Search

Sex differences in human performance have been documented across a wide array of human endeavours. Males tend to exhibit higher performance in intellectually demanding and competitive domains, and this difference tends to be more pronounced the higher the level of performance. Here, we analyse publishing performance for the whole population of associate and full professors in relatively sex-balanced disciplines, namely Education, Nursing and Caring Science, Psychology, Public Health, Sociology, and Social Work, comprising 426 women and 562 men. We find that sex differences in the number of publications, citations, and citations per publication were small across low and medium levels of productivity, but become more pronounced the higher the level of performance. In the top performing 10% the female proportion decreases from the average 43.2% to 26% (25 F, 71 M), which further decreases to 15% in the top 5%. The results are discussed with respect to the greater male variability hypothesis, sex differences in psychological traits, and environmental factors such as sex discrimination.

Objective: There is substantial evidence that poorly designed and reported research can mislead decision making in clinical care. This review investigates the methodological quality of Swedish trials of a wide array of psychological and social interventions. Method: The review includes 302 articles published in peer-reviewed journals during 1990-2014, which evaluated a psychological or social intervention; included a randomized or nonrandomized control group with a pre-post- or pre-follow-up design; and targeted individuals in order to prevent or rehabilitate from physical, psychological, or social problems. The results are based on the information reported in the articles. Results: Overall, methodological quality increased with time. However, more recent studies contained methodological deficits. For example, few had used blinded data collectors, reported power analyses, or searched for adverse events. Conclusion: The results indicate a potential risk of biased results in both older and newer trials. Possible implications for practice and research are discussed. [Paper presented at the Stockholm Conference on Behavioral and Social Intervention Research, 11-12 May, 2017.]

Background: Because of the shift towards earlier diagnosis of dementia and/or Alzheimer's disease (AD), increasing numbers of individuals with subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are seen in memory clinics. Yet, evidence indicates that there is room for improvement when it comes to tailoring of the diagnostic work‐up to the needs of individual patients. To optimize the quality of care, we explored patients' perspectives regarding the diagnostic work‐up at a specialized memory clinic. Methods: This interview study was conducted at Karolinska University Hospital (Sweden). The comprehensive diagnostic work‐up for dementia at the memory clinic in Solna is conducted within 1 week. A sample of 15 patients (8 female; mean age = 61 years [range 50–72]; 11 SCD, 1 MCI and 3 AD dementia) was purposively selected for a series of three semistructured interviews, focussing on (1) needs and expectations (during the week of diagnostic testing), (2) experiences (within 2 weeks after test‐result disclosure) and (3) reflections and evaluation (3 months after disclosure). Transcribed audio‐recorded data were analyzed using thematic content analysis (using MaxQDA software). Results: Three key themes were identified: (1) the expectations and motivations of individuals for visiting the memory clinic strongly impacted their experience; (2) the diagnostic work‐up impacted individuals psychosocially and (3) the diagnostic work‐up provided an opportunity to motivate individuals to adopt a healthier lifestyle. Conclusion: Our findings underscore the importance of enquiring about the expectations and needs of individuals referred to a specialized memory clinic, allowing for expectation management and personalization of provided information/advice, and potentially informing the selection of patients in need of a comprehensive diagnostic work‐up. Structural guidance might be needed to support those with SCD and MCI to help them cope with uncertainty, potentially resolve their issues, and/or stimulate brain health. Patient or Public Contribution: We gathered the perspectives of 15 individuals who had been referred to the memory clinic at three different time points through semistructured interviews, and these interviews were the primary data source. [ABSTRACT FROM AUTHOR]

Objective: To investigate the use of menopausal hormone therapy (MHT) in premenopausal women after bilateral oophorectomy. Design: Retrospective register‐based cohort study. Setting: Sweden. Population: Swedish women aged 35–44 years without malignancy who underwent bilateral oophorectomy in 2005–2020 were identified using The Swedish National Quality Register of Gynaecological Surgery (GynOp). Methods: Data from GynOp were cross‐linked with data on dispensed drugs extracted from the Swedish Prescribed Drug Register. Main outcome measures: Proportion of women dispensed MHT at least once within 1 year after surgery. Repeated treatment episodes were defined, and the proportion of 'person time' covered by dispensations was analysed. Results: In total, 1231 of all women (n = 1706) were dispensed MHT at some point after surgery, with 1177 women dispensed MHT within 1 year. This proportion increased from 64% in 2005 to 84% in 2019 (p < 0.001). In the total population, 4537 'treatment years' transpired, corresponding to 43% of the mean time covered. In women dispensed MHT within 1 year, the proportion of time covered was 63%. Conclusions: Only 69% of all women without malignancy of any kind who underwent bilateral oophorectomy were dispensed MHT within 1 year after surgery, and the duration of treatment was limited. It is important to study further the reasons behind the low dispensation rate in this group to increase adherence to current treatment guidelines, improve quality of life, and avoid increased morbidity and mortality. [ABSTRACT FROM AUTHOR]

In social work, practitioners are often faced with situations in which they have to choose an intervention. A fundamental ethical principle of social work practice is to minimize the risk of adverse effects caused by social services. To adhere to this principle, practitioners must be aware of the possible positive and negative effects of potential services. There are hundreds of interventions currently in use in social work. Although there are a growing number of controlled trials on social work interventions, there are only a few interventions based on research that has the highest degree of certainty, making it difficult to know how and in what way these interventions can support a person in need of assistance. This article, based in part on the experience we gained training practitioners working in Swedish social services, presents a tentative model for assessing the best available evidence comparing interventions when scientific evidence is sparse. [ABSTRACT FROM AUTHOR]

