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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.
    Amin, R.
    et al.
    Karolinska Institutet, Sweden.
    Mittendorfer-Rutz, E.
    Karolinska Institutet, Sweden.
    Mehlum, L.
    University of Oslo, Norway.
    Runeson, B.
    Karolinska Institutet, Sweden.
    Helgesson, M.
    Karolinska Institutet, Sweden.
    Tinghög, Petter
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institutet, Sweden.
    Björkenstam, E.
    Karolinska Institutet, Sweden.
    Holmes, E. A.
    Karolinska Institutet, Sweden; Uppsala University, Sweden.
    Qin, P.
    University of Oslo, Norway.
    Does country of resettlement influence the risk of suicide in refugees?: A case-control study in Sweden and Norway2021In: Epidemiology and Psychiatric Sciences, ISSN 2045-7960, E-ISSN 2045-7979, Vol. 30, article id e62Article in journal (Refereed)
    Abstract [en]

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

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  • 5.
    Amin, Ridwanul
    et al.
    Karolinska Institutet.
    Helgesson, Magnus
    Karolinska Institutet.
    Runeson, Bo
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences.
    Mehlum, Lars
    University of Oslo, Oslo, Norway.
    Qin, Ping
    University of Oslo, Oslo, Norway.
    Holmes, Emily A
    Karolinska Institutet / Uppsala universitet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Suicide attempt and suicide in refugees in Sweden - a nationwide population-based cohort study2021In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 51, no 2, p. 254-263Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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  • 6.
    Amin, Ridwanul
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet.
    Rahman, Syed
    Department of Clinical Neuroscience, Karolinska Institutet.
    Helgesson, Magnus
    Department of Clinical Neuroscience, Karolinska Institutet.
    Björkenstam, Emma
    Department of Clinical Neuroscience, Karolinska Institutet.
    Runeson, Bo
    Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences.
    Mehlum, Lars
    National Centre for Suicide Research and Prevention, University of Oslo.
    Qin, Ping
    National Centre for Suicide Research and Prevention, University of Oslo.
    Mittendorfer-Rutz, Ellenor
    Department of Clinical Neuroscience, Karolinska Institutet.
    Trajectories of antidepressant use before and after a suicide attempt among refugees and Swedish-born individuals: a cohort study2021In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 20, no 1, article id 131Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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  • 7.
    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)
  • 8.
    Bashkin, O.
    et al.
    Ashkelon Academic College, Israel.
    Dopelt, K.
    Ashkelon Academic College, Israel; Ben Gurion University of the Negev, Israel.
    Mor, Z.
    Ashkelon Academic College, Israel.
    Leighton, L.
    The Association of Schools of Public Health in the European Region (ASPHER), Belgium.
    Otok, R.
    The Association of Schools of Public Health in the European Region (ASPHER), Belgium.
    Duplaga, M.
    Jagiellonian University Medical College, Poland.
    MacLeod, F.
    University College Cork, Ireland.
    De Nooijer, J.
    Maastricht University, The Netherlands.
    Neumark, Y.
    Hebrew University-Hadassah, Israel.
    Paillard-Borg, Stéphanie
    The Swedish Red Cross University College, Department of Health Sciences.
    Tulchinsky, T.
    Ashkelon Academic College, Israel.
    Zelber-Sagi, S.
    University of Haifa, Israel.
    Davidovitch, N.
    Ben Gurion University of the Negev, Israel; Israeli Medical Association, Israel.
    The future public health workforce in a changing world: A conceptual framework for a european–israeli knowledge transfer project2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 17, article id 9265Article in journal (Refereed)
    Abstract [en]

    Health services quality and sustainability rely mainly on a qualified workforce. Adequately trained public health personnel protect and promote health, avert health disparities, and allow rapid response to health emergencies. Evaluations of the healthcare workforce typically focus on physicians and nurses in curative medical venues. Few have evaluated public health workforce capacity building or sought to identify gaps between the academic training of public health employees and the needs of the healthcare organizations in which they are employed. This project report describes the conceptual framework of “Sharing European Educational Experience in Public Health for Israel (SEEEPHI): harmonization, employability, leadership, and outreach”—a multinational Erasmus+ Capacity Building in Higher Education funded project. By sharing European educational experience and knowledge, the project aims to enhance professionalism and strengthen leadership aspects of the public health workforce in Israel to meet the needs of employers and the country. The project’s work packages, each jointly led by an Israeli and European institution, include field qualification analysis, mapping public health academic training programs, workforce adaptation, and building leadership capacity. In the era of global health changes, it is crucial to assess the capacity building of a well-qualified and competent workforce that enables providing good health services, reaching out to minorities, preventing health inequalities, and confronting emerging health challenges. We anticipate that the methods developed and the lessons learned within the Israeli context will be adaptable and adoptable by other countries through local and cultural adjustments.

