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  • 1.
    Aceijas, Carmen
    et al.
    Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium; School of Health Sciences, University of Salford, Salford, Greater Manchester, UK..
    Brall, Caroline
    Department of International Health, School CAPHRI, Maastricht University, The Netherlands.
    Schröder-Bäck, Peter
    Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium.
    Otok, Robert
    Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium.
    Maeckelberghe, Els
    Institute for Medical Education, University Medical Center Groningen, The Netherlands.
    Stjernberg, Louise
    Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium; School of Health Science, Blekinge Institute of Technology.
    Strech, Daniel
    School of Health Science, Blekinge Institute of Technology.
    Tulchinsky, Theodore H
    Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium; Braun School of Public Health, Hebrew University-Hadassah, Ein Karem, Jerusalem, Israel.
    Teaching Ethics in Schools of Public Health in the European Region: Findings from a Screening Survey2012In: Public Health Reviews, ISSN 0301-0422, E-ISSN 2107-6952, Vol. 34, no 1, p. 1-10Article in journal (Refereed)
    Abstract [en]

    A survey targeting ASPHER members was launched in 2010/11, being a first initiative in improving ethics education in European Schools of Public Health. An 8-items questionnaire collected information on teaching of ethics in public health. A 52% response rate (43/82) revealed that almost all of the schools (95% out of 40 respondents with valid data) included the teaching of ethics in at least one of its programmes. They also expressed the need of support, (e.g.: a model curriculum (n=25), case studies (n=24)), which indicates further work to be met by the ASPHER Working Group on Ethics and Values in Public Health.

  • 2.
    Alexandersson, Kristina
    et al.
    Karolinska Institutet.
    Lumikukka, Tuula
    Karolinska universitetssjukhuset, Huddinge.
    Tinghög, Petter
    Karolinska Institutet.
    Åkerlund, Kerstin
    Karolinska universitetssjukhuset, Solna.
    Att uppmärksamma barn till svårt sjuka patienter på en neurologisk klinik - utvärdering av implementering av rutiner och arbetssätt2017In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 4, p. 485-495Article in journal (Refereed)
    Abstract [sv]

    Barn till allvarligt somatiskt sjuka föräldrar löper en förhöjd risk för egen psykisk ohälsa. Här presenteras resultat från utvärderingen av implementering av rutiner och arbetssätt som syftade till att förbättra arbetet med att identifiera, informera samt stödja minderåriga barn till patienter på en neurologisk klinik. Fyra delstudier genomfördes. Resultaten indikerar att trots betydande insatser för att säkerställa att kliniken lever upp till sina lagstadgade uppgifter, fanns en stor förbättringspotential. Hela 80% av patienter med minderåriga barn hade inte fått information om sina barns rätt till stöd och 40% hade inte tillräckligt stöd för att utöva sin föräldraroll. Samtidigt noterades en tydlig ökning i andelen personal på kliniken som hade kunskap om sin skyldighet att erbjuda information, råd och stöd. 

  • 3.
    Amin, M. Ridwanul
    et al.
    Karolinska Institutet.
    Helgesson, M.
    Karolinska Institutet.
    Runeson, B.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences.
    Mehlum, L.
    National Centre for Suicide Research and Prevention, Oslo, Norway.
    Holmes, E.
    Karolinska Institutet.
    Mittendorfer-Rutz, E.
    Karolinska Institutet.
    The risk of suicidal behaviour in refugees and other immigrants to Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Suppl. 4, p. 191-191Article in journal (Other academic)
  • 4.
    Arwidson, Charlotta
    et al.
    Svenska Röda Korset.
    Eriksson, Anneli
    Karolinska Institutet.
    Hälso- och sjukvård till papperslösa och andra utsatta grupper i Sverige2014In: Omvårdnadens grunder: Ansvar och utveckling / [ed] Anna Ehrenberg & Lars Wallin, Studentlitteratur AB, 2014, 2 uppl., p. 497-511Chapter in book (Other academic)
  • 5.
    Bennet, Louise
    et al.
    Department of Clinical Sciences, University Hospital of Malmö, Lund University; Blekinge Institute of Research and Development.
    Fraenkel, Carl-Johan
    Department of Infectious Diseases, Blekinge County Hospital Karlskrona.
    Garpmo, Ulf
    Department of Clinical Microbiology, Kalmar County Hospital.
    Halling, Anders
    Blekinge Institute of Research and Development, Karlskrona.
    Ingman, Mikael
    Department of Clinical and Experimental Infectious Medicine, University Hospital of Lund.
    Ornstein, Katharina
    Department of Clinical and Experimental Infectious Medicine, University Hospital of Lund.
    Stjernberg, Louise
    Blekinge Institute of Technology, School of Health Science, Karlskrona.
    Berglund, Johan
    Department of Clinical Sciences, University Hospital of Malmö, Lund University; Blekinge Institute of Research and Development, Karlskrona; Blekinge Institute of Technology, School of Health Science, Karlskrona.
    Clinical appearance of erythema migrans caused by Borrelia afzelii and Borrelia garinii: effect of the patient´s sex2006In: Wiener Klinische Wochenschrift, ISSN 0043-5325, E-ISSN 1613-7671, Vol. 118, no 17-18, p. 531-537Article in journal (Refereed)
    Abstract [en]

    Aim: The aim in this survey was to study the clinical characteristics of infections caused by Borrelia genospecies in patients with erythema migrans where Borrelial origin was confirmed by polymerase chain reaction. The aim was also to study factors influencing the clinical appearance of erythema migrans. Methods: The study was conducted in southern Sweden from May 2001 to December 2003 on patients 18 years and older attending with erythema migrans at outpatient clinics. All erythema migrans were verified by polymerase chain reaction, photographed and categorized into “annular” or “non-annular” lesions. A logistic regression model was used to analyze relations between the appearance of the erythema migrans (i.e., annular or non-annular) and factors that influenced its clinical appearances. Results: A total of 118 patients, 54 women (45.8%) and 64 men (54.2%), fulfilled the inclusion criteria. Of these patients, 74% were infected by B. afzelii, 26% by B. garinii ( p < 0.001). A total of 45% (38/85) of the erythema migrans were annular, 46% (39/85) were non-annular and 9.4% (8/85) were atypical. For men infected by B. afzelii the odds ratio of developing non-annular erythema migrans was 0.09 (95% CI: 0.03 - 0.33) in comparison with women with the same infection. Conclusions: In this prospective study of a large series of erythema migrans, where infecting genospecies were confirmed by polymerase chain reaction, the sex of patients infected with B. afzelii had a strong influence on the appearance of the rash. Patients infected by B. garinii more often had non-annular erythema migrans and a more virulent infection with more individuals presenting with fever, raised levels of C-reactive protein and seroreactivity in the convalescence sera.

  • 6.
    Bennet, Louise
    et al.
    Department of Clinical Sciences, the University Hospital of Malmö, Lund University; Blekinge Institute of Research and Development.
    Stjernberg, Louise
    Blekinge Institute of Research and Development; School of Health Science, Blekinge Institute of Technology.
    Berglund, Johan
    Blekinge Institute of Research and Development; School of Health Science, Blekinge Institute of Technology.
    Effect of Gender on Clinical and Epidemiologic Features of Lyme Borreliosis2007In: Vector Borne and Zoonotic Diseases, ISSN 1530-3667, E-ISSN 1557-7759, Vol. 7, no 1, p. 34-41Article in journal (Refereed)
    Abstract [en]

    The aim is to highlight the influence of patients’ gender on Lyme borreliosis and especially erythema migrans (EM), focusing on exposure to tick bites, epidemiology, and the clinical picture. All studies were conducted in the county of Blekinge, located in southeastern Sweden. A prospective study was conducted in 235 individuals (women, n=110; men, n=125) engaged in recreational or occupational activities focusing on exposure to tick bites. A retrospective epidemiological study evaluating 123,495 electronic patients´ records (women, n=61,712; men, n=61,783) and a prospective clinical study including 118 patients (women, n=54; men, n=64) 18 years or older seeking care for EM > 5 cm in diameter with genospecies verified by polymerase chain reaction were conducted. Results: Women 40 years or older had a 48% higher risk than men 40 years or older and 42% higher risk than women younger than 40 years of attracting tick bites (0.0188 versus 0.0127 and 0.0188 versus 0.0132 tick bites respectively per hour). Additionally they had a 96% higher risk than men younger than 40 years of attracting tick bites (0.0188 versus 0.0096). The annual incidence rate of EM in women was 506 and in men 423 cases per 100,000 inhabitants (p<0.001). Significant differences in incidence rates occurred in those 40 years or older. Odds ratios for males infected with Borrelia afzelii developing nonannular EM were 0.09 (95% confidence interval [CI] 0.03 to 0.33) in comparison with females infected by Borrelia afzelii. Conclusions: Significant gender differences in the risk of contracting tick bites, incidence rates, and clinical picture of EM have been observed. Exposure to tick bites alone may not explain these observations and further studies need to be done to clarify the biologic, immunologic, and sociological mechanisms causing these differences.

