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  • 1.
    Bergevi, Julia
    et al.
    Sophiahemmet Högskola.
    Andermo, Susanne
    Woldamanuel, Yohannes
    Sophiahemmet Högskola.
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Hagströmer, Maria
    Sophiahemmet Högskola.
    Rossen, Jenny
    Sophiahemmet Högskola.
    User perceptions of eHealth and mHealth services promoting physical activity and healthy diets: Systematic review2022Inngår i: JMIR Human Factors, E-ISSN 2292-9495, Vol. 9, nr 2, artikkel-id e34278Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Physical activity and a diet that follows general recommendations can help to prevent noncommunicable diseases. However, most adults do not meet current recommended guidelines, and support for behavior change needs to be strengthened. There is growing evidence that shows the benefits of eHealth and mobile health (mHealth) services in promoting healthy habits; however, their long-term effectiveness is uncertain because of nonadherence.

    OBJECTIVE: We aimed to explore users' perceptions of acceptability, engagement, and usability of eHealth and mHealth services that promote physical activity, healthy diets, or both in the primary or secondary prevention of noncommunicable diseases.

    METHODS: We conducted a systematic review with a narrative synthesis. We performed the literature search in PubMed, PsycINFO, and CINAHL electronic databases in February 2021 and July 2021. The search was limited to papers published in English between 2016 and 2021. Papers on qualitative and mixed method studies that encompassed eHealth and mHealth services for adults with a focus on physical activity, healthy diet, or both in the primary or secondary prevention of noncommunicable diseases were included. Three authors screened the studies independently, and 2 of the authors separately performed thematic analysis of qualitative data.

    RESULTS: With an initial finding of 6308 articles and the removal of 427 duplicates, 23 articles were deemed eligible for inclusion in the review. Based on users' preferences, an overarching theme-eHealth and mHealth services provide value but need to be tailored to individual needs-and 5 subthemes-interactive and integrated; varying and multifunctional; easy, pedagogic, and attractive; individualized and customizable; and reliable-emerged.

    CONCLUSIONS: New evidence on the optimization of digital services that promote physical activity and healthy diets has been synthesized. The findings represent users' perceptions of acceptability, engagement, and usability of eHealth and mHealth services and show that services should be personalized, dynamic, easily manageable, and reliable. These findings can help improve adherence to digital health-promoting services.

    Fulltekst (pdf)
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  • 2. Blomgren, Johanna
    et al.
    Gabrielsson, Sara
    Erlandsson, Kerstin
    Wagoro, Miriam C A
    Namutebi, Mariam
    Chimala, Eveles
    Lindgren, Helena
    Sophiahemmet Högskola.
    Maternal health leaders' perceptions of barriers to midwife-led care in Ethiopia, Kenya, Malawi, Somalia, and Uganda2023Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 124, s. 103734-, artikkel-id 103734Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To identify and examine barriers to midwife-led care in Eastern Africa and how these barriers can be reduced DESIGN: A qualitative inductive study with online focus group discussions and semi-structured interviews using content analysis SETTING: The study examines midwife-led care in Ethiopia, Malawi, Kenya, Somalia, and Uganda -five African countries with an unmet need for midwives and a need to improve maternal and neonatal health outcomes.

    PARTICIPANTS: Twenty-five participants with a health care profession background and current position as a maternal and child health leader from one of the five study countries.

    FINDINGS: The findings demonstrate barriers to midwife-led care connected to organisational structures, traditional hierarchies, gender disparities, and inadequate leadership. Societal and gendered norms, organisational traditions, and differences in power and authority between professions are some factors explaining why the barriers persist. A focus on intra- and multisectoral collaborations, the inclusion of midwife leaders, and providing midwives with role models to leverage their empowerment are examples of how to reduce the barriers.

    KEY CONCLUSIONS: This study provides new knowledge on midwife-led care from the perspectives of health leaders in five African countries. Transforming outdated structures to ensure midwives are empowered to deliver midwife-led care at all healthcare system levels is crucial to moving forward.

    IMPLICATIONS FOR PRACTISE: This knowledge is important as enhancing the midwife-led care provision is associated with substantially improved maternal and neonatal health outcomes, higher satisfaction of care, and enhanced utilisation of health system resources. Nevertheless, the model of care is not adequately integrated into the five countries' health systems. Future studies are warranted to further explore how reducing barriers to midwife-led care can be adapted at a broader level.

    Fulltekst (pdf)
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  • 3. Bohman, Tony
    et al.
    Holm, Lena W
    Hallqvist, Johan
    Pico-Espinosa, Oscar J
    Skillgate, Eva
    Sophiahemmet Högskola.
    Healthy lifestyle behaviour and risk of long-duration troublesome neck pain among men and women with occasional neck pain: results from the Stockholm public health cohort2019Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 9, nr 11, artikkel-id e031078Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: The effect of a healthy lifestyle on the prognosis of neck pain is unknown. This study aimed to investigate if a healthy lifestyle behaviour influences the risk of long-duration troublesome neck pain among men and women with occasional neck pain.

    DESIGN: Longitudinal cohort study.

    SETTINGS: General population, and a subsample of the working population, in Stockholm County, Sweden.

    PARTICIPANTS: This study involved 5342 men and 7298 women, age 18 to 84, from the Stockholm Public Health Cohort, reporting occasional neck pain at baseline in 2006.

    MEASURES: Baseline information about leisure physical activity, smoking, alcohol consumption and consumption of fruits and vegetables were dichotomised into recommendations for healthy/not healthy behaviour. The exposure, a healthy lifestyle behaviour, was categorised into four levels according to the number of healthy behaviours (HB) met. Generalised linear models were applied to assess the exposure on the outcome long-duration troublesome neck pain (activity-limiting neck pain ≥2 days/week during the past 6 months), at follow-up in 2010.

    RESULTS: The adjusted risk of long-duration troublesome neck pain decreased with increasing adherence to a healthy lifestyle behaviour among both men and women (trend test: p<0.05). Compared with the reference category, none or one HB, the risk decreased by 24% (risk ratio 0.76, 95% CI 0.58 to 0.98) among men and by 34% (0.66, 0.54 to 0.81) among women, with three or four HBs. The same comparison showed an absolute reduction of the outcome by 3% in men (risk difference -0.03, 95% CI -0.05 to -0.01) and 5% in women (-0.05,-0.08 to -0.03). Similar results were found in the working population subsample.

    CONCLUSION: Adhering to a healthy lifestyle behaviour decreased the risk of long-duration troublesome neck pain among men and women with occasional neck pain. The results add to previous research and supports the importance of promoting a healthy lifestyle behaviour.

    Fulltekst (pdf)
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  • 4. Bohman, Tony
    et al.
    Holm, Lena W
    Lekander, Mats
    Hallqvist, Johan
    Skillgate, Eva
    Sophiahemmet Högskola.
    Influence of work ability and smoking on the prognosis of long-duration activity-limiting neck/back pain: A cohort study of a Swedish working population2022Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 4, artikkel-id e054512Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Long-duration activity-limiting neck/back pain is common, but the knowledge of what work and lifestyle factors that influence the prognosis is sparse. The objective was therefore to evaluate if two factors, good self-perceived work ability and no daily smoking, are associated with a favourable prognosis of long-duration activity-limiting neck/back pain in a working population, and if these exposures have a synergistic prognostic effect.

    DESIGN: A prospective cohort study based on three subsamples from the Stockholm Public Health Cohort.

    SETTINGS: A working population in Stockholm County, Sweden.

    PARTICIPANTS: Individuals, 18-61 years old, reporting long-duration activity-limiting neck/back pain the previous 6 months at baseline in 2010 (n=5177).

    MEASURES: The exposures were: self-perceived work ability (categorised into good, moderate and poor) and daily smoking (no/yes). The outcome in 2014 was 'absence of long-duration activity-limiting neck/back pain' the previous 6 months representing a favourable prognosis of reported problems at baseline in 2010. Risk ratios (RRs) and risk differences (RDs) with 95% CI was estimated by general linear regressions, and the synergistic effect was estimated by the synergy index (SI) with 95% CI.

    RESULTS: Participants with moderate or good work ability, respectively, had an adjusted RR for a favourable prognosis of 1.37 (95% CI 1.11 to 1.69), and 1.80 (1.49 to 2.17) in comparison with participants with poor work ability. The corresponding adjusted RD were 0.07 (0.02 to 0.11) and 0.17 (0.12 to 0.22). Participants not smoking on daily basis had an adjusted RR of 1.21 (1.02 to 1.42), and an adjusted RD of 0.05 (0.01 to 0.10) for a favourable outcome compared with daily smokers. The adjusted SI was 0.92 (0.60 to 1.43).

    CONCLUSION: For participants with long-duration activity-limiting neck/back pain, moderate or good self-perceived work ability and not being a daily smoker were associated with a favourable prognosis but having both exposures seemed to have no synergistic prognostic effect.

    Fulltekst (pdf)
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  • 5. Bondesson, Tina
    et al.
    Petersson, Lena-Marie
    Wennman-Larsen, Agneta
    Sophiahemmet Högskola.
    Alexanderson, Kristina
    Kjeldgård, Linnea
    Nilsson, Marie I
    A study to examine the influence of health professionals' advice and support on work capacity and sick leave after breast cancer surgery2016Inngår i: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, nr 10, s. 4141-4148Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The aim of this study was to investigate how women, shortly after breast cancer surgery, experienced encounters with, and information from, healthcare professionals regarding work and sick leave and if these experiences were associated with self-reported work capacity and sick leave.

    METHODS: This is a cross-sectional study based on questionnaire data from 605 women who had had breast cancer surgery, aged 20-63 years. Exclusion criteria were known distant metastases, pre surgical therapy, and/or previous breast cancer. Data on age, type of surgery, global health, and work environment were included as covariates in multivariable logistic regression analysis.

    RESULTS: Five percent of the women had not received any advice concerning work or sick leave. Women reporting receiving useful advice or support related to paid work had lower risk of reporting reduced physical or psychological/social work capacity due to the cancer or treatment (OR 0.46 (95 % CI 0.26-0.81) respective OR 0.45 (95 % CI 0.26-0.77)). There were no associations between having received useful advice or support concerning work and being on sick leave. Women encouraged to take sick leave had an OR of 2.17 (95 % CI 1.39-3.37) of being sickness absent. They also to a higher extent had reduced physical and psychological/social work capacity. Women who reported to have been encouraged to work were sickness absent to a lower extent (OR 0.64; 95 % CI 0.41-0.98) and reported higher physical work capacity.

    CONCLUSIONS: Work and sick leave is being discussed during consultations with women with breast cancer and the advice given seems to be in line with the women's subjective work capacity.