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  • 9.
    Bashkin, Osnat
    et al.
    Ashkelon Academic College, Ashkelon, Israel.
    Otok, Robert
    Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium.
    Kapra, Ori
    Ashkelon Academic College, Ashkelon, Israel.
    Czabanowska, Kasia
    Maastricht University, Maastricht, Netherlands.
    Barach, Paul
    Jefferson College of Population Health, Philadelphia, PA, United States; Sigmund Freud University Vienna, Vienna, Austria.
    Baron-Epel, Orna
    University of Haifa, Haifa, Israel.
    Dopelt, Keren
    Ashkelon Academic College, Ashkelon, Israel; Ben Gurion University of the Negev, Beer-Sheva, Israel.
    Duplaga, Mariusz
    Jagiellonian University Medical College, Krakow, Poland.
    Leighton, Lore
    Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium.
    Levine, Hagai
    Israeli Medical Association, Ramat-Gan, Israel.
    MacLeod, Fiona
    University College Cork, Cork, Ireland.
    Neumark, Yehuda
    Hebrew University of Jerusalem, Jerusalem, Israel.
    Paillard-Borg, Stéphanie
    Swedish Red Cross University, Department of Health Sciences.
    Tulchinsky, Theodore
    Ashkelon Academic College, Ashkelon, Israel.
    Mor, Zohar
    Ashkelon Academic College, Ashkelon, Israel.
    Identifying the Gaps Between Public Health Training and Practice: A Workforce Competencies Comparative Analysis2022In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 67, article id 1605303Article in journal (Refereed)
    Abstract [en]

    Objectives: The study aimed to generate insights on how best to enhance the compatibility between Public Health training program competencies and the implementation of competencies required by employers to address current and emerging public health needs.

    Methods: A survey adapted from the WHO-ASPHER Competency Framework for the Public Health Workforce was conducted online among Israeli public health managers from August to November 2021. The survey was formulated to mirror Essential Public Health Operations. Forty-nine managers participated (37.6% response rate) in an assessment of 44 public health competencies and the core organizational public health operations.

    Results: Analysis of Essential Public Health Operations revealed a notably high deficiency reported for Advocacy Communication and Social Mobilization for health competencies. Collaborations and Partnership and, Leadership and System Thinking were the most reported insufficient competencies, particularly in health departments and research institutes. Governmental offices reported Organizational Literacy and Adaptability competencies being deficient. Deficiencies were more impactful as the level of expertise increased.

    Conclusion: There is a clear need for public health professionals to acquire versatile and innovative competencies in response to the ever-changing health threats.

  • 10.
    Bashkin, Osnat
    et al.
    Ashkelon Academic College, Israel.
    Otok, Robert
    The Association of Schools of Public Health in the European Region (ASPHER), Belgium.
    Leighton, Lore
    The Association of Schools of Public Health in the European Region (ASPHER), Belgium.
    Czabanowska, Kasia
    Maastricht University, Netherlands..
    Barach, Paul
    Thomas Jefferson University, USA; Sigmund Freud University, Austria.
    Davidovitch, Nadav
    Ben Gurion University of the Negev, Israel; Israeli Medical Association, Israel.
    Dopelt, Keren
    Ashkelon Academic College, Israel; Ben Gurion University of the Negev, Israel.
    Duplaga, Mariusz
    Jagiellonian University Medical College, Poland.
    Okenwa-Emegwa, Leah
    Swedish Red Cross University, Department of Health Sciences.
    MacLeod, Fiona
    University College Cork, Ireland.
    Neumark, Yehuda
    Hebrew University-Hadassah, Israel.
    Raz, Maya Peled
    University of Haifa, Israel.
    Tulchinsky, Theodore
    Ashkelon Academic College, Israel.
    Mor, Zohar
    Ashkelon Academic College, Israel.
    Emerging lessons from the COVID-19 pandemic about the decisive competencies needed for the public health workforce: A qualitative study2022In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, article id 990353Article in journal (Refereed)
    Abstract [en]

    The global COVID-19 crisis exposed the critical need for a highly qualified public health workforce. This qualitative research aimed to examine public health workforce competencies needed to face COVID-19 challenges and identify the gaps between training programs and the competency demands of real-world disasters and pandemics. Through a sample of thirty-one participant qualitative interviews, we examined the perspectives of diverse stakeholders from lead public health organizations in Israel. Grounded Theory was used to analyze the data. Six themes emerged from the content analysis: public health workforce's low professional status and the uncertain future of the public health workforce; links between the community and Higher Education institutions; the centrality of communication competencies; need to improve health promotion; the role of leadership, management, and partnership, and innovation in public health coherence. Increasing the attractiveness of the profession, professional and financial support, and improving the working conditions to ensure a sustainable and resilient PH system were deemed necessary. This paper describes and cultivates new knowledge and leadership skills among public health professionals, and lays the groundwork for future public health leadership preparedness programs.

  • 11.
    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.

  • 12.
    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.

  • 13.
    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.

  • 14.
    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.

  • 15.
    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, 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.

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  • 16.
    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.

