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  • 1.
    Axelsson, John
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Tigerström, L
    Does rapid eye movement (REM) sleep prepare the brain for wakening?2014In: Journal of sleep research, Special issue: 22nd Congress of the European Sleep Research Society, 16-20 September, 2014, Tallinn, Estonia, 2014Conference paper (Other academic)
  • 2. Castanon, Nathalie
    et al.
    Lasselin, Julie
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. French National Institute for Agricultural Research (INRA), France; University of Bordeaux, France.
    Capuron, Lucile
    Neuropsychiatric comorbidity in obesity: role of inflammatory processes2014In: Frontiers in Endocrinology, ISSN 1664-2392, E-ISSN 1664-2392, Vol. 5, article id 74Article, review/survey (Refereed)
    Abstract [en]

    Neuropsychiatric symptoms are frequent in obesity. In addition to their substantial economic and health impact, these symptoms significantly interfere with the quality of life and social function of obese individuals. While the pathophysiological mechanisms underlying obesity-related neuropsychiatric symptoms are still under investigation and remain to be clearly identified, there is increasing evidence for a role of inflammatory processes. Obesity is characterized by a chronic low-grade inflammatory state that is likely to influence neuropsychiatric status given the well-known and highly documented effects of inflammation on brain activity/function and behavior. This hypothesis is supported by recent findings emanating from clinical investigations in obese subjects and from experimentations conducted in animal models of obesity. These studies converge to show that obesity-related inflammatory processes, originating either from the adipose tissue or gut microbiota environment, spread to the brain where they lead to substantial changes in neurocircuitry, neuroendocrine activity, neurotransmitter metabolism and activity, and neurogenesis. Together, these alterations contribute to shape the propitious bases for the development of obesity-related neuropsychiatric comorbidities.

  • 3.
    Chungkham, Holendro Singh
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ingre, Michael
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Karasek, Robert
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Factor Structure and Longitudinal Measurement Invariance of the Demand Control Support Model: An Evidence from the Swedish Longitudinal Occupational Survey of Health (SLOSH)2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 8, article id e70541Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To examine the factor structure and to evaluate the longitudinal measurement invariance of the demand-control-support questionnaire (DCSQ), using the Swedish Longitudinal Occupational Survey of Health (SLOSH).

    METHODS: A confirmatory factor analysis (CFA) and multi-group confirmatory factor analysis (MGCFA) models within the framework of structural equation modeling (SEM) have been used to examine the factor structure and invariance across time.

    RESULTS: FOUR FACTORS: psychological demand, skill discretion, decision authority and social support, were confirmed by CFA at baseline, with the best fit obtained by removing the item repetitive work of skill discretion. A measurement error correlation (0.42) between work fast and work intensively for psychological demands was also detected. Acceptable composite reliability measures were obtained except for skill discretion (0.68). The invariance of the same factor structure was established, but caution in comparing mean levels of factors over time is warranted as lack of intercept invariance was evident. However, partial intercept invariance was established for work intensively.

    CONCLUSION: Our findings indicate that skill discretion and decision authority represent two distinct constructs in the retained model. However removing the item repetitive work along with either work fast or work intensively would improve model fit. Care should also be taken while making comparisons in the constructs across time. Further research should investigate invariance across occupations or socio-economic classes.

  • 4. Dorlo, Thomas P. C.
    et al.
    Fernández, Carmen
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute.
    Troye-Blomberg, Marita
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute.
    De Vries, Peter J.
    Boraschi, Diana
    Mbacham, Wilfred F.
    Poverty-Related Diseases College: a virtual African-European network to build research capacity2016In: BMJ global health, ISSN 2059-7908, Vol. 1, no 1, article id e000032Article in journal (Refereed)
    Abstract [en]

    The Poverty-Related Diseases College was a virtual African-European college and network that connected young African and European biomedical scientists working on poverty-related diseases. The aim of the Poverty-Related Diseases College was to build sustainable scientific capacity and international networks in poverty-related biomedical research in the context of the development of Africa. The Poverty-Related Diseases College consisted of three elective and mandatory training modules followed by a reality check in Africa and a science exchange in either Europe or the USA. In this analysis paper, we present our experience and evaluation, discuss the strengths and encountered weaknesses of the programme, and provide recommendations to policymakers and funders.