  • 6. Chastin, Sebastien
    et al.
    McGregor, Duncan
    Palarea-Albaladejo, Javier
    Diaz, Keith M
    Hagströmer, Maria
    Sophiahemmet Högskola.
    Hallal, Pedro Curi
    van Hees, Vincent T
    Hooker, Steven
    Howard, Virginia J
    Lee, I-Min
    von Rosen, Philip
    Sabia, Séverine
    Shiroma, Eric J
    Yerramalla, Manasa S
    Dall, Philippa
    Joint association between accelerometry-measured daily combination of time spent in physical activity, sedentary behaviour and sleep and all-cause mortality: A pooled analysis of six prospective cohorts using compositional analysis2021Inngår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 55, nr 22, s. 1277-1285, artikkel-id bjsports-2020-102345Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To examine the joint associations of daily time spent in different intensities of physical activity, sedentary behaviour and sleep with all-cause mortality.

    METHODS: Federated pooled analysis of six prospective cohorts with device-measured time spent in different intensities of physical activity, sedentary behaviour and sleep following a standardised compositional Cox regression analysis.

    PARTICIPANTS: 130 239 people from general population samples of adults (average age 54 years) from the UK, USA and Sweden.

    MAIN OUTCOME: All-cause mortality (follow-up 4.3-14.5 years).

    RESULTS: Studies using wrist and hip accelerometer provided statistically different results (I2=92.2%, Q-test p<0.001). There was no association between duration of sleep and all-cause mortality, HR=0.96 (95% CI 0.67 to 1.12). The proportion of time spent in moderate to vigorous physical activity was significantly associated with lower risk of all-cause mortality (HR=0.63 (95% CI 0.55 to 0.71) wrist; HR=0.93 (95% CI 0.87 to 0.98) hip). A significant association for the ratio of time spent in light physical activity and sedentary time was only found in hip accelerometer-based studies (HR=0.5, 95% CI 0.42 to 0.62). In studies based on hip accelerometer, the association between moderate to vigorous physical activity and mortality was modified by the balance of time spent in light physical activity and sedentary time.

    CONCLUSION: This federated analysis shows a joint dose-response association between the daily balance of time spent in physical activity of different intensities and sedentary behaviour with all-cause mortality, while sleep duration does not appear to be significant. The strongest association is with time spent in moderate to vigorous physical activity, but it is modified by the balance of time spent in light physical activity relative to sedentary behaviour.

    Fulltekst (pdf)
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  • 7. Clason van de Leur, Jakob
    et al.
    Buhrman, Monica
    Wallby, Kajsa
    Karlström, Amanda
    Johansson, Fred
    Sophiahemmet Högskola.
    Associations between improvements in psychological variables and subsequent sick leave among persons receiving a multimodal intervention for exhaustion disorder2023Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, artikkel-id 1976Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The incidence of sick leave due to stress-related disorders such as exhaustion disorder (ED) is high in many economically developed countries. Meanwhile, knowledge about facilitating return to work during clinical interventions for ED patients is still limited. The current study aimed to investigate if improvements in exhaustion symptoms, insomnia, perfectionistic behaviors, psychological flexibility, and perceived work ability during treatment of ED were associated with subsequent sick leave in the year following treatment.

    METHODS: Using a cohort of 880 ED patients who had participated in a multimodal intervention based on Cognitive Behavior Therapy, we estimated the association between one standard deviation (SD) improvement in treatment-related variables and the rate of net days of sick leave one-year following treatment.

    RESULTS: Our results showed that improvements in all treatment-related variables were associated with lower sick leave rates one year following treatment. Improvements in exhaustion symptoms (rate ratio (RR): 0.70 [95% CI 0.66; 0.75]) and self-perceived work ability (RR 0.56 [95% CI 0.50; 0.63]) showed the strongest associations to subsequent sick leave.

    CONCLUSIONS: These findings suggest that interventions focusing on exhaustion symptoms, insomnia, perfectionistic behaviors, psychological flexibility, and perceived work ability can have a meaningful impact on ED patients' subsequent sick leave.

    TRIAL REGISTRATION: Clinicaltrials.gov (Identifier: NCT03360136).

    Fulltekst (pdf)
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  • 8. Dohrn, Ing-Mari
    et al.
    Welmer, Anna-Karin
    Hagströmer, Maria
    Sophiahemmet Högskola.
    Accelerometry-assessed physical activity and sedentary time and associations with chronic disease and hospital visits: a prospective cohort study with 15 years follow-up2019Inngår i: International Journal of Behavioral Nutrition and Physical Activity, E-ISSN 1479-5868, Vol. 16, nr 1, artikkel-id 125Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Associations of objectively assessed physical activity in different intensities and risk of developing chronic disease that requires hospital care have not yet been examined in long term population-based studies. Studies addressing the link between physical activity and sedentary time and subsequent hospital admissions are lacking.

    OBJECTIVE: To examine the prospective associations between physical activity and sedentary time with morbidity defined as: 1) a registered main diagnosis of cardiovascular disease, cancer, type-2 diabetes, dementia, obesity or depression; 2) number of in- and outpatient hospital visits; and 3) number of in-hospital days.

    METHODS: In total, 1220 women and men, 18-75 years, from the population-based Sweden Attitude Behaviour and Change study 2000-2001 were included. Time spent sedentary, in light-intensity physical activity and in moderate-to-vigorous physical activity, and total accelerometer counts were assessed using the ActiGraph 7164 accelerometer. Morbidity data were obtained 2016 from Swedish registers. Cox proportional hazards models estimated hazard ratios (HR) of morbidity with 95% confidence intervals (CI) and negative binomial regression estimated incidence rate ratio (IRR) with 95% CI for number of hospital visits, and length of hospital stay.

    RESULTS: Over a follow-up of 14.4 years (SD = 1.6), 342 persons had at least one registered hospital visit due to any of the included diagnoses. Higher moderate-to-vigorous physical activity was associated with significant risk reductions for combined morbidity (all included diagnoses) (HR: 0.65, 95% CI: 0.48-0.88) and cardiovascular disease (HR: 0.52, 95% CI: 0.33-0.82). Higher total counts showed similar results, and was also associated with fewer hospital visits (IRR = 0.56, 95% CI: 0.37-0.85). Higher sedentary time increased the risk of in-hospital days. (IRR = 2.38, 95% CI: 1.20-4.74).

    CONCLUSION: This study supports the importance of moderate-to-vigorous physical activity for preventing chronic disease that requires hospital care, especially cardiovascular disease. High volumes of sedentary behavior may increase the risk of future hospitalization. Our results support the public health message "sit less and move more".

    Fulltekst (pdf)
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  • 9.
    Edlund, Klara
    et al.
    Sophiahemmet Högskola.
    Johansson, Fred
    Sophiahemmet Högskola.
    Lindroth, Rebecca
    Bergman, Louise
    Sundberg, Tobias
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Body image and compulsive exercise: Are there associations with depression among university students?2022Inngår i: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 27, nr 7, s. 2397-2405Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Mental health problems among university students have been reported to be significantly increasing and suggested to be associated with college drop-out. Body dissatisfaction and compulsive exercise are both constructs relevant for mental health problems in general and eating disorders in particular. This study examined associations between body dissatisfaction, compulsive exercise and self-reported symptoms of depression among Swedish university students.

    METHODS: Participants (n = 4262) are students in an ongoing cohort study, and data from the baseline assessment were used. Four linear regression models were built to explore the associations between body dissatisfaction, compulsive weight control exercise and depressive symptoms.

    RESULTS: Our findings showed that females reported higher levels of body dissatisfaction than males. Body dissatisfaction and compulsive exercise were associated with self-reported symptoms of depression in this non-clinical population. Results showed that compulsive exercise was negatively associated with reported symptoms of depression, while body dissatisfaction was positively associated with symptoms of depression.

    CONCLUSION: In line with previous research, there was a gender difference in body dissatisfaction where females displayed higher levels of dissatisfaction than males.  Body dissatisfaction was  positively associated with reported symptoms of depression, suggesting support of previous research indicating body dissatisfaction to increase mental health problems. Compulsive exercise was negatively associated with symptoms of depression suggesting a behavior negatively reinforced, supporting both constructs to be of interest for reported symptoms of depression in a non-clinical population of Swedish university students.

    LEVEL OF EVIDENCE: III, cohort study.

    TRIAL REGISTRATION: http://clinicaltrials.gov/ID : NCT04465435.

    Fulltekst (pdf)
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  • 10.
    Edlund, Klara
    et al.
    Sophiahemmet Högskola.
    Nigicser, Isabel
    Sansone, Mikael
    Identeg, Fredrik
    Hedelin, Henrik
    Forsberg, Niklas
    Tranaeus, Ulrika
    Protocol for a 2-year longitudinal study of eating disturbances, mental health problems and overuse injuries in rock climbers (CLIMB)2023Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 13, nr 9, artikkel-id e074631Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Rock climbing is a rapidly growing sport in which performance may be affected by participant's weight and leanness, and there may be pressure on athletes with respect to their eating behaviour and body weight. However, there is sparse research performed on climbers, constituting a knowledge gap which the present study aims to fill. The primary outcomes of the study are to examine disordered eating and overuse injuries in rock climbers. Secondary variables are body image, indicators of relative energy deficiency, mental health problems, compulsive training, perfectionism, sleep quality and bone density.

    METHOD AND ANALYSIS: This prospective longitudinal study aims to recruit Swedish competitive rock climbers (>13 years) via the Swedish Climbing Federation. A non-athlete control group will be recruited via social media (n=equal of the climbing group). Data will be collected using streamlined validated web-based questionnaires with three follow-ups over 2 years. Inclusion criteria for rock climbers will be a minimum advanced level according to International Rock-Climbing Research Association. The non-athlete control group is matched for age and gender. Exclusion criteria are having competed at an elite level in any sport as well as training more often than twice per week. Statistical analyses will include multinominal logistic regression, multivariate analysis of variance (MANOVA) and structural equation modelling (SEM). We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up.

    ETHICS AND DISSEMINATION: The Rock-Climbers' Longitudinal attitudes towards Injuries, Mental health and Body image study, CLIMB, was approved by the Swedish ethics authority (2021-05557-01). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications.

    TRIAL REGISTRATION NUMBER: NCT05587270.

    Fulltekst (pdf)
    fulltext
  • 11.
    Edlund, Klara
    et al.
    Sophiahemmet Högskola.
    Sundberg, Tobias
    Sophiahemmet Högskola.
    Johansson, Fred
    Sophiahemmet Högskola.
    Onell, Clara
    Sophiahemmet Högskola.
    Rudman, Ann
    Holm, Lena W
    Sophiahemmet Högskola.
    Grotle, Margreth
    Jensen, Irene
    Côté, Pierre
    Skillgate, Eva
    Sophiahemmet Högskola.
    Sustainable UNiversity Life (SUN) study: Protocol for a prospective cohort study of modifiable risk and prognostic factors for mental health problems and musculoskeletal pain among university students2022Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 4, artikkel-id e056489Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Mental health problems and musculoskeletal pain are common health problems among young adults including students. Little is known about the aetiology and prognosis of these problems in university students. We aim to determine the role of personal, sociodemographic, academic and environmental factors for risk and prognosis of symptoms of depression, anxiety and stress as well as musculoskeletal pain in university students. The constructs that will be studied are based on the biopsychosocial model and psychopathology associated with disabling pain. This model acknowledges illness to consist of interrelated mechanisms categorised into biological, psychological, environmental and social cues.