  • 7.
    Berggren, M
    et al.
    Blekinge Institute of Technology.
    Stjernberg, Louise
    Blekinge Institute of Technology.
    Lindström, F
    Blekinge Institute of Technology.
    Claesson, I
    Blekinge Institute of Technology.
    Audio processing solution for video conference based aerobics2010In: 2010 Digest of Technical Papers, International Conference on Consumer Electronics: (ICCE 2010) : Las Vegas, Nevada, USA : 9-13 January, 2010, Piscataway, N.J.: IEEE conference proceedings, 2010, p. 407-408Conference paper (Refereed)
    Abstract [en]

    In this paper an audio processing solution for video conference based aerobics is presented. The proposed solution leaves the workout music unaltered by separating it from the speech and processing each signal separately. The speech signal processing is also performed at a lower sample rate, which saves computational power. Real time evaluation of the system shows that high quality music as well as a good two-way communication is maintained during the aerobic session.

  • 8.
    Berglund, Johan
    et al.
    Lund University / Blekinge Institute of Technology / Research Centre for Zoonotic Ecology and Epidemiology.
    Stjernberg, Louise
    Lund University / Blekinge Institute of Technology.
    Ornstein, Katharina
    Lund University.
    Tykesson-Joelsson, Katarina
    Båstad Health Center.
    Walter, Hallstein
    Örkelljunga Health Center.
    5-y follow-up study of patients with neuroborreliosis2002In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 34, no 6, p. 421-425Article in journal (Refereed)
    Abstract [en]

    The objective of this follow-up study was to determine the long-term outcome of strictly classified cases of neuroborreliosis treated with antibiotics. A one-year prospective population-based survey of Lyme borreliosis was conducted in southern Sweden, between 1992 and 1993. A total of 349 identified cases with suspected neuroborreliosis were followed up 5 years later. Medical records were reviewed and all participants filled in a questionnaire. Of those classified with definite neuroborreliosis 114/130 completed the follow-up, of whom 111 had completed the initial antibiotic treatment. Of the 114 patients followed up, 86 (75%) had recovered completely and 70 (61%) had recovered within 6 months. Residual neurological symptoms such as facial palsy, concentration disorder, paresthesia and/or neuropathy were reported by 28/114. No significant differences between different antibiotic treatments were observed in terms of occurrence of sequelae. To conclude, we found that 25% (95% confidence interval 17-33%) of the patients suffered from residual neurological symptoms 5 years post-treatment. However, the clinical outcome of treated neuroborreliosis is favourable as only 14/114 (12%) of the patients had sequelae that influenced their daily activity post-treatment. Early diagnosis and treatment would seem to be of great importance in order to avoid such sequelae.

  • 9.
    Bexelius, T.
    et al.
    Karolinska Institutet.
    Lachmann, Hanna
    The Swedish Red Cross University College, Department of Health Sciences.
    Järnbert-Pettersson, H.
    Karolinska Institutet.
    Kalén, S.
    Karolinska Institutet.
    Möller, R.
    Karolinska Institutet.
    Ponzer, S.
    Karolinska Institutet.
    Stress among medical students during clinical courses: a longitudinal study using contextual activity sampling system2019In: International Journal of Medical Education, ISSN 2042-6372, E-ISSN 2042-6372, Vol. 10, p. 68-74Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate medical students’ experiences of stress and other emotions related to their professional roles, as defined by the CanMEDS framework, by using the Contextual Activity Sampling System (CASS).

    Methods: Ninety-eight medical students agreed to participate of whom 74 completed this longitudinal cohort study. Data was collected between 6th and 8th term via CASS methodology: A questionnaire was e-mailed to the participants every 3rd week (21questionnaires/measurements) during clinical rotations and scientific project work term. Emotions were measured by a 7-point Likert scale (e.g., maximum stress = 7). Answers were registered through mobile technology. We used a linear mixed-model regression approach to study the association between stress over time in relation to socio-demographic and learning activities related to CanMEDS roles.

    Results: Participants completed 1390 questionnaires. Mean stress level over all time points was 3.6. Stress was reported as highest during the scientific project term. Learning activities related to ‘Communicator,’ ‘Collaborator,’ ‘Scholar,’ ‘Manager’ and ‘Professional’ were associated with increased stress, e.g. ’Scholar’ increased stress with 0.5 points (t=3.91, p<0.001). A reduced level of stress was associated with ’Health Advocate’ of 0.39 points (t=-2.15, p=0.03). No association between perceived stress and demographic factors, such as gender or age was found.

    Conclusions: An association between different learning activities related to CanMEDS Roles and feelings of stress were noted. The CASS methodology was found to be useful when observing learning experiences and might support educational development by identifying course activities linked to stress.

  • 10.
    Bjegovic-Mikanovic, Vesna
    et al.
    Belgrade University, Belgrade, Serbia.
    Foldspang, Anders
    Aarhus University, Aarhus, Denmark.
    Jakubowski, Elke
    WHO Regional Office for Europe, Copenhagen, Denmark.
    Müller-Nordhorn, Jaqueline
    Berlin School of Public Health – Charité, Berlin, Germany.
    Otok, Robert
    ASPHER Office, Brussels, Belgium.
    Stjernberg, Louise
    Blekinge Institute of Technology.
    Developing The Publichealth Workforce2015In: Eurohealth, ISSN 1356-1030, Vol. 21, no 1, p. 24-27Article in journal (Other academic)
    Abstract [en]

    The development of the public health workforce is acornerstone in WHO's Action Plan for Strengthening Public HealthServices and Capacities. Public health education shall combineEssential Public Health Operations – surveillance; monitoring; healthprotection and promotion; disease prevention; service delivery;communication and research – with the competences needed within:public health methods; population health and its social, economicand environmental determinants; and man-made systems andinterventions to improve population health. An authorised publichealth profession founded on graduation from comprehensive publichealth education is needed. The capacity and standards of Schoolsof Public Health should accordingly be continuously developed.

  • 11.
    Björkenstam, B.
    et al.
    University of California Los Angeles, Los Angeles, CA USA / Karolinska Institutet / Stockholms universitet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Cochran, S.
    University of California Los Angeles, Los Angeles, CA USA.
    Andersson, G.
    University of California, Los Angeles, USA.
    Alexanderson, K.
    University of California, Los Angeles, USA / Karolinska Institutet.
    Bränström, R.
    Karolinska Institutet.
    Is work disability more common among same-sex than different-sex married people?2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no Suppl. 1, p. 305-Article in journal (Other academic)
  • 12.
    Björkenstam, Charlotte
    et al.
    Division of Insurance Medicine, Karolinska Institutet.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Wiberg, Michael
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Heterogeneity of sickness absence and disability pension trajectories among individuals with MS2015In: Multiple Sclerosis Journal, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 1, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Background The variability of progression of multiple sclerosis (MS) suggests that MS is a heterogeneous entity.

    Objective The objective of this article is to determine whether sickness absence (SA) and disability pension (DP) could be used to identify groups of patients with different progression courses.

    Methods We analyzed mean-annual net months of SA/DP, five years prior to MS diagnosis, until the year of diagnosis, and five years after for 3543 individuals diagnosed 2003–2006, by modeling trajectory subgroups.

    Results Five different groups were identified, revealing substantial heterogeneity among MS patients. Before diagnosis, 74% had a flat trajectory, while the remaining had a sharply increasing degree of SA/DP. After diagnosis, 95% had a flat or marginally increasing trajectory, although at various SA/disability pension (DP) levels, whereas a small group of 5% had decreasing SA/DP. A majority had few or no SA/DP months throughout the 11-year study period. Higher age and a lower educational level were associated with an unfavorable trajectory (p values <0.01).

    Conclusions There’s a considerable heterogeneity of MS progression in terms of SA/DP. Compared with other measures of disability, sickness-absence and disability pension offer a continuous variable that can be assigned to every individual for each time period without missing data. To what extent the SA/DP measure reflects classical MS outcome-measures as well as how correlated it is with co-morbidities and working-conditions needs to be investigated further.

  • 13.
    Björkenstam, Charlotte
    et al.
    Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Brenner, Philip
    Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet.
    Jokinen, Jussi
    Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet.
    Alexanderson, Kristina
    Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Is disability pension a risk indicator for future need of psychiatric healthcare or suicidal behavior among MS patients- a nationwide register study in Sweden?2015In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 15, no 1, p. 1-8, article id 286Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mental disorders and suicidal behavior are common in patients with multiple sclerosis (MS), they also carry a higher risk of disability pension (DP). Our aim was to investigate if DP and other factors are associated with psychiatric disorders and suicidal behavior among MS patients, and whether DP is a stronger risk indicator among certain groups.

    METHOD: A prospective population-based cohort study with six-year follow-up (2005-2010), including 11 346 MS patients who in 2004 were aged 16-64 and lived in Sweden. Incidence rate ratios (IRR) with 95 % confidence intervals (CI) were calculated.