This study reports the results from a Swedish randomized controlled trial of a standardized behavior management intervention. The intervention targeted students with externalizing behavior in a regular education setting. First- and second-grade students (N = 100) from 38 schools were randomly assigned to either the intervention or an active comparison group. Observer, teacher, and peer ratings were collected at pretest, posttest (6 months later), and follow-up (14 months after pretest). Significant intervention effects were found on student externalizing behavior and teacher behavior management at both posttest and follow-up. The intervention effect on student externalizing behavior was mediated by change in teacher behavior. Moderating effects of demographic and classroom variables were explored, as well as the social validity of the intervention. The results are discussed in relation to cost-effectiveness and feasibility of behavioral interventions in typical school settings. (Contains 2 tables.)

This study explores the psychosocial working conditions of 7930 Swedish 9th grade students, distributed over 475 classes and 130 schools, in relation to their subjective health using multilevel modeling. At the individual level, students with "strained" working conditions in school (i.e. those experiencing a high level of demands in combination with a low level of control) demonstrated significantly worse health compared to students in "low-strain" situations. "Strained" conditions in combination with a weak school-related sense of coherence were especially unfavourable for health. These findings remained significant when support from teachers, school marks, norm-breaking behaviours, family-relations and certain class- and school-contextual conditions were adjusted for. Thus, while demands are an essential part of school work, this study suggests that high levels of control and a strong school-related sense of coherence can protect against the more detrimental effects on health that high demands at school may cause. (Contains 5 tables and 1 figure.)

This article presents an account of Sweden's Institute for Evidence-Based Social Work Practice (IMS), located in Stockholm, Sweden. The article places IMS in the context of making Swedish social care services less opinion-based and more evidence-based. The institute is an example of how policy-driven processes promote the use of evidence-based practices in this European nation. The article includes presentations of history, organization, and products of IMS, and concludes with comments on future opportunities and challenges.

Purpose: The purpose of this paper is to examine factors predicting parental participation and retention in a Swedish version of the Strengthening Families Programme (SFP). Design/methodology/approach: This study is based on data from a randomised controlled trial to evaluate the effects of the Swedish version of the SFP. The sample involves 441 parents of sixth graders, and the data are obtained from parents' questionnaires measuring demographics, parental warmth, rule setting, perception of norm-breaking behaviours, knowledge of school performance, and parents' attitude towards adolescents and alcohol. Predictors of parental participation and retention are analysed with multiple logistic regressions. Findings: There were two significant predictors for programme recruitment: having a low score on a scale measuring parents' emotional warmth and having a more restrictive attitude towards youth and alcohol. Retention was associated with being born in Sweden, and having a low score on the scale measuring warmth. Practical implications: There are few predictors of participation and retention in the Swedish version of the SFP, indicating that the programme seem to attract all types of parents in the general population. The fact that a low level of warmth predicts participation indicates that parents with a stronger need for support are recruited. Retention was greater among those who were born in Sweden, which indicates that efforts might be needed to meet the needs of those coming from another country. Originality/value: Recruiting and retaining parents into family programmes is challenging and it is important to identify the underlying factors for successful recruitment. (Contains 2 notes, 2 tables and 1 figure.)

The implementation of new treatment methods in social work practice is warranted. Moreover, little is known about professionals' attitudes toward the introduction of evidence-based practices into their communities. Therefore, this article reports on the implementation of a Swedish research project that evaluated Multisystemic Therapy (MST). All investigating social workers in a community-based social work practice and their supervisors completed a questionnaire concerning attitudes toward the research project, as well as attitudes toward MST as a treatment method. A large majority of participants were positive toward the research project, felt sufficiently informed, and thought that the implementation occurred at an appropriate pace. Likewise, participants felt positively toward the adoption of MST as a treatment method, toward evidence-based research in general, and in their affinity toward community-family-based services. On the other hand, investigating social workers differed in their practice attitudes. Potential reasons for these discrepancies, including the influence of top-down implementation, differences in experience, and differences due to the position held are discussed. (Contains 4 tables and 1 note.)

Objective: Between 1995 and 1997, the Swedish Association of Local Authorities implemented Family Group Conferences (FGC) in 10 local authorities throughout Sweden. This study reports on client outcomes of this implementation. Method: 97 children involved in 66 FGCs between November 1996 and October 1997 were compared with 142 children from a random sample of 104 traditional child protection investigations by the Child Protective Services (CPS). All children were followed for exactly 3 years for future child maltreatment events reported to CPS. Effects were modeled using multiple regressions, controlling for the child's age, gender, family background, and type and severity of problems. Results: After controlling for initial differences, FGC-children experienced higher rates of re-referral to CPS compared to the group that had been processed in traditional investigations. They were more often re-referred due to abuse, were more often re-referred by the extended family, were longer in out-of-home placements, but tended over time to get less intrusive support from the CPS. FGCs were not related to re-referrals of neglect, of case-closure after 3 years or number of days of received services. The results suggest that the impact of the FGC was scant, accounting for 0-7% of the statistical variance of outcome variables. Conclusions: The findings did not support the alleged effectiveness of the FGC model compared to traditional investigations in preventing future maltreatment cases. If these results are confirmed in future research, they serve as a reminder of the necessity to evaluate models based on untested theories or on extrapolations from other countries/cultures, before these models are widely spread in a national practice context.

