. Smokers constituted 84.3% of the patients, with a majority (61.7%) consuming more than 20 cigarettes per day. A weak, statistically significant correlation was found between histopathological patterns and smoking habits among smokers (rho=0.054; p=0.04). Acinar IAC was more common in those consuming up to 20 cigarettes daily, while the solid pattern predominated in those smoking more than 20 cigarettes (rho=0.189; p=0.04). No significant correlation was observed with the duration of smoking history. Conclusion: The study reveals a predictive relationship between smoking habits, including the number of cigarettes consumed, and the histopathological pattern of IAC in resected specimens. Acinar and solid subtypes were more prevalent, with distinct associations to smoking behaviors. Understanding these relationships can contribute to personalized treatment approaches and further research on lung adenocarcinoma.

Background: Despite the overall success of THA, between 5 and 20% report unsatisfactory results. Several factors may cause this variable outcome. 1 of them might be ethnicity which, because of its potential social impact on living conditions, may influence quality of life too. It should be studied whether patients born and being operated in their home country Bosnia and Herzegovina (BH) had similar results as immigrants being operated in Sweden (IS). Methods: Data of 280 patients were collected prospectively from questionnaires in the BH group. Patients of the IS group were eligible if both of their parents were born outside the Nordic countries, not having Swedish as their native language. Data were gained from the Swedish Arthroplasty Registry (SAR), 449 patients were included. Outcomes were pain VAS, satisfaction VAS, EQ-VAS, and the EQ-5D. Logistic and linear regression models including age, sex, diagnosis, type of fixation, surgical incision, marital status and educational level were analysed to compare those 2 groups. Results: There were considerable differences in patient demographics between the 2 groups. Before the operation, patients in the BH group reported more problems with self-care and usual activities, even after adjustment for confounding factors (p < 0.0005). Patients in the IS group reported a higher EQ-VAS and more pain VAS (p < 0.0005), the difference in the EQ-VAS was not significant after adjustment for confounding factors (p = 0.41). After 1 year patients in the BH group reported better scores in all dimensions of the EQ-5D (p ⩽ 0.005) apart from self-care. After adjustment for confounding factors, patients in the BH group were more satisfied too (p < 0.0005). Conclusions: Immigrated patients (IS group) seemed to experience less benefit from THA 1 year after the operation despite more symptoms preoperatively. There were considerable limitations affecting the results. Nevertheless, the data are a point of concern, and it is suggested to take more multidimensional care of immigrant patients.

Introduction The World Health Organization (WHO) Surgical Safety Checklist is a tool developed by the WHO to promote safer surgical practices and reduce the incidence of surgical errors and complications. This study aims to describe the role of assistant nurses in the implementation of this checklist by surgical teams. Materials and methods This descriptive study utilized a questionnaire-based survey conducted between September 2018 and March 2019 among 196 healthcare professionals at two surgical units in a university hospital in Sweden. The questionnaire covered demographic information such as age, gender, and occupation, as well as details about their workplace, experience, education/training on using the WHO checklist, the adaptation of the checklist to their department, their responsibilities in implementing and using the checklist, the frequency of use in emergency situations, and the impact on patient safety. Results The results of the study showed that assistant nurses, despite having the lowest level of education among healthcare professionals, were highly trusted and valued by other members of the surgical team. Most healthcare professionals were unsure who was responsible for using the WHO checklist but believed it was the assistant nurse's responsibility to ensure its implementation. Assistant nurses reported little to no training on using the checklist but noted that it had been adapted to the department's needs. Almost half (48.8%) of assistant nurses believed that the checklist was often used in emergency surgery, and most believed that it improved patient safety. Conclusions Improved understanding of the significance of assistant nurses in implementing the WHO Surgical Safety Checklist may enhance adherence to the checklist and potentially improve patient safety, as they were the most valued and trusted healthcare professionals in the surgical team according to the study's findings.

