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  • 1. Aarseth, Espen
    et al.
    Edman, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Helmersson Bergmark, Karin
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    van Rooij, Antonius J.
    Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal2017In: Journal of Behavioral Addictions, ISSN 2062-5871, E-ISSN 2063-5303, Vol. 6, no 3, p. 267-270Article in journal (Other academic)
    Abstract [en]

    Concerns about problematic gaming behaviors deserve our full attention. However, we claim that it is far from clear that these problems can or should be attributed to a new disorder. The empirical basis for a Gaming Disorder proposal, such as in the new ICD-11, suffers from fundamental issues. Our main concerns are the low quality of the research base, the fact that the current operationalization leans too heavily on substance use and gambling criteria, and the lack of consensus on symptomatology and assessment of problematic gaming. The act of formalizing this disorder, even as a proposal, has negative medical, scientific, public-health, societal, and human rights fallout that should be considered. Of particular concern are moral panics around the harm of video gaming. They might result in premature application of diagnosis in the medical community and the treatment of abundant false-positive cases, especially for children and adolescents. Second, research will be locked into a confirmatory approach, rather than an exploration of the boundaries of normal versus pathological. Third, the healthy majority of gamers will be affected negatively. We expect that the premature inclusion of Gaming Disorder as a diagnosis in ICD-11 will cause significant stigma to the millions of children who play video games as a part of a normal, healthy life. At this point, suggesting formal diagnoses and categories is premature: the ICD-11 proposal for Gaming Disorder should be removed to avoid a waste of public health resources as well as to avoid causing harm to healthy video gamers around the world.

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  • 2.
    Aasa, Jenny
    et al.
    Stockholm University, Faculty of Science, Department of Environmental Science and Analytical Chemistry.
    Vryonidis, Efstathios
    Stockholm University, Faculty of Science, Department of Environmental Science and Analytical Chemistry.
    Abramsson-Zetterberg, Lilianne
    Törnqvist, Margareta
    Stockholm University, Faculty of Science, Department of Environmental Science and Analytical Chemistry.
    Internal Doses of Glycidol in Children and Estimation of Associated Cancer Risk2019In: Toxics, E-ISSN 2305-6304, Vol. 7, no 1, article id 7Article in journal (Refereed)
    Abstract [en]

    The general population is exposed to the genotoxic carcinogen glycidol via food containing refined edible oils where glycidol is present in the form of fatty acid esters. In this study, internal (in vivo) doses of glycidol were determined in a cohort of 50 children and in a reference group of 12 adults (non-smokers and smokers). The lifetime in vivo doses and intakes of glycidol were calculated from the levels of the hemoglobin (Hb) adduct N-(2,3-dihydroxypropyl)valine in blood samples from the subjects, demonstrating a fivefold variation between the children. The estimated mean intake (1.4 mu g/kg/day) was about two times higher, compared to the estimated intake for children by the European Food Safety Authority. The data from adults indicate that the non-smoking and smoking subjects are exposed to about the same or higher levels compared to the children, respectively. The estimated lifetime cancer risk (200/10(5)) was calculated by a multiplicative risk model from the lifetime in vivo doses of glycidol in the children, and exceeds what is considered to be an acceptable cancer risk. The results emphasize the importance to further clarify exposure to glycidol and other possible precursors that could give a contribution to the observed adduct levels.

  • 3. Abdollahi, Abbas
    et al.
    Abu Talib, Mansor
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Harvey, Richard
    Yaacob, Siti Nor
    Ismail, Zanariah
    Problem-solving skills and perceived stress among undergraduate students: The moderating role of hardiness2018In: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 23, no 10, p. 1321-1331Article in journal (Refereed)
    Abstract [en]

    This study was designed to examine the relationships between problem-solving skills, hardiness, and perceived stress and to test the moderating role of hardiness in the relationship between problem-solving skills and perceived stress among 500 undergraduates from Malaysian public universities. The analyses showed that undergraduates with poor problem-solving confidence, external personal control of emotion, and approach-avoidance style were more likely to report perceived stress. Hardiness moderated the relationships between problem-solving skills and perceived stress. These findings reinforce the importance of moderating role of hardiness as an influencing factor that explains how problem-solving skills affect perceived stress among undergraduates.

  • 4. Abdollahi, Abbas
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Coping Style as a Moderator of Perfectionism and Suicidal Ideation Among Undergraduate Students2017In: Journal of Rational-Emotive & Cognitive-Behavior Therapy, ISSN 0894-9085, E-ISSN 1573-6563, Vol. 35, no 3, p. 223-239Article in journal (Refereed)
    Abstract [en]

    Suicide is a serious and growing public health problem and remains an unnecessary cause of death globally. In Iran, the highest prevalence of acute and chronic suicidal ideation is among young people aged 16-24. This study investigates the relationship between coping style, two types of perfectionism, and suicidal ideation among undergraduates, and examines coping style as a moderator of the relationship between perfectionism and suicidal ideation. Multi-stage cluster random sampling was employed to recruit 547 undergraduate students aged 19-24 years from the Islamic Azad University of Karaj. Structural Equation Modelling indicated that suicidal ideation was negatively associated with adaptive perfectionism and task-focused coping but positively associated with emotion-focused coping, avoidance coping, and maladaptive perfectionism. Coping style (including the three styles of task-focused, emotion-focused, and avoidance coping) was found to moderate the relationship between perfectionism and suicidal ideation. The study advances understanding of the importance of coping style in this context and explains how perfectionism affects suicidal ideation.

  • 5. Aboagye, Emmanuel
    et al.
    Gustafsson, Klas
    Jensen, Irene
    Hagberg, Jan
    Aronsson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Marklund, Staffan
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Bergström, Gunnar
    What is Number of Days in Number of Times?: Associations Between, and Responsiveness of, Two Sickness Presenteeism Measures2020In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 62, no 5, p. e180-e185Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the associations between sickness presenteeism (SP) reported as number of days with SP reported as number of times and to evaluate their responsiveness.

    Methods: The study population (n = 454) consisted of employed individuals, at risk of long-term sickness absence. Correlation analyses were performed to examine associations between the two SP measures and external constructs such as work performance, general health, and registered sick leave. Both SP constructs were measured several times to examine responsiveness.

    Results: The SP measures are moderately correlated. They moderately correlated with work performance and health status measures. SP reported as number of times seems to be more sensitive than number of days in detecting changes after rehabilitation.

    Conclusions: Numerical or categorical constructs are valid sources of data on SP. However, categorized SP seems to be more responsive.

  • 6.
    Abougazar, Eman Silmy
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
      Barriers to equal access to eHealth in Stockholm  : A qualitative study2022Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    The aim behind this study was to observe and understand barriers to access the eHealth system equally. The study was conducted in Stockholm based on qualitative data in which semi- structured interviews were conducted among 15 interviewees from different localities of Stockholm. The findings from the collected data revealed that language barriers, lack of knowledge about digital literacy, unawareness of Swedish healthcare services, psychological and social barriers, safety and privacy concerns, and the lack of an e-identification are all major barriers to accessing the eHealth system. From the data, it has also been observed that the main causes of the aforementioned hurdles are based on varied socioeconomic levels, literacy conditions of an individual, cultural background, and age. Another important observation shows that highly qualified people with limited language abilities have a difficult time using eHealth services. 

    Keywords 

    Ehealth, Covid-19, nudge approach, digital literacy, linguistic skills, Bank ID, 1177.se, Alltid öppet. 

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  • 7.
    Abougazar, Eman Silmy
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Barriers to equal access to eHealth in Stockholm: A qualitative study2022Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The aim behind this study was to observe and understand barriers to access the eHealth system equally. The study was conducted in Stockholm based on qualitative data in which semi- structured interviews were conducted among 15 interviewees from different localities of Stockholm. The findings from the collected data revealed that language barriers, lack of knowledge about digital literacy, unawareness of Swedish healthcare services, psychological and social barriers, safety and privacy concerns, and the lack of an e-identification are all major barriers to accessing the eHealth system. From the data, it has also been observed that the main causes of the aforementioned hurdles are based on varied socioeconomic levels, literacy conditions of an individual, cultural background, and age. Another important observation shows that highly qualified people with limited language abilities have a difficult time using eHealth services. 

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  • 8. Abrahamsen, Annbjørg Selma
    et al.
    Johannesen, Ása
    Debes, Fróði
    van Leeuwen, Wessel M. A.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Weihe, Pál
    Working environment and fatigue among fishers in the north Atlantic: a field study2023In: International Maritime Health, ISSN 1641-9251, E-ISSN 2081-3252, Vol. 74, no 1, p. 1-14Article in journal (Refereed)
    Abstract [en]

    Background: This study investigates how Faroese deep-sea fishers’ exposure to work-related stressors affects their sleep, sleepiness, and levels of fatigue. Being constantly exposed to the unpredictable and harsh North Atlantic Ocean, having long work hours and split sleep for up to 40 days consecutively, they will arguably suffer from fatigue.

    Materials and methods: One hundred and fifty seven fishers participated in this study, and data was gathered throughout 202 days at sea. Subjective data was collected at the start and end of trips via questionnaires, sleep and sleepiness diaries and supplemented by objective sleep data through actigraphs. Ship movements were logged with a gyroscope connected to a laptop. A noise metre measured each work station and resting area, and noise exposure profiles were calculated based on each participant’s activity and location. Linear mixed-effect models investigated the effects of work exposure variables on sleep efficiency, and cumulative link mixed models measured effects on the Karolinska Sleepiness Scale and physical fatigue scale.