  • 17.
    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)
  • 18.
    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, Experimental, Translational and Clinical, E-ISSN 2055-2173, 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.

  • 19.
    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, 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.

  • 20.
    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, 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.

  • 21.
    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.

  • 22.
    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, 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.

  • 23.
    Carvajal, Liliana
    et al.
    Division of Data Analytics Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Ottman, Katherine
    Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia.
    Åhs, Jill
    Swedish Red Cross University, Department of Health Sciences. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Li, Geffrey Nan
    UNICEF, Belize City, Belize.
    Simmons, Juliet
    Department of Mental Health, Ministry of Health and Wellness, Belize City, Belize.
    Chorpita, Bruce
    Department of Psychology, University of California, Los Angeles, Los Angeles, California.
    Requejo, Jennifer Harris
    Division of Data Analytics Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York.
    Kohrt, Brandon A
    Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia.
    Translation and Adaptation of the Revised Children's Anxiety and Depression Scale: A Qualitative Study in Belize2023In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 72, no S1, p. S34-S39Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Adapting data collection instruments using transcultural translation and adaptation processes is essential to ensure that respondents comprehend the items and the original meaning is retained across languages and contexts. This approach is central to UNICEF's efforts to expand the use of standard data collection tools across settings and close the global data gap on adolescent mental health.

    METHODS: We conducted transcultural translation and adaptation processes in Belize using the Revised Children's Anxiety and Depression Scale (RCADS). Items from the original scale were translated into Belizean English and Kriol, reviewed by local mental health experts, and discussed in focus groups. Cognitive interviews were conducted with adolescents and parents. The information collected was analyzed with cultural equivalence domains: comprehensibility, acceptability, relevance, completeness, and technical equivalence. Bilingual discussions of findings informed the final item wordings, and the adapted tool was back-translated.

    RESULTS: Adaptation of terms and specific expressions were done to improve comprehensibility and to ensure the appropriate clinical meaning. For example, the expression 'feeling scared' was perceived to imply immaturity or threaten masculinity and was adapted to 'feeling afraid.' Expressions like "shaky" were modified to "trimble" in Kriol. Statements were reworded as questions to enhance acceptability and comprehensibility.

    DISCUSSION: A culturally adapted version of the RCADS was developed for use among adolescents in Belize in Belizean English and Kriol. The transcultural translation and adaptation procedure can be applied for other settings or tools to design contextual adaptations of mental health instruments prior to their validation or use in new settings.

  • 24.
    Carvajal, Liliana
    et al.
    UNICEF, USA; Karolinska Institutet, Sweden.
    Åhs, Jill W.
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institutet, Sweden.
    Requejo, Jennifer Harris
    UNICEF, USA.
    Kieling, Christian
    Hospital de Clínicas de Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Brazil.
    Lundin, Andreas
    Karolinska Institutet, Sweden.
    Kumar, Manasi
    University of Nairobi, Kenya.
    Luitel, Nagendra P.
    Transcultural Psychosocial Organization (TPO) Nepal, Nepal.
    Marlow, Marguerite
    Stellenbosch University, UK.
    Skeen, Sarah
    Stellenbosch University, UK.
    Tomlinson, Mark
    Stellenbosch University, UK; Queens University, UK.
    Kohrt, Brandon A.
    George Washington University, USA.
    Measurement of Mental Health Among Adolescents at the Population Level: A Multicountry Protocol for Adaptation and Validation of Mental Health Measures2023In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 72, no 1S, p. S27-S33Article in journal (Refereed)
    Abstract [en]

    Purpose: Mental disorders are among the leading causes of disability among adolescents aged 10-19 years. However, data on prevalence of mental health conditions are extremely sparse across low- and middle-income countries, even though most adolescents live in these settings. This data gap is further exacerbated because few brief instruments for adolescent mental health are validated in these settings, making population-level measurement of adolescent mental health especially cumbersome to carry out. In response, the UNICEF has undertaken the Measurement of Mental Health Among Adolescents at the Population Level (MMAP) initiative, validating open-access brief measures and encouraging data collection in this area.

    Methods: This protocol presents the MMAP mixed-methods approach for cultural adaptation and clinical validation of adolescent mental health data collection tools across settings. Qualitative activities include an initial translation and adaptation, review by mental health experts, focus-group discussions with adolescents, cognitive interviews, synthesis of findings, and back-translation. An enriched sample of adolescents with mental health problems is then interviewed with the adapted tool, followed by gold-standard semistructured diagnostic interviews.

    Results: The study protocol is being implemented in Belize, Kenya, Nepal, and South Africa and includes measures for anxiety, depression, functional limitations, suicidality, care-seeking, and connectedness. Analyses, including psychometrics, will be conducted individually by country and combined across settings to assess the MMAP methodological process.

    Discussion:This protocol contributes to closing the data gap on adolescent mental health conditions by providing a rigorous process of cross-cultural adaptation and validation of data collection approaches.