    METHODS AND ANALYSIS: This cohort study aims to recruit around 5000 Swedish full-time students. Data will be collected using five online surveys during one academic year. A subgroup (n=1851) of the cohort, recruited before the COVID-19 pandemic, receive weekly text messages with three short questions assessing mood, worry and pain, sent through the web-based platform SMS-track . Statistical analyses will include Kaplan-Meier estimates, Cox regression analyses, multinomial logistic regression analyses and generalised estimating equations. We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up.

    PROTOCOL AMENDMENTS: Due to opportunity and timing of the study, with relevance to the outbreak of the COVID-19 pandemic, this study further aims to address mental health problems, musculoskeletal pain and lifestyle in university students before and during the pandemic.

    ETHICS AND DISSEMINATION: The Sustainable UNiversity Life study was approved by the Swedish ethics authority (2019-03276; 2020-01449). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications.

    TRIAL REGISTRATION NUMBER: NCT04465435.

    Fulltekst (pdf)
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  • 12. Eklund, Caroline
    et al.
    Elfström, Magnus L
    von Heideken Wågert, Petra
    Söderlund, Anne
    Gustavsson, Catharina
    Cederbom, Sara
    Thunborg, Charlotta
    Lööf, Helena
    Sophiahemmet Högskola.
    The meaning of sedentary behavior as experienced by people in the transition from working life to retirement: An empirical phenomenological study2021Inngår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 101, nr 8, artikkel-id pzab117Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Sedentary behavior (SB) is defined as a mean of >6 hours of daytime sitting or lying down. SB has been shown to increase with older age and is a risk factor for disease. During the transition from working life to retirement, changes in daily life activities occur, risking increased SB. The aim of the present study was to gain a deeper understanding of SB in relation to the transition from working life to retirement as experienced by persons in retirement.

    METHODS: The study was grounded in a phenomenological life-world perspective. Fourteen semi-structured interviews were conducted with participants aged 64-75. Data were analyzed using the empirical phenomenological psychological method.

    RESULTS: The participants described that voluntary sedentary time was positively related to general health and well-being, while involuntary sedentary time was negatively related to health. Increased sedentary time was described as natural when aging. Retirement was expressed as a time for rest after hard work and the ability to choose a slower pace in life. Internal and external demands and daily routines interrupted SB, whereas loneliness was perceived to increase SB. Participants strived to find a balance between physical activity and sedentary time. The variations in the participants' descriptions formed three typologies: in light of meaningful sedentary behavior, in the shadow of involuntary sedentary behavior, and a dual process - postponing sedentary behavior with physical activity.

    CONCLUSIONS: Increased SB was perceived as natural when aging, but something that may be postponed by conscious choices. SB was perceived as associated with health, rest and recovery but also with the risk of deteriorating health.

    IMPACT: This knowledge of the experienced meaning of SB could guide the design of health promotion interventions and may be helpful in targeting those in need of support and individualizing interventions to decrease SB in retirement.

    LAY SUMMARY: This study reveals how persons in retirement describe sedentary behavior as something healthy but also as unhealthy and that sedentary behavior is natural in aging and can be postponed by physical activity.

    Fulltekst (pdf)
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  • 13.
    Fossum, Bjöörn
    et al.
    Sophiahemmet Högskola.
    Arborelius, Elisabeth
    Bremberg, Sven
    Evaluation of a counseling method for the prevention of child exposure to tobacco smoke: an example of client-centered communication2004Inngår i: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 38, nr 3, s. 295-301Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Environmental tobacco smoke (ETS) is an important risk factor. The aim of this study is to evaluate effects of the counseling method "Smoke-free children" that focuses on protection of infants. METHODS: The counseling method, "Smoke-free children", has been developed and implemented at Swedish child health centers. The counseling method's point of departure is based upon a client-centered approach. Saliva cotinine samples from the mothers were collected when the child was 1-4 weeks and 3 months of age. Interviews regarding mothers' smoking habits and self-reported maternal smoking were also carried out. RESULTS: Forty-one mothers participated in the study, 26 in the intervention group and 15 in the control group. Cotinine was collected from 22 subjects in the intervention and 8 in the control group. Before the intervention, the mean cotinine level was 185 ng/mL in the intervention group and 245 ng/mL in the control group. After the intervention, cotinine levels were reduced in the intervention group (165 ng/mL) and increased in the control group (346 ng/mL). Yet, after the intervention, the mothers themselves reported more smoking in the intervention group than in the control group. Only weak correlations were found between self-reported smoking and cotinine. CONCLUSIONS: The statistical analysis supports the view that a client-centered intervention, aimed at increasing self-efficacy, exerts a positive effect on maternal smoking in the prevention of infant exposure to ETS, when applied in a routine clinical setting.

  • 14.
    Fältström, Anne
    et al.
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Weiss, Nathan
    Sophiahemmet Högskola.
    Källberg, Henrik
    Sophiahemmet Högskola.
    Lyberg, Victor
    Sophiahemmet Högskola.
    Waldén, Markus
    Hägglund, Martin
    Asker, Martin
    Sophiahemmet Högskola.
    Tranaeus, Ulrika
    Lifestyle characteristics in adolescent female football players: Data from the Karolinska football Injury Cohort2022Inngår i: BMC Sports Science, Medicine & Rehabilitation, ISSN 2052-1847, Vol. 14, nr 1, s. 212-, artikkel-id 212Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Normative values of lifestyle characteristics in adolescent female football players may be used by clinicians and coaches to take actions because the potential important for well-being, performance on the pitch, and risk of injury. The aim was to report descriptive characteristics of lifestyle factors in adolescent female football players and potential changes over 1 year.

    METHODS: We included 419 adolescent competitive female football players from 12 clubs and 27 teams (age 14 ± 1 years, range 12-17 years) and 286 were followed over 1 year. The players completed an extensive questionnaire regarding demographics, football-related factors, and lifestyle factors including tobacco consumption, alcohol use, medicine intake, eating and sleeping habits, well-being, stress, coping, and passion. Baseline data are presented for the total cohort and separately for 4 age groups (12, 13, 14, and 15-17 years).

    RESULTS: 12% skipped breakfast, 8% skipped lunch and 11% used protein supplements several days per week. 16% slept less than 8 h/night, 8% had impaired sleep with daytime consequences, and 22% stated that they were tired in daily activities several days per week. 32% experienced stress some or most days/week and 24% were classified as having psychological distress. Medicine intake (23% vs. 34%), skipping breakfast or lunch several days per week (10% vs. 47% and 20 vs. 33%), tiredness (20% vs. 27%), stress (26% vs. 40%), and psychological distress (27% vs. 37%) increased significantly (P = 0.031 to < 0.001) at the 1-year follow-up.

    CONCLUSION: Many adolescent female football players skip breakfast and lunch, have insufficient sleep, experience stress and are classified as having psychological distress. These factors increased over 1 year.

    Fulltekst (pdf)
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  • 15. Gebrie, Mignote Hailu
    et al.
    Asfaw, Hussen Mekonnen
    Bilchut, Workagegnehu Hailu
    Lindgren, Helena
    Sophiahemmet Högskola.
    Wettergren, Lena
    Health-related quality of life among patients with end-stage renal disease undergoing hemodialysis in Ethiopia: A cross-sectional survey2023Inngår i: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 21, nr 1, artikkel-id 36Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Measurement of health-related quality of life (HRQOL) enables identification of treatment-related side effects of a disease. Such aspects may negatively impact on patients' lives and should be taken into consideration in medical decision-making. In sub-Saharan Africa, research from the perspective of patients with chronic kidney disease is scarce, and it is almost non-existent in patients undergoing hemodialysis. We aimed to determine HRQOL among end-stage renal disease patients undergoing maintenance hemodialysis in Ethiopia and to identify factors associated with HRQOL.

    METHODS: A multi-center cross-sectional study was conducted in Addis Ababa, Ethiopia directed to all patients receiving hemodialysis due to kidney failure at 11 randomly-selected government and private hospitals/dialysis centers in the capital of Ethiopia. Data were collected by trained nurses using the KDQOL-36 instrument with five subscales measuring generic and disease-specific HRQOL. Study-specific items were used to collect socio-demographic and clinical data. Factors associated with HRQOL were examined using multivariable linear regression models.

    RESULTS: Four hundred eighty-one patients completed the survey through face-to-face interviews (response rate 96%; mean age 45.34 ± 14.67). The mean scores of the subscales ranged from 25.6 to 66.68 (range 0-100), with higher scores reflecting better health. Factors associated with low HRQOL included older age, female sex, no formal education, poor medication adherence, > 2 hemodialysis sessions/week, lower body mass index (< 18.5), longer duration of hemodialysis treatment (≥ 12 months), and poor social support.

    CONCLUSION: Patients with kidney failure undergoing hemodialysis in Addis Ababa, Ethiopia, had low HRQOL across all subscales compared to previous studies. Therefore, the implementation of guidelines is crucial to improve patients' adherence to their prescribed medications. Furthermore, establishing patient support groups and encouraging patients to use the available support resources from family members, neighbors, and friends have the potential to improve patients' HRQOL.

    Fulltekst (pdf)
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  • 16. Guldbrandsson, Karin
    et al.
    Fossum, Bjöörn
    Sophiahemmet Högskola.
    An exploration of the theoretical concepts policy windows and policy entrepreneurs at the Swedish public health arena2009Inngår i: Health Promotion International, ISSN 1460-2245, Vol. 24, nr 4, s. 434-44Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In John Kingdon's Policy Streams Approach policy formation is described as the result of the flow of three 'streams', the problem stream, the policy stream and the politics stream. When these streams couple, a policy window opens which facilitate policy change. Actors who promote specific solutions are labelled policy entrepreneurs. The aim of this study was to test the applicability of the Policy Streams Approach by verifying whether the theoretical concepts 'policy windows' and 'policy entrepreneurs' could be discernable in nine specified cases. Content analyses of interviews and documents related to child health promoting measures in three Swedish municipalities were performed and nine case studies were written. The policy processes preceding the municipal measures and described in the case studies were scrutinized in order to find statements related to the concepts policy windows and policy entrepreneurs. All conditions required to open a policy window were reported to be present in eight of the nine case studies, as was the most important resource of a policy entrepreneur, sheer persistence. This study shows that empirical examples of policy windows and policy entrepreneurs could be identified in child health promoting measures in Swedish municipalities. If policy makers could learn to predict the opening of policy windows, the planning of public health measures might be more straightforward. This also applies to policy makers' ability to detect actors possessing policy entrepreneur resources.