    Results: Time of day followed by ship movement were the exposure variables with the highest impact on the outcome variables of sleep efficiency, sleepiness and physical fatigue. The number of days at sea revealed correlations to outcome variables either by itself or interacting with the sleep periods per day. Crew size, shift system or noise did not impact outcome variables when in the model with other variables. Larger catches improved sleep efficiency but did not affect sleepiness and physical fatigue ratings.

    Conclusions: The findings indicate a chronically fatigued fisher population, and recommends urgent attention being paid to improving the structure of vessels and installing stabilators for greater stability at sea; work schedules being evaluated for protection of health; and work environments being designed that fulfill human physiological requirements in order to ensure the wellbeing and safety of those at sea.

  • 9. Abrahamsen, Annbjørg Selma
    et al.
    Weihe, Pál
    van Leeuwen, Wessel M. A.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Debes, Fróði
    Impact of work exposure on cognitive performance in Faroese deep-sea fishers: a field study2022In: International Maritime Health, ISSN 1641-9251, E-ISSN 2081-3252, Vol. 73, no 3, p. 150-161Article in journal (Refereed)
    Abstract [en]

    Background: This study examines the impact of work-related exposure on the cognitive performance of Faroese deep-sea fishers. Faroese fishing crews work long hours in demanding and noisy environments amidst highly uncertain and challenging weather conditions. These factors, together with compromised patterns of rest and sleep, are known to increase fatigue. Our aim was to study if changes could be measured in fishers’ cognitive performance at the end of the trip when compared with the baseline measure at the beginning.

    Materials and methods: Data was collected over 15 months (May 2017 to July 2018) from 157 fishers on 18 fishing trips which involved 202 investigative days on board. Questionnaires and six computerised cognitive tests: Simple Reaction Time, Numeric Working Memory, Corsi Blocks, Rapid Visual Information Processing, Digit Vigilance, and Card Sorting Test were used for data collection at the beginning and end of the trip. Differences between the outcomes on the two test points were analysed with one-way ANOVA comparing the performances at the beginning and end of the voyage, and two-way ANOVA to examine the interactive effect of chronotype and test occasions on the outcomes. Mixed models were used to test for the effects of predictor variables.

    Results: Significant declines in cognitive performance were observed from the beginning to the end of the trip, with decreases in visuospatial memory and reaction times, and increases in cognitive lapses. Furthermore, slowing in response times was observed in the second half of the Digit Vigilance test when comparing the halves.

    Conclusions: Declines in performance were observed from the start to the end of the trip. Furthermore, fishers performed significantly worse in the second half of some parted tests, and evening types seem less influenced by irregular work hours. These findings call for improving the safety of the vessels and their crew.

  • 10. Abrahamsen, Annbjørg
    et al.
    Weihe, Pál
    Debes, Fróði
    van Leeuwen, Wessel MA.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Sleep, Sleepiness, and Fatigue on Board Faroese Fishing Vessels2022In: Nature and Science of Sleep, ISSN 1179-1608, Vol. 14, p. 347-362Article in journal (Refereed)
    Abstract [en]

    Purpose: Faroese fishers have four times more accidents than workers on land. The aim was to understand fishers’ fatigue better and how their work and sleep patterns influenced their sleepiness levels and cognitive performance.

    Materials and Methods: A total of 157 Faroese fishers wore wrist-worn actigraphs at sea and one week on land and filled in sleep and sleepiness diaries during the trip. Furthermore, a 3-minute simple reaction time (SRT) test was completed at the beginning and end of the trip. The ship’s movement and noise were also logged. The actiwatch results were analysed with mixed methods repeated measures. The sleepiness registrations and performance on the SRT-test were analysed with paired t-test. The ship movements (Pitch and roll) were divided into approximately three same-sized groups (lowest 1/3, medium 1/3, and highest 1/3) and compared against the Karolinska Sleepiness Scores (KSS ranging from 1– 9) ≥ 7 and physical tiredness (ranging from 1– 9) scores ≥ 7. Chi-square tests were used to determine the significance of these differences. Mean sleepiness scores at sea, and the proportion of sleepiness scores ≥ 7 were calculated, as well as sleepiness scores as a function of the time of day.

    Results: While at sea, fishers had more split sleep, slept less, and had lower sleep efficiency than onshore. Sleepiness was higher at the end of the trip, and cognitive decline was found. The number of major lapses was higher at the end of the trip, but with no significant difference between the median reaction times.

    Conclusion: The crew on-board the freezer longliner, who worked 8– 8 shifts, slept the most, had the longest continuous sleep periods, the highest sleep efficiency, the lowest sleepiness levels, and the highest noise exposure during their time off.

  • 11.
    Abrahamson, Maria
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Moral norms in older Swedish women’s drinking narratives. Enduring patterns and successively new features2012In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, Vol. 29, no 4, p. 371-396Article in journal (Refereed)
    Abstract [en]

    AIMS - To examine how the changes in women's relationship to alcohol during the 1960s appear in narratives of situated drinking occasions. DATA - Newly collected autobiographies written by women born between 1918 and 1951 are analysed using theories by William Labov on narrative construction and Kenneth Burke on the rhetoric of motives. RESULTS - The historically restrictive attitude to women at all drinking is present in the oldest women's narratives, while the liberalisation of attitudes to alcohol that took place in the 1960s likewise marks the narratives told by the younger women, even though they when writing are of pension able age. With the writers' diminishing age, the norms framing the narratives have changed, from sobriety among the oldest women to controlled moderation among the younger. And yet, the narratives also demonstrate a stable pattern of questioning women's drinking, although the focus has shifted from tasting alcohol at all to the state of becoming intoxicated. CONCLUSIONS - A controlling norm remains in place, which the women have internalised and made their own. The mitigating circumstances and the neutralising explanations that are presented throughout indicate that the women are conscious of the narratives' deviation from the prevailing norm, and show that women take a risk in drinking alcohol. When a woman drinks she risks her femininity.

  • 12.
    Abrahamson, Maria
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Heimdahl, Karin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kvinnor dricker för att de mår dåligt - män dricker för att de är män: om könad diskurs i alkoholpolitiska propositioner och utredningar 1965 - 20112012In: Samhället, alkoholen och drogerna: politik, konstruktioner och dilemman / [ed] Jessica Storbjörk, Stockholm: Stockholms universitets förlag, 2012, p. 104-129Chapter in book (Other academic)
  • 13.
    Abrahamsson, Klara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Perceived neighbourhood insecurity and psychosomatic health complaints among adolescents in Stockholm: Exploring district-level and gendered inequalities2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The neighbourhood is an essential arena for adolescents’ health development and research suggests that perceived neighbourhood insecurity (PNI) is associated with socio-economic status and self-rated health. The present study explored the distribution of adolescents’ PNI and its association with psychosomatic health complaints across districts. It also examined gender differences and whether family socio-economic position, foreign background and previous exposure to crime could explain part of the association. Data came from classroom-surveys within Stockholm municipality’s 14 districts in 2010, 2012 and 2014 (n=10,291). Linear and logistic multilevel regression models were applied. Results showed that the average level of PNI varied considerably between districts and were strongly connected to its socio-demographic composition. However, individual characteristics in terms of family background and previous exposure to crime only explained a minor part of the variation in PNI across districts. Girls reported more insecurity than boys in all districts. Gender differences in PNI decreased in absolute numbers, but increased in relative numbers, as the overall ‘neighbourhood safety’ increased. Between-district differences in health were minor, but PNI was still a strong predictor of individual-level health, especially for boys. Furthermore, the predictive power of PNI on health was stronger in districts perceived as safer.

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    Abrahamsson (2016)
  • 14.
    Abramsson, Marianne
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Human Geography.
    Hagberg, Jan-Erik
    Housing plans of the oldest: ageing in semi-rural areas in Sweden2020In: Journal of Housing and the Built Environment, ISSN 1566-4910, E-ISSN 1573-7772, Vol. 35, no 1, p. 27-43Article in journal (Refereed)
    Abstract [en]

    A number of smaller municipalities have decreasing population rates. Generally, the young move out, increasing the proportion of older people. To increase our understanding of the living conditions of an ageing population in small municipalities, a postal survey was conducted in three small, semi-rural municipalities in southern Sweden. In the survey the respondents answered questions about their living situation and their housing plans. The aim of this study was to investigate the housing situation and housing plans of the very old in semi-rural areas and research questions analysed for this study concerned the current housing situation and plans for future housing. A total of 1386 surveys were sent out in March 2014, to all inhabitants aged 80 years or more, residing in the ordinary housing market in the three municipalities, the response rate was 60%. The results show that most of the respondents were firmly rooted in the area as most of them had lived in the municipality for more than 20 years and 60% had lived in their current dwelling for more than 20 years. Ageing in place was the dominating plan, although one quarter of the respondents answered that they did not know what would happen in the future. Those who planned to move wanted to move to housing that required less maintenance and to a more central location. Residential mobility is at play also in old age as 27% of the respondents had moved at some point during the last 10 years, i.e., after the age of 70.

