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Kavaliunas, A., Tinghög, P., Friberg, E., Olsson, T., Alexanderson, K., Hillert, J. & Karrenbauer, V. D. (2019). Cognitive function predicts work disability among multiple sclerosis patients. Multiple sclerosis journal - experimental, translational and clinical, 5(1), Article ID 2055217318822134.
Open this publication in new window or tab >>Cognitive function predicts work disability among multiple sclerosis patients
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2019 (English)In: Multiple sclerosis journal - experimental, translational and clinical, ISSN 2055-2173, Vol. 5, no 1, article id 2055217318822134Article in journal (Refereed) Published
Abstract [en]

Background: In multiple sclerosis various aspects of cognitive function can be detrimentally affected. More than that, patients´ employment and social functioning is likely to be impacted.

Objective: To determine whether work disability among multiple sclerosis patients could be predicted by the symbol digit modalities test.

Methods: A register-based cohort study was conducted. Individual data on work disability, operationalised as annual net days of sickness absence and/or disability pension were retrieved at baseline, when the symbol digit modalities test was performed, after one-year and 3-year follow-up for 903 multiple sclerosis patients. The incidence rate ratios for work disability were calculated with general estimating equations using a negative binomial distribution and were adjusted for gender, age, educational level, family composition, type of living area and physical disability.

Results: After one year of follow-up, the patients in the lowest symbol digit modalities test quartile were estimated to have a 73% higher rate of work disability when compared to the patients in the highest symbol digit modalities test quartile (incidence rate ratio 1.73, 95% confidence interval 1.42‒2.10). This estimate after 3-year follow-up was similar (incidence rate ratio 1.68, 95% confidence interval 1.40‒2.02).

Conclusion: Cognitive function is to a high extent associated with multiple sclerosis patients' future work disability, even after adjusting for other factors.

Keywords
Multiple sclerosis, cognition, employment, prognosis, socioeconomic factors, work
National Category
General Practice
Identifiers
urn:nbn:se:rkh:diva-2750 (URN)10.1177/2055217318822134 (DOI)30729025 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2019-02-25 Created: 2019-02-25 Last updated: 2019-02-27Bibliographically approved
Gyllensten, H., Kavaliunas, A., Murley, C., Alexanderson, K., Hillert, J., Tinghög, P. & Friberg, E. (2019). Costs of illness progression for different multiple sclerosis phenotypes: a population-based study in Sweden. Multiple Sclerosis Journal Experimental, Translational and Clinical, 5(2), Article ID 2055217319858383.
Open this publication in new window or tab >>Costs of illness progression for different multiple sclerosis phenotypes: a population-based study in Sweden
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2019 (English)In: Multiple Sclerosis Journal Experimental, Translational and Clinical, ISSN 2055-2173, Vol. 5, no 2, article id 2055217319858383Article in journal (Refereed) Published
Abstract [en]

Background

Population-based estimates of costs of illness and health-related quality of life, by disability levels among people with multiple sclerosis, are lacking.

Objectives

To estimate the annual costs of illness and health-related quality of life, by disability levels, among multiple sclerosis patients, 21–64 years of age.

Methods

Microdata from Swedish nationwide registers were linked to estimate the prevalence-based costs of illness in 2013, including direct costs (prescription drug use and specialised healthcare) and indirect costs (calculated using sick leave and disability pension), and health-related quality of life (estimated from the EQ-5D). Disability level was measured by the Expanded Disability Status Scale (EDSS).

Results

Among 8906 multiple sclerosis patients, EDSS 0.0–3.5 and 7.0–9.5 were associated with mean indirect costs of SEK 117,609 and 461,357, respectively, whereas direct costs were similar between the categories (SEK 117,423 and 102,714, respectively). Prescription drug costs represented 40% of the costs of illness among multiple sclerosis patients with low EDSS, while among patients with high EDSS more than 80% were indirect costs. Among the 1684 individuals who had reported both EQ-5D and EDSS, the lowest health-related quality of life scores were found among those with a high EDSS.

Conclusion

Among people with multiple sclerosis, we confirmed higher costs and lower health-related quality of life in higher disability levels, in particular high indirect costs.