  • 17.
    Hansson, Anna
    et al.
    Sophiahemmet Högskola.
    Forsell, Yvonne
    Hochwälder, J
    Hillerås, Pernilla
    Sophiahemmet Högskola.
    Impact of changes in life circumstances on subjective well-being in an adult population over a 3-year period2008Inngår i: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 122, nr 12, s. 1392-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Mental health problems are a major issue worldwide, and there is a need to further explore factors that may increase or decrease people's subjective well-being (SWB). The main aim of the present study was to extend knowledge concerning changes in cohabitation, social support or financial situation and their influence on SWB, after controlling for personality (i.e. neuroticism), in a 3-year follow-up of an adult population-based sample. The change in overall well-being was also studied during the 3- year interval. STUDY DESIGN: Longitudinal design. METHODS: A random sample of Swedish citizens, aged 20-64 years, residing in Stockholm County received a questionnaire by post, comprising items pertaining to demographics, personality, social support and SWB. All the respondents received a second questionnaire 3 years later. In total, 8324 subjects were included in the present study. RESULTS: The overall well-being of the study sample was relatively stable. Separate analyses of the three life circumstances indicated that, after controlling for personality, positive and negative changes in each sphere of life still affected SWB. CONCLUSIONS: Despite personality and the stability of SWB, these results indicate that changes in financial situation, social support and cohabitation influence SWB. It is important for society and the healthcare services to be aware that a negative change in any of these life circumstances may lead to decreased well-being for a period of at least 3 years.

  • 18. Haukeli, Kristine
    et al.
    Edlund, Klara
    Sophiahemmet Högskola.
    Two-year longitudinal case study of intensive exposure treatment in an adolescent girl with social anxiety disorder2022Inngår i: Clinical Case Reports, ISSN 2050-0904, Vol. 10, nr 3, s. e05588-, artikkel-id e05588Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose was to adapt the "Bergen 4-Day Treatment" for severe social anxiety disorder and to study the 28 months follow-up effects for a 16-year-old girl. It was delivered over three full days. At post-treatment, 48% reduction in symptoms, she no longer met the diagnostic criteria for SAD.

    Fulltekst (pdf)
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  • 19. Identeg, Fredrik
    et al.
    Nigicser, Isabel
    Edlund, Klara
    Sophiahemmet Högskola.
    Forsberg, Niklas
    Sansone, Mikael
    Tranaeus, Ulrika
    Hedelin, Henrik
    Mental health problems, sleep quality and overuse injuries in advanced Swedish rock-climbers: The CLIMB study2024Inngår i: BMC Sports Science, Medicine & Rehabilitation, ISSN 2052-1847, Vol. 16, artikkel-id 46Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To examine the prevalence of mental health problems (depression, anxiety, and stress), sleep quality, and disability due to overuse injuries in advanced and elite rock-climbers. The rock-climbers were compared to a group of non-climbing controls.

    METHODS: A self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A control group, matched in size was recruited. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index and The Oslo Sports Trauma Research Center Overuse Injury Questionnaire.

    RESULTS: A total of 183 participants were included in the rock-climbing group, and 180 participants in the control group. In the rock-climbing group the mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. The mean BMI of women was 21.2 (2.2) and 22.8 (2.1) in men. A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression and 23.1% (17.2% men, 30.8% women) at least moderate levels of symptoms of anxiety. A total of 48.4% of rock-climbers (39.1% men, and 61.6% women) reported at least moderate levels of symptoms of stress. Among the rock-climbers, 45.0% reported having poor sleep quality. There were no statistical significant differences (p = 0.052-0.96) in mental health problems or sleeping problems between the rock-climbers and the controls. Among rock-climbers, reports of one-week prevalence of injury related problems was: Finger and hand (49.5%), Shoulder (35.2%), Knee (29.1%), Lumbar back (26.4%), Arm (25.3%), Thoracic back and neck (17.0%), and Foot and lower leg (12.1%).

    CONCLUSION: The overall results indicate high levels of symptoms of mental health problems and poor sleep quality in both rock-climbers and controls. Although no significant differences between the climbing group and the control group was displayed, symptoms that warrant clinical attention is high. Overuse injuries were commonly reported among the rock-climbers in all examined injury locations. Previous studies reporting mental health problems to be more prevalent among athletes were contradicted in this study. The results display the need for a broader perspective regarding climbers general health and the need to provide structured care and adequate support in order to come to terms with these concerns.

    Fulltekst (pdf)
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  • 20. Jakobsson, Sofie
    et al.
    Alexanderson, Kristina
    Wennman-Larsen, Agneta
    Sophiahemmet Högskola.
    Taft, Charles
    Ringsberg, Karin C
    Self-rated health over a two-year period after breast cancer surgery: prospective ratings and retrospective rating by means of a health-line2020Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: There are difficulties in clinical assessment of patients' health, and there is a need for evaluating instruments that measures self-rated health over time and that are based on the patient's own experiences of their health situation.

    AIM: To describe the trajectory of self-rated health given in a retrospective health-line and its correspondence with the ratings of health given at six different time points during 2 years following a first breast cancer surgery.

    DESIGNS AND METHODS: An explorative prospective cohort study presented according to the STROBE guideline. At six time points, 459 women (26-63 years) completed assessments of self-rated health during 2 years following a first breast cancer surgery. Subsequently, the women retrospectively rated health month by month over the two years by means of a health-line. The women were included consecutively in 2007-2009, last data collection was performed in 2012. Statistical analyses were used to compare the health-line with previous ratings.

    RESULTS: Most women (74-88%) rated their health as good, very good or excellent at all six time points. Health-line ratings were somewhat lower than the ratings made at the actual time-point; however, the illustrated trajectories back in time followed the same patterns as the women had reported during the two years. The lowest ratings of self-rated health were reported at four months after surgery. The retrospective illustrations varied greatly, and poorer health was reported by women undergoing chemotherapy, with lower education and who reported more life events.

    CONCLUSIONS: Even if the retrospective ratings by the health-line were somewhat lower than the ratings at the actual time-point, the health-line captures the health trajectory. The individual graphic illustration by means of a health-line may serve as a basis for assessment and support patient health narratives. The findings indicate that life event, lower education and chemotherapy influence concurrent and retrospective self-assessment of health.

  • 21.
    Johansson, Fred
    et al.
    Sophiahemmet Högskola.
    Billquist, Jessica
    Andreasson, Hanna
    Jensen, Irene
    Onell, Clara
    Sophiahemmet Högskola.
    Berman, Anne H
    Skillgate, Eva
    Sophiahemmet Högskola.
    Study environment and the incidence of mental health problems and activity-limiting musculoskeletal problems among university students: The SUN cohort study2023Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 13, nr 9, artikkel-id e072178Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To determine the association between different aspects of study environment and the incidence of mental health problems and activity-limiting musculoskeletal problems.

    DESIGN, SETTING AND PARTICIPANTS: We recruited a cohort of 4262 Swedish university students of whom 2503 (59%) were without moderate or worse mental health problems and 2871 (67%) without activity-limiting musculoskeletal problems at baseline. The participants were followed at five time points over 1 year using web surveys.

    EXPOSURES: Self-rated discrimination, high study pace, low social cohesion and poor physical environment measured at baseline.

    OUTCOMES: Self-rated mental health problems defined as scoring above cut-off on any of the subscales of the Depression, Anxiety and Stress Scale. Self-rated activity-limiting musculoskeletal problems in any body location assessed by the Nordic Musculoskeletal Questionnaire.

    STATISTICAL ANALYSIS: Discrete survival-time analysis was used to estimate the hazard rate ratio (HR) of each exposure-outcome combination while adjusting for gender, age, living situation, education type, year of studies, place of birth and parental education as potential confounders.

    RESULTS: For discrimination, adjusted HRs were 1.75 (95% CI 1.40 to 2.19) for mental health problems and 1.39 (95% CI 1.12 to 1.72) for activity-limiting musculoskeletal problems. For high study pace, adjusted HRs were 1.70 (95% CI 1.48 to 1.94) for mental health problems and 1.25 (95% CI 1.09 to 1.43) for activity-limiting musculoskeletal problems. For low social cohesion, adjusted HRs were 1.51 (95% CI 1.29 to 1.77) for mental health problems and 1.08 (95% CI 0.93 to 1.25) for activity-limiting musculoskeletal problems. For perceived poor physical study environment, adjusted HRs were 1.20 (95% CI 0.99 to 1.45) for mental health problems and 1.20 (95% CI 1.01 to 1.43) for activity-limiting musculoskeletal problems.

    CONCLUSIONS: Several aspects of the study environment were associated with the incidence of mental health problems and activity-limiting musculoskeletal problems in this sample of Swedish university students.

    Fulltekst (pdf)
    fulltext
  • 22.
    Johansson, Fred
    et al.
    Sophiahemmet Högskola.
    Côté, Pierre
    Hogg-Johnson, Sheilah
    Rudman, Ann
    Holm, Lena W
    Grotle, Margreth
    Jensen, Irene
    Sundberg, Tobias
    Sophiahemmet Högskola.
    Edlund, Klara
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Depression, anxiety and stress among Swedish university students before and during six months of the COVID-19 pandemic: A cohort study2021Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 49, nr 7, s. 741-749, artikkel-id 14034948211015814Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: The COVID-19 pandemic has had a profound effect on societies and citizens worldwide, raising concerns about potential mental health impacts. We aimed to describe trajectories of depression, anxiety and stress symptoms during the COVID-19 outbreak compared to before the outbreak, and to determine if trajectories were modified by pre-pandemic loneliness, poor sleep quality and mental health problems.

    METHODS: We conducted a cohort study with 1836 Swedish university students entering the study before 13 March 2020, the onset of the pandemic, with follow-ups within three (FU1) and six months (FU2) of the outbreak. Generalized Estimating Equations were used to estimate mean differences in symptom levels over time-periods, and to estimate potential effect modifications.

    RESULTS: We found small differences in mean levels of the depression, anxiety and stress scale (DASS-21) over time. Compared to before the pandemic, depression increased by 0.25 points of 21 (95% CI: 0.04 to -0.45) at FU1 and decreased by 0.75/21 (95% CI:-0.97 to -0.53) at FU2. Anxiety decreased from baseline to FU1 by 0.09/21 (95% CI: -0.24 to -0.07) and by 0.77/21 (95% CI: -0.93 to -0.61) to FU2. Stress decreased from baseline to FU1 by 0.30/21 (95% CI: -0.52 to -0.09) and by 1.32/21 (95% CI: -1.55 to -1.09) to FU2. Students with pre-pandemic loneliness, poor sleep quality or pre-pandemic mental health problems did not have worse trajectories of mean mental health symptoms.

    CONCLUSIONS: Symptom levels were relatively stable during the first three months of the pandemic, while there was a slight decrease during the summer months, probably due to seasonality effects.