  • 15. Adams, Jimi
    et al.
    Lawrence, Elizabeth M.
    Goode, Joshua A.
    Schaefer, David R.
    Möllborn, Stefanie
    Stockholm University, Faculty of Social Sciences, Department of Sociology. University of Colorado Boulder, USA.
    Peer Network Processes in Adolescents' Health Lifestyles2022In: Journal of health and social behavior, ISSN 0022-1465, E-ISSN 2150-6000, Vol. 63, no 1, p. 125-141Article in journal (Refereed)
    Abstract [en]

    Combining theories of health lifestyles-interrelated health behaviors arising from group-based identities-with those of network and behavior change, we investigated network characteristics of health lifestyles and the role of influence and selection processes underlying these characteristics. We examined these questions in two high schools using longitudinal, complete friendship network data from the National Longitudinal Study of Adolescent to Adult Health. Latent class analyses characterized each school's predominant health lifestyles using several health behavior domains. School-specific stochastic actor-based models evaluated the bidirectional relationship between friendship networks and health lifestyles. Predominant lifestyles remained stable within schools over time, even as individuals transitioned between lifestyles. Friends displayed greater similarity in health lifestyles than nonfriend dyads. Similarities resulted primarily from teens' selection of friends with similar lifestyles but also from teens influencing their peers' lifestyles. This study demonstrates the salience of health lifestyles for adolescent development and friendship networks.

  • 16. Adams, John
    et al.
    Pike, Tim
    Corna, Laurie M.
    Platts, Loretta G.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Worts, Diana
    McDonough, Peggy
    Di Gessa, Giorgio
    Sacker, Amanda
    Glaser, Karen
    Price, Debora
    How do female lifecourses affect income in retirement?2016Report (Other academic)
    Abstract [en]

    This Briefing Note examines the influence of various lifecourses on income in retirement. The primary focus of this note is to consider how women’s retirement income is affected by motherhood. This includes the impact of taking time out of work to care for children, as well as the implications of the Motherhood Penalty, which is the observation that mothers tend to have reduced incomes relative to women without children.

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  • 17. Adjei, Nicholas Kofi
    et al.
    Schlüter, Daniela K.
    Melis, Gabriella
    Schultz Straatmann, Viviane
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Fleming, Kate M.
    Wickham, Sophie
    Munford, Luke
    McGovern, Ruth
    Howard, Louise M.
    Kaner, Eileen
    Wolfe, Ingrid
    Taylor-Robinson, David C.
    Impact of Parental Mental Health and Poverty on the Health of the Next Generation: A Multi-Trajectory Analysis Using the UK Millennium Cohort Study2024In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 74, no 1, p. 60-70Article in journal (Refereed)
    Abstract [en]

    Purpose: Exposure to parental mental ill-health and poverty in childhood impact health across the lifecourse. Both maternal and paternal mental health may be important influences, but few studies have unpicked the complex interrelationships between these exposures and family poverty for later health.

    Methods: We used longitudinal data on 10,500 children from the nationally representative UK millennium cohort study. Trajectories of poverty, maternal mental health, and secondary caregiver mental health were constructed from child age of 9 months through to 14 years. We assessed the associations of these trajectories with mental health outcomes at the age of 17 years. Population-attributable fractions were calculated to quantify the contribution of caregivers' mental health problems and poverty to adverse outcomes at the country level.

    Results: We identified five distinct trajectories. Compared with children with low poverty and good parental mental health, those who experienced poverty and poor primary or secondary caregiver mental health (53%) had worse outcomes. Children exposed to both persistent poverty and poor caregiver mental health were at markedly increased risk of socioemotional behavioural problems (aOR 4.2; 95% CI 2.7–6.7), mental health problems (aOR 2.5; CI 1.6–3.9), and cognitive disability (aOR 1.7; CI 1.1–2.5). We estimate that 40% of socioemotional behavioural problems at the age of 17 were attributable to persistent parental caregivers' mental health problems and poverty.

    Discussion: More than half of children growing up in the UK are persistently exposed to either one or both of poor caregiver mental health and family poverty. The combination of these exposures is strongly associated with adverse health outcomes in the next generation.

  • 18. Adjei, Nicholas Kofi
    et al.
    Schlüter, Daniela K.
    S. Straatmann, Viviane
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Melis, Gabriella
    Fleming, Kate M.
    McGovern, Ruth
    Howard, Louise M.
    Kaner, Eileen
    Wolfe, Ingrid
    Taylor-Robinson, David C.
    Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study2022In: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 13, article id 100279Article in journal (Refereed)
    Abstract [en]

    Background Children exposed to poverty and family adversities including domestic violence, parental mental ill health and parental alcohol misuse may experience poor outcomes across the life course. However, the complex interrelationships between these exposures in childhood are unclear. We therefore assessed the clustering of trajectories of household poverty and family adversities and their impacts on adolescent health outcomes.

    Methods We used longitudinal data from the UK Millennium Cohort study on 11564 children followed to age 14 years. Family adversities included parent reported domestic violence and abuse, poor mental health and frequent alcohol use. We used a group-based multi-trajectory cluster model to identify trajectories of poverty and family adversity for children. We assessed associations of these trajectories with child physical, mental and behavioural outcomes at age 14 years using multivariable logistic regression, adjusting for confounders.

    Findings Six trajectories were identified: low poverty and family adversity (43·2%), persistent parental alcohol use (7·7%), persistent domestic violence and abuse (3·4%), persistent poor parental mental health (11·9%), persistent poverty (22·6%) and persistent poverty and poor parental mental health (11·1%). Compared with children exposed to low poverty and adversity, children in the persistent adversity trajectory groups experienced worse outcomes; those exposed to persistent poor parental mental health and poverty were particularly at increased risk of socioemotional behavioural problems (adjusted odds ratio 6·4; 95% CI 5·0 – 8·3), cognitive disability (aOR 2·1; CI 1·5 – 2·8), drug experimentation (aOR 2·8; CI 1·8 – 4·2) and obesity (aOR 1·8; CI 1·3 – 2·5).

    Interpretation In a contemporary UK cohort, persistent poverty and/or persistent poor parental mental health affects over four in ten children. The combination of both affects one in ten children and is strongly associated with adverse child outcomes, particularly poor child mental health.

  • 19.
    af Klinteberg, Britt
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Granskaya, J
    Birath Scheffel, C
    Beijer, U
    Tsvetkova, L
    Personality characteristics and perceived health in Russian and Swedish female young adults with alcohol drinking habits2014In: Personality and Individual Differences, ISSN 0191-8869, E-ISSN 1873-3549, Vol. 60, no Suppl., p. S64-Article in journal (Refereed)
  • 20.
    af Klinteberg, Britt
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology. Karolinska Institutet, Sweden.
    Johansson, Sven-Erik
    Levander, Maria
    Alm, Per Olof
    Oreland, Lars
    Smoking habits – Associations with personality/behavior, platelet monoamine oxidase activity and plasma thyroid hormone levels2017In: Personality and Individual Differences, ISSN 0191-8869, E-ISSN 1873-3549, Vol. 118, p. 71-76Article in journal (Refereed)
    Abstract [en]

    The objective was to outline results from our scientific studies on the associations among childhood behavior, adult personality, and biochemical factors in smoking habits. The studies consisted of: (1) follow-up of young criminals and controls, subdivided into risk for antisocial behavior groups, based on childhood rating levels of a projective test; and adult smoking habit groups; and (2) a large group of young adults examined on the same inventories. Personality in terms of KSP and EPQ-I scale scores, controlled for intelligence, indicated that the high and very high risk groups displayed significantly higher self-rated impulsiveness, anxiety, and nonconformity, as compared to the low risk group. Further, the very high risk group subjects, found to be overrepresented among subjects with heavy smoking habits, displayed lower mean platelet MAO-B activity and higher thyroid hormone levels than the low risk group. Thus, the higher the childhood risk for antisocial behavior, the clearer the adult personality pattern making subjects more disposed for smoking appeared; and the higher smoking habits, the stronger the relationships with biochemical measures. Results are discussed in terms of possible underlying mechanisms influencing personality and smoking habits.

  • 21.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Dahlberg, Lena
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Dalarna University, Sweden.
    Lennartsson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Social integration and alcohol consumption among older people: A four-year follow-up of a Swedish national sample2019In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 196, p. 40-45Article in journal (Refereed)
    Abstract [en]

    Background: Today's older people drink more alcohol than earlier cohorts of older people. Social integration has been identified as an important factor for older people's drinking, but the association is complex. This study investigates both high and low levels of social integration and their associations with longitudinal patterns of alcohol consumption among older women and men.

    Methods: Longitudinal nationally representative data of older Swedish women and men aged over 65 - the Swedish Level of Living Survey (LNU) and Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) - from 2010/2011 and 2014 (n = 1048). Associations between social contacts and social activities at baseline and longitudinal patterns of drinking frequency were examined with multinomial logistic regression analyses.

    Results: Men reported drinking alcohol more often than women, but the most common drinking frequency among both women and men was to drink monthly or less. Drinking habits were generally stable over time. People with high levels of social activity at baseline were more likely to have a stable daily or weekly drinking frequency or increased drinking frequency over the four-year follow-up period, particularly women. People with low levels of social contacts and/or social activities were less likely to have a stable daily or weekly drinking frequency, compared to people in the low and stable drinking frequency group.

    Conclusions: Alcohol consumption is embedded in a social context, older people drink in social situations and social integration predicts continued drinking patterns.

