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.

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.

New drugs and expanded drug indications are constantly being introduced. Welfare states strive to provide equity in drug treatment for all of its citizens and todaýs healthcare systems spend financial resources on drugs for the elderly in a higher rate than for any other age group. Drug utilization in elderly persons has an impact in health and wellbeing in older people.

THE PURPOSE OF THE RESEARCH: It was to describe the changes in medication use including people aged 78 years and over regardless of residence and other characteristics over 20 years.

MATERIALS AND METHODS: The study population consisted of 4304 participants in three population-based cross-sectional surveys conducted in the Kungsholmen area of central Stockholm, Sweden. The participant's current drug utilization was reviewed by physicians following standardized protocols. Data were statistical analyzed. Logistic regression models was used to estimate odds ratios and 95% confidence intervals for use of analgesics and psychotropic drugs in the cohorts of 2001 and 2007, controlling for age, gender, education and cognition.

THE PRINCIPAL RESULTS AND MAJOR CONCLUSIONS: Results shows that the prevalence of medication use and polypharmacy in older adults has increased dramatically the late 1980s to the 2000s in central Stockholm, Sweden. In particular, the use of analgesics increased significantly, while some drug groups decreased, i.e., antipsychotics. Women used more medication than men in all three cohorts. Older adults living in service buildings used the largest amount of drugs in 1987, whereas those living in institutions were the most frequent users in 2001 and 2007.

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.

BACKGROUND: Administration of medication to care recipients is delegated to home-care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home-care assistants have practical administration skills, but lack formal medical knowledge.

AIM: The aim of this study was to explore how home-care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care.

METHODS: Four focus groups consisting of 19 home-care assistants were conducted. Data were analysed using qualitative content analysis.

RESULTS: According to home-care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home-care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality.

CONCLUSIONS: Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home-care recipients.

IMPLICATIONS FOR PRACTICE: This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients' best interest and to ensure patient safety.

BACKGROUND: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care.

AIM: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care.

DESIGN: A qualitative descriptive study.

METHODS: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used.

FINDINGS: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process.

CONCLUSIONS: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine.

RELEVANCE TO CLINICAL PRACTICE: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.

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.

Un telecentro ofrece a las comunidades de escasos recursos la oportunidad de adquirir información electrónica que puede ser útil para el aprendizaje, la educación, información social, o, sea, negocios. El objetivo de este estudio fue poner de relieve la importancia de los usuarios de telecentros – las mujeres en especial – para garantizar un telecentro socialmente sostenible. Como método principal dirigimos al campo etnográfico. Se notaban que la mayoría de los usuarios son estudiantes y mujeres. Llevar a cabo más estudios permitirá el seguimiento de estas mujeres con el fin de ver si se puede motivar a otras mujeres a empezar a ir al telecentro, y si este nuevo comportamiento de las mujeres refleja los cambios en el modelo tradicional de género.

This paper explores the reasoning and use of information and communications technology (ICT) in lifelong learning by immigrant women. Data were collected from semi-structured and unstructured interviews. The study was carried out primarily in a school environment, which also makes it possible to draw conclusions about the connection between learning in and outside school environments. Most participants experienced major differences in the use of and access to ICT after moving to their new country. Most women use and access ICT, even if not of their own volition. Providing a summary of some of the benefits and barriers that emerged, our study has shown that it is important to distinguish the way someone reasons about ICT and their actual use of it. No account was taken of cultural differences between the participants’ countries of origin. This study made it possible for the immigrant women to voice their experiences, knowledge, and feelings about their situations in school and in everyday life.

The aim of this study was to find answers to how self-regulated learning (SRL) and cooperation learning orientation correlate with study success. At DSV, a department of Stockholm University, a web based support system for students’ thesis writing referred to as SciPro was implemented. The system also allowed for statistics of thesis process. Through the SciPro system, we were able to retrieve students and supervisors; data were retrieved from 45 supervisors and 47 students with regard to their respective responsibilities in the thesis writing process. Vermunt’s instrument, Inventory of Learning Styles (ILS), was employed to measure students’ SRL. Overall, the relation between SRL and completed thesis was not as strong as expected.

