Merging existing practices with new ones: the adjustment of organizational routines to using cancer patient pathways in primary healthcare

Background The introduction of new tools can bring unintended consequences for organizational routines. Cancer Patient Pathways (CPP) were introduced into the Swedish healthcare system in 2015 to shorten time to diagnosis and treatment. Primary healthcare (PHC) plays a central role since cancer diagnosis often begins in PHC units. Our study aimed to understand how PHC units adjusted organizational routines to utilizing CPPs. Method Six PHC units of varied size from both urban and rural areas in northern Sweden were included. Grounded theory method was used to collect and analyse group interviews at each unit. Nine group interviews with nurses and physicians, for a total of 41 participants, were performed between March and November 2019. The interviews focused on CPPs as tools, the PHC units’ routines and providers’ experiences with using CPPs in their daily work. Results Our analysis captured how PHC units adjusted organizational routines to utilizing CPPs by fusing existing practices with new practices to offer better quality of care. Specifically, three overarching organizational routines within the PHC units were identified. First, Manoeuvring diverse patient needs with easier patient flow, the PHC units handled the diverse needs of the population while simultaneously drawing upon CPPs to ease the patient flow within the healthcare system. Second, (Dis) integrating internal know-how, the PHC units drew upon internal competence even when PHC know-how was not taken into account by those driving the CPP initiative. Third, Coping with unequal relationships toward secondary care, the PHC units dealt with being in an unequal position while adopting CPPs instead further decreased possibilities to influence decision-making between care-levels. Conclusion Adopting CPPs as a tool within PHC units brought various unintended consequences in organizational routines. Our study from northern Sweden illustrates that the PHC know-how needs to be integrated into the healthcare system to improve the use of new tools as CPP. Further, the relationships between different levels of care should be taken in account when introducing new tools for healthcare. Also, when adopting innovations, unintended consequences need to be further explored empirically in diverse healthcare contexts internationally in order to generate deeper knowledge in the research area.

Graphite market imbalance will grow in the 2020s

Significance Price rises were underpinned by higher-than-expected steel production, requiring additional graphite for the industrial process. Prices were also supported by fresh environmental inspections of Chinese production hubs in several provinces, when plants with excessive emissions were banned from applying for a 'pollutant discharge permit' for up to three years. Impacts Given the size of its steel industry, China will continue to dominate the graphite market; it accounts for 55% of global demand. Graphite developers will benefit from investors’ interest in the battery sector. Talga’s Vittangi project in northern Sweden has been confirmed as the world's highest-grade graphite deposit. The unstable security situation in Mozambique raises questions about the near-term viability of graphite projects in the country.

Impacts of climate warming on reindeer herding require new land-use strategies

Climate in the Arctic has warmed at a more rapid pace than the global average over the past few decades leading to weather, snow, and ice situations previously unencountered. Reindeer herding is one of the primary livelihoods for Indigenous peoples throughout the Arctic. To understand how the new climate state forces societal adaptation, including new management strategies and needs for preserved, interconnected, undisturbed grazing areas, we coupled changes in temperature, precipitation, and snow depth recorded by automatic weather stations to herder observations of reindeer behaviour in grazing areas of the Laevas Sámi reindeer herding community, northern Sweden. Results show that weather and snow conditions strongly determine grazing opportunities and therefore reindeer response. We conclude that together with the cumulative effects of increased pressures from alternative land use activities, the non-predictable environmental conditions that are uniquely part of the warming climate seriously challenge future reindeer herding in northern Sweden.

Risk factors for loneliness among older people in a Nordic regional context – a longitudinal study

The aim of this study was to examine the prevalence of loneliness among older people and to identify risk factors for loneliness in a Nordic regional context over a six-year period. Longitudinal data from the Gerontological Regional Database (GERDA) study of 4,269 older adults living in northern Sweden and western Finland, aged 65, 70, 75 and 80 at baseline in 2010, were analysed. Logistic regressions were used to analyse socio-demographic, social and health-related risk factors at baseline and changes in these for experiences of loneliness at follow-up. The results showed that most older adults (85%) did not experience loneliness at baseline or at follow-up in our study region. However, 3 per cent of the sample reported loneliness in both study years, indicating enduring and chronic loneliness. Analyses revealed that being widowed and becoming a widow/er as well as poor self-rated health at baseline and the onset of depression were risk factors for loneliness. Finally, the risk of loneliness was higher in older people living in Sweden. Further work is needed to explore changes and stability in loneliness as well as to increase our understanding of between-country differences in loneliness.

