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Murley, C., Tinghög, P., Teni, F. S., Machado, A., Alexanderson, K., Hillert, J., . . . Friberg, E. (2023). Excess costs of multiple sclerosis: a register-based study in Sweden. European Journal of Health Economics, 24, 1357-1371
Open this publication in new window or tab >>Excess costs of multiple sclerosis: a register-based study in Sweden
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2023 (English)In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 24, p. 1357-1371Article in journal (Refereed) Published
Abstract [en]

Background and objective: Population-based estimates of the socioeconomic burden of multiple sclerosis (MS) are limited, especially regarding primary healthcare. This study aimed to estimate the excess costs of people with MS that could be attributed to their MS, including primary healthcare.

Methods: An observational study was conducted of the 2806 working-aged people with MS in Stockholm, Sweden and 28,060 propensity score matched references without MS. Register-based resource use was quantified for 2018. Annual healthcare costs (primary, specialised outpatient, and inpatient healthcare visits along with prescribed drugs) and productivity losses (operationalised by sickness absence and disability pension days) were quantified using bottom-up costing. The costs of people with MS were compared with those of the references using independent t-tests with bootstrapped 95% confidence intervals (CIs) to isolate the excess costs of MS from the mean difference.

Results: The mean annual excess costs of MS for healthcare were €7381 (95% CI 6991–7816) per person with MS with disease-modifying therapies as the largest component (€4262, 95% CI 4026–4497). There was a mean annual excess cost for primary healthcare of €695 (95% CI 585–832) per person with MS, comprising 9.4% of the excess healthcare costs of MS. The mean annual excess costs of MS for productivity losses were €13,173 (95% CI 12,325–14,019) per person with MS, predominately from disability pension (79.3%).

Conclusions: The socioeconomic burden of MS in Sweden from healthcare consumption and productivity losses was quantified, updating knowledge on the cost structure of the substantial excess costs of MS.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Multiple sclerosis, Cost of illness, Real world data, Disability pension, Sick leave, Primary healthcare, Healthcare costs, Productivity losses, Medical/health economics, Propensity score matching
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:rkh:diva-4433 (URN)10.1007/s10198-022-01547-6 (DOI)000895463400103 ()36418785 (PubMedID)
Funder
Swedish Research Council, 2017-00624
Available from: 2022-12-16 Created: 2022-12-16 Last updated: 2023-11-30Bibliographically approved
van Eggermont Arwidson, C., Holmgren, J., Gottberg, K., Tinghög, P. & Eriksson, H. (2022). Living a frozen life: a qualitative study on asylum seekers’ experiences and care practices at accommodation centers in Sweden. Conflict and Health, 16(1), Article ID 47.
Open this publication in new window or tab >>Living a frozen life: a qualitative study on asylum seekers’ experiences and care practices at accommodation centers in Sweden
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2022 (English)In: Conflict and Health, ISSN 1752-1505, E-ISSN 1752-1505, Vol. 16, no 1, article id 47Article in journal (Refereed) Published
Abstract [en]

Background: Forced migrants fleeing conflict and violence face a high risk of mental health problems due to experiences before displacement, perilous journeys, and conditions in the new host societies. Asylum seekers seem to be in particularly vulnerable situations, indicated by higher prevalence rates of mental health problems compared to resettled refugees. Asylum seekers’ mental health is highly influenced by the conditions they face in host countries while awaiting a decision on their case. In Sweden, 40% of asylum seekers reside in state-provided accommodation centers during the asylum process. Collective accommodation centers for asylum seekers have been said to impose restrictive social conditions and to be associated with poorer mental health outcomes than other housing forms (e.g., self-organized housing). However, there seems to be a scarcity of qualitative studies exploring the experiences of asylum seekers in different contexts. The aim of this study was therefore to explore the experiences of asylum seekers and how they manage their mental wellbeing while living at accommodation centers in Sweden.

Methods: Fourteen semi-structured interviews with asylum seekers were conducted at two accommodation centers in Sweden. Participants were recruited using purposeful sampling and represented a diverse group of asylum seekers regarding age, background, and gender. The data was analyzed using content analysis.

Results: Three overarching categories were identified; 1) Frozen life, 2) Constant worrying and “overthinking”, and 3) Distractions and peer support. Participants experienced a state of being that could be characterized as a frozen life, which was associated with intense feelings of psychological distress, mostly described as manifesting itself in consuming patterns of ruminative thoughts, for instance overthinking and constant worrying. However, despite high levels of distress, participants demonstrated agency in managing negative mental health outcomes through self-care practices, peer support, and the development of care practices in caring for others in need.