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  • 25.
    Carvajal-Velez, Liliana
    et al.
    Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Harris Requejo, Jennifer
    Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York.
    Åhs, Jill
    Swedish Red Cross University, Department of Health Sciences. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Idele, Priscilla
    UNICEF Office of Research-Innocenti, Florence, Italy.
    Adewuya, Abiodun
    Lagos State University College of Medicine, Lagos, Nigeria.
    Cappa, Claudia
    Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York.
    Guthold, Regina
    Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland.
    Kapungu, Chisina
    WomenStrong International, Washington, District of Columbia.
    Kieling, Christian
    Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
    Patel, Vikram
    Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Sangath, Goa, India.
    Patton, George
    University of Melbourne and Murdoch Children’s Research Institute, Melbourne, Victoria, Australia.
    Scott, James G.
    Child and Youth Mental Health Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
    Servili, Chiara
    Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.
    Wasserman, Danuta
    National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.
    Kohrt, Brandon A.
    Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia.
    Increasing Data and Understanding of Adolescent Mental Health Worldwide: UNICEF’s Measurement of Mental Health Among Adolescents at the Population Level Initiative2023In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 72, no S1, p. S12-S14Article in journal (Other academic)
  • 26.
    Carvajal-Velez, Liliana
    et al.
    UNICEF, USA; Karolinska Institutet, Sweden.
    Åhs, Jill W.
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institutet, Sweden.
    Lundin, Andreas
    Karolinska Institutet, Sweden.
    van den Broek, Myrthe
    University of Amsterdam, Netherlands.
    Simmons, Juliet
    Ministry of Health and Wellness, Belize.
    Wade, Paulette
    UNICEF, Belize.
    Chorpita, Bruce
    University of California, USA.
    Requejo, Jennifer Harris
    UNICEF, USA.
    Kohrt, Brandon A.
    George Washington University, USA.
    Validation of the Kriol and Belizean English Adaptation of the Revised Children's Anxiety and Depression Scale for Use With Adolescents in Belize2023In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 72, no S1, p. S40-S51Article in journal (Refereed)
    Abstract [en]

    Purpose: To validate a culturally-adapted Kriol and Belizean English version of the Revised Children's Anxiety and Depression Scale (RCADS) through comparison with clinical diagnoses made using the Kiddie Schedule of Affective Disorders and Schizophrenia.

    Methods: Participants comprised of 256 adolescents aged 10-14 years and 15-19 years, who completed the adapted RCADS (10 depression items, 12 anxiety items) in one-on-one interviews, followed by a diagnostic assessment using Kiddie Schedule of Affective Disorders and Schizophrenia administered by trained clinicians. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratios, area under the curve (AUC), and Youden's Index were calculated for RCADS cutoffs and scores on the total scale and anxiety and depression subscales.

    Results: For adolescents aged 10-14 years (n = 161), the AUC was 0.72 for the full scale, 0.67 for anxiety subscale, and 0.76 for depression subscale. For adolescents aged 15-19 years (n = 95), the AUCs were 0.82, 0.77, and 0.83. Most depression items performed well in discriminating those with and without diagnoses. Separation anxiety items performed poorly. "Thoughts of death" were common even among adolescents not meeting diagnostic criteria. The RCADS depression subscale presented the strongest psychometric properties with adolescents aged 15-19 years (at cutoff of 13, sensitivity = 0.83, specificity = 0.77, positive predictive value = 0.47, negative predictive value = 0.95, odds ratio = 15.96).

    Conclusion: The adapted RCADS-22 had acceptable categorization for adolescents aged 10-14 years and excellent categorization for adolescents aged 15-19 years; therefore, the tool is recommended for use among the latter age group. Based on sensitivity and specificity values at different cutoffs, guidance is provided to select different thresholds to suit clinical, public health, or other uses to detect and quantify adolescent depression and anxiety in Belize.

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  • 27.
    Celso, Christine Nicole
    et al.
    Swedish Red Cross University.
    Guzman Velasquez, Sol Melodi
    Swedish Red Cross University.
    ”Sjukhuset stressar mig!”: En litteraturstudie om orsaker till sjuksköterskors upplevelse av arbetsrelaterad stress2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Nurses have a responsibility when it comes to patients’ health and safety in the hospital. Challenges and greater demands lead to stressful conditions, which have shown to have negative effects on health. Work-related stress is high among nurses who work in hospitals, this affects not only the nurses but also the patients care. 

    Aim: The aim of this study was to describe the causes of nurses' experience of work-related stress in hospitals

    Method: A literature study with a qualitative approach that follows Polit and Beck’s nine-step model and Braun and Clarke’s thematic analysis. Original articles were retrieved from the following databases: PubMed and Cinahl. 

    Results: Five main themes were identified and presented in the results: Multitasking, Lack of interaction between employees, Lack of staff, Insufficient support and guidance from managers and dissatisfaction and violence

    Conclusions: Nurses experience work-related stress which can result in physical and mental illness. In addition, it has been shown that work-related stress reduces nurses' work performance, job satisfaction and quality of care.