    Fulltekst (pdf)
    fulltext
  • 23.
    Johansson, Fred
    et al.
    Sophiahemmet Högskola.
    Côté, Pierre
    Hogg-Johnson, Sheilah
    Skillgate, Eva
    Sophiahemmet Högskola.
    Depression, anxiety and stress among Swedish university students during the second and third waves of COVID-19: A cohort study2021Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 49, nr 7, s. 750-754, artikkel-id 14034948211031402Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: This study aims to describe the mean trajectories of depression, anxiety and stress symptoms among Swedish university students before and during the second and third waves of the COVID-19 pandemic.

    METHODS: We recruited 1835 participants in September 2020, of whom 81% provided follow-ups in December 2020-January 2021 and 77% provided follow-ups in March-April 2021. The short-form Depression, Anxiety and Stress Scale was used to measure mental health symptoms. Generalized estimating equations were used to estimate the mean differences in symptom levels over the three time periods.

    RESULTS: Compared with September, mean depression was 0.91 points of 21 higher (95% confidence interval (CI) 0.70-1.13) in December 2020-January 2021 and 0.66 points higher (95% CI 0.43-.88) in March-April 2021. Anxiety levels were 0.20 points higher (95% CI 0.05-0.34) in December 2020-January 2021 and 0.17 points higher (95% CI 0.02-0.33) in March-April 2021. Stress levels were 0.21 points higher (95% CI 0.00-0.41) in December 2020-January 2021 and 0.16 points lower (95% CI -0.38 to 0.05) in March-April 2021.

    CONCLUSIONS: Our results indicate relatively stable levels of mental health among Swedish university students during the second and third waves of COVID-19 compared with before the second wave. Mean depression symptom scores increased slightly, but the importance of this small increase is uncertain.

    Fulltekst (pdf)
    fulltext
  • 24.
    Johansson, Fred
    et al.
    Sophiahemmet Högskola.
    Côté, Pierre
    Onell, Clara
    Sophiahemmet Högskola.
    Källberg, Henrik
    Sophiahemmet Högskola.
    Sundberg, Tobias
    Sophiahemmet Högskola.
    Edlund, Klara
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Strengths of associations between depressive symptoms and loneliness, perfectionistic concerns, risky alcohol use and physical activity across levels of sleep quality in Swedish university students: A cross-sectional study2023Inngår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 32, nr 2, artikkel-id e13745Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Previous research shows that sleep quality may interact with some other predictors of depression, such that poor sleep could strengthen the association between these factors and depression. We aimed to determine the presence of statistical interactions between sleep quality and loneliness, risky alcohol use, perfectionistic concerns and/or physical inactivity in relation to depressive symptoms. Further, we aimed to describe the functional form of the statistical interactions and associations. We used a cross-sectional design and included 4262 Swedish university students. All measures were self-reported, sleep quality was measured with the Pittsburgh Sleep Quality Index, and depressive symptoms with the short-form Depression, Anxiety and Stress Scale. Regression models of increasing complexity (linear and non-linear, with and without interactions) were compared to determine the presence of associations and statistical interactions, and to explore the best functional form for these associations and interactions. Out-of-sample R2 from repeated cross-validation was used to select the final models. We found that sleep quality was associated with depressive symptoms in all final models. Sleep quality showed a linear interaction with perfectionistic concerns in relation to depressive symptoms, such that perfectionistic concerns were more strongly associated with depressive symptoms when sleep quality was poor. Loneliness, risky alcohol use and physical inactivity were non-linearly associated with depressive symptoms but did not interact with sleep quality. We concluded that out of the four examined variables, only perfectionistic concerns interacted with sleep quality in relation to depressive symptoms. This interaction was weak and explained little of the overall variance in depressive symptoms.

    Fulltekst (pdf)
    fulltext
  • 25.
    Johansson, Fred
    et al.
    Sophiahemmet Högskola.
    Edlund, Klara
    Sophiahemmet Högskola.
    Sundgot-Borgen, J
    Björklund, C
    Côté, P
    Onell, Clara
    Sophiahemmet Högskola.
    Sundberg, Tobias
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Sexual harassment, sexual violence and subsequent depression and anxiety symptoms among Swedish university students: A cohort studyManuskript (preprint) (Annet vitenskapelig)
  • 26.
    Johansson, Fred
    et al.
    Sophiahemmet Högskola.
    Rozental, Alexander
    Edlund, Klara
    Sophiahemmet Högskola.
    Côté, Pierre
    Sundberg, Tobias
    Sophiahemmet Högskola.
    Onell, Clara
    Sophiahemmet Högskola.
    Rudman, Ann
    Skillgate, Eva
    Sophiahemmet Högskola.
    Associations between procrastination and subsequent health outcomes among university students in Sweden2023Inngår i: JAMA Network Open, E-ISSN 2574-3805, Vol. 6, nr 1, s. e2249346-, artikkel-id e2249346Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    IMPORTANCE: Procrastination is prevalent among university students and is hypothesized to lead to adverse health outcomes. Previous cross-sectional research suggests that procrastination is associated with mental and physical health outcomes, but longitudinal evidence is currently scarce.

    OBJECTIVE: To evaluate the association between procrastination and subsequent health outcomes among university students in Sweden.

    DESIGN, SETTING, AND PARTICIPANTS: This cohort study was based on the Sustainable University Life study, conducted between August 19, 2019, and December 15, 2021, in which university students recruited from 8 universities in the greater Stockholm area and Örebro were followed up at 5 time points over 1 year. The present study used data on 3525 students from 3 time points to assess whether procrastination was associated with worse health outcomes 9 months later.

    EXPOSURE: Self-reported procrastination, measured using 5 items from the Swedish version of the Pure Procrastination Scale rated on a Likert scale from 1 ("very rarely or does not represent me") to 5 ("very often or always represents me") and summed to give a total procrastination score ranging from 5 to 25.

    MAIN OUTCOMES AND MEASURES: Sixteen self-reported health outcomes were assessed at the 9-month follow-up. These included mental health problems (symptoms of depression, anxiety, and stress), disabling pain (neck and/or upper back, lower back, upper extremities, and lower extremities), unhealthy lifestyle behaviors (poor sleep quality, physical inactivity, tobacco use, cannabis use, alcohol use, and breakfast skipping), psychosocial health factors (loneliness and economic difficulties), and general health.

    RESULTS: The study included 3525 participants (2229 women [63%]; mean [SD] age, 24.8 [6.2] years), with a follow-up rate of 73% (n = 2587) 9 months later. The mean (SD) procrastination score at baseline was 12.9 (5.4). An increase of 1 SD in procrastination was associated with higher mean symptom levels of depression (β, 0.13; 95% CI, 0.09-0.17), anxiety (β, 0.08; 95% CI, 0.04-0.12), and stress (β, 0.11; 95% CI, 0.08-0.15), and having disabling pain in the upper extremities (risk ratio [RR], 1.27; 95% CI, 1.14-1.42), poor sleep quality (RR, 1.09, 95% CI, 1.05-1.14), physical inactivity (RR, 1.07; 95% CI, 1.04-1.11), loneliness (RR, 1.07; 95% CI, 1.02-1.12), and economic difficulties (RR, 1.15, 95% CI, 1.02-1.30) at the 9-month follow-up, after controlling for a large set of potential confounders.

    CONCLUSIONS AND RELEVANCE: This cohort study of Swedish university students suggests that procrastination is associated with subsequent mental health problems, disabling pain, unhealthy lifestyle behaviors, and worse psychosocial health factors. Considering that procrastination is prevalent among university students, these findings may be of importance to enhance the understanding of students' health.

    Fulltekst (pdf)
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  • 27. Jolof, Linda
    et al.
    Rocca, Patricia
    Mazaheri, Monir
    Sophiahemmet Högskola.
    Okenwa Emegwa, Leah
    Carlsson, Tommy
    Experiences of armed conflicts and forced migration among women from countries in the Middle East, Balkans, and Africa: A systematic review of qualitative studies2022Inngår i: Conflict and Health, E-ISSN 1752-1505, Vol. 16, nr 1, artikkel-id 46Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: A significant proportion of the global population is displaced, many being women. Qualitative studies can generate in-depth findings that will contribute to an understanding of their experiences, but there is a need for further synthetization efforts. The aim was to provide a comprehensive perspective about adult women's experiences of armed conflicts and forced migration, focusing on women in or from countries in the Middle East, Balkans, or Africa.

    METHODS: Systematic review of English reports presenting empirical qualitative studies published in scientific journals 1980 or later, utilizing searches performed in September 2021 within three databases combined with manual screening. Of the 3 800 records screened in total, 26 were included. Methodological details and quality were appraised using pre-specified extraction and appraisal tools. The findings within the included reports were analyzed with thematic analysis.

    RESULTS: Most reports utilized interviews, including in total 494 participants, and were appraised as having insignificant methodological limitations. The first theme concerns changed living conditions, involving reduced safety, insufficient access to resources meeting basic needs, forced migration as a last resort, and some positive effects. The second theme concerns the experienced health-related consequences, involving psychological distress, risks during pregnancy and childbirth, exposure to violence and discrimination as a woman, as well as a lack of adequate healthcare services and social support. The third theme concerns the resources and strategies that enhance resilience, involving social support and family life, as well as utilization of internal resources and strategies.

    CONCLUSION: When experiencing armed conflicts and forced migration, women face significant challenges related to changed living conditions and are exposed to health-related consequences. Consistently, women are targets of severe structural and personal violence, while lacking access to even the most basic healthcare services. Despite facing considerable hardships, these women display extraordinary resilience and endurance by finding strength through social support and internal resources. Synthesized qualitative research illustrates that women value social support, including peer support, which is a promising intervention that needs to be evaluated in future experimental studies.

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  • 28. Kabwama, Steven Ndugwa
    et al.
    Wanyenze, Rhoda K
    Razaz, Neda
    Ssenkusu, John M
    Alfvén, Tobias
    Lindgren, Helena
    Sophiahemmet Högskola.
    How interventions to maintain services during the COVID-19 pandemic strengthened systems for delivery of maternal and child health services: A case-study of Wakiso District, Uganda2024Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 17, nr 1, artikkel-id 2314345Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Health systems are resilient if they absorb, adapt, and transform in response to shocks. Although absorptive and adaptive capacities have been demonstrated during the COVID-19 response, little has been documented about their transformability and strengthened service delivery systems. We aimed to describe improvements in maternal and child health service delivery as a result of investments during the COVID-19 response.

    METHODS: This was a descriptive case study conducted in Wakiso District in central Uganda. It included 21 nurses and midwives as key informants and 32 mothers in three focus group discussions. Data were collected using an interview guide following the Systems Engineering Initiative for Patient Safety theoretical framework for service delivery.