The overall aim of the group is to examine how shortages of food and water lead to vulnerability to ill-health, abuse, and exploitation at the local level.

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

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

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

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

Clinical Implications

Asthma during adolescence impairs health-related quality of life, especially if the asthma is uncontrolled. To use questions about health-related quality of life (HRQoL) and markers associated with asthma control in the clinic can identify adolescents with an increased risk for impaired HRQoL.

OBJECTIVE: There is limited knowledge about how adolescents with asthma view their disease in daily life and how these views impact on management. The aim of this study was to describe experiences of daily life, with particular focus on thoughts, feelings and management of adolescents with asthma.

METHODS: In this qualitative study, data were obtained from 10 interviews with adolescents (aged 16-18 years) with asthma recruited from the Swedish population-based prospective birth cohort, BAMSE. Data were analysed through Systematic Text Condensation.

RESULTS: Experiences of daily life among adolescents with asthma were defined in four categories: Insight and understanding; Asthma not the focus of daily life; Being acknowledged and, Being affected by asthma symptoms. The adolescents had developed an insight into and understanding of their disease, but did not want asthma to be the focus of their daily lives. The adolescents wanted their asthma to be acknowledged, but not to the point that they were defined by their asthma. They reported having many asthma symptoms, especially during physical activity, but also described a desire to feel healthy, "normal" and like their peers.

CONCLUSIONS: Having asthma in adolescence involves several struggles with ambivalence between adapting socially, feeling healthy and managing one's asthma.

IMPLICATIONS IN CLINICAL PRACTICE: The provision of person-centred care may be one way to handle the ambivalence among adolescents with asthma and thereby help them to manage their asthma.

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

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

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

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

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

The concepts of target efficiency can be used to assess the extent to which service provision is in line with the needs of the population. Horizontal target efficiency denotes the extent to which those deemed to need a service receive it and vertical target efficiency is the corresponding extent to which those who receive services actually need them. The aim of this study was to assess the target efficiency of the Swedish eldercare system and to establish whether target efficiencies differ in different geographical areas such as large urban, midsize urban and rural areas. Vertical efficiency was measured by studying those people who received eldercare services and was expressed as a percentage of those who received services who were functionally dependent. To measure horizontal target efficiency, data collected at baseline in the longitudinal population study SNAC (Swedish National study on Aging and Care) during the years 2001-2004 were used. The horizontal efficiency was calculated as the percentage of functionally dependent persons who received services. Functional dependency was measured as having difficulty with instrumental activities of daily living (IADL) and/or personal activities of daily living (PADL). Services included long-term municipal eldercare services (LTC). Horizontal target efficiency for the public LTC system was reasonably high in all three geographical areas, when using dependency in PADL as the measure of need (70-90 %), but efficiency was lower when the less restrictive measure of IADL dependency was used (40-50 %). In both cases, the target efficiency was markedly higher in the large urban and the rural areas than in the midsize urban areas. Vertical target efficiency showed the same pattern-it was almost 100 % in all areas for IADL dependency, but only 50-60 % for PADL dependency. Household composition differed in the areas studied as did the way public long-term care was provided to people living alone as compared to those co-habiting.

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

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

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

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

Background: Individuals with chronic heart failure (CHF) need to cope with both the physical limitations and the psychological impacts of the disease. Since some coping strategies are beneficial and others are linked to increased mortality and worse health-related quality of life (HRQoL), it is important to have a reliable and valid instrument to detect different coping styles. Brief COPE, a self-reporting questionnaire, has been previously used in the context of CHF. There is, however, currently a lack of consensus about the theoretical or empirical foundations for grouping the multiple coping strategies assessed by Brief COPE into higher order categories of coping. The main purpose of this study was to examine the structure of Brief COPE, founded on the higher order grouping of its subscales in order to establish an assessment model supported by theoretical considerations. Furthermore, the associations between these higher order categories of coping and HRQoL were examined to establish the predictive validity of the selected model in the context of CHF.

Method: One hundred eighty-three patients diagnosed with CHF were recruited at a heart failure outpatient clinic or at a cardiac ward. Self-reported questionnaires were filled in to measure coping strategies and HRQoL. Confirmatory factor analyses were performed to investigate different hierarchical structures of Brief COPE found in the literature to assess coping strategies in patients with CHF. Regression analyses explored associations of aggregated coping strategies with HRQoL.