Background: The correlation between diabetes mellitus and acute myocardial infarction is greater every day. The mean platelet volume (MPV), which is the determinant of platelet function, is an independent risk factor for the cardiovascular disease. The aim of the study was to investigate the effect of each disease (hypothyroidism, hypertension, myocardial infarction) individually and combined on MPV in diabetic patients.Methods: The cross-sectional study included 102 patients who suffer from diabetes mellitus type 2 (DMT2), of both sexes (46 females, 56 males), with the average age of 58.91 (SD=12.93). All the patients were treated at the Primary Health Centre in Zenica from May to July 2017. All patients had diabetes mellitus and the disease had lasted for 10 years in both sexes.Results: Mean platelet volume was significantly higher in patients with myocardial infarction than in those without myocardial infarction. Age, sex, HbA1c, BMI, lipids and platelet count did not show any significance in either group of patients. Regression analysis showed that the prevalence of myocardial infarction had the highest predictive significance for MPV values, (predictor importance 0.49; coefficient 1.275, p<0.001).Conclusions: Mean platelet volume was significantly higher in patients with diabetes mellitus and myocardial infarction than in DM patients without myocardial infarction. Regression analysis showed correlation with acute myocardial infarction in patients with DMT2, but not with other chronic illnesses. The highest platelet volume indices were observed in patients with myocardial infarction. MPV can be used as a specific indicator in diabetic patients with myocardial infarction.   

Objectives. The present study aimed to assess changes in the perception of and willingness to participate in organ donation (OD) among immigrants from Bosnia and Herzegovina living in Sweden from the perspective of gender differences. Materials and Methods. A cross-sectional study with 60 participants born in Bosnia and Herzegovina and living in Sweden was performed. Data were collected using a self-administrative questionnaire, providing demographic characteristics, information about opinions, awareness, and knowledge on the donation process and religious approach to the subject, willingness to donate/receive organs, and possession of a donor card. Results. Our results showed significant differences between genders regarding the definition of transplantation (P<0.0001), information about OD (P<0.0001), knowledge (P<0.0001) and importance of OD (P<0.003), religious permitting (P=0.0001), and religious opposing (P=0.0007) to OD. Furthermore, a significant difference was observed regarding the preferred recipient (P=0.0062) and the possession of the donor card (P<0.0001). Regression analysis showed that female gender and higher income were statistically significant in prediction of positive attitudes toward OD (P=0.0027, P=0.0002, respectively). Conclusion. Change of social background and integration into Swedish society undoubtedly led to change in the attitudes toward OD, regardless of the perspective of gender differences. However, women were found to have more positive attitudes toward OD.

Introduction: In Sweden, during specialty training, the nurse anesthetist learns how to ensure patient safety in a health-care setting by implementing the surgical checklist measures during perioperative care. To date, there are still considerable shortcomings when it comes to implementing these patient safety measures in Swedish hospitals. Aim: The purpose of this study is to describe the use of the WHO surgical safety checklist (WHOSSC) by surgical teams, with special emphasis on nurse anesthetists to increase patient safety. Materials and Methods: This descriptive questionnaire-based study was performed between September 2018 and March 2019 and included 196 health-care professionals who completed the questionnaire. The survey was carried out among all the health-care professionals at two surgical units at a university hospital during the data collection period. Results: The results reveal that the majority of health-care staff in this study agree with the need to implement the WHOSSC during surgery and the necessity of doing so to ensure patient safety. However, it is not clear whether this checklist needs to be made a matter of routine at the clinics and whether this is possible in emergency situations. Conclusion: The nurse anesthetists, as members of the surgical team, use the list all the time in emergency situations and conclude, like other members of the team, that the list improves patient safety. Clearer procedures are needed during surgery regarding the usage of the checklist in practice, and there should be a designated person in the surgical team responsible for implementing the checklist.