  • 22.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kelfve, Susanne
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Linköping University, Sweden.
    Hassing, Linda B.
    Lindwall, Magnus
    Alcohol Consumption Over the Retirement Transition in Sweden: Different Trajectories Based on Education2022In: Work, Aging and Retirement, ISSN 2054-4642, E-ISSN 2054-4650, Vol. 8, no 1, p. 74-81Article in journal (Refereed)
    Abstract [en]

    Retirement is a major life transition that involves changes to everyday routines, roles, and habits. Previous studies suggest that retirement may influence drinking habits. Many natural inhibitors of alcohol consumption disappear with the removal of work constraints. The potential impact depends on both individual and contextual factors. Women in the cohorts undergoing retirement now have been more active on the labor market, including the occupation of higher status jobs, which indicates more financial resources as well as a larger role loss after retirement. Also, the current cohorts who retire have had more liberal drinking habits throughout their lives compared to previous cohorts. We therefore examined changes in alcohol consumption surrounding retirement in different education groups among women and men undergoing retirement using annual data from the Health, Aging and Retirement Transitions in Sweden (HEARTS) study, a longitudinal national study of 60- to 66-year-olds (n = 5,913), from 2015 to 2018. Latent growth curve models were used to estimate trajectories of alcohol consumption. Results showed that those who retired during the follow-up increased their usual weekly alcohol consumption while those who worked or were retired throughout the period had stable drinking habits. Those who were retired reported the highest alcohol consumption. The increase surrounding retirement was driven by people with higher education. Women with tertiary education and men with intermediate or tertiary education increased their weekly alcohol intake after retirement, while those with low education had unchanged drinking habits. Mechanisms and motivations that may fuel increased alcohol intake among people with higher education should be further investigated.

  • 23.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kelfve, Susanne
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lennartsson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Alcohol consumption in very old age and its association with survival: A matter of health and physical function2016In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 159, p. 240-245Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol consumption in very old age is increasing; yet, little is known about the personal and health-related characteristics associated with different levels of alcohol consumption and the association between alcohol consumption and survival among the oldest old. Methods: Nationally representative data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD, ages 76-101; n=863) collected in 2010/2011 were used. Mortality was analyzed unti12014. Alcohol consumption was measured with questions about frequency and amount. Drinks per month were calculated and categorized as abstainer, light-to-moderate drinker (0.5-30 drinks/month) and heavy drinker (>30 drinks/month). Multinomial logistic regressions and Laplace regressions were performed. Results: Compared to light-to-moderate drinkers, abstainers had lower levels of education and more functional health problems, while heavy drinkers were more often men, had higher levels of education, and no serious health or functional problems. In models adjusted only for age and sex, abstainers died earlier than drinkers. Among light-to-moderate drinkers, each additional drink/month was associated with longer survival, while among heavy drinkers, each additional drink/month was associated with shorter survival. However, after adjusting for personal and health-related factors, estimates were lower and no longer statistically significant. Conclusions: The association between alcohol consumption and survival in very old age seems to have an inverse J-shape; abstention and heavy use is associated with shorter survival compared to light-to moderate drinking. To a large extent, differences in survival are due to differences in baseline health and physical function.

  • 24.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Morin, Lucas
    Virtanen, Marianna
    Pentti, Jaana
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Vahtera, Jussi
    Stenholm, Sari
    Heavy alcohol consumption before and after negative life events in late mid-life: longitudinal latent trajectory analyses2022In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 76, no 4, p. 360-366Article in journal (Refereed)
    Abstract [en]

    Background People who experience negative life events report more heavy alcohol consumption compared with people without these experiences, but little is known about patterns of change within this group. This study aims to identify trajectories of heavy alcohol consumption before and after experiencing either divorce, or severe illness or death in the family. Furthermore, the aim is to examine characteristics of individuals belonging to each trajectory.

    Methods Longitudinal study of public sector employees from the Finnish Retirement and Aging Study with up to 5 years of annual follow-ups (n=6783; eligible sample n=1393). Divorce and severe illness or death in the family represented negative life events. Heavy alcohol consumption was categorised as >14 units/week.

    Results Based on latent trajectory analysis, three trajectories of heavy drinking were identified both for divorce and for severe illness or death in the family: ‘No heavy drinking’ (82% illness/death, 75% divorce), ‘Constant heavy drinking’ (10% illness/death, 13% divorce) and ‘Decreasing heavy drinking’ (7% illness/death, 12% divorce). Constant heavy drinkers surrounding illness or death in the family were more likely to be men, report depression and anxiety and to smoke than those with no heavy drinking. Constant heavy drinkers surrounding divorce were also more likely to be men and to report depression compared with those with no heavy drinking.

    Conclusions Most older workers who experience divorce or severe illness or death in the family have stable drinking patterns regarding heavy alcohol consumption, that is, most do not initiate or stop heavy drinking.

  • 25.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Shaw, Benjamin A.
    Smoking trajectories from midlife to old age and the development of non-life-threatening health problems: A 34-year prospective cohort study2013In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 57, no 2, p. 107-112Article in journal (Refereed)
    Abstract [en]

    Objective. To examine how trajectories of smoking observed over a 34-year period, were associated with the progression of mobility impairment, musculoskeletal pain, and symptoms of psychological distress from midlife to old age. Method. The Swedish Level of Living Survey (LNU) and the Swedish Panel Study of the Oldest Old (SWEOLD) were merged to create a nationally representative longitudinal sample of Swedish adults (aged 30-50 at baseline; n = 1060), with four observation periods, from 1968 through 2002. Five discrete smoking trajectory groups were treated as predictors of variation in health trajectories using multilevel regression. Results. At baseline, there were no differences in mobility impairment between smoking trajectory groups. Over time all smokers, particularly persistent and former heavy smokers, exhibited faster increases in mobility problems compared with persistent non-smokers. Additionally, all smoking groups reported more pain symptoms than the non-smokers, at baseline and over time, but most of these differences did not reach statistical significance. Persistent heavy smokers reported elevated levels of psychological distress at baseline and over time. Conclusion. Smokers, and even some former smokers, who survive into old age appear to be at increased risk for non-life-threatening conditions that can diminish quality of life and increase demands for services.

  • 26.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Shaw, Benjamin A.
    Fors, Stefan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Social and economic conditions in childhood and the progression of functional health problems from midlife into old age2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 8, p. 734-740Article in journal (Refereed)
    Abstract [en]

    Background Childhood living conditions have been found to predict health and mortality in midlife and in old age. This study examines the associations between social and economic childhood conditions and the onset and progression of functional health problems from midlife into old age, and the extent to which potential associations are mediated by educational attainment and smoking. Methods Data from the Level of Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old were merged to create a longitudinal data set with five repeated measures from 1968 to 2004 (n=1765, aged 30-50 years and free from functional health problems at baseline). Multilevel regression models were used to analyse retrospective reports of social and economic conditions in childhood (eg, conflicts or economic problems in the family) in relation to the progression of functional health problems over the 36-year period. Results Results showed that social and economic disadvantages in childhood were associated with an earlier onset and a faster progression of functional health problems from midlife into old age. Subsequent models showed that differences in educational attainment, but not smoking, explained much of the association between childhood disadvantages and trajectories of functional health problems. Conclusions According to these results, adverse social and economic conditions in childhood affect the development of functional health problems from midlife into old age indirectly through less favourable life careers, including lower education. Creating equal opportunities for educational attainment may help reduce the long-term effects of disadvantaged childhood conditions and postpone functional health problems.

  • 27. Agardh, Emilie E.
    et al.
    Allebeck, Peter
    Flodin, Pär
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Ramstedt, Mats
    Knudsen, Ann Kristin
    Øverland, Simon
    Kinge, Jonas Minet
    Tollånes, Mette C.
    Eikemo, Terje A.
    Skogen, Jens Christoffer
    Mäkelä, Pia
    Gissler, Mika
    Juel, Knud
    Moesgaard Iburg, Kim
    McGrath, John J.
    Naghavi, Mohsen
    Vollset, Stein Emil
    Gakidou, Emmanuela
    Danielsson, Anna-Karin
    Alcohol-attributed disease burden in four Nordic countries between 2000 and 2017: Are the gender gaps narrowing? A comparison using the Global Burden of Disease, Injury and Risk Factor 2017 study2021In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 40, no 3, p. 431-442Article in journal (Refereed)
    Abstract [en]

    Introduction and Aims. The gender difference in alcohol use seems to have narrowed in the Nordic countries, but it is not clear to what extent this may have affected differences in levels of harm. We compared gender differences in all-cause and cause-specific alcohol-attributed disease burden, as measured by disability-adjusted life-years (DALY), in four Nordic countries in 2000-2017, to find out if gender gaps in DALYs had narrowed. Design and Methods. Alcohol-attributed disease burden by DALYs per 100 000 population with 95% uncertainty intervals were extracted from the Global Burden of Disease database. Results. In 2017, all-cause DALYs in males varied between 2531 in Finland and 976 in Norway, and in females between 620 in Denmark and 270 in Norway. Finland had the largest gender differences and Norway the smallest, closely followed by Sweden. During 2000-2017, absolute gender differences in all-cause DALYs declined by 31% in Denmark, 26% in Finland, 19% in Sweden and 18% in Norway. In Finland, this was driven by a larger relative decline in males than females; in Norway, it was due to increased burden in females. In Denmark, the burden in females declined slightly more than in males, in relative terms, while in Sweden the relative decline was similar in males and females. Discussion and Conclusions. The gender gaps in harm narrowed to a different extent in the Nordic countries, with the differences driven by different conditions. Findings are informative about how inequality, policy and sociocultural differences affect levels of harm by gender.