    RESULTS: Maternal and child health service delivery during the pandemic involved service provision without changes, service delivery with temporary changes and outcomes, and service delivery that resulted into sustained changes and outcomes. Temporary changes included patient schedule adjustments, community service delivery and negative outcomes such as increased workload and stigma against health workers. Sustained changes that strengthened service delivery included new infrastructure and supplies such as ambulances and equipment, new roles involving infection prevention and control, increased role of community health workers and outcomes such as improved workplace safety and teamwork.

    CONCLUSIONS: In spite of the negative impact the COVID-19 pandemic had on health systems, it created the impetus to invest in system improvements. Investments such as new facility infrastructure and emergency medical services were leveraged to improve maternal and child health services delivery. The inter-departmental collaboration during the response to the COVID-19 pandemic resulted into an improved intra-hospital environment for other service delivery. However, there is a need to evaluate lessons beyond health facilities and whether these learnings are deliberately integrated into service delivery. Future responses should also address the psychological and physical impacts suffered by health workers to maintain service delivery.

    Fulltekst (pdf)
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  • 29. Karami, Fatemeh
    et al.
    Nikbakht Nasrabadi, Alireza
    Torabizadeh, Camellia
    Mazaheri, Monir
    Sophiahemmet Högskola.
    Sayadi, Leila
    The challenges of voluntary care provision for hospitalized patients with COVID-19: A qualitative study of the public volunteers' experiences2024Inngår i: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 27, nr 2, artikkel-id e13998Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: During the COVID-19 pandemic, there was a remarkable increase in public volunteering for the care of hospitalized patients. They faced challenges during their voluntary care provision. This study aimed at exploring public volunteers' experiences of the challenges of the voluntary care provision to hospitalized patients with COVID-19.

    METHODS: A descriptive qualitative study with an inductive content analysis method was conducted, 2022-2023. Eighteen public volunteers providing care to hospitalized patients with COVID-19 were purposefully selected among 10 hospitals, specialized in COVID-19 care in Tehran and Shiraz, Iran. Data were collected over 7 months through in-depth semistructured interviews and concurrently analyzed using conventional content analysis methods.

    FINDINGS: The challenges of voluntary care provision to hospitalized patients with COVID-19 were illustrated in five main categories, each with two subcategories. The categories included structural challenges, interpersonal conflicts, financial constraints, covert participation and the deteriorating condition of care provision. The subcategories comprised lack of volunteer recruitment bases, ineffective organization of voluntary activities, pervasive distrust, heightened risk of clinical errors, conflicts between volunteer commitments and primary occupation, lack of financial support, lack of family support, isolation by friends, mental trauma and physical exhaustion.

    CONCLUSION: Public volunteers encounter diverse challenges while providing care to hospitalized patients with COVID-19, which negatively impacts their motivation to serve. By addressing these challenges, we can create a more supportive environment for volunteers and enhance the quality of care provided to patients during public health emergencies. Identifying such challenges can assist healthcare managers and policymakers develop effective strategies to mitigate mounting difficulties and enhance volunteer services, thereby improving the overall quality of care provided to patients during public health crises.

    PATIENT CONTRIBUTIONS: Participants were identified and recruited after the study objectives were explained in person to the managers. The participants were approached and interviewed by one author. Participation was voluntary and the participants did not receive any financial compensation for their time.

    Fulltekst (pdf)
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  • 30. Lager, Anton C J
    et al.
    Fossum, Bjöörn
    Sophiahemmet Högskola.
    Rörvall, Göran
    Bremberg, Sven G
    Children's overweight and obesity: local and national monitoring using electronic health records2009Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, nr 2, s. 201-5Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To test the feasibility of a system for monitoring children's obesity and overweight based on data from electronic health records in the school health services. METHODS: Data on weight and height from electronic health records at school health services were collected for 10-year-olds in 2003-2004, 2004-2005 and 2005-2006. School health personnel extracted group-level data with a simple program installed on the computer containing the health records. Four Swedish municipalities were included in the study: Karlstad, Umeå, Västerås, and Ystad. RESULTS: The system achieved coverage of 92-96% of all children in 2005-2006. The overall prevalence rates were 4.2% (3.8-4.7%) obese and 22.0% (21.1-23.0%) overweight, including obesity. CONCLUSIONS: A system based on electronic health records from the school health services can successfully provide data. The system has practical, economical and ethical strengths.

  • 31. Lager, Anton
    et al.
    Fossum, Bjöörn
    Sophiahemmet Högskola.
    Bremberg, Sven
    Övervikt bland barn: nytt system för nationell uppföljning2005Rapport (Annet vitenskapelig)
    Abstract [en]

    Rapporten visar att det är praktiskt genomförbart att basera ett nationellt uppföljningssystem av barns övervikt och fetma på statistiken från skolhälsovården. Fyra kommuner med datoriserade journalsystem lämnade uppgifter: Västerås, Umeå, Karlstad och Ystad. Övervikt och fetma är ett stort folkhälsoproblem och antalet barn och ungdomar med övervikt har fördubblas på femton år. För att värdera de samlade effekterna av förebyggande insatser är det angeläget att följa utvecklingen över tid.Uppgifter från skolhälsovården kan enkelt sammanställas för att följa utvecklingen i Sverige.

  • 32. Lager, Anton
    et al.
    Guldbrandsson, Karin
    Fossum, Bjöörn
    Sophiahemmet Högskola.
    The chance of Sweden's public health targets making a difference2007Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 80, nr 3, s. 413-21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: There is a trend in health policy towards more focus on determinants and societal interventions and less on individuals. The Swedish public health targets are in line with this trend. The value of public health targets lies in their ability to function as a tool in governing with targets. This paper examines the possibility of the Swedish targets functioning as such a tool. METHOD: Document analyses were performed to examine three prerequisites of governing with targets: (1) the influence of the administration in the target setting process, (2) the explicitness of targets and (3) the follow-up system. The material consisted of the documents from the committee drafting the targets, the written opinions on the drafts, and the governmental bill with the adopted public health targets. RESULTS: The administration influenced the target setting process. Further, the government invests in a follow-up system that makes indicators on health determinants visible. However, although there existed explicit targets earlier in the process, the final targets in the bill are not explicit enough. CONCLUSION: The Swedish public health targets are not explicit enough to function in governing with targets. The reasons for this were political rather than technical. This suggests that policy makers focusing health determinants should not put time and resources in technical target formulating. Instead they could make indicators visible, thereby drawing attention to trends that are political by nature.

  • 33. Larisch, Lisa-Marie
    et al.
    Blom, Victoria
    Hagströmer, Maria
    Sophiahemmet Högskola.
    Ekblom, Maria
    Ekblom, Örjan
    Nilsson, Jonna
    Kallings, Lena V
    Improving movement behavior in office workers: Effects of two multi-level cluster-RCT interventions on mental health2024Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 24, artikkel-id 127Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: We have previously reported on the design and efficacy of two cluster-randomized multi-level workplace interventions, attempting to decrease sedentary behavior (SED) or increase moderate to vigorous physical activity (MVPA) among office workers to improve mental health outcomes. The aim of this study was to investigate intervention effects on mental health outcomes, i.e., mental wellbeing, depression or anxiety symptoms, and stress immediately after the 6-month intervention period.

    METHODS: Teams of 263 office workers were cluster-randomized to one of two interventions or a waitlist control group. The PA intervention (iPA) focused on increasing MVPA and the SED intervention (iSED) on reducing SED. Both multi-level interventions targeted individual office workers and their social, physical, and organizational work environment, incorporating counseling based on cognitive behavioral therapy and motivational interviewing. Mental health outcomes were assessed using validated questionnaires before and immediately after the intervention. Intervention effects were analyzed using linear mixed effects models.

    RESULTS: Participants were mostly female and highly educated, with a mean age of 42 years and had favorable levels of mental health at baseline. Mental wellbeing improved for the iSED group (β = 8, 95% CI 1 to 15, p = 0.030) but not for the iPA group (β = 6, 95% CI -1 to 12, p = 0.072) compared to the control group. No effects were found for depression or anxiety symptoms or stress.

    CONCLUSIONS: The multi-level interventions improved mental wellbeing among this population of office workers, reaching statistical significance in the iSED group. The size of the effect can be regarded meaningful, considering favorable mental health and high PA level at baseline. Thus, workplace interventions that provide support on multiple levels appear to have potential for improving mental wellbeing, but not reducing ill-health variables, among healthy office workers. More research is needed to understand the mechanisms through which such improvements can be achieved and to identify the most effective intervention components.

    TRIAL REGISTRATION: ISRCTN92968402 (27 February 2018).

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  • 34. Larisch, Lisa-Marie
    et al.
    Kallings, Lena V
    Hagströmer, Maria
    Sophiahemmet Högskola.
    Desai, Manisha
    von Rosen, Philip
    Blom, Victoria
    Associations between 24 h movement behavior and mental health in office workers2020Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, nr 17, artikkel-id E6214Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The associations between 24 h movement behavior, i.e., the way people distribute their time in different movement-related behaviors, on mental health are not well understood. This study applied a compositional data analysis approach to explore cross-sectional associations between device-measured moderate to vigorous physical activity (MVPA), light intensity physical activity (LIPA), sedentary behavior (SED), self-reported time in bed and mental health outcomes, i.e., depression or anxiety symptoms, burnout, mental wellbeing and stress, in office workers. ActiGraph accelerometers were worn for 24 h for at least 4 days to assess MVPA, LIPA, and SED. Sleep diaries were used in addition to identify time in bed. Analytic sample sizes for the different outcomes ranged from N = 345-370 participants. In this population of office workers with high levels of MVPA, the entire movement behavior composition was not associated to any of the mental health outcomes, but MVPA relative to all other behaviors was positively associated with mental wellbeing. This confirms the importance of MVPA for health relative to other movement-related behaviors.

    Fulltekst (pdf)
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  • 35.
    Larsson, Kristina
    et al.
    Sophiahemmet Högskola.
    Hagströmer, Maria
    Sophiahemmet Högskola.
    Rossen, Jenny
    Sophiahemmet Högskola.
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Norman, Åsa
    Experiences of supporting persons with metabolic risk factors to increase physical activity level2022Konferansepaper (Annet vitenskapelig)
  • 36.
    Larsson, Kristina
    et al.
    Sophiahemmet Högskola.
    Onell, Clara
    Sophiahemmet Högskola.
    Edlund, Klara
    Sophiahemmet Högskola.
    Källberg, Henrik
    Sophiahemmet Högskola.
    Holm, Lena W
    Sundberg, Tobias
    Sophiahemmet Högskola.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Lifestyle behaviors in Swedish university students before and during the first six months of the COVID-19 pandemic: A cohort study2022Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 22, nr 1, artikkel-id 1207Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Changes in Swedish university students' lifestyle behaviors during the COVID-19 pandemic are unknown. This study aimed to assess physical activity, sitting time, meal frequency and risk substance use (alcohol, tobacco, and illicit use of drugs) in Swedish university students before and during the first six months of the COVID-19 pandemic, for all and stratified by age and sex.