Results: A four factorial structure of Brief COPE displayed the most adequate psychometric properties, consisting of problem focused coping, avoidant coping, socially supported coping and emotion focused coping. Avoidant coping was associated with worse HRQoL in CHF.

Conclusions: This study provides support for a four-factor model of coping strategies in patients with CHF. This could facilitate assessment of coping both in clinical and research settings.

BACKGROUND: Impaired emotional well-being has detrimental effects on health outcomes in patients with chronic heart failure (CHF).AIMS:To evaluate a nurse-led Coping Effectiveness Training (CET) group intervention for patients with CHF. It was hypothesized that CET would increase emotional well-being (primary outcome) and health-related quality (HRQoL) of life and improve clinical outcomes. Furthermore, changes in appraisal and coping as mediators of the intervention effect were examined.

METHODS: Participants were randomized to either control group (n=51) receiving standard health care or CET intervention group (n=52). Self-assessments of positive affect, negative affect, depression, anxiety, HRQoL, illness perception, coping strategies and social support were performed pre- and post-intervention and after six weeks, six months and 12 months. Time to death and hospitalizations were measured during the entire follow-up (median 35 months, interquartile range 11 months).

RESULTS: No significant improvements for emotional well-being and HRQoL in the intervention group compared with the control group were found. After excluding patients with clinical anxiety and depression at baseline the intervention group had significantly lower negative affect (p = 0.022). There were no significant differences regarding cardiovascular events between the groups. The intervention group had greater sense of control over their illness in the short-term (p = 0.036).

CONCLUSION: CET intervention was found to increase sense of control over the illness in the short term. Psychosocial support programmes, like CET, for patients with CHF is currently lacking evidence for implementing in clinical practice. However, the results provide a basis for future studies with a modified CET intervention design and increased study size.

BACKGROUND: Individuals with a history of suicide attempt have a high risk for subsequent labour market marginalization. This study aimed at assessing the effect of individual and parental factors on different measures of marginalization.

METHODS: Prospective cohort study based on register linkage of 5 649 individuals who in 1994 were 16-30 years old, lived in Sweden and were treated in inpatient care for suicide attempt during 1992-1994. Hazard ratios (HRs) for labour market marginalization defined as long-term unemployment (>180 days), sickness absence (>90 days), or disability pension in 1995-2010 were calculated with Cox regression.

RESULTS: Medical risk factors, particularly any earlier diagnosed specific mental disorders (e.g., schizophrenia: HR 5.4 (95% CI: 4.2, 7.0), personality disorders: HR 3.9, 95% CI: 3.1, 4.9), repetitive suicide attempts (HR 1.6, 95% CI: 1.4, 1.9) were associated with a higher relative risk of disability pension. Individual medical factors were of smaller importance for long-term sickness absence, and of only marginal relevance to long-term unemployment. Country of birth outside Europe had an opposite effect on disability pension (HR 0.6, 95% CI: 0.4, 0.8) and long-term unemployment (HR 1.5, 95% CI: 1.3, 1.8). Female sex was positively correlated with long-term sickness absence (HR 1.6, 95% CI: 1.4, 1.7), and negatively associated with long-term unemployment (HR: 0.8, 95% CI: 0.7, 0.9).

CONCLUSIONS: As compared to disability pension, long-term sickness absence and unemployment was more strongly related to socio-economic variables. Marginalization pathways seemed to vary with migration status and sex. These findings may contribute to the development of intervention strategies which take the individual risk for marginalization into account.

PURPOSE: The purpose of this study is to investigate how women, during the 2 years following breast cancer surgery, rate importance of work and vocational satisfaction, and baseline factors associated with rating over time.

METHODS: A prospective cohort study of 692 women aged 20-63 included about 4 weeks after a first breast cancer surgery. Register data on treatment and data from six repeated questionnaires during a 2-year follow-up (at baseline, 4, 8, 12, 18, 24 months) were used in two-way mixed repeated analysis of variance and mixed repeated measures analysis of covariance.

