Breast cancer affected more than 2.3 million women in 2022 and is the most diagnosed cancer among women worldwide. The incidence rates are greater in developed regions and are significantly higher among women with higher education and socioeconomic status. Therefore, it is reasonable to assume that the way women live their lives may impact their risk of being diagnosed with breast cancer. This systematic review aimed to identify what is known about the causes and risk factors of breast cancer, excluding genetic causes. A comprehensive systematic search identified 2387 systematic reviews, 122 were included and six overall themes identified. In our “top list” with the 36 most important findings, a study of breast density had the highest effect size for increasing the risk of breast cancer, and a high sex-hormone-binding globulin level was the most protective factor. Many of the included studies investigating the same topics had conflicting results. The conclusion from this evidence synthesis reveals a lack of consensus of factors associated with the causes and risk of breast cancer. These findings suggest that recommendations about lifestyle and breast cancer should be made with caution.

The COVID-19 pandemic forced educational institutions to move online, and it is important to understand how students perceive learning in a digital learning environment. We aimed to investigate students’ perceived learning outcomes in a digital learning environment and associations between perceived learning outcomes and grades achieved. An anonymous electronic survey was used (n = 230, response rate 34%). A significant linear relationship between overall perceived learning outcome and grade achieved was found (B 0.644, 95% CI 0.52 to 0.77). Of the different learning activities, attending digital seminars were positively associated with grades (B 0.163, 95% CI 0.002 to 0.32). In particular, participating in voluntary colloquium group (B 0.144, 95% CI 0.03 to 0.26) and motivation to learn (B 0.265, 95% CI 0.13 to 0.41) predicted the students’ grades. Intrinsic motivation was positively associated with grades (B 0.285, 95% CI 0.12 to 0.45), and extrinsic motivation was negatively associated with grades (B-0.213, 95% CI-0.35 to -0.07). Nursing students’ perceived learning outcomes and grades were positively associated. Of the different learning activities, attending digital seminars predicted higher grades. Additionally, attending colloquium groups and being motivated to learn predicted higher grades, while high extrinsic motivation was associated with lower grades.

Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.

Residents in nursing homes are fragile and at high risk of serious illness or death from healthcare-associated infections. The COVID-19 pandemic posed a significant risk of suffering and mortality for residents of nursing homes. Surveillance of infections is essential for infection prevention and is missing in many countries. The aim of this study is to explore infection rates and antibiotic use in nursing homes during the COVID-19 pandemic. Data collection was conducted from February to September 2021. Each week, healthcare workers at 21 nursing home wards answered a questionnaire on infections, antibiotic use, deaths, and hospital admissions related to infections. A total of 495 infections were reported, and 97.6% were treated with antibiotics. The total infection rate was 5.37 per 1000 bed days, and there were reported 53 hospital admissions and 11 deaths related to or caused by infections. The infection rate and high use of antibiotics found in this study indicated that it is difficult to treat infections in residents in nursing homes and make it difficult to achieve the global goal of reducing infections and antibiotic resistance rates. This emphasizes the need for stricter infection control programs to reduce antibiotic use and patient suffering.

Background: Hand hygiene adherence in nursing homes is too low to prevent transmission of healthcare-associated infections, and it is difficult to achieve long-lasting increased hand hygiene adherence. There is a need for more information about healthcare workers’ knowledge, beliefs, and routines in hand hygiene practices to better understand how to improve them. Methods: Five second-year students in a bachelor’s degree in nursing conducted nine interviews of healthcare workers as part of an intervention to increase hand hygiene adherence in a nursing home ward. Results: Four major topics emerged from the analyses of the transcript data: hand hygiene is important, inadequate knowledge, barriers to infection practices, and suggestions for improvement. Discussion: The healthcare workers knew that proper hand hygiene was important for preventing the spread of infections, but they had limited knowledge of when and how to perform it. They saw that other healthcare workers did not perform hand hygiene when it was required, but few of them wanted to correct or remind ‘the others’ of what was correct. Conclusion: The healthcare workers experienced stress, and tiredness and said it was challenging to balance providing good care for residents with proper hand hygiene. Nursing home leaders should ensure staff receive proper training, regular reminders, and access to hand hygiene resources.

Residents in Norwegian nursing homes are vulnerable and fragile, and hand hygiene adherence is too low to prevent transmission of all infections. This study aimed to investigate hand hygiene in nursing homes during and after the COVID-19 pandemic, and if interventions targeting behavior change can improve adherence. Observations of hand hygiene were collected in February and March 2021 and September and October 2022, using the WHO observation tool. The observations were carried out by trained nursing students and researchers. The first observations were during the pandemic when it was strict regulations in nursing homes, and the last observations were when there were no regulations related to COVID-19. Over 12 months, from August 2021 to August 2022, three of the 22 participating nursing home wards implemented interventions to improve hand hygiene. Multimodal interventions targeting behavior change, including education, UV-light box, and posters, were implemented. This study shows that the implementation of interventions aimed at behavioral change increased hand hygiene adherence in nursing home wards. Despite hand hygiene adherence being lower, and inappropriate glove use higher than hoped for during the pandemic, we can see that attention and focus on hand hygiene during the pandemic probably had an increased effect on adherence. Attention to hand hygiene and activation of the motivation of healthcare workers is crucial, for receiving an effect of interventions. Hand hygiene adherence decreased after the pandemic when the focus on hand hygiene diminished. Behavior is likely to decline over time, and continuous reinforcement is needed to maintain a behavior change. All Authors: No reported disclosures