Conclusion: This study offers new insights into the everyday challenges that asylum seekers at accommodation centers face. Furthermore, it offers valuable observations of how asylum seekers at accommodation centers cope through self-care practices, peer support, and care practices in caring for peers in need. In order to enable sustainable and empowering support, mental health and psychosocial support services must identify and address both challenges and strengths, be grounded in the lived reality of asylum seekers, and build on existing resources. Moreover, further policy work needs to be done to enable faster asylum processes.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Accommodation centers, Asylum seekers, Care practices, Mental health, Peer support, Qualitative study, Wellbeing
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-4377 (URN)10.1186/s13031-022-00480-y (DOI)36071462 (PubMedID)
Funder
Swedish Red Cross University
Available from: 2022-09-13 Created: 2022-09-13 Last updated: 2022-09-13Bibliographically approved
Murley, C., Tinghög, P., Alexanderson, K., Hillert, J., Friberg, E. & Karampampa, K. (2021). Cost-of-Illness Progression Before and After Diagnosis of Multiple Sclerosis: A Nationwide Register-Based Cohort Study in Sweden of People Newly Diagnosed with Multiple Sclerosis and a Population-Based Matched Reference Group. PharmacoEconomics (Auckland), 39, 835-851
Open this publication in new window or tab >>Cost-of-Illness Progression Before and After Diagnosis of Multiple Sclerosis: A Nationwide Register-Based Cohort Study in Sweden of People Newly Diagnosed with Multiple Sclerosis and a Population-Based Matched Reference Group
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2021 (English)In: PharmacoEconomics (Auckland), ISSN 1170-7690, E-ISSN 1179-2027, Vol. 39, p. 835-851Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Multiple sclerosis (MS) is a chronic disease associated with increased healthcare utilisation and productivity losses.

OBJECTIVE: The objective of this study was to explore the progression of healthcare costs and productivity losses before and after diagnosis of MS in comparison to that of a population-based matched reference group.

METHODS: We conducted a nationwide, Swedish register-based cohort study of working-aged people with MS diagnosed in 2010-12 (n = 1988) and population-based matched references without MS (n = 7981). Nine years of observation spanned from 4 years prior (Y-4) to 4 years (Y+4) after the year of diagnosis (Y0). Differences in annual all-cause healthcare costs (inpatient and specialised outpatient healthcare as well as pharmacy-dispensed prescribed drugs) and costs of productivity loss (days with sickness absence and disability pension) were estimated between the people with MS and references using t tests with 95% confidence intervals. The average excess costs of MS were estimated using generalised estimating equation models.

RESULTS: People with multiple sclerosis had higher costs before the diagnosis of MS and also thereafter. The mean differences in healthcare costs and productivity losses between the people with MS and matched references in Y-4 were 216 EUR (95% confidence interval 58-374) and 1540 EUR (95% confidence interval 848-2233), with larger cost excesses observed in later study years. Summarising the 9 study years, people with MS had fivefold higher excess healthcare costs than references, and more than twice as high productivity losses.

CONCLUSIONS: Excess healthcare costs and productivity losses occur already before the diagnosis of MS and increase with time. The excess costs findings before diagnosis could suggest that an earlier diagnosis might lead to reduced excess costs of MS over time.

Place, publisher, year, edition, pages
Springer, 2021
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-4009 (URN)10.1007/s40273-021-01035-4 (DOI)33970446 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2007-1762)
Note

Funding: Biogen (Grant number 4-2803/2019)

Available from: 2021-05-19 Created: 2021-05-19 Last updated: 2021-06-22Bibliographically approved
Amin, R., Mittendorfer-Rutz, E., Mehlum, L., Runeson, B., Helgesson, M., Tinghög, P., . . . Qin, P. (2021). Does country of resettlement influence the risk of suicide in refugees?: A case-control study in Sweden and Norway. Epidemiology and Psychiatric Sciences, 30, Article ID e62.
Open this publication in new window or tab >>Does country of resettlement influence the risk of suicide in refugees?: A case-control study in Sweden and Norway
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2021 (English)In: Epidemiology and Psychiatric Sciences, ISSN 2045-7960, E-ISSN 2045-7979, Vol. 30, article id e62Article in journal (Refereed) Published
Abstract [en]