RESULTS: The women rated importance of work (m = 3.74; sd 0.88) (maximum 5) and vocational satisfaction (m = 4.30; sd 1.38) (maximum 6) high during the 2 years. Women with planned chemotherapy rated lower vocational satisfaction and especially so at 4 months after inclusion (F 1, 498 = 8.20; p = 0.004). Higher age, better physical, and mental/social work ability at baseline influenced rating of vocational satisfaction. Supportive colleagues was an important covariate that significantly affected ratings of importance of work as well as vocational satisfaction, i.e., women with better support rated on average higher on these outcomes. The effect of chemotherapy disappeared after including the abovementioned baseline covariates.

CONCLUSIONS: Women diagnosed with breast cancer in the following 2 years rate importance of work and vocational satisfaction high, which are associated to lower work ability and social support.

IMPLICATIONS FOR CANCER SURVIVORS: Work is a very important aspect in life also after a cancer diagnosis, which has to be acknowledged when discussing treatment and rehabilitation plans with women with breast cancer. Furthermore, workplace support needs to be assessed as this is an influential factor.

BACKGROUND: Reducing patient delay for patients afflicted by an acute myocardial infarction is a task of great complexity, which might be alleviated if more factors that influence this delay could be identified. Although a number of self-reported instruments associated with patient delay exist, none of these taps the content of the appraisal process related to patients' subjective emotions.

AIM: The aim of this study was to develop and validate a questionnaire aimed at assessing patients' appraisal, emotions and action tendencies when afflicted by an acute myocardial infarction.

METHODS: An item pool was generated based on themes conceptualized in a recent qualitative study of acute myocardial infarction patients' thoughts, feelings and actions preceding the decision to seek medical care. The 'Think-Aloud Protocol' and test-retest analysis at item level were performed. The modified item pool was administered to 96 patients when treated for acute myocardial infarction. Explorative factor analysis and principal component analysis with the non-linear iterative partial least squares algorithm were performed to examine the underlying factor structure of the items.

RESULTS: The findings indicated three core dimensions corresponding to three subscales, namely, 'symptom appraisal'; 'perceived inability to act'; 'autonomy preservation'. The results demonstrated acceptable measures of reliability and validity CONCLUSIONS: The PA-AMI questionnaire demonstrated satisfactory psychometric properties. Assessment of the included core dimensions may contribute to greater understanding of the appraisal processes for patients afflicted by an acute myocardial infarction.

There is an urgent need to train public health professionals at undergraduate level who can face global challenges that are due to longstanding conflicts, increasing number of displaced people, natural disasters, and growing inequalities between and within countries. Future public health professionals will lead activities ranging from national and international community planning, strategic work geared towards integration of migrants and crisis management of refugees, and humanitarian services. Consequently, the need for public health professionals with deep and wide theoretical and practical competencies in global contexts has become most relevant. In response to this need, The Swedish Red Cross University College has created such a programme leading to a Bachelor degree in Public Health Science, specialization Global Health.

Det föreligger ett akut behov att utbilda folkhälsovetare på grundnivå och som kan möta de globala utmaningarna. Hälsoutmaningarna förändras i takt med långvariga konflikter, människor på flykt, stora katastrofer och en ökande ojämlikhet mellan och inom länder, i en omvärld som är i ständig rörelse. Dagens och morgondagens folkhälsovetare ska kunna arbeta med olika aktörer på skilda arenor; med hälso- och sjukdomsprevention kommunalt, regionalt, nationellt (regering, myndigheter) och internationellt (europeiskt och globalt). Det innefattar även integrationsarbete, internationellt biståndsarbete och humanitärt arbete. Behovet av professionella folkhälsovetare med breda och djupa teoretiska och praktiska kompetenser i globala sammanhang har därför blivit högst relevant. Därför agerar nu Röda Korsets Högskola och startar ett folkhälsovetenskapligt program på kandidatnivå med global inriktning.