Background: Despite the overall success of THA, betwen 5-20% report unsatisfactory results. Several factors may cause this variable outcome. One of them is ethnicity, which because of its potential social impact on living conditions may influence life quality. We investigated whether patients born and operated in their home country Bosnia and Herzegovina, report the same results as do patients living in Sweden, born in Europe outside the Nordic countries.Methods: Data were prospectively collected from 280 patients planned to be operated with a THA in Bosnia and Herzegovina, and 449 immigrants born in Europe but outside the Nordic countries. Logistic and linear regression models including age, sex, diagnosis, type of fixation, surgical incision, marital status, and education level were analyzed. Outcomes were the 5 dimensions in EQ-5D, EQ-VAS, pain, VAS, and satisfaction VAS. Data collected before the operation and 1 year after were studied. Results: Before the operation patients born and living in Bosnia and Herzegovina reported more problems with self-care and usual activities before and after adjustment for confounding. Patients living in Sweden reported higher EQ-VAS and more pain on VAS than did those born in Bosnia and Herzegovina, but the difference in EQ-VAS became statistically insignificant after adjustment for confounding. A higher share of patients living in Bosnia and Herzegovina reported more benefit 1 year after the operation in all dimension except from self-care as reflected in the basic chi-square test and the unadjusted and adjusted regression analyses. After adjustment for confounding this group of patients was also more satisfied, but there was no statistically significant difference in pain VAS and EQ-VAS when compared to the immigrant group living in Sweden. Conclusion: Our findings that immigrant patients operated in Sweden despite a tendency to more symptoms before the operation have less benefit from a THA according to EQ5D 1 year after the operation cause concern. We do not know to what extent this situation can be improved by a more multidimensional caretaking of immigrant patients. Probably other factors not only involving the healthcare system play a role as do probably also methodological problems related to these types of studies.

Background For many patients with end-stage disease, organ transplant often provides the only chance for survival. Organ donation (OD) is affected by legislation, cultural and ethnic background, and knowledge and attitudes play a crucial role in promoting that concept. The present study aimed to assess differences in education level, perception, and willingness towards OD among Bosnian immigrants living in Sweden and respondents living in Bosnia and Herzegovina. Study design We performed a quantitative cross-sectional study using a self-administered questionnaire among 204 participants. Methods The questionnaire provided demographic characteristics, information about opinions, awareness, and knowledge on the donation process and religious approach to the subject, willingness to donate/receive organs, and possession of a donor card. Results All respondents supported OD, regardless of their education level. Only 2% of university-educated individuals from Bosnia and Herzegovina claimed to be donor card owners (p<0.001). Most of the university-educated respondents in Sweden, compared to Bosnia and Herzegovina, agreed that OD is needed and should be promoted (73.8% vs. 46.9%, p=0.007), opposite to the non-university-educated (51.4% vs. 66.0%, p=0.024). University-educated respondents stated that the donor card was informative enough (p=0.014) and considered self-perceived knowledge about OD to be sufficient or excellent (p<0.001). Most respondents were married and employed, practicing Muslims. Most of non-university-educated respondents from both countries believe their religion does not oppose OD (p=0.032). However, university-educated individuals strongly believe that OD does not have to be within the same religious group (p=0.016), while other participants did not have a definitive opinion. Conclusions Public behavior towards OD is affected by the social environment and the educational level. The study highlights the importance of achieving a suitable social climate for donation. Also, it suggests that more efforts are needed to harvest the benefits of the substantial support for OD among the Bosnian population.

Background Despite ACL re-ruptures being common, research on patient experiences after knee trauma has primarily focused on the time after primary ACL reconstruction. Integrating qualitative research and patient experiences can facilitate researchers and clinicians in understanding the burden of an ACL re-rupture. The aim of the study was to explore the experiences of an ACL re-rupture journey in young active females aiming to return to knee-strenuous sports after primary ACL reconstruction. Method A two-stage partially mixed sequential dominant status design was used. Fifteen young (19.1[range 16-23] years old) female who suffered an ACL re-rupture were interviewed. Qualitative content analysis using deductive approach based on Wiese-Bjornstal’s ‘integrated model of psychological response to injury’ was used. Results The results are presented in two timelines 1) from first ACL injury to ACL re-rupture, and 2) from ACL re-rupture to present day, and further stratified according to the domains of the ‘integrated model of psychological response to injury’. Results in the first timeline are summarised into seven categories: Finding hope for the journey; Accepting my ACL injury; I succeeded; What matters now? Who am I?; Where will this end? What is going to happen? In the second timeline, eight categories were identified: Fighting spirit; A helping hand; Working hard; I am a new me; I am destroyed; Loneliness; Painful changes; and, I could have made it to the pro´s. Conclusion Young females who suffered an ACL re-rupture did not express any positive experience following their first ACL injury, however, in contrast, expressed positive experiences and personal growth after going through the ACL re-rupture journey, characterized by a lot of struggling, and ultimately lead to the experience of becoming a new, stronger person.