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  • 1.
    Hiswåls, Anne-Sofie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Section of Public Health Sciences, Mid-Sweden University, Sweden.
    Marttila, Anneli
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Mälstam, Emelie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Section of Public Health Sciences, Mid-Sweden University, Sweden; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Epidemiology Unit-ISPUP, University of Porto Medical School, Portugal.
    Experiences of Unemployment  and Well-Being  After Job Loss During Economic Recession: Results of a Qualitative Study in East Central Sweden2017In: Journal of Public Health Research, ISSN 2279-9028, E-ISSN 2279-9036, Vol. 6, no 3, p. 135-141, article id 995Article in journal (Refereed)
    Abstract [en]

    Introduction: Several studies have revealed an association between unemployment and ill health, and shown that unemployment can affect people differently. This study aimed to provide an understanding of the experiences of unemployment and perceptions of wellbeing among persons who involuntary lost their work during the recent economic recession in Gävle Municipality. Methods: Sixteen unemployed men and women aged 28-62 were interviewed face-to-face. A purposeful sampling strategy was used in order to suit the research question and to increase the variation among informants. The interview texts were analysed using thematic analysis. Results: Six different themes emerged from the accounts: The respondents perceived work as the basis for belonging, and loss of work affected their social life and consumption patterns due to changes in their financial situation. They also expressed feelings of isolation, loss of self-esteem, and feelings of hopelessness, which affected their physical well-being. Longer duration of unemployment increased the respondents’ negative emotions. The respondents reported activities, structure, and affiliation in other contexts as part of their coping strategy against poor mental health. Conclusions: After job loss, the respondents experienced feelings of loss of dignity and belonging as a human being. They also felt worry, insecurity, and stress due to their changed financial situation, which in turn led to isolation and loss of self-esteem. Social support and having other activities gave the respondents structure and meaning.

  • 2.
    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.
  • 3.
    Mälstam, Emelie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Bensing, Sophie
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm; Department of Endocrinology, Metabolism and Diabetes , Karolinska University Hospital Solna, Stockholm, Sweden, Sweden; .
    Asaba, Eric
    Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden; Unit for Research, Development, and Education, Stockholms Sjukhem Foundation, Stockholm, Sweden; Graduate School of Health Sciences, Tokyo Metropolitan University, Tokyo, Japan.
    Everyday managing and living with autoimmune Addison's disease: Exploring experiences using photovoice methods2018In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 25, no 5, p. 358-370Article in journal (Refereed)
    Abstract [en]

    People with rare diseases are a minority group that faces risks for healthcare and work inequities because knowledge and resources on how to systematically support health or working life are limited. Integrating voices of persons living with rare diseases are an important aspect in inclusive and relevant healthcare practices. This study sought to actively involve persons with autoimmune Addison's disease (AAD), a rare condition, in exploring challenges and possibilities situated in everyday life. Photovoice methods were utilized to incorporate experiences through photographic documentation and group discussions with five persons over seven weeks. Data generated from group sessions were visually analyzed or transcribed and analyzed with thematic analysis. Five themes emerged: Individual and fine tuning in everyday life; It is not how it was; The power of knowledge and support; Becoming the expert in an uncertain context; and, Finding balance and paving new ways. The findings showed that everyday life with AAD was more complex than earlier portrayed; entailing several barriers and negotiations. In order to meet the needs of persons with AAD, more extensive and relevant information, support and self-management education is needed. Moreover, a complementary focus on everyday life to promote their health and wellbeing is also important.

  • 4.
    Patomella, Ann-Helen
    et al.
    Karolinska institutet.
    Guidetti, Susanne
    Karolinska institutet.
    Mälstam, Emelie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Public Health and Sport Science, Public Health Science. Karolinska institutet.
    Eriksson, Christina
    Karolinska institutet.
    Bergström, Aileen
    Karolinska institutet.
    Åkesson, Elisabet
    Karolinska institutet.
    Kottorp, Anders
    Karolinska institutet; Malmö högskola.
    Asaba, Eric
    Karolinska institutet.
    Primary prevention of stroke: randomised controlled pilot trial protocol on engaging everyday activities promoting health2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 11, article id e031984Article in journal (Refereed)
    Abstract [en]

    Introduction Stroke is a globally common disease that has detrimental effects on the individual and, more broadly, on society. Lifestyle change can contribute to reducing risk factors for stroke. Although a healthy lifestyle has direct benefits, sustaining and incorporating healthy activities into everyday life is a challenge. Engaging everyday activities have the potential to support lifestyle change and to promote sustainable activity patterns. Current healthcare is failing to reduce modifiable risk factors in people at risk, and in addition to current practice, there is a need for systematic and efficient non-pharmacological and non-surgical stroke-prevention strategies. The aim of the pilot study was to increase knowledge about the effects of a prevention programme and its feasibility to promote sustainable and healthy activity patterns among persons at risk of stroke.Methods and analysis The proposed pilot study will be a two-armed randomised, assessor-blinded, parallel pilot trial. The study will include feasibility data, investigating acceptability and delivery of the intervention. Persons at risk of stroke (n=60) will be included in a mobile phone-supported prevention programme. The 10-week programme will be conducted at primary healthcare clinics, combining group meetings and online resources to support self-management of lifestyle change. Main outcomes are stroke risk, lifestyle habits and healthy activity patterns. Assessments will be performed at baseline and at follow-up (immediately following the end of the programme and at 6 and 12 months). Effects of the programme will be analysed using inferential statistics. Feasibility will be analysed using both qualitative and quantitative methods.Ethics and dissemination The study has been approved by the Regional Ethical Review Board in Stockholm, Sweden, being granted reference numbers 2015/834-31, 2016/2203-32 and 2019/01444. Study results will be disseminated through peer-review journals and presentations to mixed audiences at regional and international conferences.Trial registration number NCT03730701.

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