Keywords
Multiple sclerosis, cost of illness, healthcare costs, registries, sick leave, health-related quality of life, disability evaluation, disease progression
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3013 (URN)10.1177/2055217319858383 (DOI)31285832 (PubMedID)
Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-08-12Bibliographically approved
Wiberg, M., Murley, C., Tinghög, P., Alexanderson, K., Palmer, E., Hillert, J., . . . Friberg, E. (2019). Earnings among people with multiple sclerosis compared to references, in total and by educational level and type of occupation: a population-based cohort study at different points in time.. BMJ Open, 9(7), Article ID e024836.
Open this publication in new window or tab >>Earnings among people with multiple sclerosis compared to references, in total and by educational level and type of occupation: a population-based cohort study at different points in time.
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e024836Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To investigate earnings among people with multiple sclerosis (PwMS) before and after MS diagnosis compared with people without MS, and if identified differences were associated with educational levels and types of occupations. Furthermore, to assess the proportions on sickness absence (SA) and disability pension (DP) in both groups.

DESIGN: Population-based longitudinal cohort study, 10 years before until 5 years after MS diagnosis.

SETTING: Working-age population using microdata linked from nationwide Swedish registers.

PARTICIPANTS: Residents in Sweden in 2004 aged 30-54 years with MS diagnosed in 2003-2006 (n=2553), and references without MS (n=7584) randomly selected by stratified matching.

OUTCOME MEASURES: Quartiles of earnings were calculated for each study year prior to and following the MS diagnosis. Mean earnings, by educational level and type of occupation, before and after diagnosis were compared using t-tests. Tobit regressions investigated the associations of earnings with individual characteristics. The proportions on SA and/or DP, by educational level and type of occupation, for the diagnosis year and 5 years later were compared.

RESULTS: Differences in earnings between PwMS and references were observed beginning 1 year before diagnosis, and increased thereafter. PwMS had lower mean earnings for the diagnosis year (difference=SEK 28 000, p<0.05), and 5 years after diagnosis, this difference had more than doubled (p<0.05). These differences remained after including educational level and type of occupation. Overall, the earnings of PwMS with university education and/or more qualified occupations were most like their reference peers. The proportions on SA and DP were higher among PwMS than the references.

CONCLUSIONS: The results suggest that the PwMS' earnings are lower than the references' beginning shortly before MS diagnosis, with this gap increasing thereafter. Besides SA and DP, the results indicate that educational level and type of occupation are influential determinants of the large heterogeneity of PwMS' earnings.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
disability pension, earnings, multiple sclerosis, sick leave, social insurance, work
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:rkh:diva-3003 (URN)10.1136/bmjopen-2018-024836 (DOI)31300492 (PubMedID)
Available from: 2019-08-06 Created: 2019-08-06 Last updated: 2019-08-06Bibliographically approved
Gyllensten, H., Kavaliunas, A., Alexanderson, K., Hillert, J., Tinghög, P. & Friberg, E. (2018). Costs and quality of life by disability among people with multiple sclerosis: a register-based study in Sweden. Multiple sclerosis journal - experimental, translational and clinical, 4(3), Article ID 2055217318783352.
Open this publication in new window or tab >>Costs and quality of life by disability among people with multiple sclerosis: a register-based study in Sweden
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2018 (English)In: Multiple sclerosis journal - experimental, translational and clinical, E-ISSN 2055-2173, Vol. 4, no 3, article id 2055217318783352Article in journal (Refereed) Published
Abstract [en]

Background: Population-based estimates of costs of illness and health-related quality of life, by disability levels among people with multiple sclerosis, are lacking.

Objectives: To estimate the annual costs of illness and health-related quality of life, by disability levels, among multiple sclerosis patients, 21-64 years of age.

Methods: Microdata from Swedish nationwide registers were linked to estimate the prevalence-based costs of illness in 2013, including direct costs (prescription drug use and specialised healthcare) and indirect costs (calculated using sick leave and disability pension), and health-related quality of life (estimated from the EQ-5D). Disability level was measured by the Expanded Disability Status Scale (EDSS).

Results: Among 8906 multiple sclerosis patients, EDSS 0.0-3.5 and 7.0-9.5 were associated with mean indirect costs of SEK 117,609 and 461,357, respectively, whereas direct costs were similar between the categories (SEK 117,423 and 102,714, respectively). Prescription drug costs represented 40% of the costs of illness among multiple sclerosis patients with low EDSS, while among patients with high EDSS more than 80% were indirect costs. Among the 1684 individuals who had reported both EQ-5D and EDSS, the lowest health-related quality of life scores were found among those with a high EDSS.

Conclusion: Among people with multiple sclerosis, we confirmed higher costs and lower health-related quality of life in higher disability levels, in particular high indirect costs.