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  • 28.
    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.

  • 29.
    Colvin, Christopher J
    et al.
    University of Cape Town.
    Smith, Helen J
    Liverpool School of Tropical Medicine.
    Swartz, Alison
    University of Cape Town.
    Åhs, Jill
    Duke University.
    de Heer, Jodie
    University of Cape Town.
    Opiyo, Newton
    KEMRI-Wellcome Trust Research Programme.
    Kim, Julia C
    UNICEF.
    Marraccini, Toni
    University of Cape Town.
    George, Asha
    Johns Hopkins University.
    Understanding careseeking for child illness in sub-Saharan Africa: a systematic review and conceptual framework based on qualitative research of household recognition and response to child diarrhoea, pneumonia and malaria2013In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 86, p. 66-78, article id S0277-9536(13)00113-5Article in journal (Refereed)
    Abstract [en]

    Diarrhoea, pneumonia and malaria are the largest contributors to childhood mortality in sub-Saharan Africa. While supply side efforts to deliver effective and affordable interventions are being scaled up, ensuring timely and appropriate use by caregivers remains a challenge. This systematic review synthesises qualitative evidence on the factors that underpin household recognition and response to child diarrhoea, pneumonia and malaria in sub-Saharan Africa. For this review, we searched six electronic databases, hand searched 12 journals from 1980 to 2010 using key search terms, and solicited expert review. We identified 5104 possible studies and included 112. Study quality was appraised using the Critical Appraisal Skills Program (CASP) tool. We followed a meta-ethnographic approach to synthesise findings according to three main themes: how households understand these illnesses, how social relationships affect recognition and response, and how households act to prevent and treat these illnesses. We synthesise these findings into a conceptual model for understanding household pathways to care and decision making. Factors that influence household careseeking include: cultural beliefs and illness perceptions; perceived illness severity and efficacy of treatment; rural location, gender, household income and cost of treatment. Several studies also emphasise the importance of experimentation, previous experience with health services and habit in shaping household choices. Moving beyond well-known barriers to careseeking and linear models of pathways to care, the review suggests that treatment decision making is a dynamic process characterised by uncertainty and debate, experimentation with multiple and simultaneous treatments, and shifting interpretations of the illness and treatment options, with household decision making hinging on social negotiations with a broad variety of actors and influenced by control over financial resources. The review concludes with research recommendations for tackling remaining gaps in knowledge.

  • 30.
    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.

  • 31. Dalman, Christina
    et al.
    Corman, Diana
    Dal, Henrik
    Hollander, Anna-Clara
    Jablonska, Beata
    Kosidou, Kyriaki
    Wicks, Susanne
    Åhs, Jill
    Fördjupning barn och unga –uppdrag psykisk hälsa2017Report (Other academic)
  • 32.
    Dangmann, C.
    et al.
    Inland Norway University of Applied Sciences, Norway.
    Solberg, Øivind
    Swedish Red Cross University, Department of Health Sciences.
    Steffenak, A. K. M.
    Inland Norway University of Applied Sciences, Norway.
    Hoye, S.
    Inland Norway University of Applied Sciences, Norway.
    Andersen, P. N.
    Inland Norway University of Applied Sciences, Norway.
    Resilience in Syrian refugee youth2022In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background: The importance of resilience factors in the positive adaptation of refugee youth is widely recognised. However, their actual mechanism of impact remains under-researched. The aim of this study was therefore to explore protective and promotive resilience mechanisms on both negative and positive mental health outcomes. Promotive resilience is seen as a direct main effect and protective resilience as a moderating effect.

    Methods: Cross-sectional study with 160 Syrian youth aged 13-24 years, who recently resettled in Norway. A multi-dimensional measure for resilience was used to explore the potential impact of resilience factors on pathways between potentially traumatic events from war and flight (PTE), post-migration stress, mental distress and health-related quality of life (HRQoL). Analyses included regression, moderation and moderated mediation using the PROCESS macro for SPSS.

    Results: A direct main effect of resilience factors (promotive resilience mechanism) was found for HRQoL and general mental distress, but not for post-traumatic stress disorder (PTSD). No moderating effects of resilience factors (protective resilience mechanism) were found. Post-migration stressors mediated the effects of PTE, and this indirect effect was present at all levels of resilience. Relational and environmental level resilience factors and combined amounts had more impact than individual level factors.

    Conclusions: Despite high risk exposure and mental distress, resilience was also high. The direct main effect of resilience factors and less impact on PTSD, suggests universal resilience building interventions may be beneficial, compared to exclusively targeting groups with high symptom levels. These interventions should target relational and environmental resilience factors as well as individual coping techniques. Additionally, reducing current stress and symptoms could increase the efficacy of resilience factors already present.