Japan has become a super-aged society, facing demographic challenges resulting in societal and economic consequences. In its political structural reform, the Japanese government presented the urgency to consider the increase in labor mobility that includes the issues of immigration and female employment, both domestic and foreign. The aim of this study was to explore, from a Japanese woman’s perspective, the intertwined issues of immigration. An in-depth interview was performed and analyzed by content analysis with a methodological departure in qualitative journalistic interviewing. The case was a Japanese woman with a unique profile. The results of this study, family permanency and group cohesiveness, can contribute to understand the potential interdependency between the roles, within the Japanese society, of foreign female domestic workers and Japanese women. In conclusion, it appears that the pivotal role of women in the Japanese society and the global feminization of migration challenge Japanese social consistency.

BACKGROUND: Despite common mental disorders (CMDs) being a main reason for preterm exit from the labour market, there is limited knowledge regarding healthcare use around the time of being granted disability pension (DP) due to CMD. The aim was to study specialized healthcare use before and after being granted DP due to CMD and whether these trajectories differed before and after changes in DP granting criteria in Sweden in 2008.

METHODS: Included individuals lived in Sweden, aged 19-64 years with incident DP due to CMD before (wave 1, 2005-06, n = 24 298) or after (wave 2, 2009-10, n = 4056) the changes in 2008. Healthcare trajectories during a 7-year window were assessed by generalized estimating equations. Between- and within-wave differences were examined by interaction models.

RESULTS: Psychiatric healthcare increased until the year preceding DP and declined thereafter, with one exception; such outpatient care kept increasing in wave 1 following DP. In the year preceding DP, 4.6 and 19.2% of the individuals in wave 1 had psychiatric in- and specialized outpatient care, respectively, compared with 7.9 and 46.6% in wave 2. No clear pattern was observed regarding somatic healthcare. The slopes of the different DP waves differed mainly during DP granting years (1 year prior to 1 year after), showing a sharper decline in wave 2.

CONCLUSION: Transition to DP due to CMD seems to be associated with changes in psychiatric healthcare use, with higher rates in the year preceding DP. Outpatient healthcare patterns somewhat differed among those granted DP after stricter rules were introduced.

OBJECTIVES: Dispositional optimism is viewed as a key personality resource for resiliency and has been linked to adjustment among women with breast cancer. The aim was to examine (a) the psychometric proprieties of Life Orientation Test-Revised (LOT-R), (b) the potential independence and co-occurrence of positive and negative dimensions of future outcome expectancies, (c) the longitudinal invariance of LOT-R and the temporal stability of dispositional optimism over 2 years following surgery, and (d) the predictive impact of optimism and pessimism on emotional distress among women with breast cancer.

METHODS: Data from a prospective study (n = 750) of women with breast cancer were acquired shortly after surgery, and the women were followed up for 2 years. Assessments of LOT-R, Hospital Anxiety and Depression Scale, treatment-related, and demographic variables were subjected to structural equation modeling analysis.

RESULTS: A bidimensional and temporarily invariant structure of LOT-R displayed acceptable fit indices. Three profiles of future expectancies consisting of optimists, pessimists, and ambiguous were identified. Temporal stability in optimism and pessimism over 2 years was established. Women with higher education displayed higher degrees of pessimism. Baseline dispositional optimism inversely predicted emotional distress at 2 years.

CONCLUSIONS: The LOT-R should be approached as a bidimensional measure. Co-occurrence of optimism and pessimism may indicate a cautious defensive coping effort in women with breast cancer. The importance of systematic efforts to enhance optimism as well as the capacity to acknowledge both positive and negative future expectancies is emphasized. Copyright © 2015 John Wiley & Sons, Ltd.

BACKGROUND: Anxiety is one of the main components of distress among women with breast cancer (BC), particularly in the early stages of the disease. Changes in anxiety over time may reflect the process of adjustment or lack thereof. The process of adjustment in the traverse of acute to transitional stages of survivorship warrants further examination.

AIM: To examine the trajectory of anxiety and the specific patterns that may indicate a lack of adjustment within two years following BC surgery.

METHODS: Survey data from a two-year prospective cohort study of 725 women with BC were analyzed by Mixture Growth Modelling and logistic regression and analysis of variance.