    RESULTS: MS patients on DP had a modestly higher risk of requiring psychiatric healthcare, IRR: 1.36 (95 % CI: 1.18-1.58). MS patients with previous psychiatric healthcare had a higher IRR for both psychiatric healthcare and suicidal behavior; 2.32 (2.18-2.47) and 1.91 (1.59-2.30), respectively. DP moderated the association between sex and psychiatric healthcare, where women on DP displayed higher risk than men, X(2) 4.74 (p = 0.03).

    CONCLUSION: The findings suggest that losing one's role in work life aggravates rather than alleviates the burden of MS, as MS patients on DP seem to have a higher need for psychiatric healthcare, especially among women; which calls for extra awareness among clinicians.

  • 14.
    Brenner, Philip
    et al.
    Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Björkenstam, Charlotte
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital.
    Jokinen, Jussi
    Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Psychiatric diagnoses, medication and risk for disability pension in multiple sclerosis patients: a population-based register study2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 8, article id e104165Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychiatric comorbidity is common among multiple sclerosis (MS) patients. The majority of MS patients of working ages are on disability pension. The aims of this study were to chart the prevalences of psychiatric diagnoses and medications among MS patients of working ages, and to investigate their association with the risk for future disability pension.

    METHODS: This nationwide, population-based prospective cohort study includes 10,750 MS patients and 5,553,141 non-MS individuals who in 2005 were aged 17-64 years. Psychiatric diagnoses and medications were identified using nationwide registers. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated adjusting for socio-demographics. Furthermore, a survival analysis with five-year follow-up was performed among the 4,571 MS patients not on disability pension in 2005, with psychiatric diagnoses and medication as risk factors, and disability pension as the outcome.

    RESULTS: Among MS patients, 35% had been prescribed psychiatric medication compared to 10% of non-MS individuals, adjusted OR 3.72 (95% CI 3.57 to 3.88). Ten percent of MS patients had received a psychiatric diagnosis, compared to 5.7% of non-MS individuals, OR 1.82 (95% CI 1.71 to 1.94). Serotonin reuptake inhibitors (SSRIs), were the most commonly prescribed drugs (17%) among MS patients, while depression (4.8%) was the most common psychiatric diagnosis. In the survival analysis, MS patients with any psychiatric diagnosis had a hazard ratio (HR) of 1.83 (95% CI 1.53 to 2.18) for disability pension compared to other MS patients. MS patients with any psychiatric drug prescription had a HR for disability pension of 2.09 (95% CI 1.84 to 2.33).

    CONCLUSION: Psychiatric diagnoses and medications are common among MS patients and adversely affect risk for disability pension. This highlights the importance of correct diagnosis and management of psychiatric comorbidity, in a clinical as well as in a societal perspective.

  • 15.
    Brenner, Philip
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet; Center for Psychiatry Research, Karolinska Universitetssjukhuset.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Jokinen, Jussi
    Department of Clinical Neuroscience, Karolinska Institutet; Center for Psychiatry Research, Karolinska Universitetssjukhuset; Department of Clinical Sciences, Umeå University.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Prescribed psychiatric medication among multiple sclerosis patients before and after disability pension: a register study with matched controls.2016In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 51, no 7, p. 1047-1054Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Many multiple sclerosis (MS) patients of working ages have psychiatric comorbidity, and 60 % are on disability pension (DP). It is unknown how DP is associated with MS patients' mental health. The objective of this study was to investigate the association between prescriptions of psychiatric medication and time before and after receiving full-time DP in MS patients compared with matched controls.

    METHODS: Nationwide Swedish registers were used to identify 3836 MS patients who were granted DP in 2000-2012 and 19,180 DP controls matched on socio-demographic variables by propensity scores. Patients and controls were organized in groups by year granted DP. Adjusted odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated for being prescribed selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, or sleeping agents in 2006.

    RESULTS: Both patients and controls, who were not yet on DP in the study year of 2006, had lower OR compared with those who were granted DP in the same year. The OR increased when being closer to DP. MS patients, who had been granted DP 5-6 years earlier, had a higher risk for prescription of benzodiazepines (OR 1.72; 95 % CI 1.16-2.57) than controls (OR 1.14; 95 % CI 1.14-1.18). These patients also had a higher risk for SSRI prescription when compared directly with controls (OR 1.76; 95 % CI 1.44-2.15).

    CONCLUSIONS: MS patients have substantially higher odds ratios for being prescribed psychiatric drugs after DP than other disability pensioners. Further research on the association of DP with the mental health of MS patients is warranted.

  • 16.
    Bygren, Lars Olov
    et al.
    Department of Biosciences and Nutrition, Karolinska Institutet; Department of Community Medicine and Rehabilitation, University of Umeå.
    Tinghög, Petter
    Department of Clinical Neuroscience, Karolinska Institutet.
    Carstensen, John
    Department of Medical and Health Sciences, University of Linköping.
    Edvinsson, Sören
    The Demographic Database, University of Umeå.
    Kaati, Gunnar
    Department of Biosciences and Nutrition, Karolinska Institutet.
    Pembrey, Marcus E
    Institute of Child Health, University College London, UK.
    Sjöström, Michael
    Department of Biosciences and Nutrition, Karolinska Institutet.
    Change in paternal grandmothers' early food supply influenced cardiovascular mortality of the female grandchildren.2014In: BMC Genetics, ISSN 1471-2156, E-ISSN 1471-2156, Vol. 15, article id 12Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study investigated whether large fluctuations in food availability during grandparents' early development influenced grandchildren's cardiovascular mortality. We reported earlier that changes in availability of food - from good to poor or from poor to good - during intrauterine development was followed by a double risk of sudden death as an adult, and that mortality rate can be associated with ancestors' childhood availability of food. We have now studied transgenerational responses (TGR) to sharp differences of harvest between two consecutive years' for ancestors of 317 people in Överkalix, Sweden.

    RESULTS: The confidence intervals were very wide but we found a striking TGR. There was no response in cardiovascular mortality in the grandchild from sharp changes of early exposure, experienced by three of the four grandparents (maternal grandparents and paternal grandfathers). If, however, the paternal grandmother up to puberty lived through a sharp change in food supply from one year to next, her sons' daughters had an excess risk for cardiovascular mortality (HR 2.69, 95% confidence interval 1.05-6.92). Selection or learning and imitation are unlikely explanations. X-linked epigenetic inheritance via spermatozoa seemed to be plausible, with the transmission, limited to being through the father, possibly explained by the sex differences in meiosis.

    CONCLUSION: The shock of change in food availability seems to give specific transgenerational responses.

  • 17.
    Chruzander, Charlotte
    et al.
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Department of Physiotherapy, Karolinska University Hospital.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Ytterberg, Charlotte
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Department of Physiotherapy, Karolinska University Hospital.
    Widén Holmqvist, Lotta
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Department of Physiotherapy, Karolinska University Hospital; Division of Neuroscience, Department of Clinical Neuroscience.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet.
    Johansson, Sverker
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Department of Physiotherapy, Karolinska University Hospital.
    Longitudinal changes in sickness absence and disability pension, and associations between disability pension and disease-specific and contextual factors and functioning, in people with multiple sclerosis.2016In: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 367, p. 319-325Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Even though it is well known that disability due to MS is highly associated with employment status, the long-term longitudinal perspective on sickness absence and disability pension over the MS trajectory is lacking. In addition, further knowledge of risk factors for future disability pension is needed.

    OBJECTIVES: To explore long-term longitudinal changes in the prevalence of sickness absence and disability pension in people with MS (PwMS), as well as to explore associations between disease-specific factors, contextual factors and functioning, and the outcome of future full-time disability pension.

    METHODS: A prospective, population-based survival cohort study, with a nine year follow-up, including 114 PwMS was conducted by combining face-to-face collected data and register-based data.

    RESULTS: The prevalence of full-time disability pension increased from 20% to 50%, however 24% of the PwMS had no disability pension at all at end of follow-up. Sex, age, disease severity and impaired manual dexterity were associated with future full-time disability pension.

    CONCLUSIONS: The large increase in prevalence of PwMS on full-time disability pension during the MS trajectory, calls for the development and implementation of evidence-based interventions, aiming at keeping PwMS in the work force. Modifiable factors, such as manual dexterity should be targeted in such interventions.

  • 18.
    Czabanowska, Katarzyna
    et al.
    Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
    Laaser, Ulrich
    Faculty of Health Sciences, University of Bielefeld, Germany; Centre School of Public Health, Faculty of Medicine, University of Belgrade, Serbia.
    Stjernberg, Louise
    Department of Health, Blekinge Institute of Technology.
    Shaping and Authorising a Public Health Profession2014In: The South Eastern European Journal of Public Health, ISSN 2197-5248, Vol. 2Article in journal (Refereed)
    Abstract [en]

    The aim of this short communication is to stimulate a discussion on the state of a public health profession in Europe and actions which need to be taken to authorise public health professionals based on their competencies. While regulated professions such as medical doctors, nurses, lawyers, and architects can enjoy the benefits of the 2005/ 36/EC Directive amended by 2013/55/EU Directive on the recognition of professional qualifications, public health professionals are left out from these elite. Firstly, we use the profession traits theory as a framework in arguing whether public health can be a legitimate profession in itself, second, we explain who public health professionals are and what usually is required for shaping the public health profession, and thirdly, we attempt to sketch the road to the authorisation or licencing of public health professionals. Finally, we will propose some recommendation.