Keywords
Multiple sclerosis, cost of illness, disability evaluation, disease progression, health-related quality of life, healthcare costs, registries, sick leave
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2611 (URN)10.1177/2055217318783352 (DOI)30090640 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2007-1762
Available from: 2018-08-30 Created: 2018-08-30 Last updated: 2018-09-03Bibliographically approved
Gyllensten, H., Wiberg, M., Alexanderson, K., Norlund, A., Friberg, E., Hillert, J., . . . Tinghög, P. (2018). Costs of illness of multiple sclerosis in Sweden: a population-based register study of people of working age. European Journal of Health Economics, 19(3), 435-446
Open this publication in new window or tab >>Costs of illness of multiple sclerosis in Sweden: a population-based register study of people of working age
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2018 (English)In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 19, no 3, p. 435-446Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Multiple sclerosis (MS) causes work disability and healthcare resource use, but little is known about the distribution of the associated costs to society.

OBJECTIVES: We estimated the cost of illness (COI) of working-aged individuals with MS, from the societal perspective, overall and in different groups.

METHODS: A population-based study was conducted, using data linked from several nationwide registers, on 14,077 individuals with MS, aged 20-64 years and living in Sweden. Prevalence-based direct and indirect costs in 2010 were calculated, including costs for prescription drug use, specialized healthcare, sick leave, and disability pension.

RESULTS: The estimated COI of all the MS patients were SEK 3950 million, of which 75% were indirect costs. MS was the main diagnosis for resource use, causing 38% of healthcare costs and 67% of indirect costs. The distribution of costs was skewed, in which less than 25% of the patients accounted for half the total COI.

CONCLUSIONS: Indirect costs contributed to approximately 75% of the estimated overall COI of MS patients of working age in Sweden. MS was the main diagnosis for more than half of the estimated COI in this patient group. Further studies are needed to gain knowledge on development of costs over time during the MS disease course.

Keywords
Cost of Illness, Multiple sclerosis, Registries, Sick leave, Socioeconomic factors, Third-party payers
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2514 (URN)10.1007/s10198-017-0894-6 (DOI)28488184 (PubMedID)
Available from: 2017-12-15 Created: 2017-12-15 Last updated: 2018-08-30Bibliographically approved
Okenwa-Emegwa, L., Saboonchi, F. & Tinghög, P. (2018). Prevalence and predictors of violence among Syrian refugee women resettled in Sweden. Paper presented at 11th European Public Health Conference Winds of change: towards new ways of improving public health in Europe Ljubljana, Slovenia 28 November–1 December 2018. European Journal of Public Health, 28(Suppl. 4), 156
Open this publication in new window or tab >>Prevalence and predictors of violence among Syrian refugee women resettled in Sweden
2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Suppl. 4, p. 156-Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background Refugee women are at more risk of a continuum of violence, pre, during and post flight. After resettlement, increased family conflicts are likely, due to shifts in gender roles and changing family structures. Prevalence estimates, however, remain scarce especially for Syrian refugee women in Europe. Given that exposure to violence is a substantial risk factor for ill health and poor adaptation, this study aims to estimate the prevalence of violence in different phases of flight and associated sociodemographic factors. Methods The study is based on a random sample of 452 Syrian refugee women resettled in Sweden. Exposure to violence was operationalised as having been a victim of torture, physical or sexual violence, pre and during flight; witnessing violence was operationalised as experiencing war at close quarters, witnessing physical violence, or forced separation from loved ones, pre and during flight; family conflicts was operationalised as experiencing distressing conflicts in the family since resettlement. Descriptive analysis were conducted to estimate prevalence and logistic regression to assess associations. Weighted data produced socio-demographically representative estimates. Robust standard errors were used to obtain 95% confidence intervals for all estimates. Results About 25.1% (95% 20.9 – 29.4) of the women were exposed to violence preflight, 7.8% (95% 5.2 – 10.4) were victims during flight. Up to 93.3% (95% 90.7 – 95.9) witnessed violence preflight, 67.2% (95% 62.6 – 71.8) during flight. About 34.2% (95% 29.7 – 38.7) are experiencing distressing family conflicts.Logistic regressions showed no significant difference after controlling for age, education and marital status. Conclusions The magnitude of violence and ongoing family conflicts calls for a closer look at the plight of refugee women.Violence is widespread and not specific to any sociodemographic group, an important finding for healthcare and public health workforce to take note of. 