Investigated effects of program auspice (nonprofit versus profit child care), adult-to-child ratios, and class age span on teaching and on preschoolers' social and cognitive development. Found that age, gender, social background, and age span were significant predictors of children's social and cognitive development; adult-to-child ratio and teaching style were not. Profit centers had larger child groups than nonprofit centers. (Author/KB)

Child care institutions (N=341) in Sweden were surveyed for suspected child abuse. Of the 3,737 children studied, 3% were suspected of being maltreated. Of these suspected cases, only 37% had been reported to child protective agencies. A follow-up study five years later showed that 43% of the suspected children were still unknown to the agencies. (Author/DB)

In Swedish child welfare, there are no mandatory guidelines on what interventions to use. Local authorities are able to set their own criteria for implementing or designing interventions. We carried out a survey to identify interventions in use in Children's Social Services and Child and Adolescent Psychiatric Care in Sweden. A total of 102 interventions were stated to have been in use, with between 31 and 45 different interventions for each of the four different child welfare populations. Of the 102 interventions, 56 were designed outside Sweden and later imported. Only 27 interventions were supported with some kind of research evidence. About half of the interventions targeted the child. Possible implications for practice and research are discussed. [ABSTRACT FROM AUTHOR]

Background: The benefits of digital development in health care may be obscured by unequal opportunities to make use of digital resources. The aim of this study was to investigate the association of health literacy with I) accessing health check test results in the Patient Electronic Health Record (PAEHR), II) searching for information to better understand individual test results, and III) using the national health information online portal provided by the Swedish national health care system.Methods: This cross-sectional study included data from 434 individuals, 50-64 years old, randomly selected from the Swedish population during the year 2017 to a cohort study including health examination and a web-based survey. Health literacy was assessed at baseline using the Swedish Communicative and Critical Health Literacy scale. Digital information outcomes were assessed after three months. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) for the separate outcomes were computed using logistic regression. Covariates included sex, age, education, country of birth, cardiovascular risk factors at baseline, general health, risk perception, referral, and new cardiovascular risk factors detected at health examination.Results: About a third of the participants (35%) had limited health literacy, while 65% had sufficient health literacy. Sufficient health literacy was associated with accessing the PAEHR (adjusted OR 1.81 95% CI 1.07-3.06) and use of the online national health information portal provided by the Swedish national health care system (adjusted OR 2.91 95% CI 1.13-7.52) but not with searching information to better understand individual test results (adjusted OR 1.29 0.75-2.20).Conclusions: Individuals with limited health literacy do not access their personal health information nor search for health information on the online national health information portal provided by the Swedish national health care system to the same extent as individuals with sufficient health literacy. More research is needed about how the level of health literacy relates to differences in online health information-seeking behavior and how digital health information sources and e-health services can be designed to ensure that the entire population has equal access to trustworthy and quality-ensured health information. [ABSTRACT FROM AUTHOR]

Background: To increase health and well-being in young children, it is important to acknowledge and promote the child's sleep behaviour. However, there is a lack of brief, validated sleep screening instruments for children. The aims of the study were to (1) present a Swedish translation of the PISI, (2) examine the factor structure of the Swedish version of PISI, and test the reliability and validity of the PISI factor structure in a sample of healthy children in Sweden.Methods: The English version of the PISI was translated into Swedish, translated back into English, and agreed upon before use. Parents of healthy 3- to 10-year-old children filled out the Swedish version of the PISI and the generic health-related quality of life instrument KIDSCREEN-27 two times. Exploratory and confirmatory factor analyses for baseline and test-retest, structural equation modelling, and correlations between the PISI and KIDSCREEN-27 were performed.Results: In total, 160 parents filled out baseline questionnaires (test), whereof 100 parents (63%) filled out the follow-up questionnaires (retest). Confirmative factor analysis of the PISI found two correlated factors: sleep onset problems (SOP) and sleep maintenance problems (SMP). The PISI had substantial construct and test-retest reliability. The PISI factors were related to all KIDSCREEN-27 dimensions.Conclusions: The Swedish version of the PISI is applicable for screening sleep problems and is a useful aid in dialogues with families about sleep. [ABSTRACT FROM AUTHOR]

Introduction: Lipid-lowering therapy (LLT) reduces the risk of cardiovascular disease (CVD) in patients with type 1 diabetes (T1D). However, socioeconomic factors and gender may have an impact on the adherence to and non-persistence with LLT. Methods: This was a nationwide register-based cohort study that included 6192 individuals with T1D aged ≥ 18 years who were registered in the Swedish National Diabetes Register and had initiated novel use of LLT. Information on socioeconomic parameters (source: Statistics Sweden) and comorbidity (source: National Patient Register) was collected. The individuals were followed for 36 months, and adherence to LLT was analyzed according to age, socioeconomics and gender. The medication possession ratio (MPR; categorized into ≤ 80% and > 80%) and non-persistence (discontinuation) with medication was calculated after 18 and 36 months. Results: Individuals older than 53 years were more adherent to LLT (MPR > 80%) than those younger than 36 years (odds ratio [(OR] 1.30, p < 0.0001) at 36 months. Women were more adherent and less prone to discontinue LLT at 18 months (OR 1.05, p = 0.0005 and OR 0.95, p = 0.0004, respectively), but not at 36 months. Divorced individuals were less adherent than married ones (OR 0.93, p = 0.0005) and discontinued LLT more often than the latter (OR 1.06, p = 0.003). Education had no impact on adherence, but individuals with higher incomes discontinued LLT less frequently than those with lower incomes. Individuals with a country of origin other than Sweden discontinued LLT more often. Conclusion: Lower adherence to LLT in individuals with T1D was associated with male gender, younger age, marital status and country of birth. These factors should be considered when evaluating adherence to LLT in clinical practice, with the aim to help patients achieve full cardioprotective treatment. [ABSTRACT FROM AUTHOR]