  • 28. Agardh, Emilie E.
    et al.
    Allebeck, Peter
    Knudsen, Ann Kristin Skrindo
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. The Norwegian Institute of Public Health, Norway.
    Aronsson, Amanda E.
    Flodin, Par
    Eikemo, Terje A.
    Bangah, Paul R.
    Skogen, Jens Christoffer
    Gissler, Mika
    Ronka, Sanna
    Mcgrath, John J.
    Sigurvinsdottir, Rannveig
    Dadras, Omid
    Deuba, Keshab
    Hedna, Khedidja
    Mentis, Alexios-Fotios A.
    Sagoe, Dominic
    Shiri, Rahman
    Weye, Nanna
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. the Norwegian Institute of Public Health, Norway; Aarhus University, Denmark.
    Hay, Simon I.
    Murray, Christopher J. L.
    Naghavi, Mohsen
    Pasovic, Maja
    Vos, Theo
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; Inland Norway University of Applied Sciences, Norway.
    Danielsson, Anna-Karin
    Disease Burden Attributed to Drug use in the Nordic Countries: a Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 20192023In: International Journal of Mental Health and Addiction, ISSN 1557-1874, E-ISSN 1557-1882Article in journal (Refereed)
    Abstract [en]

    The Nordic countries share similarities in many social and welfare domains, but drug policies have varied over time and between countries. We wanted to compare differences in mortality and disease burden attributed to drug use over time. Using results from the Global Burden of Disease (GBD) study, we extracted age-standardized estimates of deaths, DALYs, YLLs and YLDs per 100 000 population for Denmark, Finland, Iceland, Norway, and Sweden during the years 1990 to 2019. Among males, DALY rates in 2019 were highest in Finland and lowest in Iceland. Among females, DALY rates in 2019 were highest in Iceland and lowest in Sweden. Sweden have had the highest increase in burden since 1990, from 252 DALYs to 694 among males, and from 111 to 193 among females. Norway had a peak with highest level of all countries in 2001-2004 and thereafter a strong decline. Denmark have had the most constant burden over time, 566-600 DALYs among males from 1990 to 2010 and 210-240 DALYs among females. Strict drug policies in Nordic countries have not prevented an increase in some countries, so policies need to be reviewed.

  • 29. Agardh, Emilie E.
    et al.
    Lundin, Andreas
    Lager, Anton
    Allebeck, Peter
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Andreasson, Sven
    Östenson, Claes-Göran
    Danielsson, Anna-Karin
    Alcohol and type 2 diabetes: The role of socioeconomic, lifestyle and psychosocial factors2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 4, p. 408-416Article in journal (Refereed)
    Abstract [en]

    AIMS: We investigate (a) alcohol consumption in association with type 2 diabetes, taking heavy episodic drinking (HED), socioeconomic, health and lifestyle, and psychosocial factors into account, and (b) whether a seemingly protective effect of moderate alcohol consumption on type 2 diabetes persists when stratified by occupational position.

    METHODS: This population-based longitudinal cohort study comprises 16,223 Swedes aged 18-84 years who answered questionnaires about lifestyle, including alcohol consumption in 2002, and who were followed-up for self-reported or register-based diabetes in 2003-2011. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated in a multivariable-adjusted logistic regression model for all participants and stratified by high and low occupational position. We adjusted for HED, socioeconomic (occupational position, cohabiting status and unemployment), health and lifestyle (body mass index (BMI), blood pressure, smoking, physical inactivity, poor general health, anxiety/depression and psychosocial (low job control and poor social support) characteristics one by one, and the sets of these factors.

    RESULTS: Moderate consumption was inversely associated with type 2 diabetes after controlling for health and lifestyle (OR=0.47; 95% CI: 0.29-0.79) and psychosocial factors (OR=0.40; 95% CI: 0.22-0.79) when compared to non-drinkers. When adjusting for socioeconomic factors, there was still an inverse but non-significant association (OR=0.59; 95% CI: 0.35-1.00). In those with high occupational position, there was no significant association between moderate consumption and type 2 diabetes after adjusting for socioeconomic (OR=0.67; 95% CI: 0.3-1.52), health and lifestyle (OR=0.70; 95% CI: 0.32-1.5), and psychosocial factors (OR=0.75; 95% CI: 0.23-2.46). On the contrary, in those with low occupational position, ORs decreased from 0.55 (95% CI: 0.28-1.1) to 0.35 (95% CI: 0.15-0.82) when adjusting for psychosocial factors, a decrease that was solely due to low job control. HED did not influence any of these associations.

    CONCLUSIONS: Moderate alcohol consumption is associated with a lower risk of type 2 diabetes, after adjusting for HED, health and lifestyle, and psychosocial characteristics. The association was inverse but non-significant after adjusting for socioeconomic factors. When stratified by occupational position, there was an inverse association only in those with low occupational position and after adjusting for low job control.

  • 30.
    Agerholm, Janne
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Burström, Bo
    Schön, Pär
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Liljas, Ann
    How did providers of home care for older adults manage the early phase of the Covid-19 pandemic? A qualitative case study of managers' experiences in Region Stockholm2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, article id 1173Article in journal (Refereed)
    Abstract [en]

    Background In the spring of 2020, the Covid-19 outbreak sent a shock wave through the Swedish society and placed an extraordinary pressure on the health and social care system for older people. In the initial phase there were few guidelines for care providers to follow and staff in home care organisations often had to tackle challenges posed by the pandemic as they appeared. The aim of this study was to understand how the spread of Covid-19 was managed in organisations providing home care to older adults in different municipalities in Region Stockholm, and what actions were taken to minimise the spread of the disease among clients and staff.

    Method A descriptive qualitative study was performed based on eight interviews with managers of home care providers for older adults in three different municipalities in Region Stockholm.Three of the eight providers operate within an integrated care system. Data were analysed using conventional content analysis.

    Results Three themes were identified covering actions taken to handle the spread of the virus, feelings of insecurity and anxiety, and internal and external factors influencing how the pandemic was tackled. There was no single strategy followed by all municipalities or organisations, however, there were similarities between the organisations. One such example was the introduction of cohort care and the experience of lacking personal protective equipment. Providers in the integrated care system emphasized some advantages with their system that was seen as facilitators for minimising the risk of spreading the virus, like the joint meetings with managers from both health and social care and the close contact with healthcare professionals in relation to dissemination of hygiene instructions.

    Conclusion Social care workers providing home care to older persons are an important group in preventing dissemination of infectious diseases like Covid-19. For better readiness and preparedness for future pandemics, municipal home care services would need larger stocks of personal protective equipment, clear guidelines and more training on how to reduce dissemination of disease. Ways to achieve closer communication between health and social care providers should also be investigated.

  • 31.
    Agerholm, Janne
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden.
    Koitzsch Jensen, Natasja
    Liljas, Ann
    Healthcare professionals' perception of barriers and facilitators for care coordination of older adults with complex care needs being discharged from hospital: A qualitative comparative study of two Nordic capitals2023In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 23, no 1, article id 32Article in journal (Refereed)
    Abstract [en]

    Background The handover of older adults with complex health and social care from hospital admissions to homebased healthcare requires coordination between multiple care providers. Providing insight to the care coordination from healthcare professionals’ views is crucial to show what efforts are needed to manage patient handovers from hospitals to home care, and to identify strengths and weaknesses of the care systems in which they operate.

    Objective This is a comparative study aiming to examine healthcare professionals’ perceptions on barriers and facilitators for care coordination for older patients with complex health and social care needs being discharged from hospital in two capital cities Copenhagen (DK) and Stockholm (SE).

    Method Semi-structured interviews were conducted with 25 nurses and 2 assistant nurses involved in the coordination of the discharge process at hospitals or in the home healthcare services (Copenhagen n = 11, Stockholm n = 16). The interview guide included questions on the participants’ contributions, responsibilities, and influence on decisions during the discharge process. They were also asked about collaboration and interaction with other professionals involved in the process. The data was analysed using thematic analysis.

    Results Main themes were communication ways, organisational structures, and supplementary work by staff. We found that there were differences in the organisational structure of the two care systems in relation to integration between different actors and differences in accessibility to patient information, which influenced the coordination. Municipal discharge coordinators visiting patients at the hospital before discharge and the follow-home nurse were seen as facilitators in Copenhagen. In Stockholm the shared information system with access to patient records were lifted as a facilitator for coordination. Difficulties accessing collaborators were experienced in both settings. We also found that participants in both settings to a high degree engage in work tasks outside of their responsibilities to ensure patient safety.

    Conclusions There are lessons to be learned from both care systems. The written e-communication between hospitals and home health care runs more smoothly in Stockholm, whereas it is perceived as a one-way communication in Copenhagen. In Copenhagen there are more sector-overlapping work which might secure a safer transition from hospital to home. Participants in both settings initiated own actions to weigh out imperfections of the system.

  • 32.
    Agerholm, Janne
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Ponce de Leon, Antonio
    Schön, Pär
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Burström, Bo
    Impact of Integrated Care on the Rate of Hospitalization for Ambulatory Care Sensitive Conditions among Older Adults in Stockholm County: An Interrupted Time Series Analysis2021In: International Journal of Integrated Care, E-ISSN 1568-4156, Vol. 21, no 2, article id 22Article in journal (Refereed)
    Abstract [en]

    Introduction: Reducing avoidable hospital admissions is often viewed as a possible positive consequence of introducing integrated care (IC). The aim of this study was to investigate the impact of implementing IC in Norrtälje on the rate of admissions for ambulatory care sensitive conditions (ACSC).

    Method: Using interrupted time series analyses we investigated the effect of implementing IC in Norrtälje municipality in the northern part of Stockholm county, Sweden. The time period included 48 time points, from year 2000 to year 2011 with measurements before and after introducing IC in Norrtälje in 2006. In order to control for other extraneous events that could affect the outcome measure, but not related to the introduction of IC, we included a control population from Stockholm municipality.

