BackgroundThe method, Swedish Physical Activity on Prescription (SPAP), has been launched in Swedish healthcare to promote physical activity for prevention and treatment of lifestyle related health disorders. Despite scientific support for the method, and education campaigns, it is used to a limited extent by health professionals. The aim of the study was to describe the views of health professionals on perceived facilitators, barriers and requirements for successful implementation of SPAP in primary healthcare.MethodsEighteen semi-structured interviews with stakeholders in SPAP, i.e. ten people working in local or central management and eight primary healthcare professionals in two regional healthcare organisations, were analysed using qualitative content analysis.ResultsWe identified an overarching theme regarding requirements for successful implementation of SPAP: Need for knowledge and organisational support, comprising four main categories: Need for increased knowledge and affirmative attitude among health professionals; Need for clear and supportive management; Need for central supporting structures; Need for local supporting structures. Knowledge of the SPAP method content and core components was limited. Confidence in the method varied among health professionals. There was a discrepancy between the central organisation policy documents declaring that disease preventive methods were prioritised and a mandatory assignment, while the health professionals asked for increased interest, support and resources from management, primarily time and supporting structures. There were somewhat conflicting views between primary healthcare professionals and managers concerning perceived barriers and requirements. In contrast to some of the management’s beliefs, all primary healthcare professionals undisputedly acknowledged the importance of promoting physical activity, but they lacked time, written routines and in some cases competence for SPAP counselling.ConclusionThe study provides knowledge regarding requirements to facilitate the implementation of SPAP in healthcare. There was limited knowledge among health professionals regarding core components of SPAP and how to practise the method, which speaks for in-depth training in the SPAP method. The findings highlight the importance of forming policies and guidelines and establishing organisational supporting structures, and ensuring that these are well known and approved in all parts of the healthcare organisation.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3021-1) contains supplementary material, which is available to authorized users.

Sweden has had allergen-avoidance day care centers (AADCs) since 1979. The aim of this study was to measure fungal DNA by quantitative polymerase chain reaction (qPCR), a new method, in AADCs and ordinary day care centers (ODCs) and examine associations between allergen levels and building characteristics. Dust samples were collected by swabbing doorframes, vacuum-cleaning, and using Petri dishes. In total, 11 AADCs and 11 ODCs were studied (70 rooms). Total fungal DNA, measured by qPCR in the swab dust, was detected in 89%, Aspergillus or Penicillium (Asp/Pen) DNA in 34%, and Stachybotrys chartarum DNA in 6% of the rooms. Total fungal DNA was significantly higher in rooms with linoleum floor (P = 0.02), textile carpets (P = 0.03), reported dampness/molds (P = 0.02) and reported odor (P < 0.001) in the buildings, and significantly lower in wooden facade buildings (P = 0.003). Reported odor was related to the amount of sieved fine dust, reported dampness/molds and type of building construction. Total fungal DNA was related to cat, dog, horse and total allergen levels (P = 0.003) in the day care centers. In conclusion, total fungal DNA is related to reported dampness/molds, reported odor, and type of wall construction. The association between fungal and allergen contamination indicated a general 'hygiene factor' related to biological contaminants. Practical Implications The associations between fungal DNA, reported dampness/molds, and odor support the view that buildings with odor problems should be investigated for possible hidden fungal growth. There is a need to measure fungal biomass in different types of building constructions by monitoring fungal DNA. Analysis of fungal DNA with quantitative PCR can be a fast and practical way to study indoor fungal contamination. Swabbing dust from the doorframe of the main entrance to the room can be a convenient method of sampling dust for fungal DNA analysis. The high prevalence of reported dampness/molds and the common occurrence of fungal DNA indicate the need to improve the indoor environment of Swedish day care centers.

Extended NO analysis is a simple non-invasive tool that gives by far more information than F(E)NO(0.05). Based on our results, we suggest that the values for healthy subjects should be considered to fall between the following ranges: F(E)NO(0.05), 10-30 ppb; C(aw)NO, 50-250 ppb; D(aw)NO, 5-15 ml s(-1); J(aw)NO, 0.8-1.6 nl s(-1); and C(A)NO, 0-4 ppb. Values outside these intervals indicate the need for further investigation to exclude a state of disease.

BackgroundUnlike the 2014 guidelines, the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have removed lung function from the risk assessment algorithm of patients with COPD. The aim of this investigation was to analyze the proportion of subjects who would change to a lower risk group when applying GOLD2017 and determine if they exhibit different characteristics in terms of inflammation, symptoms and comorbidity compared to the subjects who would remain in a high-risk group.Subjects and methodsA total of 571 subjects with physician-diagnosed and spirometry-verified COPD were included in the present study. The data consisted of measurements of lung function, inflammatory markers, together with questionnaires that covered comorbidities, COPD symptoms and medication.ResultsFrom group C, 53% of the subjects would be reclassified to the lower risk group A, and from group D, 47% of the subjects would be reclassified to the lower risk group B when using GOLD2017 instead of GOLD2014. Compared to the subjects who would remain in group D, those who would change to group B were more often men (56% vs 72%); of an older age, mean (SD), 71 (8) years vs 68 (7) years; had more primary care contact (54% vs 33%); had lower levels of blood neutrophils, geometrical mean (95% CI), 5.3 (5.0, 5.7) vs 4.6 (4.3, 4.9); reported less anxiety/depression (20% vs 34%); experienced less asthma (29% vs 46%) and had fewer symptoms according to the COPD assessment test, 16 (5) vs 21 (7). All p-values were <0.05.ConclusionThe removal of spirometry from risk assessment in GOLD2017 would lead to the reclassification of approximately half of the subjects in the risk groups C and D to the lower risk groups A and B. There are differences in age, gender, health care contacts, inflammation, comorbidity and symptom burden among those changing from group D to group B. The effects of reclassification and changes in eventual treatment for disease control and symptom burden need further investigation.

Background: There are few studies on age and sex-specific asthma prevalence in the age range 1-6 years. The purpose of this report was to estimate age and sex specific asthma prevalence in preschool children and to analyse the influence of possible demographic and geographic determinants.