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  • 1.
    Fritzell, Kaisa
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Stake Nilsson, Kerstin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Jervaeus, Anna
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Hultcrantz, Rolf
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Wengström, Yvonne
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; Breast and Sarcoma Unit, Radiumhemmet, Karolinska University Hospital, Stockholm, Swede.
    The importance of people's values and preferences for colorectal cancer screening participation2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 6, p. 1079-1084Article in journal (Refereed)
    Abstract [en]

    Background: To explore how individuals reason when they make decisions about participating in colorectal cancer(CRC) screening.

    Methods: Individuals randomized colorectal cancer (CRC) screeningto FIT or colonoscopy included in the Screening of Swedish Colons (SCREESCO) program was invited to focus group discussions and individual telephone interviews. The concept of shared decision-making (SDM: information; values/preferences; involvement) was used as a matrixfor the analyses. To validate findings, additional focus group discussions using the nominal group technique were performed.

    Results: Lack of knowledge of CRC and CRC screening was prominent for participants and non-participants, while the results differed between the groups in relation to their values and preferences. The influence of significant others promoted participation while it prevented it among non-participants. Those who participated and those who did not made it clear that there was no need to involve health care professionals when making the decision.

    Conclusions: Based on the results, a display of different ways to spread knowledge and communicate about CRC and CRC-screening could be applied such as, community-based information campaigns, decisions aids, interactive questionnaires, chat-functions and telephone support. The disparity in values and pref-erences between participants and non-participants may be the key to understand why non-participants make theirdecisions not to participate and warrant further exploration.

  • 2.
    Fritzell, Kaisa
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Stake-Nilsson, Kerstin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Jervaeus, Anna
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Hultcrantz, Rolf
    Karolinska University Hospital, Stockholm, Sweden.
    Wengström, Yvonne
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    The importance of peoples values and preferences in promoting colorectal cancer screening participationIn: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360XArticle in journal (Refereed)
    Abstract [en]

    Background: To explore how individuals reason when they make decisions about colorectal cancer (CRC) screening participation from the perspective of participants and non-participants.

    Methods: Individuals randomized to FIT or colonoscopy included in the Screening of Swedish Colons (SCREESCO) program were invited to focus group discussions and individual telephone interviews. The concept of shared decision-making (SDM: information; values/preferences; involvement) was used as a matrix for the analyses. To validate findings, additional focus group discussions using the nominal group technique were performed.

    Results: The results covered the SDM concept. Lack of knowledge of CRC and CRC screening was prominent in both participants and non-participants, while the results differed between the groups in relation to their values and preferences. The influence of significant others promoted participation among participants while it prevented it among non-participants. Both participants and non-participants made it clear that there was no need to involve health care professionals when making their decision.

    Conclusion: Based on the results, a display of different ways to promote knowledge and communication about CRC and CRC-screening, e.g. community-based information campaigns, decisions aids, interventions, such as interactive questionnaires, chat-functions and telephone support, should be provided. The disparity in values and preferences between participants and non-participants may be the key to understand why non-participants make their decisions not to participate and should be further explored.

  • 3.
    Helgadóttir, Björg
    et al.
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Svedberg, Pia
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Mather, Lisa
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Lindfors, Petra
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Bergström, Gunnar
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Unit of Intervention and Implementation Research for Worker Health, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Blom, Victoria
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; The Swedish School of Sport and Health Sciences, Stockholm, Sweden.
    The association between part-time and temporary employment and sickness absence: a prospective Swedish twin study2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 1, p. 147-153Article in journal (Refereed)
    Abstract [en]

    Background: Sickness absence (SA) is becoming a major economic problem in many countries. Our aim was to investigate whether type of employment, including temporary employment or part-time employment, is associated with SA while controlling for familial factors (genetic and shared environment). Differences between men and women and across employment sectors were explored.

    Methods: This is a prospective twin study based on 21 105 twins born in Sweden 1959-85. The participants completed a survey in 2005 with follow-up of SA (≥15 days), using register data, until end of 2013. The data were analyzed with logistic regression, with results presented as odds ratios (OR) with 95% confidence intervals (CI).

    Results: Temporary employment involved higher odds of SA (OR=1.21 95% CI=1.04-1.40) compared to full-time employment. Both part-time workers (OR=0.84 95% CI=0.74-0.95) and the self-employed (OR=0.77 95%CI=0.62-0.94) had lower odds of SA. Stratifying by sex showed lower odds for part-timers (OR=0.82 95% CI=0.73-0.94) and self-employed women (OR=0.65 95% CI=0.47-0.90), but higher odds for men in temporary employment (OR=1.33 95% CI=1.03-1.72). Temporary employees in county councils (OR=1.73 95% CI=1.01-2.99) and municipalities (OR=1.41 95% CI=1.02-1.96) had higher odds while part-timers employed in the private sector had lower odds (OR=0.77 95% CI=0.64-0.93). Familial factors did not confound the association between employment type and SA.

