Introduction

Self-conscious emotions, such as shame and guilt, can lead to negative health behaviors in people with chronic obstructive pulmonary disease (COPD). The aim was to investigate which factors – sociodemographic, lifestyle, burden of disease, and healthcare interventions – are associated with self-conscious emotions in people with COPD.

Methods

People with COPD answered a questionnaire with questions about self-conscious emotions, sociodemographic factors, lifestyle, disease burden, and previous healthcare interventions. The relationship between self-conscious emotions and the other variables were analyzed.

Results

A total of 136 participants (68% women, 73.5 ± 7.87 years, FEV1% 53.1 ± 19.3) were included. Emotions of shame were significantly associated with being a woman (p=0.020), reporting physical activity below recommended levels (p=0.029), being a smoker (p=0.018), more severe symptoms (p=0.035), and more exacerbations (p=0.013). Meanwhile, emotions of guilt, worry and grief were significantly associated with reporting physical activity below recommended levels (p<0.001), worse lung function (p=0.018), more symptoms (p<0.001), more breathlessness (p=0.005), more comorbidities (p=0.007), and worse subjective health (p<0.001). No significant associations were found between self-conscious emotions and previous healthcare interventions.

Conclusions

This study reveals significant differences in how people with COPD experience self-conscious emotions, with specific subgroups exhibiting distinct emotional profiles. These emotions may stem from dominant norms in society and can contribute to negative health behaviors. Healthcare professionals need to acknowledge self-conscious emotions and tailor their healthcare interventions accordingly. Because of the small sample size, the findings need to be considered with caution and more comprehensive studies about COPD-related self-conscious emotions are needed.

Given its reputation for advancing gender equality, Sweden offers a unique setting for exploring how gender shapes activism. In this chapter, I use two strategies to examine how gender is deployed and challenged by activism in Sweden. First, I provide a review of research published since the 1990s. Second, I discuss three perspectives on everyday action in studies of social movements: from everyday action to extraordinary activism, from extraordinary activism to everyday action, and everyday action within extraordinary activism. Each perspective is tied to a definition of power: as a centralized authority, as movement actors’ agency, and as decentralized in everyday interactions. Therefore, each perspective sheds light on a different way in which gender shapes activism. I illustrate each perspective with research findings on a wide range of activism in Sweden and then illustrate all three perspectives using the single case of union activism.

Given its reputation for advancing gender equality, Sweden offers a unique setting for exploring how gender shapes activism. In this chapter, I use two strategies to examine how gender is deployed and challenged by activism in Sweden. First, I provide a review of research published since the 1990s. Second, I discuss three perspectives on everyday action in studies of social movements: from everyday action to extraordinary activism, from extraordinary activism to everyday action, and everyday action within extraordinary activism. Each perspective is tied to a definition of power: as a centralized authority, as movement actors’ agency, and as decentralized in everyday interactions. Therefore, each perspective sheds light on a different way in which gender shapes activism. I illustrate each perspective with research findings on a wide range of activism in Sweden, and then illustrate all three perspectives on the single case of union activism.

Chronic obstructive pulmonary disease (COPD) represents a public health challenge and self-management support is crucial to prevent deterioration of health. The Self-Management Assessment Scale was developed to screen for prerequisites for self-management but has not been tested on people with COPD. The study aimed to evaluate the psychometric properties and internal structure of the 20-item Self-Management Assessment Scale in a Swedish COPD population. The 20-item Self-Management Assessment Scale was tested in a sample of 173 participants with a verified COPD diagnosis. Data collection was performed between September 2021 and September 2022. Assessment of content validity by an expert group, confirmatory factor analysis, and test-retest reliability were performed. The scale content validity index (S-CVI) was 0.87, and the number of missing items was low. A moderate to good goodness-of-fit of a five-factor solution was shown. The five factors, Knowledge, Goals for the future, Daily routines, Wellbeing, and Social Support, had correlations within the range of 0.59 to 0.89, with the strongest correlation between Wellbeing and Daily routines. The internal reliability was high for the instrument (0.93) and for each factor (0.73–0.85). Test-retest reliability was good, with no significant difference between scale or factor scores. Good validity and reliability were shown for the Self-Management Assessment Scale and its five key domains. The low number of missing items indicates that the instrument is easy and quick for people to complete. The Self-Management Assessment Scale is, therefore, considered a valuable tool in clinical practice.

Assessment of self-conscious emotions is important to develop tailored interventions for people with chronic obstructive pulmonary disease (COPD). Previous instruments have largely been developed for mental health populations. The Self -Conscious Emotions in COPD Questionnaire was the first instrument to assess selfconscious emotions in people with COPD, but it was only available in English. The aim was to translate the Self -Conscious Emotions in COPD Questionnaire into Swedish and to evaluate its psychometric properties and internal structure in a Swedish context. The translation process included forward and backward translation, a multidisciplinary meeting, assessment of content validity, and cognitive interviews. The translated instrument was tested in a sample of 173 people with COPD between September 2021 and September 2022. Parallel analysis (PA), exploratory factor analysis (EFA), and test -retest reliability was performed. The content validity index (CVI) for the instrument was 0.88. Based on the PA, an EFA with a two -factor solution was conducted, with a high Cronbach's alpha (0.786-0.821), and one item about self -blame was excluded. The two factors were labelled: The burden of living with a disability and The desire to hide vulnerability. Test -retest reliability showed no difference between scale scores on factor or item level, except for one item. The Swedish Self -Conscious Emotions in COPD showed good validity and reliability. One item was excluded from the two subscales, indicating that the instrument needs to be further developed to cover the concept of selfblame. The instrument is expected to be a valuable tool for assessing self-conscious emotions in people with COPD.