Do instances of public gun violence increase support for Radical Right Parties? Using a pseudo-experimental design, this study investigates the impact of shootings in Sweden 2011-2018 on support for the Sweden Democrats. Using GIS techniques to combine both election results and survey data with police data on shootings, shootings show no consistent political effects. While there are some methodological caveats, the results might reffect that perceptions and fear of crime are more important determinants of political attitudes than actual crime. [ABSTRACT FROM AUTHOR]

Introduction: Low back pain (LBP) defined as ache or pain in the lowest part of the back is a common experience among people all over the world. The lifetime prevalence is reported to be as high as 84%, and the prevalence of LBP seems to be almost the same among adolescents as among adults. The risk for having LBP later in life if you experienced LBP in adolescence is high. Material and Methods: In this cross‐sectional study of 2550 students aged 16‐20 years, we used the Standardized Nordic Questionnaire for the analysis of musculo‐skeletal symptoms. We studied gender difference, prevalence, and disability of Low back pain. We also studied differences in LBP in adolescent athletes depending on hours spent on sports or physical activity. Results: Significantly, more girls than boys had had problems sometimes during their life. Those who participated in sports reported LBP to a significantly higher extent than those who were physically inactive in their spare time. Gender and spare time sports were important risk factors for getting LBP some time in life. There was a higher risk for girls to have low back pain problems more than 30 days or daily the last year if they had had low back pain some time earlier in life. Conclusion: This study shows that low back pain (LBP) is common among Swedish adolescents, more common among girls than boys. High sport activity was associated with the risk of having LBP, length of time with LBP, and disability due to LBP. [ABSTRACT FROM AUTHOR]

• The use of menopausal hormone therapy decreased from 2000 to 2007, stabilised, and then increased from 2017 to 2021. • The use of menopausal hormone therapy increased most in women close to menopause. • The increase in the use of menopausal hormone therapy was in accordance with new clinical guidelines. • Changes of prescription patterns were first visualised in incident users of menopausal hormone therapy. • A run-in of 18 months is suitable to define incident use of menopausal hormone therapy close to menopause. To describe the trends in the prevalence of use menopausal hormone therapy (MHT) in Sweden over the period 2000–2021 and to analyse the impact of different lengths of run-in on the calculated incident use. Individual-level data on MHT dispensations for 2.5 million women aged 45–69 years for the period 2006–2021 were analysed. Aggregated sales volumes in defined daily dose (DDD) were available for the whole study period (2000−2021). One-year prevalence and one-year incidence (18-month run-in) per 1000 women and DDD per 1000 women per day of MHT were the main outcome measures. The predictive values for incidence representing first-ever use of MHT were calculated for different run-in periods, which is a defined period without dispensations. Both the DDD, from 2000, and the prevalence, from 2006, decreased by over 80 % in women aged 50–54 years, until 2010, when the use of MHT stabilised. The predictive value for incident users to be first-ever users was 88 % in women aged 50–54 years, with a run-in of 18 months, in 2021. The incidence was stable between 2007 and 2016. From 2017 the incidence increased, being most pronounced for women close to menopause. MHT use decreased significantly after the turn of the century, but has increased since 2017. A run-in period of 18 months was found suitable and reliable for defining incident users of MHT in the age intervals closest to menopause. Incidence seems to be a more sensitive measure than prevalence or DDD for the early detection of changes in trends in prescriptions of MHT. [ABSTRACT FROM AUTHOR]

Background The current understanding on health-related quality of life ( HRQoL) in young Swedish children with cleft lip and/or palate ( CL/P) is sparse, and therefore, research on impact of CL/P on HRQoL in children is needed. Aims To investigate HRQoL in 5- and 10-year-old Swedish children with CL/P in comparison with non-cleft controls. Also to analyse whether there were any differences in HRQoL between children with cleft lip (with or without cleft palate, CL ± P) and cleft palate only ( CP) and/or gender differences. Design A total of 137 children with CL/P and 305 non-cleft controls participated. HRQoL was measured with KIDSCREEN-52. Results All children in the study exhibited HRQoL within or above the age-matched reference interval of the method with similar results in both groups; however, in the dimension 'social support and peers', the 10-year-old children with CL/P perceived lower HRQoL than the non-cleft controls, but it did not reach statistical significance. Type of cleft or gender did not influence HRQoL. Conclusions Both 5- and 10-year-old Swedish children with CL/P had HRQoL in the normal reference interval. Their general life situations were well adjusted to their clefts, but the older children with CL/P felt more excluded and less supported by peers. [ABSTRACT FROM AUTHOR]