    Results: After introducing IC in Norrtälje the rate of admissions for ACSC decreased. This decrease was greater in Norrtälje than in the matched control population, however the difference between the two areas was not statistically significant (p = 0.08).

    Conclusion: Introducing IC in Norrtälje may have had positive impact on admissions for ACSC for older people living in Norrtälje; however, the interpretation of the impact of IC on admissions for ACSC is complicated by intervening policy changes in health and social care during the study period. 

  • 33. Agerholm, Janne
    et al.
    Pulkki, Jutta
    Jensen, Natasja K.
    Keskimäki, Ilmo
    Andersen, Ingelise
    Burström, Bo
    Jämsen, Esa
    Tynkkynen, Liina-Kaisa
    Schön, Pär
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Liljas, Ann E. M.
    The organisation and responsibility for care for older people in Denmark, Finland and Sweden: outline and comparison of care systems2023In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
    Abstract [en]

    Aim: To outline the organisation and responsibility for health and social care provided to older people in Denmark, Finland and Sweden.

    Methods: Non-quantifiable data on the care systems were collated from the literature and expert consultations. The responsibilities for primary healthcare, specialised healthcare, prevention and health promotion, rehabilitation, and social care were presented in relation to policy guidance, funding and organisation.

    Results: In all three countries, the state issues policy and to some extent co-funds the largely decentralised systems; in Denmark and Sweden the regions and municipalities organise the provision of care services – a system that is also about to be implemented in Finland to improve care coordination and make access more equal. Care for older citizens focuses to a large extent on enabling them to live independently in their own homes.

    Conclusions: Decentralised care systems are challenged by considerable local variations, possibly jeopardising care equity. State-level decision and policy makers need to be aware of these challenges and monitor developments to prevent further health and social care disparities in the ageing population.

  • 34.
    Agerholm, Janne
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden.
    Teni, F. S.
    Sundbye, J.
    Rolfson, O.
    Burström, K.
    Patient-reported outcomes among patients undergoing total hip replacement in an integrated care system and in a standard care system in Region Stockholm, Sweden2022In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 1414Article in journal (Refereed)
    Abstract [en]

    Background: Coordination, cooperation and efficient use of resources is vital for the health- and social care sector if it is to meet the needs of an aging population. Integrated care is a patient-centred approach to provision of care aiming to improve quality of care and overcome fragmented care through co-productive partnerships and may positively affect quality of care and health outcomes, especially among those in need of highly coordinated care services.

    Aim: To compare patient-reported outcomes (PROs) among patients undergoing total hip replacement (THR) in the integrated care system in Norrtälje Municipality and in the standard care system in other municipalities in Region Stockholm, Sweden.

    Methods: Swedish Hip Arthroplasty Register PRO data during 2008–2015 were compared 1 year after THR among patients (≥50 years) in integrated care (n = 407) and standard care (n = 3501) systems using linear (EQ VAS score), logistic (EQ-5D-3L dimensions) and negative binomial (hip pain VAS score) regressions. Analyses were adjusted for the preoperative factors age, sex, BMI, ASA class and type of incision.

    Results: 1-year postoperatively, patients in the integrated care system did not report their health significantly different from patients receiving standard care. Exceptions: Female patients in integrated care reported less problems with self-care (OR:0.52; 0.29–0.96) and patients above 70 years reported more problems with mobility (OR: 1.37; 1.01–1.87).

    Conclusion: No significant differences were found between the two care systems for postoperative PROs. A longer follow-up time and analyses by socioeconomic groups would be valuable.

  • 35.
    Ahacic, Kozma
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Improvements in the aging population 1968-1991: trends in mobility and dental status2002Doctoral thesis, comprehensive summary (Other academic)
  • 36. Ahacic, Kozma
    et al.
    Damström-Thakker, Kerstin
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Recurring alcohol-related care between 1998 and 2007 among people treated for an alcohol-related disorder in 1997: a register study in Stockholm County2011In: BMC Public Health, E-ISSN 1471-2458, Vol. 11, p. 574-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Inpatient care for alcohol intoxication is increasing in Sweden, especially among young women. Since it is well known that alcohol disorder is a chronic relapsing illness, this study examines the extent to which people return for more care.

    METHOD: All inpatients with alcohol-related diagnoses in Stockholm County during 1997 were followed prospectively to 2007 through registers. The proportion reappearing for the same diagnosis, other alcohol-related inpatient, or outpatient care each year after baseline, as well as the number of years the inpatients reappeared were calculated (n = 2735). Three diagnoses were examined separately; alcohol dependence, harmful use of alcohol, and alcohol intoxication.

    RESULTS: Three out of five inpatients with an alcohol diagnoses reappeared for more alcohol-related inpatient care during the following decade. The proportion returning was largest the year after baseline and then decreased curvilinearly over time. The inclusion of outpatient care increased proportions, but did not change patterns. Of those with an alcohol dependence diagnosis at baseline 42 percent returned for more alcohol-related inpatient care the first, 28 percent the fifth, and 25 percent the tenth year. Corresponding proportions for harmful use and intoxication were smaller. One in five among those with an alcohol dependence returned for more than five of the ten years. Ordered logistic regressions confirmed that besides diagnosis, age and gender were independently related to the number of years returning to care.

    CONCLUSIONS: While middle-aged males with alcohol dependence were in a revolving door, young female inpatients with intoxication diagnosis returned to a comparably lower degree.

  • 37. Ahacic, Kozma
    et al.
    Kennison, Robert F.
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönkoping University, Sweden.
    Alcohol abstinence, non-hazardous use and hazardous use a decade after alcohol-related hospitalization: registry data linked to population-based representative postal surveys2014In: BMC Public Health, E-ISSN 1471-2458, Vol. 14, p. 874-Article in journal (Refereed)
    Abstract [en]

    Background: Although there is evident association between alcohol-related hospitalization and alcohol use, the relationship has not been well examined. This study analyzed the extent of alcohol abstinence, non-hazardous use and hazardous use among people who had experienced alcohol-related hospitalization during the preceding decade. Method: Registry data concerning alcohol-related hospitalizations between 1996 and 2007 were linked to two representative surveys, in 2006 and 2007, of residents of Stockholm County. Relevant contrasts were modeled, using logistic regression, in the pooled sample (n = 54 955). Ages were 23-84 years at follow-up. Results: Among persons previously hospitalized (n = 576), half reported non-hazardous use. Non-hazardous use was less prevalent than in the general population - and the extent of non-hazardous use did not change over time following hospitalization. There were no significant age differences, but non-hazardous use was less frequent among people with repeated episodes of care. One in six was abstinent. Abstinence was more common among the old, while hazardous use (exceeding 14 drinks per week for men, and 9 drinks per week for women) decreased with age. Abstinence also increased over time; among persons hospitalized ten years ago, the abstinence rate was twice that of the general population. Associations with hazardous use over time were less conclusive. Hazardous use among those previously hospitalized decreased over time in one sample but not in the other. After pooling the data, there were indications of a decrease over time following hospitalization, but more prevalent hazardous use than in the general population. Conclusions: Following alcohol-related hospitalization, abstinence increased, and there was no evidence of regression towards the mean, i.e., towards non-hazardous use. Abstinence was also more widespread among previously hospitalized persons of older ages. With advancing age, changing hazardous alcohol habits among previously hospitalized appears to yield a trend towards promotion of abstinence.

  • 38. Ahacic, Kozma
    et al.
    Kennison, Robert F.
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Changes in sobriety in the Swedish population over three decades: age, period or cohort effects?2012In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 107, no 4, p. 748-755Article in journal (Refereed)
    Abstract [en]

    Aims  This study aimed to examine age, cohort and period trends in alcohol abstinence.

    Design  Two surveys, the Level of Living Survey collected in 1968, 1974, 1981, 1990 and 2000, and the Swedish Panel Study of the Oldest Old (SWEOLD) collected in 1992 and 2002, were studied with graphical depictions of cross-sectional and longitudinal data presented over time and over age. Cross-sectional 10-year age group differences, time-lag differences between waves and within-cohort differences between waves for 10-year birth cohorts were examined. Logistic regression models were applied to confirm the observed patterns.

    Setting  The samples were representative of the Swedish population.

    Participants  Participants ranged in age from 18 to 75 (n = 5000 per wave), and 77+ at later waves (n = 500).

    Measurements  Alcohol abstinence was determined by asking ‘Do you ever drink wine, beer, or spirits?’, where a ‘no’ response indicated abstinence.

    Findings  Decreases in abstinence rates were observed from 1968 to 2000/02. While cross-sectional analysis indicated increased abstinence with advancing age, the longitudinal analysis suggested otherwise. Inspection of cohort differences revealed little change within cohorts and large differences between cohorts; abstinence rates declined in later-born cohorts up to the 1940s birth cohorts; stability was observed in cohorts born since the 1940s. Logistic regression models indicated that neither age nor period were significant (P > 0.05) predictors of abstinence when cohort (P < 0.001) was included.

    Conclusion  Decreasing proportions of total alcohol abstainers in Sweden from 1968 to 2000 appear to be attributable primarily to decreases in successive cohorts rather than drinkers becoming abstainers.