  • 19.
    Di Thiene, Domitilla
    et al.
    Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    La Torre, Giuseppe
    Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Suicide among first-generation and second-generation immigrants in Sweden: association with labour market marginalisation and morbidity.2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 5, p. 467-473Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous research suggests that first-generation immigrants have a lower suicide risk than those both born in Sweden and with both parents born in Sweden (natives), while the suicide risk in the second generation seems higher. The aim of this study was to investigate to what extent suicide risk in first-generation and second-generation (both parents born abroad) and intermediate-generation (only one parent born abroad) immigrants compared with natives is associated with sociodemographic factors, labour market marginalisation and morbidity.

    METHODS: A prospective population-based cohort study of 4 034 728 individuals aged 16-50 years was followed from 2005 to 2010. HRs for suicide were calculated for first-generation, intermediate-generation and second-generation immigrants compared with natives. Analyses were controlled for sociodemographic factors, morbidity and labour market marginalisation.

    RESULTS: The HR of suicide was significantly lower in first-generation immigrants (HR 0.83 CI 0.76 to 0.91), and higher in second-generation (HR 1.32, CI 1.15 to 1.52) and intermediate-generation immigrants (HR 1.20, CI 1.08 to 1.33) in comparison to natives. The excess risk was explained by differences in sociodemographics, morbidity and labour market marginalisation. In the fully adjusted models, a higher HR remained only for the Nordic second generation (HR 1.29, CI 1.09 to 1.52). There were no sex differences in HRs.

    CONCLUSIONS: The risk of suicide was shown to be lower in the first generation and higher in the second generation compared with natives. The higher HR in the Nordic second generation was not explained by differences in sociodemographics, labour market marginalisation and morbidity. Further research is warranted to investigate factors underlying this excess risk.

  • 20.
    Dorner, T E
    et al.
    Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria.
    Alexanderson, K
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Svedberg, P
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Tinghög, Petter
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Ropponen, A
    Finnish Institute of Occupational Health, Topeliuksenkatu, Helsinki, Finland.
    Mittendorfer-Rutz, E
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Synergistic effect between back pain and common mental disorders and the risk of future disability pension: a nationwide study from Sweden.2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to analyse a possible synergistic effect between back pain and common mental disorders (CMDs) in relation to future disability pension (DP).

    METHOD: All 4 823 069 individuals aged 16-64 years, living in Sweden in December 2004, not pensioned in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the cohort of this register-based study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for DP (2006-2010) were estimated. Exposure variables were back pain (M54) (sickness absence or inpatient or specialized outpatient care in 2005) and CMD (F40-F48) [sickness absence or inpatient or specialized outpatient care or antidepressants (N06a) in 2005].

    RESULTS: HRs for DP were 4.03 (95% CI 3.87-4.21) and 3.86 (95% CI 3.68-4.04) in women and men with back pain. HRs for DP in women and men with CMD were 4.98 (95% CI 4.88-5.08) and 6.05 (95% CI 5.90-6.21). In women and men with both conditions, HRs for DP were 15.62 (95% CI 14.40-16.94) and 19.84 (95% CI 17.94-21.94). In women, synergy index, relative excess risk due to interaction, and attributable proportion were 1.24 (95% CI 1.13-1.36), 0.18 (95% CI 0.11-0.25), and 2.08 (95% CI 1.09-3.06). The corresponding figures for men were 1.45 (95% CI 1.29-1.62), 0.29 (95% CI 0.22-0.36), and 4.21 (95% CI 2.71-5.70).

    CONCLUSIONS: Co-morbidity of back pain and CMD is associated with a higher risk of DP than either individual condition, when added up, which has possible clinical implications to prevent further disability and exclusion from the labour market.

  • 21.
    Döring, Nora
    et al.
    Karolinska Institutet.
    Hansson, Lena M.
    Karolinska Institutet.
    Scheers Andersson, Elina
    Karolinska Institutet.
    Bohman, Benjamin
    Karolinska Institutet.
    Westin, Maria
    Karolinska Institutet.
    Magnusson, Margaretha
    Uppsala University.
    Larsson, Christel
    University of Gothenburg / Umeå University.
    Sundblom, Elinor
    Stockholm County Council.
    Willmer, Mikaela
    Karolinska Institutet.
    Blennow, Margareta
    Södersjukhuset.
    Heitmann, Berit L.
    Copenhagen University Hospital, Denmark / University of Sydney, Australia / University of Southern Denmark.
    Forsberg, Lars
    Karolinska Institutet.
    Wallin, Sanna
    Karolinska Institutet.
    Tynelius, Per
    Karolinska Institutet / Stockholm County Council.
    Ghaderi, Ata
    Karolinska Institutet.
    Rasmussen, Finn
    Karolinska Institutet / Stockholm County Council.
    Primary prevention of childhood obesity through counselling sessions at Swedish child health centres: design, methods and baseline sample characteristics of the PRIMROSE cluster-randomised trial2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, article id 335Article in journal (Refereed)
    Abstract [en]

    Background: Childhood obesity is a growing concern in Sweden. Children with overweight and obesity run a high risk of becoming obese as adults, and are likely to develop comorbidities. Despite the immense demand, there is still a lack of evidence-based comprehensive prevention programmes targeting pre-school children and their families in primary health care settings. The aims are to describe the design and methodology of the PRIMROSE cluster-randomised controlled trial, assess the relative validity of a food frequency questionnaire, and describe the baseline characteristics of the eligible young children and their mothers. Methods/Design: The PRIMROSE trial targets first-time parents and their children at Swedish child health centres (CHC) in eight counties in Sweden. Randomisation is conducted at the CHC unit level. CHC nurses employed at the participating CHC received training in carrying out the intervention alongside their provision of regular services. The intervention programme, starting when the child is 8-9 months of age and ending at age 4, is based on social cognitive theory and employs motivational interviewing. Primary outcomes are children's body mass index and waist circumference at four years. Secondary outcomes are children's and mothers' eating habits (assessed by a food frequency questionnaire), and children's and mothers' physical activity (measured by accelerometer and a validated questionnaire), and mothers' body mass index and waist circumference. Discussion: The on-going population-based PRIMROSE trial, which targets childhood obesity, is embedded in the regular national (routine) preventive child health services that are available free-of-charge to all young families in Sweden. Of the participants (n = 1369), 489 intervention and 550 control mothers (75.9%) responded to the validated physical activity and food frequency questionnaire at baseline (i.e., before the first intervention session, or, for children in the control group, before they reached 10 months of age). The food frequency questionnaire showed acceptable relative validity when compared with an 8-day food diary. We are not aware of any previous RCT, concerned with the primary prevention of childhood obesity through sessions at CHC that addresses healthy eating habits and physical activity in the context of a routine child health services programme.

  • 22.
    Eriksson, Anneli
    et al.
    Department of Public Health Sciences, Health system and policy, Karolinska Institute.
    Ohlsén, Ylva Kristina
    The Swedish Red Cross University College, Department of Technology and Welfare.
    Garfield, Richard
    ERRB, Centers for Disease Control, Atlanta, Georgia, USA.
    von Schreeb, Johan
    Department of Public Health Sciences, Health System and Policy, Karolinska Institute.
    Who Is Worst Off?: Developing a Severity-scoring Model of Complex Emergency Affected Countries in Order to Ensure Needs Based Funding2015In: PLOS Currents, ISSN 2157-3999, E-ISSN 2157-3999, no November 3Article in journal (Refereed)
    Abstract [en]

    Background: Disasters affect close to 400 million people each year. Complex Emergencies (CE) are a category of disaster that affects nearly half of the 400 million and often last for several years. To support the people affected by CE, humanitarian assistance is provided with the aim of saving lives and alleviating suffering. It is widely agreed that funding for this assistance should be needs-based. However, to date, there is no model or set of indicators that quantify and compare needs from one CE to another. In an effort to support needs-based and transparent funding of humanitarian assistance, the aim of this study is to develop a model that distinguishes between levels of severity among countries affected by CE.

    Methods: In this study, severity serves as a predictor for level of need. The study focuses on two components of severity: vulnerability and exposure. In a literature and Internet search we identified indicators that characterize vulnerability and exposure to CE. Among the more than 100 indicators identified, a core set of six was selected in an expert ratings exercise. Selection was made based on indicator availability and their ability to characterize preexisting or underlying vulnerabilities (four indicators) or to quantify exposure to a CE (two indicators). CE from 50 countries were then scored using a 3-tiered score (Low-Moderate, High, Critical). 

    Results: The developed model builds on the logic of the Utstein template. It scores severity based on the readily available value of four vulnerability and four exposure indicators. These are 1) GNI per capita, PPP, 2) Under-five mortality rate, per 1 000 live births, 3) Adult literacy rate, % of people ages 15 and above, 4) Underweight, % of population under 5 years, and 5) number of persons and proportion of population affected, and 6) number of uprooted persons and proportion of population uprooted.