National Category
Health Sciences
Identifiers
urn:nbn:se:rkh:diva-2734 (URN)10.1093/eurpub/cky213.457 (DOI)
Conference
11th European Public Health Conference Winds of change: towards new ways of improving public health in Europe Ljubljana, Slovenia 28 November–1 December 2018
Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2019-04-09Bibliographically approved
Bränström, R., Hatzenbuehler, M. L., Tinghög, P. & Pachankis, J. E. (2018). Sexual orientation differences in outpatient psychiatric treatment and antidepressant usage: evidence from a population-based study of siblings. European Journal of Epidemiology, 33(6), 591-599
Open this publication in new window or tab >>Sexual orientation differences in outpatient psychiatric treatment and antidepressant usage: evidence from a population-based study of siblings
2018 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 33, no 6, p. 591-599Article in journal (Refereed) Published
Abstract [en]

In the past two decades, population-based health surveys have begun including measures of sexual orientation, permitting estimates of sexual orientation disparities in psychiatric morbidity and differences in treatment utilization. The present study takes advantage of the high-quality, comprehensive nationwide health registry data available in Sweden to examine whether psychiatric outpatient treatment for various diagnoses and antidepressant medication usage are greater in sexual minority individuals compared to their siblings. A longitudinal cohort study design was used with a representative random population-based sample in Stockholm, Sweden. Registry-based health record data on all specialized outpatient health care visits and prescription drug use was linked to a sample of 1154 sexual minority individuals from the Stockholm Public Health Cohort and their siblings. The main outcomes were treatment due to psychiatric diagnoses retrieved from nationwide registry-based health records. In analyses accounting for dependency between siblings, gay men/lesbians had a greater likelihood of being treated for mood disorder [adjusted odds ratio (AOR) 1.77; 99% confidence intervals (CI) 1.00, 3.16] and being prescribed antidepressants (AOR 1.51; 99% CI 1.10, 2.07) compared to their siblings. Further, bisexual individuals had a greater likelihood of any outpatient psychiatric treatment (AOR 1.69; 99% CI 1.17, 2.45) and being prescribed antidepressants (AOR 1.48; 99% CI 1.07, 2.05) as well as a greater likelihood of being treated for a mood disorder (AOR 1.98; 99% CI 1.33, 2.95) compared to their siblings. No difference in anxiety or substance use disorder treatment was found between any sexual minority subgroup and their siblings. The potential role of familial confounding in psychiatric disorder treatment was not supported for more than half of the outcomes that were examined. Results suggest that sexual minority individuals are significantly more likely to be treated for certain psychiatric disorders compared to their siblings. Future research is needed to understand mechanisms other than familial factors that might cause the substantial treatment differences based on sexual orientation reported here.

Keywords
Anxiety, Depression, Psychiatric disorders, Sexual minorities, Sibling design
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2578 (URN)10.1007/s10654-018-0411-y (DOI)29766438 (PubMedID)
Available from: 2018-05-21 Created: 2018-05-21 Last updated: 2019-08-06Bibliographically approved
Amin, M. R., Helgesson, M., Runeson, B., Tinghög, P., Mehlum, L., Holmes, E. & Mittendorfer-Rutz, E. (2018). The risk of suicidal behaviour in refugees and other immigrants to Sweden. European Journal of Public Health, 28(Suppl. 4), 191-191
Open this publication in new window or tab >>The risk of suicidal behaviour in refugees and other immigrants to Sweden
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2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Suppl. 4, p. 191-191Article in journal, Meeting abstract (Other academic) Published
Keywords
refugees, suicidal behavior, immigrants
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2797 (URN)10.1093/eurpub/cky213.562 (DOI)
Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-04-09Bibliographically approved
Murley, C., Mogard, O., Wiberg, M., Alexanderson, K., Karampampa, K., Friberg, E. & Tinghög, P. (2018). Trajectories of disposable income among people of working ages diagnosed with multiple sclerosis: a nationwide register-based cohort study in Sweden 7 years before to 4 years after diagnosis with a population-based reference group. BMJ Open, 8(5), Article ID e020392.
Open this publication in new window or tab >>Trajectories of disposable income among people of working ages diagnosed with multiple sclerosis: a nationwide register-based cohort study in Sweden 7 years before to 4 years after diagnosis with a population-based reference group
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 5, article id e020392Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To describe how disposable income (DI) and three main components changed, and analyse whether DI development differed from working-aged people with multiple sclerosis (MS) to a reference group from 7 years before to 4 years after diagnosis in Sweden.

DESIGN: Population-based cohort study, 12-year follow-up (7 years before to 4 years after diagnosis).

SETTING: Swedish working-age population with microdata linked from two nationwide registers.

