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  • 1.
    Farrants, Kristin
    et al.
    Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Sjölund, Sara
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Trajectories of future sickness absence and disability pension days among individuals with a new sickness absence spell due to osteoarthritis diagnosis ≥21 days: a prospective cohort study with 13-month follow-up2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 8, article id e030054Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Osteoarthritis is one of the most common types of musculoskeletal diagnoses also among working-age populations, and often leads to long-term sickness absence (SA) spells or even disability pension (DP).

    THE AIM: was to identify future trajectories of days of SA and/or DP among people with a new SA spell due to osteoarthritis that became ≥21 long, and to investigate sociodemographic and morbidity characteristics of individuals in identified trajectories.

    METHODS: tests and multinomial logistic regression.

    RESULTS: We identified five trajectories of SA/DP days: 'fast decrease' (36% of the cohort), 'medium fast decrease' (29%), 'slow decrease' (15%), 'fluctuating' (12%) and 'late decrease' (8%). Individuals in the two trajectories who still had SA/DP days at end of follow-up (late decrease and fluctuating) were more likely to be older, born outside the EU and have indicators of more severe morbidity than those in the other trajectories.

    CONCLUSION: Five trajectories of future SA/DP days were identified; 80% of the cohort belonged to trajectories with no SA/DP by the end of follow-up. Identifying trajectories of future SA/DP provides new insights regarding the developments of SA/DP over time among people on SA due to osteoarthritis; not only days in the initial SA spell but also in new spells during follow-up need to be included for a better understanding.

  • 2.
    Gottvall, Maria
    et al.
    The Swedish Red Cross University College, Department of Public Health and Medicine. Uppsala University.
    Stenhammar, Christina
    Uppsala University.
    Grandahl, Maria
    Uppsala University.
    Parents' views of including young boys in the Swedish national school-based HPV vaccination programme: a qualitative study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 2, article id e014255Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore parents' views of extending the human papillomavirus (HPV) vaccination programme to also include boys.

    DESIGN: Explorative qualitative design using individual, face-to-face, interviews and inductive thematic analysis.

    SETTING: 11 strategically chosen municipalities in central Sweden.

    PARTICIPANTS: Parents (n=42) who were offered HPV vaccination for their 11-12 years old daughter in the national school-based vaccination programme.

    RESULTS: The key themes were: equality from a public health perspective and perception of risk for disease. Parents expressed low knowledge and awareness about the health benefits of male HPV vaccination, and they perceived low risk for boys to get HPV. Some parents could not see any reason for vaccinating boys. However, many parents preferred gender-neutral vaccination, and some of the parents who had not accepted HPV vaccination for their daughter expressed that they would be willing to accept vaccination for their son, if it was offered. It was evident that there was both trust and distrust in authorities' decision to only vaccinate girls. Parents expressed a preference for increased sexual and reproductive health promotion such as more information about condom use. Some parents shared that it was more important to vaccinate girls than boys since they believed girls face a higher risk of deadly diseases associated with HPV, but some also believed girls might be more vulnerable to side effects of the vaccine.

    CONCLUSIONS: A vaccine offered only to girls may cause parents to be hesitant to vaccinate, while also including boys in the national vaccination programme might improve parents' trust in the vaccine. More information about the health benefits of HPV vaccination for males is necessary to increase HPV vaccination among boys. This may eventually lead to increased HPV vaccine coverage among both girls and boys.

  • 3.
    Gyllensten, Hanna
    et al.
    Karolinska institutet / Sahlgrenska Academy, University of Gothenburg.
    Wiberg, Michael
    Karolinska institutet / Swedish Social Insurance Agency.
    Alexanderson, Kristina
    Karolinska institutet.
    Hillert, Jan
    Karolinska institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    How does work disability of patients with MS develop before and after diagnosis? A nationwide cohort study with a reference group2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 11, article id e012731Article in journal (Refereed)
    Abstract [en]

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

    DESIGN: Population-based cohort study.

    SETTING: The adult Swedish general population.

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

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

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

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

  • 4.
    Hägg Martinell, Ann
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Hult, Håkan
    Karolinska Institutet.
    Henriksson, Peter
    Karolinska Institutet.
    Kiessling, Anna
    Karolinska Institutet.
    Possibilities for interprofessional learning at a Swedish acute healthcare ward not dedicated to interprofessional education: an ethnographic study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e027590Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Almost all healthcare today is team-based in collaboration over professional borders, and numerous students have work-based learning in such contexts. However, interprofessional learning (IPL) in clinical settings has mostly been systematically explored in specially designed contexts dedicated to interprofessional education (IPE). This study aimed to explore the possibilities for IPL activities, and if or how they occur, in an acute ward context not dedicated to IPE.

    DESIGN AND SETTING: Between 2011 and 2013 ethnographic observations were performed of medical and nursing students' interactions and IPL during early clerkship at an acute internal medicine ward in Sweden. Field notes were taken and analysed based on the framework of IPE: learning with, from and about.

    PARTICIPANTS: 21 medical, 4 nursing students and 30 supervisors participated.

    RESULTS: Learning with-there were no organised IPE activities. Instead, medical and nursing students learnt in parallel. However, students interacted with staff members from other professions. Learning from-interprofessional supervision was frequent. Interprofessional supervision of nursing students by doctors focused on theoretical questions and answers, while interprofessional supervision of medical students by nurses focused on the performance of technical skills. Learning about-students were observed to actively observe interactions between staff and learnt how staff conducted different tasks.