    Conclusion: The model can be used to derive support for transparent, needs-based funding of humanitarian assistance. Further research is needed to determine its validity, the robustness of indicators and to what extent levels of scoring relate to CE outcome.

  • 23.
    Ernstsson, Olivia
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Burström, Kristina
    Karolinska Institutet / Stockholm County Council.
    The External Validity of Mapping MSIS-29 on EQ-5D Among Individuals With Multiple Sclerosis in Sweden2017In: Medical Decision Making Policy & Practice, ISSN 2381-4683, Vol. 2, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Mapping can be performed to predict utility values from condition-specific measures when preference-based measures are absent. A previously developed algorithm that predicts EQ-5D-3L index values from the Multiple Sclerosis Impact Scale (MSIS-29) has not yet been externally validated. Aim: To examine the external validity of a previously developed mapping algorithm by testing the accuracy of predicting EQ-5D-3L index values from MSIS-29 among multiple sclerosis (MS) patients in Sweden. Methods: Cross-sectional individual-level data were collected from population-based Swedish registers between 2011 and 2014. Health-related quality of life was assessed through MSIS-29 and EQ-5D-3L at one point in time among 767 individuals with known disability level of MS. A previously developed mapping algorithm was applied to predict EQ-5D index values from MSIS-29 items, and the predictive accuracy was assessed through mean absolute error and root mean square error. Results: When applying the algorithm, the predicted mean EQ-5D-3L index value was 0.77 compared to the observed mean index value of 0.75. Prediction error was higher for individuals reporting EQ-5D values <0.5 compared to individuals reporting EQ-5D values ≥0.5. Mean absolute error (0.12) and root mean square error (0.18) were smaller or equal to the prediction errors found in the original mapping study. Conclusion: The mapping algorithm had similar predictive accuracy in the two independent samples although results showed that the highest predictive performance was found in groups with better health. Varied predictive accuracy in subgroups is consistent with previous studies and strategies to deal with this are warranted.

  • 24.
    Ervasti, Jenni
    et al.
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Lallukka, Tea
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Kjeldgard, Linnea
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Alexanderson, Kristina
    Division of Insurance Medicine,Department of Clinical Neuroscience, Karolinska Institutet.
    Work disability before and after diabetes diagnosis: a nationwide population-based register study in Sweden.2015In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 105, no 6, p. e22-e29Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We evaluated the risk of work disability (sick leave and disability pension) before and after diabetes diagnosis relative to individuals without diabetes during the same time period, as well as the trajectory of work disability around the diagnosis.

    METHODS: This Swedish population-based cohort study with register data included 14 428 individuals with incident diabetes in 2006 and 39 702 individuals without diabetes during 2003 to 2009.

    RESULTS: Work disability was substantially higher among people with diabetes (overall mean = 95 days per year over the 7 years, SD = 143) than among those without diabetes (mean = 35 days, SD = 95). The risk of work disability was slightly higher after diabetes diagnosis than before and compared with the risk of those without diabetes. The trajectory of work disability was already increasing before diagnosis, increased even more at the time of diagnosis, and leveled off after diagnosis. Individual sociodemographic characteristics and comorbid conditions contributed both to the risk and to the trajectory of work disability.

    CONCLUSIONS: Although diabetes has an independent effect on work disability, sex, age, education, and comorbid conditions play a significant role.

  • 25.
    Fonad, Edit
    et al.
    Karolinska Institutet.
    Robins Wahlin, Tarja-Brita
    Karolinska Institutet / The University of Queensland School of Medicine, Brisbane, Queensland, Australia.
    Hedman, Ann-Marie
    The Swedish Red Cross University College, Department of Nursing and Care.
    Associations between falls and general health, nutrition, dental health and medication use in Swedish home-dwelling people aged 75 years and over.2015In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 23, no 6, p. 594-604Article in journal (Refereed)
    Abstract [en]

    ABSTRACT The vast majority of elderly people in Sweden live in private homes in their communities for as long as possible. Poor health and a high risk of falls are very common among this group. This cross-sectional study investigates the association between falls and general health, appetite, dental health, and the use of multiple medications among home-dwelling men and women aged ≥75 years. Data were collected between October 2008 and March 2009 using a postal questionnaire. A total of 1243 people participated in the questionnaire survey (74% response rate), of which 1193 were included in the analysis. The majority of participants were women (n = 738, 62%). Falls in the previous 12-month period were reported by 434 (36%) participants. Most fallers (n = 276, 64%) were women. The majority of the fallers lived in a flat (n = 250, 58%). Poor health (aOR: 1.61; CI: 1.34-1.95), poor dental health (aOR: 1.22; CI: 1.07-1.39) and the use of four or more types of medication daily (aOR: 1.13; CI: 1.03-1.25) were significantly associated with falls in all participants. Poor dental health was found irrespectively of living in a flat (aOR: 1.23; CI: 1.04-1.46) or living in a house (aOR: 1.28; CI: 1.02-1.61), and both were significantly associated with falls. The use of more than four different types of medication daily (aOR: 1.25; CI: 1.11-1.41) was associated with falls for those living in a flat. The results highlight that falls are associated with poor general health, poor dental health and the use of four or more types of medication daily. Health professionals should provide health promotion education and investigate dental health and risk factors for oral disease. Likewise, medical and clinical practices of physicians and community care nurses should include assessing the risk of falling, and treatment that predisposes falls.© 2015 John Wiley & Sons Ltd.

  • 26.
    Georgsson, Susanne
    et al.
    The Swedish Red Cross University College. Karolinska Institutet.
    van der Spoel, Linde
    Uppsala University.
    Ferm, Johanna
    Uppsala University.
    Carlsson, Tommy
    Uppsala University / Sophiahemmet University.
    Quality of web pages about second-trimester medical abortion: A cross-sectional study of readability, comprehensiveness, and transparency2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate the readability, comprehensiveness and transparency of web pages about medical abortion in the second trimester of pregnancy.

    DESIGN: A cross-sectional descriptive study of Swedish web pages.

    METHODS: Six systematic searches were performed in Google during January 2017. The first 10 hits of each search were screened, resulting in 46 included Swedish web pages. The web pages were analyzed with readability index (LIX) to investigate readability, inductive manifest content analysis to investigate comprehensiveness, and Journal of the Medical Association benchmarks to investigate transparency.

    RESULTS: Median LIX was 29.0 and the largest proportion had LIX 31-40 (N = 17), indicating moderate readability. Visual components were observed in 13 websites. Content analysis resulted in 12 categories illustrating comprehensiveness, but eight of these were only included in ≤50% web pages. With regard to transparency, 29 (63%) adhered to no benchmark, 15 (33%) adhered to one benchmark, and 2 (4%) adhered to two benchmarks. Most web pages were written or reviewed by laypersons (N = 25) and health professionals (N = 11).

    CONCLUSION: The results indicate that web pages about medical abortion have moderate readability, varied comprehensiveness and poor transparency.

    IMPACT: Health professionals need to acknowledge the risk of contact with web-based information about poor quality. There is a need for research that aims to increase the chances that patients encounter high-quality web-based information about medical abortion in the second trimester of pregnancy.

  • 27.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet; University of Gothenburg.
    Kavaliunas, Andrius
    Karolinska Institutet.
    Murley, Chantelle
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet; Karolinska University Hospital.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Costs of illness progression for different multiple sclerosis phenotypes: a population-based study in Sweden2019In: Multiple Sclerosis Journal Experimental, Translational and Clinical, ISSN 2055-2173, Vol. 5, no 2, article id 2055217319858383Article in journal (Refereed)
    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.

  • 28.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet / Göteborgs universitet, Sahlgrenska universitetssjukhuset.
    Wiberg, M.
    Karolinska Institutet / Försäkringskassan.
    Alexanderson, K.
    Karolinska Institutet.
    Friberg, E.
    Karolinska Institutet.
    Hillert, J.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Comparing indirect costs of multiple sclerosis in three different years: A population-based study2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no Suppl. 1, p. 29-Article in journal (Other academic)
  • 29.
    Gyllensten, Hanna
    et al.
    Karolinska institutet / Sahlgrenska Academy, University of Gothenburg.
    Wiberg, Michael
    Karolinska institutet / Swedish Social Insurance Agency.
    Alexanderson, Kristina
    Karolinska institutet.
    Hillert, Jan
    Karolinska institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    How does work disability of patients with MS develop before and after diagnosis? A nationwide cohort study with a reference group2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 11, article id e012731Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We compared work disability of patients with multiple sclerosis (MS) from 5 years before with 5 years after diagnosis, with that of matched controls, and analysed whether progression in work disability among patients with MS was associated with sociodemography.

    DESIGN: Population-based cohort study.

    SETTING: The adult Swedish general population.

    PARTICIPANTS: Residents aged 24-57 diagnosed with MS (n=3685) in 2003-2006 and 18 425 matched controls without MS.