Aims Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature. We aimed to investigate (1) the risk of suicide in refugees resident in Sweden and Norway, in general, and according to their sex, age, region/country of birth and duration of residence, compared with the risk of suicide in the respective majority host population; (2) if factors related to socio-demographics, labour market marginalisation (LMM) and healthcare use might explain the risk of suicide in refugees differently in host countries. Methods Using a nested case-control design, each case who died by suicide between the age of 18 and 64 years during 1998 and 2018 (17 572 and 9443 cases in Sweden and Norway, respectively) was matched with up to 20 controls from the general population, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide. Separate models were controlled for factors related to socio-demographics, previous LMM and healthcare use. Analyses were also stratified by sex and age groups, by refugees' region/country of birth and duration of residence in the host country. Results The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI 0.5-0.6) and 0.3 (95% CI 0.3-0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI 0.7-1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age except for younger refugees aged 18-24 who did not have a statistically significant relative difference in suicide risk than their respective host country peers. Factors related to socio-demographics, LMM and healthcare use had only a marginal influence on the studied associations in both countries. Conclusions Refugees in Sweden and Norway had almost similar suicide mortality advantages compared with the Swedish-born and Norwegian-born population, respectively. These findings may suggest that resiliency and culture/religion-bound attitudes towards suicidal behaviour in refugees could be more influential for their suicide risk after resettlement than other post-migration environmental and structural factors in the host country.

Place, publisher, year, edition, pages
Cambridge University Press, 2021
Keywords
Case-control studies, Country of birth, Duration of residence, Labour market marginalisation, Migration, Refugees, Suicide
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-4125 (URN)10.1017/S2045796021000512 (DOI)000721262300001 ()
Funder
Swedish Research Council, 2017-01032
Available from: 2021-10-28 Created: 2021-10-28 Last updated: 2023-10-05Bibliographically approved
Okenwa-Emegwa, L., Tinghög, P., Vaez, M. & Saboonchi, F. (2021). Exposure to Violence Among Syrian Refugee Women Preflight and During Flight: A Population-Based Cross-Sectional Study in Sweden. SAGE Open, 11(3)
Open this publication in new window or tab >>Exposure to Violence Among Syrian Refugee Women Preflight and During Flight: A Population-Based Cross-Sectional Study in Sweden
2021 (English)In: SAGE Open, E-ISSN 2158-2440, Vol. 11, no 3Article in journal (Refereed) Published
Abstract [en]

Violence against women (VAW) is a hidden aspect of humanitarian emergencies, especially during conflicts, and prevalence estimates remain scarce. An adequate response to VAW in humanitarian contexts requires information regarding the extent of the problem and associated factors, including the role of past violence. This study is a questionnaire survey of a random sample of 452 Syrian refugee women resettled in Sweden. Findings show that the prevalence of any violence preflight and during flight was 25.1% and 7.8%, respectively. Older women and women exposed to violence preflight were more likely to experience violence during flight. Findings suggest the need for more trauma-informed systems of handling asylum seekers and refugees, as a humanitarian principle. Other implications for research and practice are discussed.

Place, publisher, year, edition, pages
Sage Publications, 2021
Keywords
physical violence, resettlement, sexual violence, torture, violence against women
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-4090 (URN)10.1177/21582440211031555 (DOI)000691258600001 ()
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2017-07194
Available from: 2021-08-17 Created: 2021-08-17 Last updated: 2024-01-17Bibliographically approved
Amin, R., Rahman, S., Tinghög, P., Helgesson, M., Runeson, B., Björkenstam, E., . . . Mittendorfer-Rutz, E. (2021). Healthcare use before and after suicide attempt in refugees and Swedish-born individuals. Social Psychiatry and Psychiatric Epidemiology, 56(2), 325-338
Open this publication in new window or tab >>Healthcare use before and after suicide attempt in refugees and Swedish-born individuals
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2021 (English)In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 56, no 2, p. 325-338Article in journal (Refereed) Published
Abstract [en]

PURPOSE: There is a lack of research on whether healthcare use before and after a suicide attempt differs between refugees and the host population. We aimed to investigate if the patterns of specialised (inpatient and specialised outpatient) psychiatric and somatic healthcare use, 3 years before and after a suicide attempt, differ between refugees and the Swedish-born individuals in Sweden. Additionally, we aimed to explore if specialised healthcare use differed among refugee suicide attempters according to their sex, age, education or receipt of disability pension.