    METHODS: Data were obtained from the Sustainable University Life cohort study in which web-based surveys were sent to university students repeatedly for one year. Baseline assessment (before the pandemic) was between August 2019-March 2020, follow-up 1 (FU1) between March-June 2020, and follow-up 2 (FU2) between June-September 2020. Participants reported weekly minutes of physical activity, daily sitting hours, meal frequency by weekly intake of different meals, and motivation for eating irregularly, if so. Also, harmful use of alcohol, tobacco and illicit drugs was assessed. Population means and differences with 95% confidence intervals (95% CI) in lifestyle behaviors between time points were calculated with Generalized Estimating Equations.

    RESULTS: 1877 students (73% women, mean age 26.5 years) answered the baseline survey. Weekly exercise decreased by -5.7 min (95% CI: -10.0, -1.5) and -7.7 min (95% CI: -12.6, -2.8) between baseline and FU1 and FU2, respectively. Weekly daily activities increased by 5.6 min (95% CI: 0.3, 11.7) and 14.2 min (95% CI: 7.9, 20.5) between baseline and FU1 and FU2. Daily sitting time decreased by -1.4 h (95% CI: -1.7, -1.2) between baseline and FU2. Breakfast intake increased by 0.2 days per week (95% CI: 0.1, 0.3) between baseline and FU2. Lunch intake decreased by -0.2 days per week (95% CI: -0.2, -0.1) between baseline and FU1 and by -0.2 days per week (95% CI: -0.3, -0.0) between baseline and FU2. Dinner intake decreased by -0.1 days per week (95% CI: -0.2, -0.0) between baseline and both FU1 and FU2. Only minor differences in risk substance use were observed. Similar changes were observed in analyses stratified by age and sex.

    CONCLUSIONS: Lifestyle behaviors in Swedish university students slightly improved during the first six months of the COVID-19 pandemic compared to before.

    TRIAL REGISTRATION: ClinicalTrials.gov, NCT04465435 . 10/07/2020.

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  • 37. Larsson, Sam
    et al.
    Lilja, John
    Fossum, Bjöörn
    Sophiahemmet Högskola.
    Vem får man vara i vårt samhälle?: en kort introduktion till rapporten Om transpersoners psykosociala situation och psykiska hälsa2008Rapport (Annet vitenskapelig)
  • 38. Larsson, Sam
    et al.
    Lilja, John
    Fossum, Bjöörn
    Sophiahemmet Högskola.
    Vem får man vara i vårt samhälle?: om transpersoners psykosociala situation och psykiska hälsa2008Rapport (Annet vitenskapelig)
    Abstract [sv]

    Det här är den första svenska kunskapssammanställningen om transpersoners psykiska och psykosociala hälsa. Särskilt fokus ligger på grupperna manliga transvestiter och transsexuella – de grupper som det i nuläget finns mest forskning om. Några viktiga frågor som rapporten försöker ge svar på är: Vad syftar begreppet transperson på? Hur kan transpersoners livssituation beskrivas i relevanta avseenden,som bakgrund, utveckling, identitetsupplevelse, social situation och sociala relationer? Vilka psykiska eller psykosociala påfrestningar kan finnas för transpersoner i samhället kopplat till att de är just transpersoner? Hur kan transpersoner förstås kopplat till samhällets identitets- och genusnormer samt i relation till heteronormen? Hur kan transpersoner förstås i ett historiskt och kulturellt sammanhang? Hur beskriver transpersoner sin situation med egna ord? Vilka förslag till insatser skulle kunna förbättra den psykosociala hälsosituationen för transpersoner?Vi vet att psykisk ohälsa har samband med utanförskap och diskriminering – något som drabbar många transpersoner. Denna rapport är ett viktigt bidrag till hur vi alla ska kunna skapa ett samhälle som visar större förståelse och acceptans för skilda sätt att vara och leva. Kunskapsunderlaget är angelägen läsning för politiker och beslutsfattare. Det riktar sig också till studerande och personal inom skola och högskola samt olika kategorier av vårdpersonal som läkare, sjuksköterskor, psykologer, socionomer och socialpedagoger. Givetvis vänder sig rapporten också till en intresserad allmänhet.

  • 39. Lundberg, Emma
    et al.
    Ozanne, Anneli
    Larsdotter, Cecilia
    Sophiahemmet Högskola.
    Böling, Susanna
    Dellenborg, Lisen
    Ensted, Daniel
    Öhlén, Joakim
    Place of death among foreign-born individuals: A national population-based register study2023Inngår i: Palliative Care and Social Practice, ISSN 2632-3524, Vol. 17, artikkel-id 26323524231185157Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Relatively little is known about where foreign-born individuals die in Sweden and how birth region might influence place of death. Thus, there is a need for population-based studies investigating place of death and associated factors among foreign-born individuals.

    OBJECTIVES: The aim of this study was to identify variations in place of death among foreign-born individuals residing in Sweden and to compare place of death between the foreign- and domestic-born population. We also examine the association between place of death, underlying cause of death and sociodemographic characteristics among the foreign-born population.

    DESIGN: A population-based register study.

    METHODS: All deceased individuals ⩾18 years of age in Sweden with a registered place of death between 2012 and 2019 (n = 682,697). Among these, 78,466 individuals were foreign-born. Univariable multinomial logistic regression modelling and multivariable multinomial logistic regression analyses were performed.

    RESULTS: Overall, hospital was the most common place of death among the foreign-born population. However, there were variations in place of death related to region of birth. Compared to domestic-born, a higher proportion of foreign-born individuals dies at home, the majority of whom were born on the African continent.

    CONCLUSION: Region of birth is one of the several factors associated with place of death among foreign-born individuals. Further research is needed to explore both preferences and barriers to place of death among foreign-born individuals.

    Fulltekst (pdf)
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  • 40. Lundin, Åse
    et al.
    Ekman, Inger
    Wallström, Sara
    Andréll, Paulin
    Lundberg, Mari
    Sophiahemmet Högskola.
    Suffering out of sight but not out of mind - interpreting experiences of sick leave due to chronic pain in a community setting: A qualitative study2023Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 13, nr 4, s. e066617-, artikkel-id e066617Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Chronic pain is a complex health problem affecting about one-fifth of the European population. It is a leading cause of years lived with disability worldwide, with serious personal, relational and socioeconomic consequences. Chronic pain and sick leave adversely affect health and quality of life. Thus, understanding this phenomenon is essential for reducing suffering, understanding the need for support and promoting a rapid return to work and an active lifestyle. This study aimed to describe and interpret persons' experiences of being on sick leave due to chronic pain.

    DESIGN: A qualitative study with semistructured interviews analysed using a phenomenological hermeneutic approach.

    SETTING: Participants were recruited from a community setting in Sweden.

    PARTICIPANTS: Fourteen participants (12 women) with experiences of part-time or full-time sick leave from work due to chronic pain were included in the study.

    RESULTS: Suffering out of sight but not out of mind was the main theme of the qualitative analysis. This theme implies that the participants' constant suffering was invisible to others, causing them to feel they were not being justly treated in society. Feeling overlooked led to a continuous struggle for recognition. Moreover, the participants' identities and their trust in themselves and their bodies were challenged. However, our study also revealed a nuanced understanding of the experiences of sick leave as a consequence of chronic pain, where the participants learnt important lessons, including coping strategies and re-evaluated priorities.

    CONCLUSIONS: Being on sick leave due to chronic pain threatens a person's integrity and leads to substantial suffering. An enhanced understanding of the meaning of sick leave due to chronic pain provides important considerations for their care and support. This study highlights the importance of feeling acknowledged and being met with justice in encounters with others.

    Fulltekst (pdf)
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  • 41.
    Mazaheri, Monir
    Sophiahemmet Högskola.
    Adopting new perspectives in face of health inequalities during the COVID-19 pandemic2022Konferansepaper (Annet vitenskapelig)
  • 42.
    Mazaheri, Monir
    et al.
    Sophiahemmet Högskola.
    Eriksson, Henrik
    An intersectional analysis of health inequalities and vulnerabilities during the Covid-19 pandemic2023Inngår i: Responsible management of shifts in work modes: Values for post pandemic sustainability, volume 2 / [ed] K. Ogunyemi & A.I. Onaga, Emerald Group Publishing Limited, 2023, s. 109-118Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 43. Nilsen, Bente B
    et al.
    Yngve, Agneta
    Sophiahemmet Högskola.
    Sjöberg, Agneta
    Moraeus, Lotta
    Lissner, Lauren
    Werner, Bo
    Using different growth references to measure thinness and overweight among Swedish primary school children showed considerable variations2016Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, nr 10, s. 1158-65Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: The study compared how four different growth references determined the prevalence of thinness and overweight, based on height and weight measurements from a nationally representative sample of Swedish children from seven to nine years of age.

    METHODS: The height and weight measurements of 4,518 Swedish schoolchildren aged seven to nine years were carried out in 2008 using a standardised protocol. The prevalence of different degrees of thinness and overweight were calculated using international growth references from the World Health Organization, the International Obesity Task Force and two Swedish growth references from Werner and Karlberg.

    RESULTS: Depending on which growth reference we used, the prevalence of different degrees of thinness varied from 7.5%-16.9% for the boys and 6.9%-13.7% for the girls, while for the prevalence of overweight, including obesity and severe obesity, varied from 16.5%-25.7% for the boys and 18.2-25.2% for the girls. There were also significant gender differences depending on the growth reference we used.

    CONCLUSION: Using four different growth references, two international and two Swedish, produced wide variations in the prevalence of thinness and overweight, together with significant gender differences. In the absence of a global definition, we need both national and international growth references. This article is protected by copyright. All rights reserved.

  • 44. Olsson, M
    et al.
    Nilsson, M
    Fugl-Meyer, K
    Petersson, LM
    Wennman-Larsen, Agneta
    Sophiahemmet Högskola.
    Kjeldgård, L
    Alexanderson, K
    Life satisfaction of women of working age shortly after breast cancer surgery2017Inngår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 26, nr 3, s. 673-684Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE:

    To explore, among women of working age, satisfaction with life as a whole and with different life domains, and its associations with social and health variables, shortly after breast cancer surgery.

    METHODS:

    This cross-sectional study included 605 women, aged 20-63 years, who had had breast cancer surgery with no distant metastasis, pre-surgical chemotherapy, or previous breast cancer. Associations between LiSat-11 and demographic and social factors as well as health- and treatment-related variables were analysed by multivariable logistic regression.

    RESULTS:

    Compared with Swedish reference levels, the women were, after breast cancer surgery, less satisfied with life, particularly sexual life. Women working shortly after breast cancer surgery were more often satisfied with life in provision domains compared with the reference population. Although most included variables showed associations with satisfaction, after adjustment for all significantly associated variables, only six variables-having children, being in work, having emotional and informational social support, and having good physical and emotional functioning-were positively associated with satisfaction with life as a whole. The odds ratios for satisfaction were higher in most life domains if the woman had social support and good emotional and cognitive functioning.