RESULTS: A piece wise growth curve displayed the best fit to the data, indicating a significant decrease in anxiety in the first year, followed by a slower rate of change during the second year. Four classes of trajectories were identified of which a High Stable anxiety class showed the most substantive indications of lack of adjustment. This subgroup was predominantly characterized by sociodemographic variables such as financial difficulties.

CONCLUSION: Our results support an emphasize on the transitional nature of the stage that follows the end of primary active treatment, and imply a need for supportive follow up care for those who display lack of adjustment at this stage.

Studies have shown that a high proportion of refugees have been subjected to potentially traumatic experiences (PTEs). PTEs, including torture, are powerful predictors of mental ill health. This paper reports a review of refugee trauma history self-report measures used in population studies.

Methods

A review of existing instruments and checklists, up to September 2015, was performed.

Results

The types of measures for refugee trauma history vary from semi-structured interviews and medical records to extensive multi-item trauma-checklists. The Harvard Trauma Questionnaire (HTQ) was the most commonly used instrument for measuring trauma history among refugee populations. Few checklists included PTEs during the flight.

Conclusion

Trauma history checklists are often used as a tool to control for background variables when studying refugees’ mental health and have mostly been developed in clinical or semi-clinical settings. There is a need for acceptable, reliable and valid brief checklists for measuring trauma in refugees, for the purpose of performing larger scale population studies.

Aim: To describe and appraise the research literature reporting prevalence of torture and/or war-related potentially traumatic experiences (PTEs) in adult forced migrants living in high-income countries.

Methods: A search for peer-reviewed articles in English was conducted in PubMed, Web of Science, PILOTS, key journals, and reference lists. Studies based on clinical samples and samples where less than half of participants were forced migrants were excluded. Data was extracted and a methodological quality appraisal was performed.

Results: A total of 3,470 titles and abstracts were retrieved and screened. Of these, 198 were retrieved in full-text. Forty-one articles fulfilled inclusion criteria and the total number of study participants was 12,020 (median 170). A majority focused on specific ethnic groups or nationalities, Southeast Asian, Middle Eastern and Balkan being the most frequent. Reported prevalence rates of torture ranged between one and 76 % (median 27 %). Almost all participants across all studies had experienced some kind of war-related PTE.

Conclusions: Reported prevalence rates of torture and war-related PTEs vary between groups of forced migrants. Trauma history was often studied as a background variable in relation to mental health. The heterogeneity of data, as well as the methodological challenges in reaching forced migrants and defining and measuring traumatic experiences, prevent generalisation concerning trauma history across groups.

BACKGROUND: The aim of the study was to examine 1) the incidence of disability in Activities of Daily Living (ADL), in persons 78 years and older 2) explore whether being physical active earlier is a significant predictor of being disability free at follow-up and 3) describe the amount of informal and formal care in relation to ADL-disability.

METHODS: Data were used from a longitudinal community-based study in Nordanstig (SNAC-N), a part of the Swedish National Study on Aging and Care (SNAC). To study objectives 1) and 2) all ADL-independent participants at baseline (N = 307) were included; for objective 3) all participants 78 years and older were included (N = 316). Data were collected at baseline and at 3- and 6-year follow-ups. ADL-disability was defined as a need for assistance in one or more activities. Informal and formal care were measured using the Resource utilization in Dementia (RUD)-instrument.

RESULTS: The incidence rates for men were similar in the age groups 78-81and 84 years and older, 42.3 vs. 42.5/1000 person-years. For women the incidence rate for ADL-disability increased significantly from the age group 78-81 to the age group 84 years and older, 20.8 vs.118.3/1000 person-years. In the age group 78-81 years, being physically active earlier (aOR 6.2) and during the past 12 month (aOR 2.9) were both significant preventive factors for ADL-disability. Both informal and formal care increased with ADL-disability and the amount of informal care was greater than formal care. The incidence rate for ADL-disability increases with age for women and being physically active is a protective factor for ADL-disability.

CONCLUSION: The incidence rate for ADL-disability increases with age for women, and being physical active is a protective factor for ADL-disability.