    PRIMARY AND SECONDARY OUTCOME MEASURES: Annual net days of sickness absence (SA) and disability pension (DP), used as a proxy for work disability, followed from 5 years before to 5 years after diagnosis (ie, T-5-T+5). For patients with MS, regression was used to identify sociodemographic factors related to progression in work disability.

    RESULTS: Work disability of patients with MS increased gradually between T-5 and T-1 (mean: 46-82 days) followed by a sharp increase (T+1, 142 days), after which only a marginal increase was observed (T+5, 149 days). The matched controls had less work disability, slightly increasing during the period to a maximum of ∼40 days. Men with MS had a sharper increase in work disability before diagnosis. High educational level was associated with less progression in work disability before and around diagnosis.

    CONCLUSIONS: Patients with MS had more work disability days also 5 years before diagnosis. Several sociodemographic variables were associated with the absolute level and the progression in SA and DP.

  • 30.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet / University of Gothenburg.
    Wiberg, Michael
    Karolinska Institutet / Swedish Social Insurance Agency.
    Alexanderson, Kristina
    Karolinska Institutet.
    Norlund, Anders
    Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Ernstsson, Olivia
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Costs of illness of multiple sclerosis in Sweden: a population-based register study of people of working age2018In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 19, no 3, p. 435-446Article in journal (Refereed)
    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.

  • 31.
    Hallberg, David
    The Swedish Red Cross University College, Department of Health Sciences. University of Douala, Douala, Cameroun.
    Community gardens as multipurpose, technological systems2018In: Journal of Sociology and Social Anthropology, ISSN 0976-6634, Vol. 9, no 2, p. 38-48Article in journal (Refereed)
    Abstract [en]

    This paper introduces the notion of community gardens as multipurpose, technological systems with dynamic boundaries. It also strives to revise the notion of food security and health in regards to such systems. This is a cross-cultural project where twelve community gardens located in urban regions within three different countries were examined. This paper explores common tendencies rather than diversities or differences. The paper describes a behavioural chain that depends on various factors and affects various types of health. It is suggested that a community garden has the potential to serve as a link between the past and the present. While a community garden may provide food, it is suggested that it may also encourage social interactions, knowledge sharing, and relaxation. The cultivation of food occurs, but it may not always be the sole purpose.

  • 32.
    Hallberg, David
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. University of Douala, Douala, Cameroon.
    Kimario, T. D.
    Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Mtuya, C.
    Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Msuya, M.
    Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Factors affecting HIV disclosure among partners in Morongo, Tanzania2019In: International Journal of Africa Nursing Sciences, E-ISSN 2214-1391, Vol. 10, p. 49-54Article in journal (Refereed)
    Abstract [en]

    Background: Human immunodeficiency virus (HIV) remains a major concern globally and locally. Married couples and those in stable relationships account for the highest percentage of new HIV and acquired immune deficiency syndrome (AIDS) infections. The rate of HIV disclosure among couples is low and affected by both known and unknown factors. The aim of this study was to describe the reasons for HIV status (non)disclosure among partners in Morongo. Methods: A sampling containing two stages was used in this quantitative, exploratory, and descriptive study to select the 100 participants. The location was a Care and Treatment Clinic in the Morogoro municipality. Results: The participants had a moderate level of knowledge about the importance of HIV serostatus disclosure. Female genital mutilation was the most mentioned (44%) custom affecting disclosure. The participants’ level of knowledge about their partner's HIV status was also moderate (28%). Nitty-six percent had not disclosed due to fear of divorce and 98% due to fear of loss of financial support. Cultural factors such as traditional practices (95%) were also a major reason that hindered disclosure. Conclusions: Interventions to address the negative attitudes are necessary to promote HIV disclosure and, in turn, better adherence to psychological adjustment therapy and reduction in the risk of HIV transmission among couples.

  • 33.
    Hanpatchaiyakul, Kulnaree
    et al.
    School of Health Care and Social Welfare, Mälardalen University; Boromarajonani College of Nursing Changwat Nonthaburi, Thailand.
    Eriksson, Henrik
    The Swedish Red Cross University College, Department of Nursing and Care.
    Kijsomporn, Jureerat
    Praboromarajchanok Institute for Health Workforce Development (PIHWD), Ministry of Public Health, Nonthaburi, Thailand.
    Östlund, Gunnel
    School of Health Care and Social Welfare, Mälardalen University .
    Healthcare providers' experiences of working with alcohol addiction treatment in Thailand2016In: Contemporary Nurse: health care across the lifespan, ISSN 1037-6178, E-ISSN 1839-3535, Vol. 52, no 1, p. 59-73Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The high prevalence of alcohol consumption, together with its associated health risk factors, has long-term negative impacts on both society and the economy in Thailand.

    AIM: The aim of this study was to explore the experiences of healthcare providers working with people experiencing alcohol addiction and the treatment programs in a Thai hospital.

    METHODS: Qualitative study was applied in this study by conducting focus group interviews with 32 interdisciplinary healthcare providers, most of which were nurses. Content analysis was applied to analyze the verbatim-transcribed data.

    FINDINGS: Two main topics emerged: (1) the collaborative practices related to alcohol treatment, and (2) the fit of the program, including how the treatment program functions. Obstacles were identified and formulated from several sub-categories.

    CONCLUSIONS: The findings included obstacles linked to the imported (Western) program and the patriarchal structure in Thai culture, which seem to intersect and reinforce each other.

  • 34.
    Helgesson, Magnus
    et al.
    Uppsala universitet / Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Niederkrotenthaler, T.
    Medical Univiversity Vienna, Vienna, Austria.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Mittendorfer-Rutz, E.
    Karolinska Institutet.
    Labour-market marginalisation after a mental diagnosis among natives and immigrants living in Sweden2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no Suppl. 1, p. 38-Article in journal (Other academic)
  • 35.
    Helgesson, Magnus
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Niederkrotenthaler, Thomas
    Medical University Vienna, Vienna, Austria.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Labour-market marginalisation after mental disorders among young natives and immigrants living in Sweden2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, no 1, article id 593Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim was to investigate the associations between mental disorders and three different measures of labour-market marginalisation, and differences between native Swedes and immigrants.

    METHODS: The study comprised 1,753,544 individuals, aged 20-35 years, and resident in Sweden 2004. They were followed 2005-2011 with regard to disability pension, sickness absence (≥90 days) and unemployment (≥180 days). Immigrants were born in Western countries (Nordic countries, EU, Europe outside EU or North-America/Oceania), or in non-Western countries (Africa, Asia or South-America). Mental disorders were grouped into seven subgroups based on a record of in- or specialised outpatient health care 2001-2004. Hazard ratios (HRs) with 95% confidence intervals (CIs) were computed by Cox regression models with both fixed and time-dependent covariates and competing risks. We also performed stratified analyses with regard to labour-market attachment.

    RESULTS: Individuals with mental disorders had a seven times higher risk of disability pension, a two times higher risk of sickness absence, and a 20% higher risk of unemployment than individuals without mental disorders. Individuals with personality disorders and schizophrenia/non-affective psychoses had highest risk estimates for having disability pension and long-term sickness absence, while the risk estimates of long-term unemployment were similar among all subgroups of mental disorders. Among persons with mental disorders, native Swedes had higher risk estimates for disability pension (HR:6.6; 95%CI:6.4-6.8) than Western immigrants (4.8; 4.4-5.2) and non-Western immigrants (4.8; 4.4-5.1), slightly higher risk estimates for sickness absence (2.1;2.1-2.2) than Western (1.9;1.8-2.1), and non-Western (1.9;1.7-2.0) immigrants but lower risk estimates for unemployment (1.4;1.3-1.4) than Western (1.8;1.7-1.9) and non-Western immigrants (2.0;1.9-2.1). There were similar risk estimates among sub-regions within both Western and non-Western countries. Stratification by labour-market attachment showed that the risk estimates for immigrants were lower the more distant individuals were from gainful employment.

    CONCLUSIONS: Mental disorders were associated with all three measures of labour-market marginalisation, strongest with subsequent disability pension. Native Swedes had higher risk estimates for both disability pension and sickness absence, but lower risk estimates for unemployment than immigrants. Previous labour-market attachment explained a great part of the association between immigrant status and subsequent labour-market marginalisation.

  • 36.
    Helgesson, Magnus
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Wang, Mo
    Karolinska Institutet.
    Rahman, Syed
    Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Trajectories of work disability and unemployment among young adults with common mental disorders2018In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 1228Article in journal (Refereed)
    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.

  • 37.
    Helgesson, Magnus
    et al.
    Karolinska Institutet.
    Wang, Mo
    Karolinska Institutet.
    Niederkrotenthaler, Thomas
    Medical University of Vienna, Vienna, Austria.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Labour market marginalisation among refugees from different countries of birth: a prospective cohort study on refugees to Sweden2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 5, p. 407-415Article in journal (Refereed)
    Abstract [en]

    Background: The aim was to elucidate if the risk of labour market marginalisation (LMM), measured as long-term unemployment, long-term sickness absence, disability pension and a combined measure of these three measures, differed between refugees and non-refugee migrants with different regions of birth compared with native Swedes.