  • 39. Ahacic, Kozma
    et al.
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institute .
    Helgason, Asgeir R.
    Allebeck, Peter
    Non-response bias and hazardous alcohol use in relation to previous alcohol-related hospitalization: comparing survey responses with population data2013In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 8, p. 10-Article in journal (Refereed)
    Abstract [en]

    Background: This study examines whether alcohol-related hospitalization predicts survey non-response, and evaluates whether this missing data result in biased estimates of the prevalence of hazardous alcohol use and abstinence. Methods: Registry data on alcohol-related hospitalizations during the preceding ten years were linked to two representative surveys. Population data corresponding to the surveys were derived from the Stockholm County registry. The alcohol-related hospitalization rates for survey responders were compared with the population data, and corresponding rates for non-responders were based on the differences between the two estimates. The proportions with hazardous alcohol use and abstinence were calculated separately for previously hospitalized and non-hospitalized responders, and non-responders were assumed to be similar to responders in this respect. Results: Persons with previous alcohol-related admissions were more likely currently to abstain from alcohol (RR=1.58, p<.001) or to have hazardous alcohol use (RR=2.06, p<.001). Alternatively, they were more than twice as likely to have become non-responders. Adjusting for this skewed non-response, i. e., the underrepresentation of hazardous users and abstainers among the hospitalized, made little difference to the estimated rates of hazardous use and abstinence in total. During the ten-year period 1.7% of the population were hospitalized. Conclusions: Few people receive alcohol-related hospital care and it remains unclear whether this group's underrepresentation in surveys is generalizable to other groups, such as hazardous users. While people with severe alcohol problems - i.e. a history of alcohol-related hospitalizations -are less likely to respond to population surveys, this particular bias is not likely to alter prevalence estimates of hazardous use.

  • 40. Ahacic, Kozma
    et al.
    Trygged, Sven
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Income and Education as Predictors of Stroke Mortality after the Survival of a First Stroke2012In: Stroke Research and Treatment, ISSN 2090-8105, E-ISSN 2042-0056, Vol. 2012, article id 983145Article in journal (Refereed)
    Abstract [en]

    Background. It is well known that socioeconomic indicators, such as income and education, predict both stroke incidence and stroke mortality. This means that persons in lower socioeconomic positions are less likely to survive their stroke, and there will be a selective survival in the group discharged from hospital after their first stroke. Question. Does socioeconomic position continue to predict mortality, stroke specific, or from other causes, among patients surviving their first stroke in spite of this selective survival? Methods. All persons in Sweden aged 40–59 years who were discharged after a first hospitalization for stroke in 1996–2000 were included (n = 10,487), then followed up until the end of the fourth calendar year after discharge. Data were analysed with Cox regressions controlling for age, sex, and stroke type. Results. Persons with high socioeconomic position, measured by education and income, have lower mortality than those of low position. Education was not significant when adjusted for income, however. The risk of dying was similar for stroke-specific mortality and all-cause mortality, for those with cerebral infarction as well as for all patients. Conclusions. Socioeconomic position predicted stroke-specific mortality also in the selective group of persons who survived their first stroke.

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  • 41.
    Ahlbom, Anders
    et al.
    Karolinska Institutet.
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Lundström, Hans
    Statistics Sweden.
    Den åldrande befolkningen2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 48, p. 3048-3051Article in journal (Refereed)
  • 42. Ahlner, Felicia
    et al.
    Erhag, Hanna Falk
    Johansson, Lena
    Fässberg, Madeleine Mellqvist
    Sterner, Therese Rydberg
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Gothenburg, Sweden.
    Samuelsson, Jessica
    Zettergren, Anna
    Waern, Margda
    Skoog, Ingmar
    Patterns of Alcohol Consumption and Associated Factors in a Population-Based Sample of 70-Year-Olds: Data from the Gothenburg H70 Birth Cohort Study 2014–162022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 14, article id 8248Article in journal (Refereed)
    Abstract [en]

    Older adults of today consume more alcohol, yet knowledge about the factors associated with different consumption levels is limited in this age group. Based on the data from a population-based sample (n = 1156, 539 men and 617 women) in The Gothenburg H70 Birth Cohort Study 2014–16, we examined sociodemographic, social, and health-related factors associated with alcohol consumption levels in 70-year-olds, using logistic regression. Total weekly alcohol intake was calculated based on the self-reported amount of alcohol consumed. Alcohol consumption was categorized as lifetime abstention, former drinking, moderate consumption (≤98 g/week), and at-risk consumption (>98 g/week). At-risk consumption was further categorized into lower at-risk (98–196 g/week), medium at-risk (196–350 g/week), and higher at-risk (≥350 g/week). We found that among the 1156 participants, 3% were lifetime abstainers, 3% were former drinkers, 64% were moderate drinkers, and 30% were at-risk drinkers (20% lower, 8% medium, 2% higher). Among several factors, former drinking was associated with worse general self-rated health (OR 1.65, 95% CI 1.08–2.51) and lower health-related quality of life (measured by physical component score) (OR 0.94, 95% CI 0.91–0.97), higher illness burden (OR 1.16, 95% CI 1.07–1.27), and weaker grip strength (OR 0.96, 95% CI 0.94–0.98). Higher at-risk drinkers more often had liver disease (OR 11.41, 95% CI 3.48–37.37) and minor depression (OR 4.57, 95% CI 1.40–14.95), but less contacts with health care (OR 0.32, 95% CI 0.11–0.92). Our findings demonstrate the importance of classifications beyond abstinence and at-risk consumption, with implications for both the prevention and clinical management of unhealthy consumption patterns in older adults.

  • 43. Ahlsson, Fredrik
    et al.
    Kaijser, Magnus
    Adami, Johanna
    Lundgren, Maria
    Palme, Mårten
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    School Performance After Preterm Birth2015In: Epidemiology, ISSN 1044-3983, Vol. 26, no 1, p. 106-111Article in journal (Refereed)
    Abstract [en]

    Background: An increased risk of poor school performance for children born preterm has been shown in many studies, but whether this increase is attributable to preterm birth per se or to other factors associated with preterm birth has not been resolved. Methods: We used data from the Swedish Medical Birth Register, the Longitudinal Integration Database for Sickness Insurance and Labor Market Study, the Swedish Multigeneration Register, and the National School Register to link records comprising the Swedish birth cohorts from 1974 through 1991. Linear regression was used to assess the association between gestational duration and school performance, both with and without controlling for parental and socioeconomic factors. In a restricted analysis, we compared siblings only with each other. Results: Preterm birth was strongly and negatively correlated with school performance. The distribution of school grades for children born at 31-33 weeks was on average 3.85 (95% confidence interval = -4.36 to -3.35) centiles lower than for children born at 40 weeks. For births at 22-24 weeks, the corresponding figure was -23.15 (-30.32 to -15.97). When taking confounders into account, the association remained. When restricting the analysis to siblings, however, the association between school performance and preterm birth after week 30 vanished completely, whereas it remained, less pronounced, for preterm birth before 30 weeks of gestation. Conclusions: Our study suggests that the association between school performance and preterm birth after 30 gestational weeks is attributable to factors other than preterm birth per se.

  • 44. Ahlström, Christer
    et al.
    Anund, Anna
    Fors, Carina
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Effects of the road environment on the development of driver sleepiness in young male drivers2018In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 112, p. 127-134Article in journal (Refereed)
    Abstract [en]

    Latent driver sleepiness may in some cases be masked by for example social interaction, stress and physical activity. This short-term modulation of sleepiness may also result from environmental factors, such as when driving in stimulating environments. The aim of this study is to compare two road environments and investigate how they affect driver sleepiness. Thirty young male drivers participated in a driving simulator experiment where they drove two scenarios: a rural environment with winding roads and low traffic density, and a suburban road with higher traffic density and a more built-up roadside environment. The driving task was essentially the same in both scenarios, i.e. to stay on the road, without much interaction with other road users. A 2 x 2 design, with the conditions rural versus suburban, and daytime (full sleep) versus night-time (sleep deprived), was used. The results show that there were only minor effects of the road environment on subjective and physiological indicators of sleepiness. In contrast, there was an increase in subjective sleepiness, longer blink durations and increased EEG alpha content, both due to time on task and to night-time driving. The two road environments differed both in terms of the demand on driver action and of visual load, and the results indicate that action demand is the more important of the two factors. The notion that driver fatigue should be countered in a more stimulating visual environment such as in the city is thus more likely due to increased task demand rather than to a richer visual scenery. This should be investigated in further studies.

  • 45. Ahlström, Christer
    et al.
    Fors, Carina
    Anund, Anna
    Hallvig, David
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Video-based observer rated sleepiness versus self-reported subjective sleepiness in real road driving2015In: European Transport Research Review, ISSN 1867-0717, E-ISSN 1866-8887, Vol. 7, no 4, article id 38Article in journal (Refereed)
    Abstract [en]

    Purpose: Observer-rated sleepiness (ORS) based on video recordings of the driver's face is often used when analysing naturalistic driving data. The aim of this study is to investigate if ORS ratings agree with subjective self-reported sleepiness (SRS). Methods: Forty raters assessed 54 video-clips showing drivers with varying levels of sleepiness. The video-clips were recorded during a field experiment focusing on driver sleepiness using the same cameras that are typically used in large-scale field studies. The weak results prompted a second test. Ten human factors researchers made pairwise comparisons of videos showing the same four participants in an alert versus a very sleepy condition. The task was simply to select the video-clip where the driver was sleepy. Results: The overall average percentage of video segments where ORS and SRS matched was 41 % in Test 1. ORS 0 (alert) and ORS 2 (very sleepy) were easier to score than ORS 1 and it was slightly harder to rate night-time drives. Inter-rater agreement was low, with average Pearson's r correlations of 0.19 and Krippendorff's alpha of 0.15. In Test 2, the average Pearson's r correlations was 0.35 and Krippendorff's alpha was 0.62. The correspondence between ORS and SRS showed an agreement of 35 %. Conclusions: The results indicate that ORS ratings based on real road video recordings correspond poorly with SRS and have low inter-rater agreement. Further research is necessary in order to further evaluate the usefulness of ORS as a measure of sleepiness.