PARTICIPANTS: Residents diagnosed with MS in 2009 aged 25-59 years (n=785), and references without MS (n=7847) randomly selected with stratified matching (sex, age, education and country of birth).

PRIMARY AND SECONDARY OUTCOME MEASURES: DI was defined as the annual after tax sum of incomes (earnings and benefits) to measure individual economic welfare. Three main components of DI were analysed as annual sums: earnings, sickness absence benefits and disability pension benefits.

RESULTS: We found no differences in mean annual DI between people with and without MS by independent t-tests (p values between 0.15 and 0.96). Differences were found for all studied components of DI from diagnosis year by independent t-tests, for example, in the final study year (2013): earnings (-64 867 Swedish Krona (SEK); 95% CI-79 203 to -50 528); sickness absence benefits (13 330 SEK; 95% CI 10 042 to 16 500); and disability pension benefits (21 360 SEK; 95% CI 17 380 to 25 350). A generalised estimating equation evaluated DI trajectory development between people with and without MS to find both trajectories developed in parallel, both before (-4039 SEK; 95% CI -10 536 to 2458) and after (-781 SEK; 95% CI -6988 to 5360) diagnosis.

CONCLUSIONS: The key finding of parallel DI trajectory development between working-aged MS and references suggests minimal economic impact within the first 4 years of diagnosis. The Swedish welfare system was responsive to the observed reductions in earnings around MS diagnosis through balancing DI with morbidity-related benefits. Future decreases in economic welfare may be experienced as the disease progresses, although thorough investigation with future studies of modern cohorts are required.

Keywords
income, insurance benefits, multiple sclerosis, sick leave, socioeconomic status, welfare state
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2579 (URN)10.1136/bmjopen-2017-020392 (DOI)29743325 (PubMedID)
Available from: 2018-05-21 Created: 2018-05-21 Last updated: 2018-05-28Bibliographically approved
Helgesson, M., Tinghög, P., Wang, M., Rahman, S., Saboonchi, F. & Mittendorfer-Rutz, E. (2018). Trajectories of work disability and unemployment among young adults with common mental disorders. BMC Public Health, 18, Article ID 1228.
Open this publication in new window or tab >>Trajectories of work disability and unemployment among young adults with common mental disorders
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2018 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 1228Article in journal (Refereed) Published
Abstract [en]

BackgroundLabour-market marginalisation (LMM) and common mental disorders (CMDs) are serious societal problems. The aims were to describe trajectories of LMM (both work disability and unemployment) among young adults with and without CMDs, and to elucidate the characteristics associated with these trajectories.MethodsThe study was based on Swedish registers and consisted of all individuals 19-30years with an incident diagnosis of a CMD in year 2007 (n=7245), and a matched comparison group of individuals without mental disorders during the years 2004-07 (n=7245). Group-based trajectory models were used to describe patterns of LMM both before, and after the incident diagnosis of a CMD. Multinomial logistic regressions investigated the associations between sociodemographic and medical covariates and the identified trajectories.ResultsTwenty-six percent (n=1859) of young adults with CMDs followed trajectories of increasing or constant high levels of work disability, and 32 % (n=2302) followed trajectories of increasing or constant high unemployment. In the comparison group, just 9 % (n=665) followed increasing or constant high levels of work disability and 21 % (n=1528) followed trajectories of increasing or constant high levels of unemployment. A lower share of young adults with CMDs followed trajectories of constant low levels of work disability (n=4546, 63%) or unemployment (n=2745, 38%), compared to the level of constant low work disability (n=6158, 85%) and unemployment (n=3385, 50%) in the comparison group. Remaining trajectories were fluctuating or decreasing. Around 50% of young adults with CMDs had persistent levels of LMM at the end of follow-up. The multinomial logistic regression revealed that educational level and comorbid mental disorders discriminated trajectories of work disability, while educational level, living area and age determined differences in trajectories of unemployment (R-difference(2)=0.02-0.05, p<0.001).ConclusionsA large share, nearly 50%, of young adults with CMDs, substantially higher than in the comparison group of individuals without mental disorders, display increasing or high persistent levels of either work disability or unemployment throughout the follow-up period. Low educational level, comorbidity with other mental disorders and living in rural areas were factors that increased the probability for LMM.

Keywords
Sick leave, Disability pension, Unemployment, Common mental disorders, Labour market marginalisation, Education
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2733 (URN)10.1186/s12889-018-6141-y (DOI)30400785 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015–00742
Available from: 2018-11-22 Created: 2018-11-22 Last updated: 2018-11-22Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6138-6427

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