Background: Several interventions have been carried out to tackle health inequalities between migrant groups, especially refugees, and native-born European populations. These initiatives are often address language or cultural barriers. One of them is the International Health Advisors (IHA) in Sweden; a peer education intervention aimed at providing health information for recently settled migrants. It is known that social determinants, such as educational level and access to social capital, affect health. Social determinants may also affect how health information is received and transformed into practice. The aims of this study was to a) assess the impact of the IHA on recently settled migrants' self-reported health status, and received health information; b) determine the moderating role of educational level and social capital; and c) critically discuss the outcomes and suggest implications for health promotion practice.Methods: The study was designed as a prospective cohort study. A postal questionnaire translated to Arabic was sent to recently settled Iraqi migrants in eight counties in Sweden, in May 2008 and May 2010. Two of the counties were exposed to the intervention, and six were used as references.Results: The proportion of individuals who reported that they had received information on healthy diet and physical exercise was higher in the intervention group than in the non-intervention group (OR 2.31, 95% CI 1.02-5.22), after adjustments. Low social participation was negatively associated with deteriorated or unchanged health needs (OR 0.47, 95% CI 0.24-0.92). No other statistically significant differences in health outcomes could be observed between the groups. No signs of effect modification on this association by social capital or educational level could be found.Conclusions: Health information provided by the IHA increased self-reported level of knowledge on healthy diet and physical exercise. The interpretation of the observed negative association between low social participation and deteriorated or unchanged health needs is that participation was limited to one's own social group, and therefore had limited positive influence on health seeking behaviour. The lack of measurable improvements in health status could be explained by limitations in the study, in the theoretical assumptions underlying the intervention, and in the implementation of the intervention. Further research is needed to understand success factors in health promoting interventions among recently settled migrants better. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study are to analyse adherence to antidepressant treatment over 2 years in Sweden among women and men who initiated treatment with citalopram and to identify groups at risk of non-adherence using trajectory models. Methods: The study population, including individuals 18-85 years who initiated citalopram use between 1 July 2006 and 30 June 2007, was identified in the Swedish Prescribed Drug Register and followed for 2 years. Adherence was estimated with continuous measure of medication acquisition (CMA) and group-based trajectory modelling, a method which describes adherence patterns over time by estimating trajectories of adherence and the individual's probability of belonging to a specific trajectory. Results: The study population included 54,248 individuals, 64 % women. Mean CMA was 52 % among women and 50 % among men ( p < 0.001). Five different adherence patterns (Trajectories) were identified. Similar proportion of women and men belonged to each Trajectory. Around 29 % of the women and 27 % of the men belonged to the Trajectory which showed full adherence throughout the 2-year study period. The other four Trajectories showed adherence that declined to different degrees and at different stages in time. Having low socioeconomic status was more common among individuals in Trajectories showing declining adherence than in the adherent Trajectory. Conclusions: Using trajectory modelling, five Trajectories describing different patterns of adherence to citalopram treatment over time were identified. A large proportion discontinued treatment early and having low socioeconomic status increased the risk of being non-adherent. [ABSTRACT FROM AUTHOR]

Poor mental health is common among migrants. This has been explained by migration-related and socio-economic factors. Weak social capital has also been related to poor mental health. Few studies have explored factors that protect mental health of migrants in the post-migration phase. Such knowledge could be useful for health promotion purposes. Therefore, this study aimed to analyse associations between financial difficulties, housing problems and experience of discrimination and poor mental health; and to detect possible effect modification by social capital, among recently settled Iraqi migrants in Sweden. A postal questionnaire in Arabic was sent to recently settled Iraqi citizens. The response rate was 51% (n = 617). Mental health was measured by the GHQ-12 instrument and social capital was defined as social participation and trust in others. Data were analysed by means of logistic regression. Poor mental health was associated with experience of discrimination (OR 2.88, 95% CI 1.73-1.79), housing problems (OR 2.79, 95% CI 1.84-4.22), and financial difficulties (OR 2.14, 95% CI 1.44-3.19), after adjustments. Trust in others seemed to have a protective effect for mental health when exposed to these factors. Social participation had a protective effect when exposed to experience of discrimination. Social determinants and social capital in the host country play important roles in the mental health of migrants. Social capital modifies the effect of risk factors and might be a fruitful way to promote resilience to factors harmful to mental health among migrants, but must be combined with policy efforts to reduce social inequities. [ABSTRACT FROM AUTHOR]

Background: Longitudinal studies indicate strong associations between school proficiency and indicators of mental health throughout adulthood, but the mechanisms of such associations are not fully elucidated. The Kupol study is a prospective cohort study in Sweden set up in order to: (i) describe the association of school pedagogic and social environment and its specific dimensions with the risk of mental ill-health and psychiatric disorders in adolescence; (ii) evaluate the direct effects of school pedagogic and social environment on mental health and the effects mediated by the individual's academic achievements; and (iii) assess if school pedagogic and social environment are associated with mental ill-health through epigenetic mechanisms, in particular those involving genes regulating the response to stress. Methods: The Kupol cohort at baseline consists of 3959 children attending the 7th grade of compulsory school (13-14 years old) in 8 regions of central Sweden in the school years 2013-2014 or 2014-2015. Three follow-up surveys in subsequent years are planned. Teachers' and students' perceptions of the culture, climate and ethos of their schools, and students' mental ill-health are assessed at the whole school level by annual questionnaire surveys. In order to conduct epigenetic analyses saliva specimens are collected from a nested sample of students at inception and two years later. Further, class-, family- and child-level information is collected at baseline and during each year of follow-up. Self-reported information is being complemented with register data via record-linkages to national and regional health and administrative registers. Discussion: The topic being investigated is new, and the sample constitutes the largest adolescent cohort in Sweden involved in an ad hoc study. Epigenetic analyses centered on environmental cues to stress response are a thoroughly new approach. Finally a notable feature is the multi-informant and multi-method data collection, with surveys at the school, class, family, and student level. Collaboration and data access: interested investigators should contact the coordinating centre. Additional information is available on the study's website, http://kupolstudien.se/. [ABSTRACT FROM AUTHOR]