  • 46. Ahlström, Christer
    et al.
    Solis-Marcos, Ignacio
    Nilsson, Emma
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    The impact of driver sleepiness on fixation-related brain potentials2020In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 29, no 5, article id e12962Article in journal (Refereed)
    Abstract [en]

    The effects of driver sleepiness are often quantified as deteriorated driving performance, increased blink durations and high levels of subjective sleepiness. Driver sleepiness has also been associated with increasing levels of electroencephalogram (EEG) power, especially in the alpha range. The present exploratory study investigated a new measure of driver sleepiness, the EEG fixation-related lambda response. Thirty young male drivers (23.6 +/- 1.7 years old) participated in a driving simulator experiment in which they drove on rural and suburban roads in simulated daylight versus darkness during both the daytime (full sleep) and night-time (sleep deprived). The results show lower lambda responses during night driving and with longer time on task, indicating that sleep deprivation and time on task cause a general decrement in cortical responsiveness to incoming visual stimuli. Levels of subjective sleepiness and line crossings were higher under the same conditions. Furthermore, results of a linear mixed-effects model showed that low lambda responses are associated with high subjective sleepiness and more line crossings. We suggest that the fixation-related lambda response can be used to investigate driving impairment induced by sleep deprivation while driving and that, after further refinement, it may be useful as an objective measure of driver sleepiness.

  • 47.
    Ahmadinia, Hamed
    et al.
    Åbo Akademi University, Finland.
    Eriksson-Backa, Kristina
    Åbo Akademi University, Finland.
    Nikou, Shahrokh
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences. Åbo Akademi University, Finland.
    Health-seeking behaviours of immigrants, asylum seekers and refugees in Europe: a systematic review of peer-reviewed articles2022In: Journal of Documentation, ISSN 0022-0418, E-ISSN 1758-7379, Vol. 78, no 7, p. 18-41Article, review/survey (Refereed)
    Abstract [en]

    Purpose - Immigrants, asylum seekers and refugees living in Europe face a number of challenges in accessing or using health information and healthcare services available in their host countries. To resolve these issues and deliver the necessary services, providers must take a comprehensive approach to better understand the types of health information and healthcare services that these individuals need, seek and use. Therefore, the purpose of this paper is to develop that comprehensive approach.

    Design/methodology/approach - In this paper, a systematic literature review of peer-reviewed publications was performed, with 3.013 articles collected from various databases. A total of 57 qualifying papers on studies conducted in Europe were included in the review after applying the predefined inclusion and exclusion requirements, screening processes and eliminating duplicates. The information seeking and communication model (ISCM) was used in the analysis.

    Findings - The findings revealed that while many health information and healthcare services are accessible in Europe for immigrants, asylum seekers and refugees, many of these individuals are unaware of their existence or how to access them. While our findings do not specify what health-related information these groups need, use or seek, they do suggest the importance and value of providing mental health, sexual health and HIV, as well as pregnancy and childbirth information and services. Furthermore, according to our results, health information services should be fact-based, easy to understand and raise awareness about healthcare structure and services available in Europe for this vulnerable population.

    Practical implications - This study has a range of practical implications, including (1) highlighting the need for mental health and behavioural health services and (2) stressing the value of addressing cultural context and religious values while investigating (health) information seeking of people with foreign background.

    Originality/value - This is one of the first studies to systematically review and examine the behaviour of immigrants, asylum seekers and refugees in relation to health information and healthcare services in the European context.

  • 48.
    Ahmed, Arif
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Lager, Anton
    Fredlund, Peeter
    Schafer Elinder, Liselotte
    Consumption of fruit and vegetables and the risk of type 2 diabetes: a 4-year longitudinal study among Swedish adults2020In: Journal of Nutritional Science, ISSN 2048-6790, E-ISSN 2048-6790, Vol. 9, article id e14Article in journal (Refereed)
    Abstract [en]

    A low intake of fruit and vegetables is a significant contributor to the global burden of disease. The aim of this study was to estimate the size of the risk of type 2 diabetes (T2D) of a low intake and to investigate possible sex differences. In this regard, this study used a longitudinal data from the Stockholm Public Health Cohort located in Sweden, collected in 2010 and 2014. The analysis included 14 718 men and 20 589 women aged 25 to 84 years. Fruit and vegetable intake, separately <2 servings/d or combined <4 servings/d (one serving corresponding to 100 g) was set as a cut-point for low intake. The sex difference at baseline was examined. Sex-stratified logistic regression was performed with onset of T2D as the outcome and fruit and vegetable intake at baseline as the exposure with adjustment for other known risk factors. Results indicate that men consumed significantly (P < 0.001) less fruit and vegetables compared with women. A 62 % higher risk to develop T2D over the 4-year period was observed in men who had low vegetable intake compared with high intake after adjusting for age, education, BMI, smoking, alcohol and physical activity (OR 1.62; 95 % CI 1.00, 2.63). In women, a significantly higher risk of T2D was also observed with a low intake of vegetables, but not after adjustment. The present study suggests that higher consumption of vegetables seems to be protective for the onset of T2D in men. Thus, increasing the intake of vegetables in men should be a public health priority.

  • 49. Ahmed, Imaduddin
    et al.
    Parikh, Priti
    Munezero, Parfait
    Stockholm University, Faculty of Social Sciences, Department of Statistics. Ericsson, Sweden.
    Sianjase, Graham
    Coffman, D'Maris
    The impact of power outages on households in Zambia2023In: Economia Politica, ISSN 1120-2890, E-ISSN 1973-820X, no 40, p. 835-867Article in journal (Refereed)
    Abstract [en]

    As global average temperatures rise, so does the frequency and intensity of El Niño-induced droughts, which in turn threaten the reliability of hydropower. 1.4 billion people live in countries where hydropower constitutes more than a quarter of the electricity production and which have experienced El Niño droughts, meaning many more power outages can be expected around the world. Little research has been conducted on the impact of power outages on mental health. This study takes Zambia as its case study to examine the impact that El Niño droughts have had on the lives of householders connected to a highly hydropower-dependant electricity grid, and includes the impact it has had on their physical and self-reported mental health. Using 54 online responses to a survey, we found that the greatest impacts of outages spoiled food, compromised entertainment, compromised ability to work and limitation in cooking options. More than a fifth of respondents reported experiencing self-reported depression to a major degree or all of the time due to power outages, with individuals writing their own responses that they felt debilitated, experienced reduced communication and reduced activities, and stress. Using Bayesian inference, we found that changes in sleeping patterns arising from power outages was a statistically significant predictor of self-reported depression. 63% of surveyed households were willing to pay approximately USD 0.10/kWh as of the end of 2019, about double the tariff that they did, to ensure reliable electricity supply. Household income was a statistically significant predictor of willingness to pay more.

  • 50. Ahmed, Sayem
    et al.
    Hasan, Md. Zahid
    Laokri, Samia
    Jannat, Zerin
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    Ahmed, Mohammad Wahid
    Dorin, Farzana
    Vargas, Veronica
    Khan, Jahangir A. M.
    Technical efficiency of public district hospitals in Bangladesh: a data envelopment analysis2019In: Cost Effectiveness and Resource Allocation, E-ISSN 1478-7547, Vol. 17, article id 15Article in journal (Refereed)
    Abstract [en]

    Background: District hospitals (DHs) provide secondary level of healthcare to a wide range of population in Bangladesh. Efficient utilization of resources in these secondary hospitals is essential for delivering health services at a lower cost. Therefore, we aimed to estimate the technical efficiency of the DHs in Bangladesh. Methods: We used input-oriented data envelopment analysis method to estimate the variable returns to scale (VRS) and constant returns to scale (CRS) technical efficiency of the DHs using data from Local Health Bulletin, 2015. In this model, we considered workforce as well as number of inpatient beds as input variables and number of inpatient, outpatient, and maternal services provided by the DHs as output variables. A Tobit regression model was applied for assessing the association of institutional and environmental characteristics with the technical efficiency scores. Results: The average scale, VRS, and CRS technical efficiency of the DHs were estimated to 85%, 92%, and 79% respectively. Population size, poverty headcount, bed occupancy ratio, administrative divisions were significantly associated with the technical efficiency of the DHs. The mean VRS and CRS technical efficiency demonstrated that the DHs, on an average, could reduce their input mix by 8% and 21% respectively while maintaining the same level of output. Conclusion: Since the average technical efficiency of the DHs was 79%, there is little scope for overall improvements in these facilities by adjusting inputs. Therefore, we recommend to invest further in the DHs for improvement of services. The Ministry of Health and Family Welfare (MoHFW) should improve the efficiency in resource allocation by setting an input-mix formula for DHs considering health and socio-economic indicators (e.g., population density, poverty, bed occupancy ratio). The formula can be designed by learning from the input mix in the more efficient DHs. The MoHFW should conduct this kind of benchmarking study regularly to assess the efficiency level of health facilities which may contribute to reduce the wastage of resources and consequently to provide more affordable and accessible public hospital care.

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