METHODS: All refugees and Swedish-born individuals, 20-64 years of age, treated for suicide attempt in specialised healthcare during 2004-2013 (n = 85,771 suicide attempters, of which 4.5% refugees) were followed 3 years before and after (Y - 3 to Y + 3) the index suicide attempt (t0) regarding their specialised healthcare use. Annual adjusted prevalence with 95% confidence intervals (CIs) of specialised healthcare use were assessed by generalized estimating equations (GEE). Additionally, in analyses among the refugees, GEE models were stratified by sex, age, educational level and disability pension.

RESULTS: Compared to Swedish-born, refugees had lower prevalence rates of psychiatric and somatic healthcare use during the observation period. During Y + 1, 25% (95% CI 23-28%) refugees and 30% (95% CI 29-30%) Swedish-born used inpatient psychiatric healthcare. Among refugees, a higher specialised healthcare use was observed in disability pension recipients than non-recipients.

CONCLUSION: Refugees used less specialised healthcare, before and after a suicide attempt, relative to the Swedish-born. Strengthened cultural competence among healthcare professionals and better health literacy among the refugees may improve healthcare access in refugees.

Place, publisher, year, edition, pages
Springer, 2021
Keywords
Attempted suicide, Cohort, Disability pension, Healthcare, Migration, Refugees
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-3428 (URN)10.1007/s00127-020-01902-z (DOI)32556379 (PubMedID)
Funder
Swedish Research Council, 2017-01032
Available from: 2020-06-23 Created: 2020-06-23 Last updated: 2021-02-10Bibliographically approved
Garoff, F., Tinghög, P., Suvisaari, J., Lilja, E. & Castaneda, A. E. (2021). Iranian and Iraqi torture survivors in Finland and Sweden: findings from two population-based studies. European Journal of Public Health, 31(3), 493-498
Open this publication in new window or tab >>Iranian and Iraqi torture survivors in Finland and Sweden: findings from two population-based studies
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2021 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, no 3, p. 493-498Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Most refugees and other forced migrants have experienced potentially traumatic events (PTEs). Torture and other traumatic experiences, as well as various daily stressors, impact the mental health and psychosocial well-being of war-affected populations.

METHODS: The study includes two population-based samples of Iranian and Iraqi men living in Finland and Sweden. The Finnish Migrant Health and Well-being Study (Maamu) was conducted in 2010-2012. The Linköping study was conducted in Sweden in 2005. In both samples, health and well-being measures, social and economic outcomes as well as health service utilization were reported.

RESULTS: The final sample for analysis consisted of two groups of males of Iranian or Iraqi origin: 278 residents in Finland and 267 residents in Sweden. Both groups were subdivided according to the reported PTEs: Torture survivors; Other PTEs; No PTEs. Migrants that reported PTEs, torture survivors in particular, had significantly poorer social and health outcomes. Torture survivors also reported lower trust and confidence in authorities and public service providers, as well as more loneliness, social isolation and experiences of discrimination.

CONCLUSIONS: Torture and other PTEs prevalent in refugee and migrant populations create a wide-ranging and long-term impact in terms of increased risk of various types of adverse social and health conditions. Early identification through systematic and effective screening should be the first step in guiding migrants and refugees suffering from experiences of torture and other PTEs to flexible, multidisciplinary services.

Place, publisher, year, edition, pages
Oxford University Press, 2021
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3993 (URN)10.1093/eurpub/ckab037 (DOI)33822940 (PubMedID)
Available from: 2021-04-13 Created: 2021-04-13 Last updated: 2021-08-23Bibliographically approved
Amin, R., Helgesson, M., Runeson, B., Tinghög, P., Mehlum, L., Qin, P., . . . Mittendorfer-Rutz, E. (2021). Suicide attempt and suicide in refugees in Sweden - a nationwide population-based cohort study. Psychological Medicine, 51(2), 254-263
Open this publication in new window or tab >>Suicide attempt and suicide in refugees in Sweden - a nationwide population-based cohort study
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2021 (English)In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 51, no 2, p. 254-263Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Despite a reported high rate of mental disorders in refugees, scientific knowledge on their risk of suicide attempt and suicide is scarce. We aimed to investigate (1) the risk of suicide attempt and suicide in refugees in Sweden, according to their country of birth, compared with Swedish-born individuals and (2) to what extent time period effects, socio-demographics, labour market marginalisation (LMM) and morbidity explain these associations.

METHODS: Three cohorts comprising the entire population of Sweden, 16-64 years at 31 December 1999, 2004 and 2009 (around 5 million each, of which 3.3-5.0% refugees), were followed for 4 years each through register linkage. Additionally, the 2004 cohort was followed for 9 years, to allow analyses by refugees' country of birth. Crude and multivariate hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. The multivariate models were adjusted for socio-demographic, LMM and morbidity factors.