  • 5. Elmberger, Agnes
    et al.
    Björck, Erik
    Liljedahl, Matilda
    Nieminen, Juha
    Bolander Laksov, Klara
    Stockholm University, Faculty of Social Sciences, Department of Education. Karolinska Institutet, Sweden.
    Contradictions in clinical teachers' engagement in educational development: an activity theory analysis2019In: Advances in Health Sciences Education, ISSN 1382-4996, E-ISSN 1573-1677, Vol. 24, no 1, p. 125-140Article in journal (Refereed)
    Abstract [en]

    Many medical universities offer educational development activities to support clinical teachers in their teaching role. Research has focused on the scope and effectiveness of such activities and on why individual teachers attend. However, systemic perspectives that go beyond a focus on individual participants are scarce in the existing literature. Employing activity theory, we explored how clinical teachers' engagement in educational development was affected by the systems they act within. Three focus groups were held with clinical teachers from different professions. A thematic analysis was used to map the contradictions between the systems that the participants were part of and the manifestations of these contradictions in the system of education. In our model, clinical teachers were part of three activity systems directed by the objects of patient care, research and education respectively. Contradictions arose between these systems as their objects were not aligned. This manifested through the enacted values of the academic hospital, difficulties establishing educational discussions in the clinical workplace, the transient nature of educational employments, and impediments to developing a teacher identity. These findings offer insights into the complexities of engaging in educational development as clinical teachers' priorities interact with the practices and values of the academic hospital, suggesting that attention needs to shift from individual teachers to developing the systems in which they work.

  • 6. Hengelbrock, Johannes
    et al.
    Höhle, Michael
    Stockholm University, Faculty of Science, Department of Mathematics. Federal Institute for Quality Assurance and Transparency in Healthcare (IQTIG), Germany.
    Evaluating quality of hospital care using time-to-event endpoints based on patient follow-up data2019In: Health Services & Outcomes Research Methodology, ISSN 1387-3741, E-ISSN 1572-9400, Vol. 19, no 4, p. 197-214Article in journal (Refereed)
    Abstract [en]

    Revisions of hip and knee arthroplasty implants and cardiac pacemakers pose a large medical and economic burden for society. Consequently, the identification of health care providers with potential for quality improvements regarding the reduction of revision rates is a central aim of quality assurance in any healthcare system. Even though the time span between initial and possible subsequent operations is a classical time-to-event endpoint, hospital-specific quality indicators are in practice often measured as revisions within a fixed follow-up period and subsequently analyzed by traditional methods like proportions or logistic regression. Methods from survival analysis, in contrast, allow the inclusion of all observations, i.e. also those with early censoring or events, and make thus more efficient and more timely use of the available data than traditional methods. This may be obvious to a statistician but in an applied context with historic traditions, the introduction of more complicated methods needs a clear presentation of their added value. We demonstrate how standard survival methods like the Kaplan-Meier estimator and a multiplicative hazards model outperform traditional methods with regard to the identification of performance outliers. Following that, we use the proposed methods to analyze 640,000 hip and knee replacement operations with about 13,000 revisions between 2015 and 2016 in more than 1200 German hospitals in the annual evaluation of quality of care. Based on the results, performance outliers are identified which are to be further investigated qualitatively with regard to their provided quality of care and possible necessary measures for improvement. Survival analysis is a sound statistical framework for analyzing data in the context of quality assurance and survival methods outperform the statistical methods that are traditionally used in this area.

  • 7.
    Justesen, Marcus
    Stockholm University, Faculty of Science, Department of Physical Geography and Quaternary Geology.
    Vägval: kortast, snabbasteller hälsosammast: En försöksmodell i GIS för ruttoptimering och beräknad inhalation av luftföroreningar för cykelrutter2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Cycling is one of the most sustainable transport modes available and it is widely promoted inmany urban areas. The health benefits from cycling has shown to be substantial, includingdecreased risks of diseases related to overweight and enhancing brain capacity. However, inurban areas cyclists can temporaly be exposed to high levels of air pollution, resulting inhealth risks as opposed to health benefits.

    The objective of this thesis is to develop a rasterbased test model in GIS that estimates theinhaled dose of air pollution for cyclists based on relative particle concentration in differenttransportation micro-environments. The method used is a least-cost path approach,calculating three different routes; shortest, fastest and least dose for four different trips withinSödermalm, Stockholm.

    The results show that the inhaled particle dose can be greatly reduced, 39% - 58% for three ofthe routes, by choosing the least dose route. One of the most interesting findings is thesubstantial increase of dose when high levels of particles are combined with uphill cycling.