The purpose of this study was to investigate the prevalence of hypothyroidism among hospitalized patients with type 2 diabetes mellitus and its related factors, and to assess the prevalence of macrovascular and microvascular diseases among type 2 diabetes mellitus inpatients with hypothyroidism and euthyroidism. A total of 1662 type 2 diabetes mellitus inpatients hospitalized at the Metabolic Diseases Hospital, Tianjin Medical University from 1 January 2008 to 1 March 2013 were included in this study. Information on demographic and anthropometric factors and additional variables related to hypothyroidism were collected from medical records. Prevalence rates were calculated and standardized using direct method based on the age-specific and sex-specific structure of all participants. Data were analyzed using binary logistic regression with adjustment for potential confounders. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and 77.0 % of the patients with hypothyroidism had subclinical hypothyroidism. The prevalence of hypothyroidism increased with age, and was higher in women (10.8 %) than in men (3.4 %). Older age (odds ratio, 1.74; 95 % confidence interval, 1. 05 to 2.89), female gender (odds ratio, 2.02; 95 % confidence interval, 1.05 to 3.87), and positive thyroid peroxidase antibody (odds ratio, 4.99; 95 % confidence interval, 2.83 to 8.79) were associated with higher odds of hypothyroidism among type 2 diabetes mellitus inpatients. The type 2 diabetes mellitus inpatients with hypothyroidism had higher prevalence of cerebrovascular diseases than those with euthyroidism after adjustment for age and gender. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and most patients had subclinical hypothyroidism. Older age, female gender, and positive thyroid peroxidase antibody could be indicators for detecting hypothyroidism in type 2 diabetes mellitus inpatients.

Människor som flyr från krig och konflikt har ofta varit med om omskakande händelser som kan leda till långvariga problem och ohälsa. Det finns lite kunskap om hur sådana erfarenheter påverkar en människa. För att öka kunskapen genomfördes under perioden maj 2015 till oktober 2016, en forskningsstudie vid Röda Korsets Högskola. Studien hade som syfte att uppskatta förekomsten av psykisk ohälsa bland nyanlända från Syrien och asylsökande från Eritrea, Syrien och Somalia samt att kartlägga förekomsten av erfarenheter av traumatiska händelser, post-migratorisk stress och svagt socialt stöd.

Data har samlats in via två enkäter samt register i två kompletterande studiepopulationer. Den första studiepopulationen bestod av 1215 nyanlända från Syrien med permanent uppehållstillstånd som blivit kommunmottagna mellan åren 2011 och 2013. Den andra studiepopulationen bestod av 173 asylsökande från Syrien, Eritrea och Somalia som bodde på ett asylboende i västra Sverige.

Resultaten från studien visar bland annat att den psykiska ohälsan i Sverige 2016 är mycket utbredd bland nyanlända från Syrien och bland asylsökande från Eritrea, Somalia och Syrien. Bland nyanlända från Syrien har var tredje en högst påtaglig depressions- eller ångestproblematik, detta samtidigt som 30 % uppger symtom som stämmer överens med posttraumatiskt stressyndrom (PTSD). Studien indikerar dessutom att psykisk ohälsa i form av depression, ångest, PTSD och lågt välbefinnande är betydligt vanligare bland asylsökande än bland nyanlända, särskilt bland asylsökande från Eritrea och Somalia.

BACKGROUND: Recent studies suggest that trends in cardiovascular risk may result in a decrease in age-specific prevalence of dementia. Studies in rural areas are rare.

OBJECTIVES: To study cohort effects in dementia prevalence and survival of people with dementia in a Swedish rural area.

METHODS: Participants were from the 1995-1998 Nordanstig Project (NP) (n = 303) and the 2001-2003 Swedish National study on Aging and Care in Nordanstig (SNAC-N) (n = 384). Overall 6-year dementia prevalence and mortality in NP and SNAC-N were compared for people 78 years and older. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for dementia occurrence using the NP study population as the reference group. Cox regression models were used to analyze time to death.

RESULTS: The crude prevalence of dementia was 21.8% in NP and 17.4% in SNAC-N. When the NP cohort was used as the reference group, the age- and gender-adjusted OR of dementia was 0.71 (95% CI 0.48-1.04) in SNAC-N; the OR was 0.47 (0.24-0.90) for men and 0.88 (0.54-1.44) for women. In the extended model, the OR of dementia was significantly lower in SNAC-N than in the NP cohort as a whole (0.63; 0.39-0.99) and in men (0.34; 0.15-0.79), but not in women (0.81; 0.46-1.44). The Cox regression models indicated that the hazard ratio of dying was lower in the SNAC-N than NP population.