    Conclusions: Employment type is associated with SA, with temporary employment involving a higher risk compared to permanent full-time employment while both part-time employment and self-employment involved a lower risk. The associations vary between women and men and across sectors.

  • 4.
    Hiswåls, Anne-Sofie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Avdelningen för hälsovetenskap.
    Ghilagaber, Gebrenegus
    Avdelningen för statistik, Stockholms universitet, Department of statistics, Stockholm University.
    Wijk, Katarina
    Samhällsmedicin, Landstinget Gävleborg, Community Medicine,Gävleborg County Council .
    Öberg, Peter
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Soares, Joaquim
    Mittuniversitetet, Avdelningen för hälsovetenskap, Mid Sweden University, Department of Health Science .
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Avdelningen för hälsovetenskap, Mid Sweden University, Department of Health Science .
    Inequalities and Suicide Ideation during Recession Times2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no Suppl. 2, p. 361-Article in journal (Other academic)
    Abstract [en]

    Background

    Suicide behaviour is a serious public health problem as it imposes economic and human costs to individuals, families and communities. Available evidence from some European countries indicates a significant rise in suicides related to economic recession. However, the debate continues regarding the role of unemployment in the reported suicide rates. In Sweden, very few studies have investigated the relationship between suicide behaviours and employment status in the context of the recent economic crisis although unemployment increased nationally and across different counties.

    The aim of this study was to examine the relationship between employment status and suicide ideation in Gävleborg, Sweden.

    Methods

    The study used data from a cross-sectional survey, Health in Equal terms, carried out in Gävleborg County in Sweden, 2010. A total of 4245 individuals, aged 16–65 years were included in the analysis. The relationship between employment status and suicide ideation was assessed using descriptive and logistic regression analyses.

    Results

    People who were not working had odds of suicide ideation of 4.21 (95% Cl 3.14–5.64) as compared to those employed. Controlling for other covariates reduced the risk to 1.73 (95% CI 1.16-2.57) but remained statistically significant. In addition variables like anxiety, self-reported stress and young age were also associated with suicide ideation. However among the covariates, people who reported anxiety had the highest odds of suicide ideation.

    Conclusions

    This study found a statistically significant association between being out of work and suicide ideation. The association was largely explained by self-reported stress, anxiety, socioeconomic and demographic variables.

    Policy-makers within the County need to pay attention to the health status of those out of work, especially during times of combined economic and labour market fluctuations.

    Key messages

    • Suicide ideation was more common among people out of labor force in Gävleborg County, Sweden.

    • Further studies are needed to investigate suicide ideation among unemployed persons during times of economic and labor market insecurity.

  • 5.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Alfredsson, J.
    Samhällsmedicin, Landstinget Gävleborg.
    Soares, Joaquim
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    Stankunas, M.
    Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Differences in health care-seeking behavior during economic recession2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no Suppl. 2Article in journal (Other academic)
    Abstract [en]

    Background

    In Europe, equitable access to high-quality healthcare constitutes a key challenge for health systems across the continent. However, the recent economic recession left many outside the labour market, causing many to fall in poverty and social exclusion. Unemployment is probably the main factor leading to social exclusion. Studies which analysed health seeking behaviour among unemployed people have reported a variety of results, from low to high utilization of health services. However, some researchers argue that during stressful economic and social circumstances can cause high utilization of the health care system due to increased psychological disorders masked by physical complaints. This study examined differences in health seeking behaviour in Gävleborg County, which at the pick of the economic recession had high levels of unemployment as compared to the national average.

    Methods

    The data for the study come from the 2010 Survey of Health in Equal terms carried out in Gävleborg County, Sweden. The sample included 4245 persons aged 16-65 years. Descriptive and binary logistic analysis was used to assess differences in health seeking behavior by employment status.

    Results

    There was a statistical significant relationship between employment status and health-seeking behavior. Compared to employed persons, people who were out of the labor market had odds ratio of 1.42 (1.12-1.62) for contact with health care services; of 1.30 (1.12-1.50) for contact with a doctor in a health care facility and 1.67 (1.42-1.97) for contact with a doctor in a hospital. Controlling for age, sex, marital status, education, income, smoking habits, physical activity, self-rated health, and long standing illness removed the statistical significance of the observed relationships. Thus, the odds for contact with health care services went from.