    Methods: All non-pensioned individuals aged 19-60 years who were resident in Sweden on 31 December 2009 were included (n= 4 441 813, whereof 216 930 refugees). HRs with 95% CIs were computed by Cox regression models with competing risks and time-dependent covariates with a follow-up period of 2010-2013.

    Results: Refugees had in general a doubled risk (HR: 2.0, 95% CI 1.9 to 2.0) and non-refugee migrants had 70% increased risk (HR: 1.7, 95% CI 1.7 to 1.7) of the combined measure of LMM compared with native Swedes. Refugees from Somalia (HR: 2.7, 95% CI 2.6 to 2.8) and Syria (HR: 2.5, 95% CI 2.5 to 2.6) had especially high risk estimates of LMM, mostly due to high risk estimates of long-term unemployment (HR: 3.4, 95% CI 3.3 to 3.5 and HR: 3.2, 95% CI 3.1 to 3.2). African (HR: 0.7, 95% CI 0.6 to 0.7) and Asian (HR: 1.0, 95% CI 1.0 to 1.1) refugees had relatively low risk estimates of long-term sickness absence compared with other refugee groups. Refugees from Europe had the highest risk estimates of disability pension (HR: 1.9, 95% CI 1.8 to 2.0) compared with native Swedes.

    Conclusion: Refugees had in general a higher risk of all measures of LMM compared with native Swedes. There were, however, large differences in risk estimates of LMM between subgroups of refugees and with regard to type of LMM. Actions addressing differences between subgroups of refugees is therefore crucial in order to ensure that refugees can obtain as well as retain a position on the labour market.

  • 38.
    Hinas, Elin
    et al.
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Nilsson, Kerstin
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Tinghög, Petter
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Mittendorfer Rutz, Ellenor
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Alexanderson, Kristina
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Prediktion av fortsatt sjukfrånvaro bland personer sjukskrivna i depressiv episod respektive i artros2015Report (Other academic)
  • 39.
    Hjern, Anders
    et al.
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institutet, Sweden.
    Arat, Arzu
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institutet, Sweden.
    Klöfvermark, Josefin
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institutet, Sweden.
    Report on differences in outcomes and performance by SES, family type and migrants of different primary care models for children2017Report (Refereed)
  • 40.
    Hjern, Anders
    et al.
    CHESS (Centre for Health Equity Studies), Karolinska Institutet/Stockholm University, Sweden.
    Berg, Lisa
    CHESS (Centre for Health Equity Studies), Karolinska Institutet/Stockholm University, Sweden.
    Arat, Arzu
    CHESS (Centre for Health Equity Studies), Karolinska Institutet/Stockholm University, Sweden.
    Klöfvermark, Josefin
    CHESS (Centre for Health Equity Studies), Karolinska Institutet/Stockholm University, Sweden.
    Manhica, Hélio
    CHESS (Centre for Health Equity Studies), Karolinska Institutet/Stockholm University, Sweden.
    Rostila, Mikael
    CHESS (Centre for Health Equity Studies), Karolinska Institutet/Stockholm University, Sweden.
    Vinnerljung, Bo
    Department of Social Work, Stockholm University, Sweden.
    Hovstadius, Bo
    eHealth Institute, Linnaeus University, Kalmar, Sweden.
    Ericson, Lisa
    eHealth Institute, Linnaeus University, Kalmar, Sweden.
    Magnusson, Lennart
    Department of Health and Caring Science, Linnaeus University; Swedish Family Care Competence Centre, Kalmar, Sweden.
    Children as next of kin in Sweden2017Report (Other academic)
  • 41.
    Hjern, Anders
    et al.
    Centrum för forskning om ojämlikhet i hälsa (CHESS), Stockholms universitet/ Karolinska Institutet, Sweden.
    Klöfvermark, Josefin
    Centrum för forskning om ojämlikhet i hälsa (CHESS), Stockholms universitet/ Karolinska Institutet, Sweden.
    Barn som anhöriga till flyktingföräldrar med post-traumatisk stress: en systematisk litteraturstudie2017Report (Other academic)
  • 42.
    Karlsson, E
    et al.
    Karolinska Institute.
    Sjögren Forss, K
    Blekinge Institute of Technology.
    Jorgréus, C
    Blekinge Institute of Technology.
    Stjernberg, Louise
    Blekinge Institute of Technology.
    Exercise and factors associated with active commuting2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no S2, p. 312-Article in journal (Other academic)
  • 43.
    Kavaliunas, Andrius
    et al.
    Karolinska Institutet.
    Wiberg, Michael
    Karolinska Institutet / Swedish Social Insurance Agency.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Glaser, Anna
    Karolinska Institutet.
    Gyllensten, Hanna
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Earnings and Financial Compensation from Social Security Systems Correlate Strongly with Disability for Multiple Sclerosis Patients2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 12, article id e0145435Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Multiple sclerosis (MS) patients earn lower incomes and receive higher benefits. However, there is limited knowledge of how this is correlated with their disability.

    OBJECTIVE: To elucidate sources and levels of income among MS patients with different disability, assessed with the Expanded Disability Status Scale.

    METHODS: A total of 7929 MS patients aged 21-64 years and living in Sweden in 2010 were identified for this cross-sectional study. Descriptive statistics, logistic and truncated linear regression models were used to estimate differences between MS patients regarding earnings, disability pension, sickness absence, disability allowance, unemployment compensation, and social assistance.

    RESULTS: The average level of earnings was ten times lower and the average level of health- related benefits was four times higher when comparing MS patients with severe and mild disability. MS patients with severe disability had on average SEK 166,931 less annual income from earnings and SEK 54,534 more income from benefits compared to those with mild disability. The combined average income for MS patients was 35% lower when comparing patients in the same groups. The adjusted risk ratio for having earnings among MS patients with severe disability compared to the patients with mild disability was 0.33 (95% CI 0.29-0.39), while the risk ratio for having benefits was 1.93 (95% CI 1.90-1.94).

    CONCLUSIONS: Disease progression affects the financial situation of MS patients considerably. Correlations between higher disability and patient income were observed, suggesting that earnings and benefits could be used as measures of MS progression and proxies of disability.

  • 44.
    Klöfvermark, Josefin
    et al.
    Stockholm University/Karolinska Institute/Karolinska University Hospital.
    Hjern, Anders
    Stockholm University/Karolinska Institute/Karolinska University Hospital.
    Juárez, Sol Pía
    Stockholm University/Karolinska Institute.
    Acculturation or unequal assimilation?: Smoking during pregnancy and duration of residence among migrants in Sweden2019In: SSM - Population Health, ISSN 2352-8273, Vol. 8, article id 100416Article in journal (Refereed)
    Abstract [en]

    A growing corpus of evidence reveals that smoking patterns of migrant women tend to converge with that of the host population over time (‘acculturation paradox’). In this paper we aim to adopt a health equity perspective by studying the extent to which this pattern reflects a convergence with the group of natives who are more socioeconomically disadvantaged. Using population-based registers, we study 1,194,296 women who gave birth in Sweden between 1991 and 2012. Using logistic regression, we estimated odds ratios to assess the effect of duration of residence on the association between smoking during pregnancy and women's origin (classified according to inequality-adjusted Human Development Index (iHDI) of the country of birth). Sibling information and multilevel models were used to assess the extent to which our results might be affected by the cross-sectional nature of the data. Smoking during pregnancy increases with duration of residence among migrants from all levels of iHDI to such an extent that they tend to converge or increase in relation to the levels of the Swedish population with low education and low income, leaving behind the native population with high education and income. The results are robust to possible selection bias related to the cross-sectional nature of the data. Ourfindings indicate the need of a health equity perspective and suggest the use of ‘unequal assimilation’ rather than ‘acculturation paradox’ as a more suitable framework to interpret these findings.

  • 45.
    Kreimeier, Simone
    et al.
    Bielefeld University, Bielefeld, Germany.
    Åström, Mimmi
    Karolinska Institutet / Stockholm County Council.
    Burström, Kristina
    Karolinska Institutet / Stockholm County Council.
    Egmar, Ann-Charlotte
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Gusi, Narcis
    University of Extremadura, Badajoz, Spain.
    Herdman, Michael
    Office of Health Economics, London, UK.
    Kind, Paul
    University of Leeds, Leeds, UK / Higher School of Economics, St Petersburg, Russia.
    Perez-Sousa, Miguel A
    University of Extremadura, Badajoz, Spain.
    Greiner, Wolfgang
    Bielefeld University, Bielefeld, Germany.
    EQ-5D-Y-5L: developing a revised EQ-5D-Y with increased response categories.2019In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 28, no 7, p. 1951-1961Article in journal (Refereed)
    Abstract [en]

    PURPOSE: EQ-5D-Y is a generic measure of health status for children and adolescents aged 8-15 years. Originally, it has three levels of severity in each dimension (3L). This study aimed to develop a descriptive system of EQ-5D-Y with an increased number of severity levels and to test comprehensibility and feasibility.