The core of evidence-based practice (EBP) as advocated for within the practice arms of the health and social sciences is to promote the routine incorporation of the best available research evidence into practice efforts. This requires discipline-specific education that is not only grounded in professional practice but also prepares would-be scientists in the application of the sophisticated techniques that characterize today's high research standards. Doctoral-level education is an important primer for future scientific endeavors across disciplines. This study examined 2334 theses published across Sweden in public health, criminology, nursing, psychiatry, psychology, social work, and sociology during the period 1997-2012. Of the theses reviewed, 13% aimed to investigate the effects of interventions. The highest percentage of effectiveness studies was found in nursing, public health, and psychology. The percentage of outcome research increased during the period. Controlled studies (with comparison group and pre- and post-test) occurred primarily within public health, nursing, psychiatry, and psychology. Of the 296 theses that included an intervention effectiveness study, 131 (44%), or 5.6% of all theses reviewed, met all four assessment criteria for quality. PhD education across seven disciplines in Sweden may be producing a professional core of scientists that is ill prepared to produce the type of research that is necessary to inform practice of the effects of its interventions as exposure to the rigors of quality effectiveness research is all but non-existent. This has implications for the advancement of an evidence-based practice and intervention science more broadly. [ABSTRACT FROM AUTHOR]

Aims: To investigate self-reported beliefs and perceived sensitivity to medicines and their effects in relation to self-reported use of medicines and herbal remedies.Methods: A survey sent to 13,931 randomly selected Swedish adults included the Beliefs about Medicines Questionnaire-General (BMQ-General) Questionnaire and the Perceived Sensitivity to Medicines Scale (PSM). The survey also asked about individuals' use of prescribed and over-the-counter (OTC) medicines and herbal remedies in the past month. We examined all associations between scores on the BMQ-General subscales and PSM in relation to the use of medicines and herbal remedies, using analysis of covariance adjusted for potential confounders.Results: Among 7099 respondents, those using herbal remedies exclusively believed strongly that prescription and OTC medicines are harmful and overprescribed. Respondents using prescription and OTC medicines reported more positive beliefs [coefficient 0.67 (95% CI 0.47-0.87) and 0.70 (95% CI 0.51-0.90)] on the benefits of medicines compared with those using herbal remedies [-0.18 (95% CI -0.57-0.20)]. Perceived sensitivity to medicines was higher among those using herbal remedies only [1.25 (95% CI 0.46-2.03)] compared with those using no medicines (reference 0) or prescription [-0.44 (95% CI -0.84 to -0.05)] or OTC [-0.27 (95% CI -0.66-0.12)] medicines alone.Conclusion: Respondents using prescription and/or OTC medicines reported stronger positive beliefs about the benefits of medicines in general, supporting the hypothesis that beliefs influence medicine use. Therefore, addressing beliefs and concerns about medicines during patient counselling may influence medicine use, particularly regarding unintentional non-adherence. [ABSTRACT FROM AUTHOR]

• The risk of subsidence damage induced by leakage was assessed. • Mitigation measures were evaluated for hydrogeological risk management. • Cost-benefit analysis was used for the risk evaluation. • Expert elicitation, data and empirical models were combined. Leakage of groundwater into underground facilities can subsequently cause groundwater drawdown, subsidence and subsidence damages to the built-up environment. In order to reduce the risk of damage, measures to mitigate the risks must often be implemented. The aim of this paper is to describe and demonstrate a probabilistic cost-benefit analysis approach to assess the economic profitability of investing in different risk mitigation alternatives. Since underground construction is always associated with uncertainties, the analysis uses probability distribution functions for uncertain parameters and Monte Carlo simulations to quantify probabilities of damage and implementation costs. The proposed approach is exemplified with a case study, the road tunnel project Bypass (Förbifart) Stockholm in eastern Sweden, for which four risk mitigation alternatives were evaluated. In conclusion, the approach helps to highlight the economic effects of different risk mitigation approaches and constitute a transparent support for decisions on implementation of risk mitigation. For the case study, the analysis indicates that the implementation costs of ∼ 7000 MSEK (700 million EUR) for risk mitigation needed to fulfil the legal requirements, from the Swedish Land- and Environmental court, in the form of ambitious sealing strategies are disproportionate relative to the benefits of ∼ 50 MSEK (5 million EUR) gained in the form of reduced damage risk for the built-up environment. In other words, billions SEK of taxpayers' money are spent on unnecessary expenses to fulfill legal requirements without societal benefits. The novelty of the paper constitutes the coupling of models and combination of established methods for management of hydrogeological risks. [ABSTRACT FROM AUTHOR]