    Conclusions

    At the pic of the recent economic recession, people who were outside the labor market had more contact with health care services, with doctor in hospitals as well as primary health care services as compared to employed counterparts. The differences in health seeking behavior were explained by demographic, socioeconomic and health variables.

    Key Words: Employment status, Health care, Gävleborg, economic recession.

    Key messages

    • People who were out of labor market in Gävleborg County in 2010 had more contact with health care services, with a doctor in hospital and primary health care respectively.

    • Future studies are warranted that can assess trends in health-seeking behavior among people outside Gävleborgs labor market.

  • 6.
    Mälstam, Emelie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Bensing, S.
    Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden.
    Asaba, E.
    Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
    Focusing on everyday life with Addison’s disease: Health promotion and secondary prevention2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3, p. 334-334Article in journal (Refereed)
    Abstract [en]

    The overal laim of this study was to generate knowledge about everyday life among people living with rare Addison’s disease (AD). Understanding experiences in contexts of everyday life are important for public health, equity in healthcare, and in order to design tailored health promotion programs, which are in line with EU policy. Addison’s disease is a rare disease and people with AD face challenges due to limited existing knowledge about the disease and often encounters health care providers who are not familiar with best practices in the area. Treatment and follow up of AD also vary greatly within Europe even though a European consensus exists and few reports of secondary and tertiary prevention have been published. AD is also usually monitored and treated in the specialist health care where individually delivered health care is dominant. In Sweden, it has been argued that all health care should integrate disease prevention and health promotion and that group-based self-management approaches could be compliments to traditional caring and curative health care. This study was conducted with qualitative methods and a participatory approach, engaging five participants with AD. Under seven weeks the participants photographed their everyday life and participated in weekly group-discussions. Preliminary results show that everyday life with AD can be more complex than previously thought and that extended information and self-management education about the disease and everyday life is perceived as important to maintain wellbeing. Also, participants perceived that health care could play a bigger role regarding health promotion and preventive actions through extended pharmacological and non-pharmacologica lparts of group-based interventions.

    Key messages:

    • Specialist health care can play a role regarding preventive self-management schooling for persons with rare Addison’s disease to improve wellbeing in everyday life.
    • Specialist health care can play a role regarding health promotion and disease prevention through extended self-management education for persons with rare Addison’s diseas.
  • 7.
    Okenwa-Emegwa, Leah
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Swedish Red Cross University College, Stockholm, Sweden.
    Saboonchi, F.
    Swedish Red Cross University College, Stockholm, Sweden.
    Tinghög, P.
    Swedish RedCross University; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Depression and Low Labour Market and Social Expectations among Resettled Syrian Refugees in Sweden2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3, p. 377-377Article in journal (Refereed)
    Abstract [en]

    Background

    Large numbers of refugees have come to Europe in search of safety. For non-refugee migrants, expectations and the extent to which they are met are shown to be integral components of adaptation and wellbeing. This study aims to explore the prevalence of low expectations for labour market, economic and social integration among Syrian refugees recently resettled in Sweden and whether depression is associated with these expectations.

    Methods

    Arandomsampleof1215Syrianrefugesofworkingage recently resettled in Sweden responded to a questionnaire in Arabic. Expectations were asse ssed by three items developed for this study. Average item score of >1.80 on the depressive symptoms  in  Hopkins  Symptom  Checklist  indicated depression. Logistic regressions adjusted for demographic factors and social support were conducted. Weighted data was used to produce socio-demographically representative prevalence rates and odds ratios (ORs). Robust standard errors were used to obtain 95% confidence intervals for all estimates.

    Results

    Prevalence  of  low  economic,  social  and  labour  market expectations were 14.1% (95% CI 12.0-16.1), 13.4% (11.3- 15.4) and 10.9% (9.1-12.6) respectively. Approximately 40.2% (36.9-43.3) of the participants had depression. Those with depression were about four times more likely to have low economic expectations (OR 3.89, 95% CI 2.66-5.92), three times more likely to have low social (OR 3.1, 2.30-5.24), and labour market (OR 2.83, 1.90-4.47) expectations.

    Conclusions

    Low expectations, while not widespread, exist among Syrian refugees in Sweden. Notable proportions had depression which was also significantly associated with low expectations. The association between depression and low expectations in keys areas necessary for adaptation and wellbeing in a new land, indicates the need to address mental health issues in current societal  level  efforts  aimed  at  boosting  labour  market participation and social inclusion.

    Key messages:

    • Notable proportions of Syrian refugees in Sweden have low expectations in domains vital for adaptation and wellbeing in a new land. Depression is significantly associated with low expectations.
    • Low expectation among Syrian refugees in domains vital for adaptation and wellbeing and the association with depres- sion indicate need to address mental health in social and labour market interventions.
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