CONCLUSIONS: Trends toward a lower prevalence of dementia in high-income countries seem to be evident in this Swedish rural area, at least in men.

OBJECTIVES: The role of different body fat indicators and age in assessing the prevalence of obesity is unclear. We aimed to examine to what extent different body fat indicators including BMI, waist circumference (WC) and waist-to-hip ratio (WHR) affect the prevalence of overweight and obesity among Chinese adults taking age into account.

METHODS: This population-based cross-sectional study included a random sample of 7,603 adults aged 20-79 years across entire Tianjin, China. BMI, WC, and WHR were used to define overweight and obesity following standard criteria. Prevalence rates were calculated and standardized using local age- and gender-specific census data. Logistic regression was used in data analysis.

RESULTS: Using the combination of BMI, WC, and WHR, the prevalence of overweight and obesity was 69.8%, and increased with age till the age of 60 and a decline thereafter. The prevalence of overweight assessed by BMI was higher than that assessed by WC and WHR, while the prevalence of obesity defined by BMI was much lower than that defined by WC or WHR.

CONCLUSION: The prevalence of overweight and obesity is about 70% among Chinese adults. Adiposity indicators and age play an important role in the prevalence of overweight and obesity.

Hypertension is common in adults and often undiagnosed, and the prevalence of pre- and undiagnosed-hypertension remains unclear. We aimed to investigate the prevalence of pre- and undiagnosed-hypertension and their correlates among urban Chinese adults. A total of 7435 participants aged 20-79 were included in this study. Data on demographics, lifestyle and medical history were collected through a structured interview. Pre- and undiagnosed-hypertension was defined as systolic blood pressure/ diastolic blood pressure (SBP/DBP) of 120-139/80-89 mm Hg and SBP⩾140 mm Hg and/or DBP⩾90 mm Hg, respectively, in participants without a history of hypertension and use of antihypertensive medication. Prevalence rates were calculated and standardized using local age- and gender-specific census data. Data were analysed using multinomial logistic regression with adjustment for potential confounders. Of all the participants, 2726 (36.7%) were diagnosed with pre-hypertension and 919 (12.3%) with undiagnosed-hypertension. Undiagnosed-hypertension accounted for 37.3% of all participants with hypertension. The prevalence of pre-hypertension gradually decreased with age, while undiagnosed-hypertension increased, although presenting different changing patterns among men and women. In a fully adjusted multinomial logistic regression, age, male sex, low socio-economic status (SES), abdominal obesity, alcohol drinking, physical inactivity and type 2 diabetes mellitus (T2DM) were significantly associated with increased odds of pre- and undiagnosed-hypertension. In conclusions, the prevalence of pre- and undiagnosed-hypertension was ~50% among urban Chinese adults. Abdominal obesity, low SES, alcohol drinking, physical inactivity and T2DM may be indicators for pre- and undiagnosed-hypertension.

BACKGROUND: China has been going through significant changes in social and economical aspects and with great socioeconomic disparity in different regions. However, data on the association between socioeconomic status (SES) and obesity are not available in Tianjin, China.

AIM: We aimed to investigate the association between SES and high adiposity among the adult population in Tianjin.

SUBJECTS & METHODS: A total of 7351 individuals aged 20-79 were included in this study. Socioeconomic information was collected through the interview following a structured questionnaire. Waist circumference, body weight and height were measured following standard procedures. Overweight and obesity were defined according to the criteria of the Working Group on Obesity in China. Data were analysed using multinomial logistic regression with adjustment for potential confounders.

RESULTS: Stratified analysis showed that higher monthly income and education were related to decreased odds of abdominal overweight/obesity in women, while high education was associated with increased odds of general overweight/obesity in men. Retirement increased the odds of abdominal overweight and obesity, and nonmanual work was associated with low odds of abdominal obesity in women.

CONCLUSIONS: SES was associated with general and abdominal overweight/obesity and sex may play a role in such an association.