  • 33.
    Dangmann, Cecilie
    et al.
    Inland Norway University of Applied Sciences, Norway.
    Dybdahl, Ragnhild
    Norwegian Institute of Public Health, Norway; University of Bergen, Norway.
    Solberg, Øivind
    Swedish Red Cross University, Department of Health Sciences. Norwegian Church Aid, Norway.
    Mental health in refugee children2022In: Current Opinion in Psychology, ISSN 2352-250X, Vol. 48, article id 101460Article, review/survey (Refereed)
    Abstract [en]

    Almost half of the world's forcibly displaced population are children, most commonly originating from Syria, Iraq, and Afghanistan. Health disparities are well documented, especially for mental health, but not consistent across groups, time or context. Despite high exposure to trauma and stress, refugee children also show remarkable resilience. An ecological model of refugee health including both risk and resilience factors is therefore recommended. The model also includes the dynamic inter-relationship of past traumatic experiences, ongoing daily stressors and the disruptions of basic systems affecting both the individual and families as a whole, offering a framework to better understand the health disparities and appropriate interventions for refugee children.

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  • 34.
    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.

  • 35.
    Dopelt, Keren
    et al.
    Ben Gurion University of the Negev, Israel; Ashkelon Academic College, Israel.
    Shevach, Itamar
    Ben Gurion University of the Negev, Israel.
    Vardimon, Ofek Eliad
    Ben Gurion University of the Negev, Israel.
    Czabanowska, Katarzyna
    Maastricht University, Netherlands.
    De Nooijer, Jascha
    Maastricht University, Netherlands.
    Otok, Robert
    The Association of Schools of Public Health in the European Region (ASPHER), Belgium.
    Leighton, Lore
    The Association of Schools of Public Health in the European Region (ASPHER), Belgium.
    Bashkin, Osnat
    Ashkelon Academic College, Israel.
    Duplaga, Mariusz
    Jagiellonian University Medical College, Poland.
    Levine, Hagai
    Israeli Medical Association, Israel; Hebrew University of Jerusalem-Hadassah, Israel.
    MacLeod, Fiona
    University College Cork, Ireland.
    Malowany, Maureen
    Hebrew University of Jerusalem-Hadassah, Israel.
    Okenwa-Emegwa, Leah
    Swedish Red Cross University, Department of Health Sciences.
    Zelber-Sagi, Shira
    University of Haifa, Israel.
    Davidovitch, Nadav
    Ben Gurion University of the Negev, Israel, Israeli Medical Association, Israel.
    Barach, Paul
    Thomas Jefferson University, USA; Sigmund Freud University Vienna, Austria; Imperial College School of Medicine, UK.
    Simulation as a key training method for inculcating public health leadership skills: a mixed methods study2023In: Frontiers in Public Health, E-ISSN 2296-2565, Vol. 11, article id 1202598Article in journal (Refereed)
    Abstract [en]

    Background: Successful management of public health challenges requires developing and nurturing leadership competencies. We aimed to evaluate the effectiveness of training simulations to assess public health leadership and decision-making competencies during emergencies as an effective learning and training method.

    Methods: We examined the effects of two simulation scenarios on public health school students in terms of their experience (compared to face-to-face learning) and new skills acquired for dealing with similar emergent situations in the future. A mixed-methods design included developing a validated and pre-tested questionnaire with open-and closed-ended questions that examined the simulation impact and the degree of student satisfaction with the conditions in which it was conducted. Semi-structured in-depth interviews were conducted with the students after going through the simulations. The questionnaire results were evaluated using descriptive analytics. The interviews were analyzed using thematic analyses. All data were collected during June 2022.

    Results: The questionnaire results indicate that students strengthened their interpersonal communication skills and learned about the importance of listening to the opinions of others before formulating their positions. Four themes emerged from 16 in-depth interviews, according to Kolb’s experimental learning cycle. Students emphasized the effectiveness of experiential learning versus traditional classroom learning. The simulation scenarios were felt to realistically convey critical issues regarding leadership, decision-making, and teamwork challenges. They effectively conveyed the importance of building a culture of conducting substantive and respectful discussions.

    Conclusion: Simulation is a powerful pedagogical training tool for public health leadership competencies. Simulations were seen to be advantageous over face-to-face learning in imparting a range of leadership skills and hands-on practice. We recommend integrating simulations in all public health leadership training programs.

  • 36.
    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.

  • 37.
    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, 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.

  • 38.
    Ekstrand, Per
    et al.
    Swedish Red Cross University, Department of Health Sciences.
    Tegnestedt, Charlotta
    Swedish Red Cross University, Department of Health Sciences.
    Schuster, Marja
    Swedish Red Cross University, Department of Health Sciences. Department of Health Sciences, The Swedish Red Cross University College, Sweden.
    Eriksson, Henrik
    University West, Sweden.
    Hägg Martinell, Ann
    Swedish Red Cross University, Department of Health Sciences.
    Larsen, Joacim
    Academic Primary Health Care Centre, Stockholm County Council, Sweden.
    The meaning of health among newly arrived immigrants: A qualitative study from stakeholders’ perspectives2023In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 43, no 1Article in journal (Refereed)
    Abstract [en]