Time is a central dimension to the study of long-term visions and political generations in social movements. Yet, missing from both concepts is theorizing of activist groups' own agency in using time as a resource. I address this problem through two main contributions. First, drawing on the findings of a Grounded Theory study among two generations of feminist activism in Ecuador and Peru, I show how these constructed long-term visions through four stages: interrupting the course of gender hierarchies, getting policy change put into practice, making feminist practices accessible, and repoliticizing feminist activism. Second, I employ David Maines and colleagues' retrieval of G.H. Mead's theory of time to analyze how the two generations used time as a source of power differently in each stage, producing a shift regarding which generation was the driving force of the construction of long-term visions across the stages.

Background: Standardized cancer patient pathways as a new policy has been adopted in healthcare to improve the quality of cancer care. Within the health systems, actors at different levels manage the adoption of new policies to develop healthcare. The various actors on different levels play an important role and influence the policy adoption process. Thus, knowledge about how these actors use strategies when adopting cancer patient pathways as a policy in the health system becomes central.

Method: The study's aim was to explore how actors at different organizational levels in the health system adopted cancer patient pathways. Our overarching case was the Swedish health system at the national, regional, and local levels. Constructivist Grounded Theory Method was used to collect and analyze qualitative interviews with persons working in organizations directly involved in adopting cancer patient pathways at each level. Twelve individual and nine group interviews were conducted including 53 participants.

Results: Organizational actors at three different levels used distinct strategies during the adoption of cancer patient pathways: acting as-missionaries, fixers, and doers. Acting as missionaries consisted of preaching the idea of cancer patient pathways and framing it with a common purpose to agree upon. Acting as fixers entailed creating a space to put cancer patient pathways into practice and overcome challenges to this. Acting as doers comprised balancing breadth and speed in healthcare provision with not being involved in the development of cancer patient pathways for the local context. These strategies were not developed in isolation from the other organizational levels but rather, each level interacted with one another.

Conclusions: When adopting new policies, it is important to be aware of the different strategies and actors at various organizational levels in health systems. Even when actors on different levels developed separate strategies, if these contribute to fulfilling the four domains of inter-organizational collaboration, they can work well together to adopt new policies. Our study highlighted that the application of two domains was lacking, which meant that local actors were not sufficiently involved in collaboration, thus constricting the local use and optimization of cancer patient pathways in practice.

Objective: To compare the diagnostic interval for patients with colorectal cancer before and after the introduction of cancer patient pathways in northern Sweden.

Design: A retrospective study comparing two cohorts (2012 and 2018) of patients diagnosed with colorectal cancer before and after the introduction of cancer patient pathways in 2016.

Setting: Three counties in northern Sweden with large sparsely populated areas and some cities (637143 residents ∼5.1 residents/km2).

Subjects: Patients were included from the Swedish Cancer Register. Electronic health records reviews were performed and linked to socioeconomic data from Statistics Sweden.

Main outcome measures: Differences in the diagnostic intervals, the patient intervals and the characteristics associated with the longest diagnostic intervals and investigations starting at the emergency department.

Results: The two cohorts included 411 patients in 2012 and 445 patients in 2018. The median diagnostic interval was reduced from 47 days (IQI 18–99) to 29 days (IQI 9–74) (p < 0.001) after the introduction of cancer patient pathways in general. Though for the cases of cancer in the right-side (ascended) colon, the reduction of the diagnostic interval was not observed and it remained associated with investigations starting at the emergency department.

Conclusion: Our results indicate that cancer patient pathways contributed to an improvement in the diagnostic interval for patients with colorectal cancer in general, yet not for patients with cancer in the right-side colon.

Implication: In general, cancer patient pathways seem to reduce the diagnostic interval for colorectal cancer but it is not a sufficient solution for all colorectal cancer localisations.

Anchored in Mannheim's theory, the concept of political generations captures how new movement recruits respond to shifting political contexts and become agents of change within a social movement. A key challenge when using this concept in generational analyses is to link context with agency. In this article, I make this link by focusing on the interactions between political contexts and movement agency. My study among two generations of feminist activism in Ecuador and Peru found that both cohorts interacted with two sociopolitical conditions—prevailing gender relations and notions of political action—when they were initially mobilized. These interactions took different forms for each cohort, thereby shaping their distinct understandings and practices of feminist activism, and continuing to have consequences for movement goals, strategies, and relationships overtime. For the earlier generation, which became active between the late 1970s and early 1990s, consequences meant practicing militancy to achieve goals, deploying vanguardism to execute a comprehensive strategy, and exerting autonomy to manage the actions of the powerful. I theorize the interactions between movement agency and political contexts as a mesostructure, where process and structure meet, thereby providing a more comprehensive account of the mechanism of change bringing about political generations.

Existing research addresses violence in youth activism from two directions, broader societal violence or specific violence targeting political action. Nonetheless, these are explored separately according to type of activism, suggesting that this is the most relevant factor shaping violence in youth activism. This article captures other crucial factors by exploring both directions together and bringing in the concept of everyday violence. Grounded theory method and situational maps were used to collect and analyse qualitative interviews with young adult activists in three Swedish cities. Three conditions were found that crosscut youth activism to shape meanings and actions of unsafety: temporal, spatial and organizational. Across the three cities, temporal conditions produced shared experiences among young adult activists with social dimensions of unsafety, which corresponded to broader societal violence. In the third city, spatial and organizational conditions produced different experiences with political dimensions of unsafety, which corresponded to specific violence targeting political action.