RESULTS: In multivariate analyses, HRs regarding suicide attempt and suicide in refugees, compared with Swedish-born, ranged from 0.38-1.25 and 0.16-1.20 according to country of birth, respectively. Results were either non-significant or showed lower risks for refugees. Exceptions were refugees from Iran (HR 1.25; 95% CI 1.14-1.41) for suicide attempt. The risk for suicide attempt in refugees compared with the Swedish-born diminished slightly across time periods.

CONCLUSIONS: Refugees seem to be protected from suicide attempt and suicide relative to Swedish-born, which calls for more studies to disentangle underlying risk and protective factors.

Place, publisher, year, edition, pages
Cambridge University Press, 2021
Keywords
Labour market marginalisation, migration, refugees, sick leave, suicide, suicide attempt
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3123 (URN)10.1017/S0033291719003167 (DOI)000619489500010 ()31858922 (PubMedID)
Available from: 2020-01-03 Created: 2020-01-03 Last updated: 2021-11-22Bibliographically approved
Amin, R., Rahman, S., Helgesson, M., Björkenstam, E., Runeson, B., Tinghög, P., . . . Mittendorfer-Rutz, E. (2021). Trajectories of antidepressant use before and after a suicide attempt among refugees and Swedish-born individuals: a cohort study. International Journal for Equity in Health, 20(1), Article ID 131.
Open this publication in new window or tab >>Trajectories of antidepressant use before and after a suicide attempt among refugees and Swedish-born individuals: a cohort study
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2021 (English)In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 20, no 1, article id 131Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: To identify key information regarding potential treatment differences in refugees and the host population, we aimed to investigate patterns (trajectories) of antidepressant use during 3 years before and after a suicide attempt in refugees, compared with Swedish-born. Association of the identified trajectory groups with individual characteristics were also investigated.

METHODS: All 20-64-years-old refugees and Swedish-born individuals having specialised healthcare for suicide attempt during 2009-2015 (n = 62,442, 5.6% refugees) were followed 3 years before and after the index attempt. Trajectories of annual defined daily doses (DDDs) of antidepressants were analysed using group-based trajectory models. Associations between the identified trajectory groups and different covariates were estimated by chi2-tests and multinomial logistic regression.

RESULTS: Among the four identified trajectory groups, antidepressant use was constantly low (≤15 DDDs) for 64.9% of refugees. A 'low increasing' group comprised 5.9% of refugees (60-260 annual DDDs before and 510-685 DDDs after index attempt). Two other trajectory groups had constant use at medium (110-190 DDDs) and high (630-765 DDDs) levels (22.5 and 6.6% of refugees, respectively). Method of suicide attempt and any use of psychotropic drugs during the year before index attempt discriminated between refugees' trajectory groups. The patterns and composition of the trajectory groups and their association, discriminated with different covariates, were fairly similar among refugees and Swedish-born, with the exception of previous hypnotic and sedative drug use being more important in refugees.

CONCLUSIONS: Despite previous reports on refugees being undertreated regarding psychiatric healthcare, no major differences in antidepressant treatment between refugees and Swedish-born suicide attempters were found.

Place, publisher, year, edition, pages
BioMed Central, 2021
Keywords
Antidepressant, Migration, Refugees, Suicide attempt, Trajectory
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-4046 (URN)10.1186/s12939-021-01460-z (DOI)000660591900002 ()34078375 (PubMedID)
Funder
Swedish Research Council, 2017–01032
Available from: 2021-06-08 Created: 2021-06-08 Last updated: 2024-01-17Bibliographically approved
Murley, C., Tinghög, P., Karampampa, K., Hillert, J., Alexanderson, K. & Friberg, E. (2020). Patterns Of Working Life Sequences Among People Recently Diagnosed With MS In Sweden: A Nationwide Register-Based Longitudinal Cohort Study. Value in Health, 23, S637-S637
Open this publication in new window or tab >>Patterns Of Working Life Sequences Among People Recently Diagnosed With MS In Sweden: A Nationwide Register-Based Longitudinal Cohort Study
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2020 (English)In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 23, p. S637-S637Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2020
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3772 (URN)10.1016/j.jval.2020.08.1405 (DOI)000614644001311 ()
Available from: 2021-02-26 Created: 2021-02-26 Last updated: 2021-03-04Bibliographically approved
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