    Good health is a prerequisite for individuals to function in everyday life. The same applies to newly arrived immigrants, where good health is crucial for successful establishment. The aim of this study was to describe stakeholders’ experiences of how newly arrived immigrants’ health affects their opportunities to establish themselves in society. The study had a qualitative design where open-ended questions were analysed following Braun and Clarke’s guidelines for conducting a qualitative thematic analysis. The results consist of three themes: Mental health problems, disabilities, and tormenting concerns about absent family members; A precarious life situation related to housing, education, and income; and Deficiencies in responding to health challenges in organisations and in society. Stakeholders face health problems among newly arrived immigrants that they do not have the right skills to deal with. We argue for the presence of nurses in organisations working with newly arrived immigrants, and that nurses’ competence is necessary to capture their needs.

  • 39.
    Ericsson, Denise
    et al.
    Swedish Red Cross University.
    Ohlin Åstrand, Astrid
    Swedish Red Cross University.
    En länk mellan sjukvården och rättsväsendet: Sjuksköterskans erfarenheter av forensisk omvårdnad i mötet med vuxna brottsoffer2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: With increased incidence of violence in Sweden, forensic nursing is becoming an increasingly topical topic in healthcare. Forensic nursing is the link that connects healthcare and the justice system. The patient group consists of perpetrators, victims and relatives. Collection and preservation of evidence are things occurring in forensic nursing.

    Purpose: To describe the nurse's experiences of forensic nursing in the meeting with adult crime victims.

    Method: Literature review with a qualitative approach, nine articles were analyzed and processed. 

    Results: Two categories were worked out in the results; barriers in handling evidence and the nurse's emotional challenge. Two subcategories were; lack of knowledge, routines and protocols and lack of time. Treatment that instills empathy and security is important. Without training in forensic nursing, it becomes difficult for nurses to identify and provide adequate and correct care to the patient group.

    Conclusion: Forensic nursing can contribute to the conviction of perpetrators, create redress for crime victims and safe care. The nurse's work to detect and prevent violent crimes is important. Thus, nurses' training in forensic nursing is crucial. There is a need for further research in the area in order to add more knowledge.

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  • 40.
    Eriksson, Anneli
    et al.
    Department of Public Health Sciences, Health system and policy, Karolinska Institute.
    Ohlsén, Ylva Kristina
    Swedish Red Cross University, 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, 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.

  • 41.
    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.

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  • 42.
    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.

  • 43.
    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.

  • 44.
    Garoff, Ferdinand
    et al.
    Faculty of Medicine/Psychology, University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Suvisaari, Jaana
    National Institute for Health and Welfare, Helsinki, Finland.
    Lilja, Eero
    National Institute for Health and Welfare, Helsinki, Finland.
    Castaneda, Anu E.
    Faculty of Medicine/Psychology, University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland.
    Iranian and Iraqi torture survivors in Finland and Sweden: findings from two population-based studies2021In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, no 3, p. 493-498Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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  • 45.
    Gasevic, Danijela
    et al.
    Monash University, Australia.
    Alif, Sheikh M.
    Monash University, Australia.
    Okenwa-Emegwa, Leah
    Swedish Red Cross University, Department of Health Sciences.
    Editorial: Workplace Health Promotion, volume II2022In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10Article in journal (Other academic)
  • 46.
    Georgsson, Susanne
    et al.
    Swedish Red Cross University. Karolinska Institutet, Sweden.
    Carlsson, Tommy
    Swedish Red Cross University, Department of Health Sciences. Uppsala University, Sweden.
    Readability, understandability and language accessibility of Swedish websites about the coronavirus disease 2019: a cross-sectional study2022In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 22, no 1, article id 131Article in journal (Refereed)
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  • 47.
    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 1365-2648, Vol. 75, no 11, p. 2683-2691Article 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.

  • 48.
    Gottvall, Maria
    et al.
    Swedish Red Cross University, Department of Health Sciences. Uppsala University, Sweden.
    Brunell, Calle
    Swedish Red Cross University, Department of Health Sciences.
    Eldebo, Anna
    Swedish Red Cross University, Department of Health Sciences.
    Johansson Metso, Frida
    Swedish Red Cross University, Department of Health Sciences.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institutet, Sweden.
    Carlsson, Tommy
    Swedish Red Cross University, Department of Health Sciences. Uppsala University, Sweden.
    Post‐migration psychosocial experiences and challenges amongst LGBTQ + forced migrants: A meta‐synthesis of qualitative reports2023In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 79, no 1, p. 358-371Article in journal (Refereed)
    Abstract [en]

    Aims: Synthesize qualitative research to illuminate the post-migration psychosocial experiences amongst LGBTQ+ forced migrants.

    Design: Meta-synthesis of qualitative reports.

    Data sources: Systematic searches in seven databases and manual screenings were performed in July 2021 (21,049 entries screened in total). The final sample included 29 English-language reports containing empirical qualitative findings about post-migration experiences and published 10 years prior to the searches, based on migrants as the primary source.