Collective imaginaries of caring landscapes for rural youth: a concept mapping study in northern Sweden

Background In the current study, the approach of ‘utopia as method’ was combined with the concept ‘landscapes of care’ to explore collective imaginaries of caring landscapes in relation to young people living in rural northern Sweden, while focusing specifically on what such landscapes should ideally look like, and how various strategies could help to realise the visions. Methods The research was conducted using a modified concept mapping methodology comprising three phases of data collection and analysis. This facilitated the integration of tacit knowledge and utopian visions of young people, professionals and policymakers living and working in various parts of northern Sweden. Results The results indicated that caring landscapes should: ‘provide services responsive to young people’s wishes and needs’, ‘be organised around values of safety, equity and youth participation’, and ‘rework metro-centredness’ in order to care for, with and about rural youth. Conclusions The findings can be viewed as an imaginary reconstitution of communities in rural northern Sweden, but also as hypothetical building blocks to be used for developing caring landscapes and a ‘good countryside’ where young people have the possibility to live a good life in decent health.

Lule Lappmark and Sources

In this chapter, we describe the study area, Lule lappmark, and the sources we used. We discuss how land use was influenced by differences in environmental settings and argue that empirical material from Lule lappmark in northern Sweden can be used to draw valid conclusions about general features regarding Sami land use and property rights in other regions as well. We introduce the reader to our interpretations of some important concepts necessary to understand the development of natural resource governance and argue that some earlier interpretations of the pre-modern Sami organization have led to misconceptions about that development.

The Meaning of Critical Illness for People Suffering From COVID-19: When a Frightening Unreality Becomes Reality

The aim of this study was to elucidate the meaning of critical illness for people with COVID-19. This study used a qualitative design. Thirteen people who were critically ill with COVID-19 during 2020 and admitted to a COVID-19 intensive care unit in northern Sweden participated in the study. Data collection was conducted as individual interviews with a narrative approach, and data were analyzed with phenomenological hermeneutic interpretation. The participants did not think they would get critically ill with this unexpected illness. They experienced terrible nightmares where their relatives had been killed, and they missed their relatives both in their dreams and in reality, as they had not been allowed to be with them due to the virus. Gratefulness was described for surviving. Participants described thoughts of not being able to imagine going through this again. They felt fear and loneliness, as a terrifying unreality had become a reality.

Error Characteristics of Pan-Arctic Digital Elevation Models and Elevation Derivatives in Northern Sweden

Many biochemical processes and dynamics are strongly controlled by terrain topography, making digital elevation models (DEM) a fundamental dataset for a range of applications. This study investigates the quality of four pan-Arctic DEMs (Arctic DEM, ASTER DEM, ALOS DEM and Copernicus DEM) within the Kalix River watershed in northern Sweden, with the aim of informing users about the quality when comparing these DEMs. The quality assessment focuses on both the vertical accuracy of the DEMs and their abilities to model two fundamental elevation derivatives, including topographic wetness index (TWI) and landform classification. Our results show that the vertical accuracy is relatively high for Arctic DEM, ALOS and Copernicus and in our study area was slightly better than those reported in official validation results. Vertical errors are mainly caused by tree cover characteristics and terrain slope. On the other hand, the high vertical accuracy does not translate directly into high quality elevation derivatives, such as TWI and landform classes, as shown by the large errors in TWI and landform classification for all four candidate DEMs. Copernicus produced elevation derivatives with results most similar to those from the reference DEM, but the errors are still relatively high, with large underestimation of TWI in land cover classes with a high likelihood of being wet. Overall, the Copernicus DEM produced the most accurate elevation derivatives, followed by slightly lower accuracies from Arctic DEM and ALOS, and the least accurate being ASTER.