    The conclusion for the thesis is that a raster-GIS model can be very useful for estimating doseof different air pollution particles and chemicals along cycling routes. For this purpose thetest model could be applied with no or little additional development, while with furtherdevelopment it might be possible to develope a cycle route planner for public use.

  • 8.
    Lasselin, Julie
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; University Hospital Essen, Germany.
    Petrovic, Predrag
    Olsson, Mats J.
    Paues Göranson, Sofie
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Jensen, Karin B.
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Sickness behavior is not all about the immune response: Possible roles of expectations and prediction errors in the worry of being sick2018In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 74, p. 213-221Article in journal (Refereed)
    Abstract [en]

    Background

    People react very differently when sick, and there are only poor correlations between the intensity of the immune response and sickness behavior. Yet, alternative predictors of the individual differences in sickness are under-investigated. Based on the predictive coding model of placebo responses, where health outcomes are function of bottom-up sensory information and top-down expectancies, we hypothesized that individual differences in behavioral changes during sickness could be explained by individual top-down expectancies and prediction errors.

    Methods

    Twenty-two healthy participants were made sick by intravenously administering lipopolysaccharide (2 ng/kg body weight). Their expectations of becoming sick were assessed before the injection.

    Results

    Participants having lower expectations of becoming sick before the injection reacted with more emotional distress (i.e., more negative affect and lower emotional arousal) than those with high expectations of becoming sick, despite having similar overall sickness behavior (i.e., a combined factor including fatigue, pain, nausea and social withdrawal). In keeping with a predictive coding model, the “prediction error signal”, i.e., the discrepancy between the immune signal and sickness expectancy, predicted emotional distress (reduction in emotional arousal in particular).

    Conclusion

    The current findings suggest that the emotional component of sickness behavior is, at least partly, shaped by top-down expectations. Helping patients having a realistic expectation of symptoms during treatment of an illness may thus reduce aggravated emotional responses, and ultimately improve patients’ quality of life and treatment compliance.

    Registration

    “Endotoxin-induced Inflammatory and Behavioral Responses and Predictors of Individual Differences”, https://clinicaltrials.gov/ct2/show/NCT02529592, registration number: NCT02529592.

  • 9. Lodin, Karin
    et al.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Syk, Jörgen
    Alving, Kjell
    Petrovic, Predrag
    Andreasson, Anna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Macquarie University, Australia.
    Longitudinal co-variations between inflammatory cytokines, lung function and patient reported outcomes in patients with asthma2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 9, article id e0185019Article in journal (Refereed)
    Abstract [en]

    Background

    Asthma is a chronic inflammatory respiratory disorder associated with reduced lung function and poor quality of life. The condition is also associated with poor self-rated health, a major predictor of objective health trajectories. Of biological correlates to self-rated health, evidence suggests a role for inflammatory cytokines and related sickness behaviours. However, this is mainly based on cross-sectional data, and the relation has not been investigated in patients with chronic inflammatory conditions.

    Objective

    To investigate inflammatory cytokines, lung function, sickness behaviour and asthma-related quality of life as determinants of self-rated health in patients with asthma, and to investigate if these variables co-vary over time. Methods Plasma cytokines (IL-5, IL-6), lung function (FEV1), sickness behaviour, asthma-related quality of life and self-rated health were assessed in 181 patients with allergic asthma aged 18-64 years in a one-year longitudinal study. Mixed effect regression models and Spearman's correlation were performed to analyse the associations between repeated measurements.

    Results

    More sickness behaviour and poorer asthma-related quality of life were associated with poorer self-rated health (p's<0.001). In men, both low and high levels of interleukin (IL)-6 and poorer lung function were related with poorer self-rated health (p's<0.05). Over the year, improved asthma-related quality of life was associated with better self-rated health (Spearman's rho = -0.34 women,-0.36 men, p's<0.01). Further, if sickness behaviour decreased, self-rated health improved, but only in women (Rho = -0.21, p<0.05). Increased FEV1 in men was associated with an increase in IL-6 (Rho = 0.24, p<0.05) as well as improved self-rated health (Rho = -0.21, p<0.05) and asthma-related quality of life (Rho = 0.29, p<0.01) over the year.

    Conclusion

    The study highlights the importance of subjectively perceived sickness behaviour and asthma-related quality of life together with lung function as determinants of self-rated health in asthmatic patients. The importance of inflammatory activation for patient reported outcomes in chronic inflammatory conditions need further investigation.