Background: Previous studies have suggested that children with oral clefts may have higher caries prevalence in comparison with non-cleft controls but the relative importance of the potential risk factors is not clear. The aim of this study was to compare the caries risk profiles in a group of cleft lip and/or palate (CL(P)) children with non-cleft controls in the same age using a computerized caries risk assessment model. Methods: The study group consisted of 133 children with CL(P) (77 subjects aged 5 years and 56 aged 10 years) and 297 non-cleft controls (133 aged 5 years and 164 aged 10 years). A questionnaire was used to collect data concerning the child's oral hygiene routines, dietary habits and fluoride exposure. Oral hygiene was assessed using Quigley-Hein plaque Index and the caries prevalence and frequency was scored according to the International Caries Detection and Assessment System. Whole saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rate. The risk factors and risk profiles were compared between the groups with aid of Cariogram and the estimated risk for future caries was categorized as “high” or “low”. Results: Children with CL(P) (the entire study group) had significantly higher counts of salivary lactobacilli (p < 0.05) and displayed less good oral hygiene (p < 0.05). More 10-year-old children in the CL(P) group had low secretion rate but this difference was not significant. The average chance to avoid caries ranged from 59 to 67 % but there were no significant differences between the groups. The odds of being categorized with high caries risk in the CL(P) group was significantly elevated (OR = 1.89; 95 % CI = 1.25-2.86). In both groups, children in the high risk category had a higher caries experience than those with low risk. Conclusion: Children with CL(P) displayed increased odds of being categorized at high caries risk with impaired oral hygiene and elevated salivary lactobacilli counts as most influential factors. The results suggest that a caries risk assessment model should be applied in the routine CL(P) care as a basis for the clinical decision-making and implementation of primary and secondary caries prevention. [ABSTRACT FROM AUTHOR]

Background: The Office Illness Project in Northern Sweden, comprising both a screening questionnaire study of 4943 office workers and a case-referent study of Sick Building Syndrome (SBS) in 464 subjects was recently completed. Previously published results from the survey showed that female gender asthma/rhinitis, high psychosocial work load, paper and visual display terminal (VDT) work were related to an increased prevalence of SBS symptoms.Methods: The case-referent study presented in this paper used data from the questionnaire supplemented with information from a clinical examination, a survey of psychosocial factors at work building data from inspection and measurements taken at the work sites.Results: Personal factors such as atopy and photosensitive skin, psychosocial conditions and physical exposure factors influencing indoor air quality (IAQ), such as outdoor air flow rates and the presence of photocopiers were related to an increased prevalence of the reported SBS symptoms. The results were established using multivariate analysis.Conclusions: The rate response relationship between actually measured ventilation rates and the prevalence of perceived SBS symptoms presents strong evidence for the association between IAQ factors and health. [ABSTRACT FROM AUTHOR]

Background Several countries have introduced generic substitution, but few studies have assessed its effect on refill adherence. This study aimed to analyse whether generic substitution influences refill adherence to statin treatment. Methods Between 1 July 2006 and 30 June 2007, new users of simvastatin (n = 108,806) and atorvastatin (n = 7,464) were identified in the Swedish Prescribed Drug Register. The present study included atorvastatin users as an unexposed control group because atorvastatin was patent-protected and thus not substitutable. We assessed refill adherence using continuous measure of medication acquisition (CMA). To control for potential confounders, we used analysis of covariance (ANCOVA). Differences in CMA associated with generic substitution and generic substitution at first-time statin purchase were analysed. Results Nine of ten simvastatin users were exposed to generic substitution during the study period, and their adherence rate was higher than that of patients without substitution [84.6% (95% CI 83.5-85.6) versus 59.9% (95% CI 58.4-61.4), p < 0.001]. CMA rose with increasing age (60-69 years 16.7%, p < 0.0001 and 70-79 years 17.8%, p < 0.0001, compared to 18-39 years) and secondary prevention (12.8%, p < 0.0001). CMA was lower among patients who were exposed to generic substitution upon initial purchase, compared to those who were exposed to a generic substitution subsequently [80.4% (95% CI 79.4-90.9) versus 89.8% (88.7-90.9), p < 0.001]. This difference decreased when those with only one statin purchase were excluded. Conclusions Statin refill adherence was higher among patients who exposed to generic substitution compared to those who were not. Increasing age and previous cardiovascular disease affected refill adherence. [ABSTRACT FROM AUTHOR]

Background: Adolescents’ alcohol consumption is a public health concern in Sweden as well as in many other countries. Underage drinking is associated with increased risks of alcohol-related injuries, risky sexual behaviours and dependence later in life. Different strategies have been used in the effort to prevent this behaviour, and to postpone the onset of alcohol. The Strengthening Families Programme 10–14 (SFP 10–14) from the USA has been highlighted as one of the more effective prevention programmes. The aim of the present article was to evaluate the effectiveness of a culturally adapted Swedish version of the SFP 10–14. Methods: This was a cluster randomized controlled trial including 587 sixth-grade students (age 12) and their parents in 19 elementary schools in Stockholm. Schools were randomly assigned to either control (9 schools, 216 students) or to the family skills training intervention (10 schools, 371 students). The SFP Swedish version consisted of two parts with seven and five sessions, respectively, held separately for youths and parents except two joint family sessions. Measures of students’ self-reported episodes of drunkenness, smoking, illicit drug use and other norm-breaking behaviours were collected at baseline (March 2003) and at three subsequent yearly surveys. Data were analysed using multilevel models with an intention-to-treat approach. Results: No preventive effects were found for smoking, alcohol and illicit drug use and other norm-breaking behaviours, nor did moderators affect the outcome. Conclusion: The Swedish version of the SFP 10–14 was not effective in preventing youths’ substance use in a Swedish context. [ABSTRACT FROM AUTHOR]