    Review Methods: Methodological quality was appraised using the CASP and JBI checklists. Through a collaborative process involving nurse-midwife researchers and experienced clinical professionals, reports were analysed with a two-stage qualitative meta-synthesis including an inductive qualitative content analysis.

    Results: The methodological quality was high and the reports included 636 participants in total. Two themes were identified through the meta-synthesis. The first theme illustrates the psychological distress and numerous challenges and stressors forced migrants face after arrival, including challenges encountered as an LGBTQ+ forced migrant, psychological reactions and manifestations, and practical issues related to resettlement and living conditions. The second theme highlights the resilience and strength they find through various internal processes and external resources, including resilience and strengthening resources, identity formation and establishing and maintaining social relationships.

    Conclusion: After arrival in the host country, forced migrants identifying as LGBTQ+ face numerous societal and personal challenges whilst being at risk of experiencing significant psychological distress. These migrants utilize a wide range of resources that may strengthen their resilience. Peer support stands out as a highly appreciated and promising resource that needs further attention in experimental research.

    Impact: Forced migrants identifying as LGBTQ+ need access to adequate and sufficient support. The findings emphasize several strength-building resources that may inform nurses, midwives, researchers and other professionals when providing psychosocial support for these persons.

    Patient or Public Contribution: No patient or public contribution.

  • 49.
    Gottvall, Maria
    et al.
    Swedish Red Cross University, Department of Health Sciences. Uppsala University, Sweden.
    Kissiti, Rogers
    Swedish Red Cross University, Department of Health Sciences.
    Ainembabazi, Ronah
    Swedish Red Cross University, Department of Health Sciences.
    Bergman, Hannah
    Swedish Red Cross University, Department of Health Sciences.
    Eldebo, Anna
    Swedish Red Cross University, Department of Health Sciences.
    Isaac, Rummage
    Swedish Red Cross University, Department of Health Sciences.
    Yasin, Sumera
    Swedish Red Cross University, Department of Health Sciences.
    Jirwe, Maria
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institute, Sweden.
    Carlsson, Tommy
    Swedish Red Cross University, Department of Health Sciences. Uppsala University, Sweden.
    Mental health and societal challenges among forced migrants of diverse sexual orientations, gender identities and gender expressions: health professionals’ descriptions and interpretations2024In: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351Article in journal (Refereed)
    Abstract [sv]

    The aim of this study was to explore health professionals’ descriptions and interpretations of post-migration mental health and societal challenges among forced migrants with diverse sexual orientations, gender identities and gender expressions. Participants representing seven professions were recruited by a combination of convenience, purposive and snowball sampling. Data were collected through focus groups and individual interviews, analysed with systematic text condensation in a collaborative process involving researchers, clinicians and migrants with lived experiences. Participants described a challenging trajectory for migrants, as migrants venture through an uncertain and demanding journey impacting their mental health. Needing to deal with legal requirements, stressful circumstances and normative expectations during the asylum process were highlighted as major challenges, along with exposure to discrimination, violence, abuse and lack of psychosocial safety. Participants described significant psychological distress among migrants, including loneliness and shame. Challenges were also recognised related to exploring, accepting and expressing sexuality and gender. Loneliness and shame are major challenges in need of further attention in research, which could be addressed through the development and evaluation of actions, programmes and interventions to provide peer support.

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  • 50.
    Gottvall, Maria
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Uppsala University.
    Sjölund, Sara
    The Swedish Red Cross University College, Department of Health Sciences.
    Arwidson, Charlotta
    The Swedish Red Cross University College, Department of Health Sciences.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Instiutet.
    Health-related quality of life among Syrian refugees resettled in Sweden2020In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 29, no 2, p. 505-514Article in journal (Refereed)
    Abstract [en]

    Purpose The main purpose of this study was to assess health-related quality of life (HRQoL) among Syrian refugees resettled in Sweden. Further, we wanted to investigate whether sex, age, education, area of residence, cohabitation and social support were associated with HRQoL in this population. Methods This is a cross-sectional study including 1215 Syrian refugees from a randomly selected sample frame resettled in Sweden between the years 2011 and 2013. HRQoL was measured by the EQ-5D-5L descriptive system, and EQ-5D-5L index values were calculated. Associations between sex, age, education, area of residence, cohabitation, social support and EQ-5D-5L were investigated using multiple linear regression analysis. Results Depression/anxiety was the most commonly (61.9%) reported EQ-5D-5L problem among the group of Syrian refugees. The mean EQ-5D-5L index value was found to be 0.754. Male sex, younger age, cohabitation and social support were found associated with a higher EQ-5D-5L index score. Conclusions Our results concerning long-lasting health problems among the study population indicate that there is a profound need for policies and interventions promoting refugees' health. Our results also show that social support, a modifiable factor, is relevant to refugees' overall health, pointing to the importance of public health interventions and policies targeting the facilitation, mobilization and enhancing of refugees' social support.

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