    METHODS: The study was conducted in Germany, Spain, Sweden and the UK. In Phase 1, a review of existing instruments and focus group interviews were carried out to create a pool of possible labels for a modified severity classification. Participants aged 8-15 rated the severity of the identified labels in individual sorting and response scaling interviews. In Phase 2, preliminary 4L and 5L versions were constructed for further testing in cognitive interviews with healthy participants aged 8-15 years and children receiving treatment for a health condition.

    RESULTS: In Phase 1, a total of 233 labels was generated, ranging from 37 (UK) to 79 labels (Germany). Out of these, 7 to 16 possible labels for each dimension in the different languages were rated in 255 sorting and response scaling interviews. Labels covered an appropriate range of severity on the health continuum in all countries. In Phase 2, the 5L version was generally preferred (by 68-88% of the participants per country) over the 4L version.

    CONCLUSIONS: This multinational study has provided a version of the EQ-5D-Y with 5 severity levels in each dimension. This extended version (EQ-5D-Y-5L) requires testing its psychometric properties and its performance compared to that of the original EQ-5D-Y-3L.

  • 46.
    Lallukka, Tea
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland Department of Public Health, University of Helsinki, Finland .
    Ervasti, Jenni
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Kjeldgård, Linnea
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    The joint contribution of diabetes and work disability to premature death during working age: a population-based study in Sweden.2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 6, p. 580-586Article in journal (Refereed)
    Abstract [en]

    AIMS: We aimed to examine how newly diagnosed diabetes and work disability jointly predict death during working age.

    METHODS: We used prospective population-based register data of 25-59-year-old adults who had lived in Sweden since 2002. All those with onset of diabetes recorded in 2006 were included (n=14266). A 2% random sample (n=78598) was drawn from the general population, comprising people with no indication of diabetes during 2003-2010. Net days of sickness absence and disability pension in 2005-2006 were examined; the follow-up time for mortality was 2007-2010. Cox regression models were fitted (hazard ratios, HR, 95% confidence interval, CI) adjusting for sociodemographics and time-dependent health conditions.

    RESULTS: Individuals with diabetes and work disability for over 6 months were at a higher risk of premature death (HR=14.2, 95% CI 12.0-16.8) than their counterparts without diabetes and work disability. A high risk was also observed among people without diabetes but equally prolonged work disability (HR=6.4, 95% CI 5.4-7.6). Diabetes was associated with premature death even without work disability (HR=3.5, 95% CI 2.8-4.4). The associations were particularly attenuated after adjustment for health conditions assessed over the follow-up.

    CONCLUSIONS: DIABETES AND WORK DISABILITY JOINTLY INCREASE THE RISK OF DEATH DURING WORKING AGE DIABETES WITH LONG-TERM WORK DISABILITY IS ASSOCIATED WITH THE HIGHEST RISK OF PREMATURE DEATH, WHICH HIGHLIGHTS THE IMPORTANCE OF THEIR PREVENTION AND EARLY DETECTION.

  • 47.
    Leander, Mai
    et al.
    The Swedish Red Cross University College. Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala.
    Lampa, Erik
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala.
    Janson, Christer
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala.
    Svärdsudd, Kurt
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala.
    Uddenfeldt, Monica
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala.
    Rask-Andersen, Anna
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala.
    Determinants for a low health-related quality of life in asthmatics2012In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, no 1, p. 57-66Article in journal (Refereed)
    Abstract [en]

    People with asthma suffer from impaired health-related quality of life (HRQL), but the determinants of HRQL among asthmatics are not completely understood. The aim of this investigation was to study determinants of low HRQL in asthmatics and to study whether the determinants of HRQL differ between sexes and age groups. A cohort of three age groups in Sweden was investigated in 1990 using a questionnaire with focus on respiratory symptoms. To study quality of life, the generic instrument Gothenburg Quality of Life was used. The participants were also investigated with interviews, spirometry, and allergy testing. Asthma was diagnosed in 616 subjects. Fifty-eight per cent (n = 359) of the subjects were women; and 24% were smokers, 22% ex-smokers, and 54% were non-smokers. Women were more likely than men to report poor health-related quality of life. Respiratory symptoms severity was another independent determinant of a lower quality of life as well as airway responsiveness to irritants. Current and former smokers also reported lower quality of life. Finally, absenteeism from school and work was associated with lower quality of life. Factors such as sex, smoking habits, airway responsiveness to irritants, respiratory symptom severity, allergy, and absenteeism from school and work were associated with low HRQL in asthmatics.

  • 48.
    Lindh, Marianne
    et al.
    Ersta Sköndal University College.
    Holmström, Inger K
    Mälardalen University / Uppsala University.
    Perseius, Kent-Inge
    The Swedish Red Cross University College, Department of Technology and Welfare. Karolinska Institutet.
    Windahl, Jenny
    Örebro University.
    Enhancing adherence to infection control in Swedish community care: Factors of importance2016In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 18, no 3, p. 275-282Article in journal (Refereed)
    Abstract [en]

    Healthcare-associated infections are the most frequent adverse event in healthcare delivery worldwide. The theory of planned behavior has proven helpful in hospital hygiene interventions and might be useful in community care. This study explored how medically-responsible nurses in Swedish community care perceived and ranked the impact of factors related to the theory of planned behavior, the factors" probability to change, enhancing the healthcare staff's adherence to infection control guidelines, and identified which theory of planned behavior subquestions should be focused on to enhance adherence to infection control. Medically-responsible nurses (n = 268) in Swedish communities answered a Web-based questionnaire regarding impact and probability to change theory of planned behavior factors in relation to infection control. Four theory of planned behavior factor constructs were found: (i) knowledge and encouragement from management; (ii) access and availability to materials and equipment, and interest among staff; (iii) influence by colleagues; and (iv) workload, and influence by patients and significant others. The theory of planned behavior factors are relevant for infection control in a home-like environment, and findings could be used as a basis for interventions enhancing hygiene in community care.

  • 49.
    Lundin, Andreas
    et al.
    Karolinska Institutet / Stockholm County Council.
    Åhs, Jill
    Karolinska Institutet.
    Åsbring, Nina
    Stockholm County Council.
    Kosidou, Kyriaki
    Karolinska Institutet / Stockholm County Council.
    Dal, Henrik
    Karolinska Institutet / Stockholm County Council.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Dalman, Christina
    Karolinska Institutet / Stockholm County Council.
    Discriminant validity of the 12-item version of the general health questionnaire in a Swedish case-control study2017In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 71, no 3, p. 171-179Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The 12-item version of the General Health Questionnaire (GHQ-12) is widely used as a proxy for Affective Disorders in public health surveys, although the cut-off points for distress vary considerably between studies. The agreement between the GHQ-12 score and having a clinical disorder in the study population is usually unknown.

    AIMS: This study aimed to assess the criterion validity and to determine the sensitivity and specificity of the GHQ-12 in the Swedish population.

    METHODS: This study used 556 patient cases surveyed in specialized psychiatric care outpatient age- and sex-matched with 556 controls from the Stockholm Health Survey. Criterion validity for two scoring methods of GHQ-12 was tested using Receiver Operating Characteristics (ROC) analyses with Area Under the Curve (AUC) as a measure of agreement. Reference standard was (1) specialized psychiatric care and (2) current depression, anxiety or adjustment disorder.

    RESULTS: Both the Likert and Standard GHQ-12 scoring method discriminated excellently between individuals using specialized psychiatric services and healthy controls (Likert index AUC = 0.86, GHQ index AUC = 0.83), and between individuals with current disorder from healthy controls (Likert index AUC = 0.90, GHQ index AUC = 0.88). The best cut-off point for the GHQ index was ≥4 (sensitivity = 81.7 and specificity = 85.4), and for the Likert index ≥14 (sensitivity = 85.5 and specificity = 83.2).

    CONCLUSIONS: The GHQ-12 has excellent discriminant validity and is well suited as a non-specific measure of affective disorders in public mental health surveys.

  • 50.
    Löfvenmark, C
    et al.
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Saboonchi, Fredrik
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Edner, M
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Billing, E
    Department of Medical Sciences, Uppsala University, Uppsala.
    Mattiasson, A.-C
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Evaluation of an educational programme for family members of patients living with heart failure: a randomised controlled trial2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 1-2, p. 115-126Article in journal (Refereed)
    Abstract [en]

    Aims and objectives.  To evaluate the effect of a group-based multi-professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study.

    Background.  When a person is diagnosed with heart failure, the daily life of the family members is also affected.

    Design.  Randomised controlled trial.

    Methods.  A total of 128 family members were randomly assigned to participate in a multi-professional educational programme or a control group. Analysis of variance and regression analysis were used.

    Results.  There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety (p < 0·001, R2 = 0·35) and depression (p = 0·021, R2 = 0·37). Younger family members were found to have a higher quality of life (p < 0·01).

    Conclusion.  Improved disease-related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members.

    Relevance to clinical practice.  Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members.

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