    CONCLUSION: This study shows that there were plenty of possibilities for IPL activities, but the potential was not fully utilised or facilitated. Serendipitous IPL activities differed between observed medical and nursing students. Although interprofessional supervision was fairly frequent, students were not learning with, from or about each other over professional borders.

  • 5.
    Hägg-Martinell, Ann
    et al.
    Karolinska Institutet.
    Hult, H
    Karolinska Institutet.
    Henriksson, P
    Karolinska Institutet.
    Kiessling, A
    Karolinska Institutet.
    Medical students' opportunities to participate and learn from activities at an internal medicine ward: an ethnographic study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 2, article id e013046Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To optimise medical students' early clerkship is a complex task since it is conducted in a context primarily organised to take care of patients. Previous studies have explored medical students' perceptions of facilitation and hindrance of learning. However, the opportunities for medical student to learn within the culture of acute medicine care have not been fully investigated. This study aimed to explore how medical students approach, interact and socialise in an acute internal medicine ward context, and how spaces for learning are created and used in such a culture.

    DESIGN AND SETTING: Ethnographic observations were performed of medical students' interactions and learning during early clerkship at an acute internal medicine care ward. Field notes were taken, transcribed and analysed qualitatively. Data analysis was guided by Wenger's theory of communities of practice.

    PARTICIPANTS: 21 medical students and 30 supervisors participated.

    RESULTS: Two themes were identified: Nervousness and curiosity-students acted nervously and stressed, especially when they could not answer questions. Over time curiosity could evolve. Unexplored opportunities to support students in developing competence to judge and approach more complex patient-related problems were identified. Invited and involved-students were exposed to a huge variation of opportunities to learn, and to interact and to be involved. Short placements seemed to disrupt the learning process. If and how students became involved also depended on supervisors' activities and students' initiatives.

    CONCLUSIONS: This study shed light on how an acute internal medicine ward culture can facilitate medical students' possibilities to participate and learn. Medical students' learning situations were characterised by questions and answers rather than challenging dialogues related to the complexity of presented patient cases. Further, students experienced continuous transfers between learning situations where the potential to be involved differed in a wide variety of ways.

  • 6.
    Murley, Chantelle
    et al.
    Karolinska Institutet.
    Mogard, Olof
    Karolinska Institutet.
    Wiberg, Michael
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Karampampa, Korinna
    Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Trajectories of disposable income among people of working ages diagnosed with multiple sclerosis: a nationwide register-based cohort study in Sweden 7 years before to 4 years after diagnosis with a population-based reference group2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 5, article id e020392Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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

  • 7.
    Tinghög, Petter
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Malm, Andreas
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet / The Swedish Red Cross Treatment Center for Persons Affected by War and Torture.
    Arwidson, Charlotta
    The Swedish Red Cross University College, Department of Health Sciences.
    Sigvardsdotter, Erika
    The Swedish Red Cross University College, Department of Health Sciences.
    Lundin, Andreas
    Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Prevalence of mental ill health, traumas and postmigration stress among refugees from Syria resettled in Sweden after 2011: a population-based survey2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e018899Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To estimate the prevalence of and associations between anxiety, depression, post-traumatic stress disorder (PTSD), low subjective well-being (SWB), potential traumas and postmigration stress among refugees from Syria resettled in Sweden.

    DESIGN: A cross-sectional and population-based questionnaire study based on a known and complete sample frame. The survey included multiple measures of mental ill health and factors of particular relevance for refugees. Weighted analyses were conducted to calculate representative prevalence rates and associations. Associations were investigated through a series of logistic regression analyses. All analyses were supplemented with robust 95% CIs.

    SETTING: Sweden.

    PARTICIPANTS: A random sample of 1215 individuals (response rate 30.4%) from Syria aged 18-64 years that were granted residency in Sweden on grounds of asylum between 2011 and 2013.

    MAIN OUTCOME MEASURES: Anxiety, depression, PTSD and low SWB were assessed through Hopkins Symptom Checklist, Harvard Trauma Questionnaire and WHO-5 Well-being Index, using established cut-offs.

    RESULTS: A majority of the participants met the criteria for at least one of the studied types of mental ill health, and the comorbidity was high. Depression was the most the common type with 40.2% (95% CI 36.9% to 43.3%), followed by low SWB with 37.7% (95% CI 34.8% to 40.1%), anxiety with 31.8% (95% CI 29.2% to 34.7%) and PTSD with 29.9% (95% CI 27.2% to 32.6%). Refugee-related potentially traumatic events (PTEs) experienced before or during migration was common as was substantial levels of postmigration stress. Most types of refugee-related PTEs, especially being exposed to interpersonal violence, and postmigration stress were associated with increased risks for anxiety, depression, low SWB and PTSD.

    CONCLUSIONS: Mental ill health, in terms of anxiety, depression, low SWB and PTSD, are highly elevated and comorbid among refugees from Syria. Increased attention from multiple societal sectors to adequately support Syrian refugees' mental health needs, promoting recovery and reducing postmigration stress are needed.

  • 8.
    Wiberg, Michael
    et al.
    Karolinska Institutet.
    Murley, Chantelle
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Palmer, Edward
    Uppsala University.
    Hillert, Jan
    Karolinska Institutet.
    Stenbeck, Magnus
    Karolinska Institutet / Swedish Social Insurance Agency.
    Friberg, Emilie
    Karolinska Institutet.
    Earnings among people with multiple sclerosis compared to references, in total and by educational level and type of occupation: a population-based cohort study at different points in time.2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e024836Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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

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