  • 10.
    Marklund, Ulrika
    et al.
    Stockholm University, Faculty of Humanities, Department of Linguistics. Danderyds Hospital, Sweden.
    Lacerda, Francisco
    Stockholm University, Faculty of Humanities, Department of Linguistics.
    Persson, Anna
    Lohmander, Anette
    The development of a vocabulary for PEEPS – SEprofiles of early expressive phonological skills for Swedish2018In: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 32, no 9, p. 844-859Article, review/survey (Refereed)
    Abstract [en]

    This paper describes the development of a vocabulary for Profiles of Early Expressive Phonological Skills for Swedish (PEEPS-SE), a tool for assessment of expressive phonology in Swedish-learning children in the age range of 18-36months. PEEPS-SE is the Swedish version of the original PEEPS, Profiles of Early Expressive Phonological Skills, which uses two age-adequate word listsa basic word list (BWL) for the assessment of 18-24-month-old children, to which an expanded word list (EWL) is added for assessment of 24-36-month-old children, or children with more than 250 words in their expressive vocabulary.The selection of words in PEEPS-SE is based on two types of criteria: age of acquisition and phonological complexity. The words also need to be easy to elicit in a natural way in test situations. Vocabulary data previously collected with the Swedish Early Communicative Development Inventory are used for selection of age-adequate words, where the BWL contains words acquired earlier compared to the additional words in the EWL. The latter also contains words that are more phonologically complex compared to those in the BWL. Word complexity was determined by the Swedish version of word complexity measure. PEEPS-SE has made an attempt to match the original version of PEEPS in terms of both assessment method and word selection.

  • 11. Sturesson, Linda
    et al.
    Öhlander, Magnus
    Stockholm University, Faculty of Humanities, Department of Ethnology, History of Religions and Gender Studies, Ethnology.
    Nilsson, Gunnar H.
    Palmgren, Per J.
    Stenfors, Terese
    Migrant physicians' entrance and advancement in the Swedish medical labour market: a cross-sectional study2019In: Human Resources for Health, ISSN 1478-4491, E-ISSN 1478-4491, Vol. 17, no 1, article id 71Article in journal (Refereed)
    Abstract [en]

    Background

    Worldwide, physicians are migrating to new countries and want to practise their profession. However, they may experience difficulties doing so. To optimise and accelerate their entrance into and advancement within the Swedish healthcare system, there is an urgent need to explore how they are currently doing so, as their competences should be put to use without any unnecessary delay. The aim of the study was to explore how migrant physicians with a medical degree from outside EU/EEA enter and advance within the medical labour market in Sweden and to identify perceived barriers and facilitating aspects in the process. The empirical findings are discussed in light of Bourdieu’s concept symbolic capital as adapted in the Swedish medical field.

    Methods

    A cross-sectional study with a self-administrated questionnaire was disseminated. A sample of 498 migrant physicians were identified. Descriptive statistical analysis and qualitative thematic analysis were used to analyse the data.

    Results

    The response rate was 57% (n = 283). Respondents mainly found their first positions via spontaneous job applications, during internships, while participating in an educational intervention or via personal contacts. Perceived barriers to entering and advancing within the medical field in Sweden were mainly related to having a medical degree from and/or originating from another country, which could in turn represent discrimination and/or having one’s competence undervalued as a result. Facilitating aspects included having or developing contacts in Swedish healthcare and gaining proficiency or fluency in the Swedish language.

    Conclusions

    When MPs find their first positions, the contacts they have developed appear to play a role, and when advancing in their positions, the active development of a variety of contacts seems to be beneficial. MPs experience a variety of barriers to entering and advancing within the field that could be related to discrimination. Many MPs perceived having their competences undervalued due to their origin or to being educated abroad. Based on the respondents’ experiences, our interpretation is that MPs as a group are hierarchically positioned lower in the Swedish medical field than physicians trained in the country. Facilitating aspects included educational interventions, having contacts and developing language skills. For optimal entry into the labour market, it is vitally important for MPs to learn the new language and obtain a job or internship in the field as soon as possible.

  • 12. Sturesson, Linda
    et al.
    Öhlander, Magnus
    Stockholm University, Faculty of Humanities, Department of Ethnology, History of Religions and Gender Studies, Ethnology.
    Nilsson, Gunnar
    Stenfors, Terese
    Migrant physicians’ conceptions of working in rural and remote areas in Sweden: A qualitative study2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 1, article id e0210598Article in journal (Refereed)
    Abstract [en]

    Objective

    To explore migrant physicians’ conceptions about working in rural and remote areas in Sweden to understand what influences their motivation to work in these areas.