    CONCLUSIONS:

    One month after breast cancer surgery, satisfaction with different life domains was associated primarily with social support and health-related functioning. However, this soon after surgery, treatment-related variables showed no significant associations with life satisfaction. These results are useful for planning interventions to enhance e.g. social support and emotional as well as cognitive functioning.

    Fulltekst (pdf)
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  • 45. Pico-Espinosa, Oscar Javier
    et al.
    Aboagye, Emmanuel
    Côté, Pierre
    Peterson, Anna
    Holm, Lena W.
    Jensen, Irene
    Skillgate, Eva
    Sophiahemmet Högskola.
    Deep tissue massage and strengthening and stretching exercises for subacute or persistent neck pain: A cost-effectiveness analysis of the Stockholm Neck trial (STONE)2020Konferansepaper (Annet vitenskapelig)
  • 46. Pico-Espinosa, Oscar Javier
    et al.
    Aboagye, Emmanuel
    Côté, Pierre
    Peterson, Anna
    Holm, Lena W
    Jensen, Irene
    Skillgate, Eva
    Sophiahemmet Högskola.
    Deep tissue massage, strengthening and stretching exercises, and a combination of both compared with advice to stay active for subacute or persistent non-specific neck pain: A cost-effectiveness analysis of the Stockholm Neck trial (STONE)2020Inngår i: Musculoskeletal science & practice, ISSN 2468-7812, Vol. 46, artikkel-id 102109Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To evaluate the cost-effectiveness of deep tissue massage ('massage'), strengthening and stretching exercises ('exercises') or a combination of both ('combined therapy') in comparison with advice to stay active ('advice') for subacute and persistent neck pain, from a societal perspective.

    METHODS: We conducted a cost-effectiveness analysis alongside a four-arm randomized controlled trial of 619 participants followed-up for one year. Health-related quality of life was measured using EQ-5D-3L and costs were calculated from baseline to one year. The interventions were ranked according to quality adjusted life years (QALYs) in a cost-consequence analysis. Thereafter, an incremental cost per QALY was calculated.

    RESULTS: In the cost-consequence analysis, in comparison with advice, exercises resulted in higher QALY gains, and massage and the combined therapy were more costly and less beneficial. Exercises may be a cost-effective treatment compared with advice to stay active if society is willing to pay 17 640 EUR per QALY. However, differences in QALY gains were minimal; on average, participants in the massage group, spent a year in a state of health valued at 0.88, exercises: 0.89, combined therapy: 0.88 and, advice: 0.88.

    CONCLUSIONS: Exercises are cost-effective compared to advice given that the societal willingness to pay is above 17 640 EUR per year in full health gained. Massage and a combined therapy are not cost-effective. While exercise appeared to have the best cost/benefit profile, even this treatment had only a modest benefit and treatment innovation is needed. Advice to stay active remains as a good therapeutic alternative from an economical perspective.

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  • 47. Prego-Domínguez, Jesús
    et al.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Orsini, Nicola
    Takkouche, Bahi
    Social factors and chronic pain: The modifying effect of sex in the Stockholm Public Health Cohort Study2022Inngår i: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 61, nr 5, s. 1802-1809, artikkel-id keab528Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To assess the relation between social factors (socioeconomic status, household load and job strain) and chronic pain occurrence, and the role of gender in this relation.

    METHODS: We used data corresponding to 8 years of follow-up of the Stockholm Public Health Cohort Study (2006 to 2014) to compute Adjusted Incidence Rate Ratios (IRR) and additive interaction measures of chronic pain episodes, social factors, and sex in 16,687 subjects.

    RESULTS: For men, increased rates were observed for skilled workers (IRR=1.27, 95% Confidence Interval (CI): 0.99, 1.61) and lower non-manual employees (IRR=1.37, 95%CI: 1.05, 1.78), compared to unskilled workers; subjects with high household load (IRR=1.39; 95%CI: 1.03, 1.88), compared to those with null score; and active jobs (IRR=1.27, 95%CI: 1.06, 1.51), compared to low strain jobs. For women, we observed decreased rates for lower (IRR=0.82, 95%CI: 0.68, 0.99), intermediate (IRR=0.74, 95%CI: 0.63, 0.88) and higher non-manual employees (IRR=0.65, 95%CI: 0.54, 0.79), compared to unskilled workers. Compared to subjects with a null score, women with low household load showed a lower rate (IRR=0.85; 95%CI: 0.72, 1.00). Compared to low strain jobs, passive jobs (IRR=1.21; 95%CI: 1.02, 1.44) and high strain jobs (IRR=1.46; 95%CI: 1.02, 2.09) showed higher rates.

    CONCLUSION: In general, our analysis yielded different results, if not opposite, when data were stratified by sex. Sex may then represent an effect modifier of the relation between social factors and chronic pain.

    RHEUMATOLOGY KEY MESSAGES: Low socioeconomic status and high job strain household load are related to chronic pain occurrence.Sex is an effect modifier of the relation between socioeconomic status and chronic pain; that is, this relation is different between men and women.

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  • 48. Prego-Domínguez, Jesús
    et al.
    Skillgate, Eva
    Sophiahemmet Högskola.
    Orsini, Nicola
    Takkouche, Bahi
    Social factors and pain worsening: A retrospective cohort study2021Inngår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 127, nr 2, s. 289-295, artikkel-id S0007-0912(21)00272-5Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Pain, specifically chronic pain, is a major public health issue worldwide with considerable health-related consequences and large economic impact. The relation between socioeconomic status and pain occurrence is well established. However, little is known on the relation between socioeconomic factors and worsening of pain, including progression from non-chronic pain to chronic pain.

    METHODS: To assess the relation between socioeconomic status and pain worsening, we used the Stockholm Public Health Cohort Study from 2006 to 2014 and analysed data of 9721 participants who completed follow-up. The adjusted incidence rate ratios (IRRs) of moderate and severe pain worsening episodes were computed, using a pain amplification model, which encompasses spreading, somatisation, and psychological distress components. Multiple imputation analysis was performed subsequently to adjust for cohort attrition.

    RESULTS: Compared with non-skilled workers, self-employed subjects (IRR=1.18; 95% confidence interval [CI], 1.01-1.39) and non-manual employees were at higher risk of moderate worsening (lower non-manual employees: IRR=1.21; 95% CI, 1.03-1.41; intermediate non-manual employees: IRR=1.26; 95% CI, 1.10-1.44; higher non-manual employees: IRR=1.25; 95% CI, 1.08-1.45). This risk increase was limited to worsening starting at stage 0 (non-chronic pain). No association was found between socioeconomic status and severe pain worsening.

    CONCLUSION: Our results support a moderate association between intermediate and high socioeconomic status, and moderate pain worsening. This association could be explained by the heterogeneous composition of the socioeconomic variable used in this cohort, and by changes in exposure and other time-varying covariables' status during follow-up.

  • 49. Rasmussen, Mette
    et al.
    Larsson, Matz
    Gilljam, Hans
    Adami, Johanna
    Sophiahemmet Högskola.
    Wärjerstam, Sanne
    Post, Ann
    Björk-Eriksson, Thomas
    Helgason, Asgeir R
    Tønnesen, Hanne
    Effectiveness of tobacco cessation interventions for different groups of tobacco users in Sweden: A study protocol for a national prospective cohort study2022Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 1, artikkel-id e053090Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Tobacco is still one of the single most important risk factors among the lifestyle habits that cause morbidity and mortality in humans. Furthermore, tobacco has a heavy social gradient, as the consequences are even worse among disadvantaged and vulnerable groups. To reduce tobacco-related inequity in health, those most in need should be offered the most effective tobacco cessation intervention. The aim of this study is to facilitate and improve the evaluation of already implemented national tobacco cessation efforts, focusing on 10 disadvantaged and vulnerable groups of tobacco users.

    METHODS AND ANALYSIS: This is a prospective cohort study. Data will be collected by established tobacco cessation counsellors in Sweden. The study includes adult tobacco or e-cigarette users, including disadvantaged and vulnerable patients, receiving in-person interventions for tobacco or e-cigarette cessation (smoking, snus and/or e-cigarettes). Patient inclusion was initiated in April 2020. For data analyses patients will be sorted into vulnerable groups based on risk factors and compared with tobacco users without the risk factor in question.The primary outcome is continuous successful quitting after 6 months, measured by self-reporting. Secondary outcomes include abstinence at the end of the treatment programme, which could be from minutes over days to weeks, 14-day point prevalence after 6 months, and patient satisfaction with the intervention. Effectiveness of successful quitting will be examined by comparing vulnerable with non-vulnerable patients using a mixed-effect logistic regression model adjusting for potential prognostic factors and known confounders.

    ETHICS AND DISSEMINATION: The project will follow the guidelines from the Swedish Data Protection Authority and have been approved by the Swedish Ethical Review Authority before patient inclusion (Dnr: 2019-02221). Only patients providing written informed consent will be included. Both positive and negative results will be published in scientific peer-reviewed journals and presented at national and international conferences. Information will be provided through media available to the public, politicians, healthcare providers and planners as these are all important stakeholders.

    TRIAL REGISTRATION NUMBER: NCT04819152.

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  • 50.
    Rossen, Jenny
    et al.
    Sophiahemmet Högskola.
    Hagströmer, Maria
    Sophiahemmet Högskola.
    Larsson, Kristina
    Sophiahemmet Högskola.
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    von Rosen, Philip
    Physical activity patterns among individuals with prediabetes or type 2 diabetes across two years: A longitudinal latent class analysis2022Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 6, artikkel-id 3667Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: This study aimed to identify distinct profiles of physical activity (PA) patterns among individuals with prediabetes or type 2 diabetes participating in a two-year PA trial and to investigate predictors of the profiles.

    METHODS: Data (n = 168, collected 2013-2020) from the cohort of a randomized trial aimed at increasing PA in individuals with prediabetes and type 2 diabetes were used. PA and sedentary behaviours were assessed by waist-worn ActiGraph GT1M accelerometers at baseline and at 6, 12, 18 and 24 months. Fifteen PA and sedentary variables were entered into a latent class mixed model for multivariate longitudinal outcomes. Multinominal regression analysis modelled profile membership based on baseline activity level, age, gender, BMI, disease status and group randomisation.

    RESULTS: Two profiles of PA patterns were identified: "Increased activity" (n = 37, 22%) included participants increasing time in PA and decreasing sedentary time. "No change in activity" (n = 131, 78%) included participants with no or minor changes. "Increased activity" were younger (p = 0.003) and more active at baseline (p = 0.011), compared to "No change in activity". No other predictor was associated with profile membership.

    CONCLUSIONS: A majority of participants maintained PA and sedentary patterns over two years despite being part of a PA intervention. Individuals improving PA patterns were younger and more active at baseline.

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