    Method and material

    The study employed a qualitative approach with semi-structured interviews with 24 migrant physicians. Transcripts were thematically analysed.

    Results

    Conceptions were identified about foremost work content and tasks, and about living in rural and remote areas. Work content and tasks related to the health care systems, type of health care facility, duties, specialty, resources, patient population, colleagues, and professional development. Conceptions about living concerned geographical characteristics, people living in rural and remote areas, opportunities for travelling, family, leisure activities, social life, and language skills. Conceptions seemed to be influenced by individual, professional and societal aspects from both previous countries and Sweden. Conceptions and biographical aspects both appeared to affect motivation.

    Discussion

    Motivation regarding working in rural and remote areas appeared to be influenced by conceptions of these areas. A specific type of place could be understood as being able to provide (or not) the external conditions needed for fulfilling needs and reaching goals, whether professional or personal, and as a tool for reaching or facilitating the achievement of these. Conceptions of an area can hence affect motivation and choices for where to work and live. However, biographical aspects also impact motivation. Our results indicate that positive rural experience in the recipient country might be a predictor for motivation.

    Conclusion

    Professional and personal life and are intertwined. Conceptions about an area influence willingness to work there. Willingness is also affected by, and intertwined with, other aspects such as previous experiences, age, marital status and family circumstances.

  • 13. Ståhle, Lars
    et al.
    Granström, Elisabeth
    Ljungdahl Ståhle, Ewa
    Isaksson, Sven
    Stockholm University, Faculty of Humanities, Department of Archaeology and Classical Studies, Archaeological Research Laboratory.
    Samuelsson, Anders
    Rudling, Mats
    Sepp, Harry
    Effects of Food or Sleep Deprivation During Civilian Survival Training on Clinical Chemistry Variables2013In: Wilderness & environmental medicine (Print), ISSN 1080-6032, E-ISSN 1545-1534, Vol. 24, no 2, p. 146-152Article in journal (Refereed)
    Abstract [en]

    Objective.-To describe clinical chemistry and weight changes after short-term food or sleep deprivation or multiple deprivations during civilian survival training. Methods.-Data from one baseline-controlled two-period crossover study designed to compare sleep deprivation for up to 50 hours with food deprivation for up to 66 hours (n = 12) and data from regular multiple-deprivations survival training comparing participants (n =-33) with nondeprived instructors (n = 10). Results.-Food deprivation was associated with decreased body weight, blood glucose, serum triglycerides, sodium, chloride, and urine pH, and there were increases in blood and urine ketones and. serum free fatty acids. Sleep deprivation was associated with a minor decrease in hemoglobin and erythrocyte particle count and volume fraction and an increase in leukocytes. Conclusions.-The clinical chemistry and body weight changes associated with food deprivation were qualitatively similar to those observed in fasting obese patients but developed quicker in the survival training setting. Sleep deprivation had few effects on the clinical chemistry profile except for hematological variables. Physicians evaluating clinical chemistry data from patients subjected to short-term food or sleep deprivation should take the physiological state into account in their assessment.

  • 14.
    Topor, Alain
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work. University of Agder, Norway.
    Ljungberg, Amanda
    "Everything is so relaxed and personal" - The construction of helpful relationships in individual placement and support2016In: American Journal of Psychiatric Rehabilitation, ISSN 1548-7768, E-ISSN 1548-7776, Vol. 19, no 4, p. 275-293Article in journal (Refereed)
    Abstract [en]

    The relationship with professionals is an important factor in relation to the outcome of interventions directed to persons with severe mental problems. However, the current knowledge regarding the development of helpful relationships within Individual Placement and Support (IPS) services is limited. The aim of the study was to investigate how participants in IPS services described their relationship with their IPS coach. The article is based on interviews from a Swedish government evaluation of IPS services, thematically analyzed. The results showed that the relationship with the coach is central for the participants' success in the service. The main theme, something different - as a human being highlighted that the conditions for the relationship are different within IPS as compared to traditional services. The other themes were here and now action, closer to wish-fulfilment - impact on the self, and from role to person. The principles of IPS parallel the results from research about helpful relationships and offers good preconditions for the occurrence of such relationships. This can represent a bridge between evidence based methods and research on helpful relationships, and should be possible to implement in the development of evidence based methods as well as of treatment as usual.

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