Flavobacterium psychrophilum is the causative agent of bacterial cold water disease (BCWD), which affects a variety of freshwater-reared salmonid species. A large-scale study was performed to investigate the genetic diversity of F. psychrophilum in the four Nordic countries: Denmark, Finland, Norway, and Sweden. Multilocus sequence typing of 560 geographically and temporally disparate F. psychrophilum isolates collected from various sources between 1983 and 2012 revealed 81 different sequence types (STs) belonging to 12 clonal complexes (CCs) and 30 singleton STs. The largest CC, CC-ST10, which represented almost exclusively isolates from rainbow trout and included the most predominant genotype, ST2, comprised 65% of all isolates examined. In Norway, with a shorter history (< 10 years) of BCWD in rainbow trout, ST2 was the only isolated CC-ST10 genotype, suggesting a recent introduction of an epidemic clone. The study identified five additional CCs shared between countries and five country-specific CCs, some with apparent host specificity. Almost 80% of the singleton STs were isolated from non-rainbow trout species or the environment. The present study reveals a simultaneous presence of genetically distinct CCs in the Nordic countries and points out specific F. psychrophilum STs posing a threat to the salmonid production. The study provides a significant contribution toward mapping the genetic diversity of F. psychrophilum globally and support for the existence of an epidemic population structure where recombination is a significant driver in F. psychrophilum evolution. Evidence indicating dissemination of a putatively virulent clonal complex (CC-ST10) with commercial movement of fish or fish products is strengthened. [ABSTRACT FROM AUTHOR]

Purpose: To examine the impact of two methods when estimating refill adherence in patients using bisphosphonates with different dosing regimens. Methods: In the Swedish Prescribed Drug Register, 18,203 new users of bisphosphonates aged 18-85 years were identified between 1 July 2006 and 30 June 2007 and followed for a maximum of 2 years. The patients were categorised based on dosing regimen: one tablet daily, one tablet weekly, switching between these regimens, and other regimens. Refill adherence was estimated with Continuous measure of Medication Acquisition (CMA, adherent if CMA ≥ 80 %) and the maximum gap method (adherent if gaps <45 days). Differences in adherence between patients in the groups were assessed with logistic regression models controlling for confounding factors. Results: The proportion of patients classified as adherent was higher using CMA compared with patients classified as adherent using the maximum gap method. Patients on one tablet weekly had significantly lower adherence compared with patients on one tablet daily in the main analyses of both methods (the maximum gap method: 73 % vs. 80 %; adjusted OR = 0.71; 95 % CI 0.57-0.89 and CMA: 84 % vs. 88 %, adjusted OR = 0.75; 95 % CI 0.57-0.99). Patients using the other two dosing regimens had significantly lower adherence compared with patients on one tablet daily using both methods. Conclusion: Choice of method has an impact on the estimates of refill adherence to bisphosphonates. Patients on one tablet weekly dosing had lower adherence compared with patients on one tablet daily dosing using both methods. [ABSTRACT FROM AUTHOR]

Does rainfall during the Election Day reduce voter turnout? Previous research shows that in the US one inch of rain reduces turnout with about one percentage point. We turn to the Swedish context in order to test whether rainfall on Election Day have the same impact in a high turnout context. We move beyond previous research by testing the impact of GIS-interpolated rainfall on three different datasets that allows us to view the issue both from a wide time frame as well as with high precision as for turnout measures: (a) aggregate turnout data for Sweden's 290 municipalities, (b) individual level data from the Swedish National Election Study and (c) data from a register-based survey on voter turnout. In none of the three datasets do we find robust negative effects of rain. [Copyright &y& Elsevier]

Background: In the Swedish reimbursement scheme, the co-payment is based on the price of the product and decreases in a stepwise manner as the total accumulated co-payment increases. The aim of this study was to analyse how refill adherence in Sweden varies according to patient’s co-payment level for medicines, with antiepileptic drug (AED) use as an example. Methods: Prevalent AED users aged 18–85 years who purchased an AED between 1 January and 30 June 2007 were identified in the Swedish Prescribed Drug Register and followed for a maximum of 2 years. Patient time was categorized based on patient’s accumulated co-payment for all drugs per reimbursement period. The continuous measure of medication acquisition (CMA) was used to estimate refill adherence in relation to the patients’ co-payment level. Associations between patients’ co-payment for all medicines and refill adherence were assessed with multilevel mixed-effects linear regression, accounting for clustering within patients. Results: The study population included 2210 patients (mean age: 56 years; 54% men). CMA for AED was 91% for patients where the co-payment corresponded to 100% of the price. Compared with these patients, refill adherence for AED was 2–4% higher (P < 0.001) for patients with reduced co-payment (co-payment of ≤50% of the price). Higher age, higher income and fenytoin use were also associated with a higher refill adherence for AED. Conclusions: Using AED as an example, a higher level of reimbursement was associated with a higher refill adherence compared with full co-payment in Sweden. [ABSTRACT FROM PUBLISHER]

Background: Early discontinuation of anti-depressant treatment is common. This study analysed whether socio-economic factors influence early discontinuation among new anti-depressant users aged 20–34 years. Methods: Our study population included all Swedes aged 20–34 years who purchased anti-depressants in 2006 and had not purchased such drugs in the preceding 6 months (n = 25 003). We obtained prescription data from the Swedish Prescribed Drug Register. Information about demographic and socio-economic factors (country of birth, marital status, household size, education level, occupation, income and social assistance) was collected from Statistics Sweden by record linkage. We defined early discontinuation as filling only one anti-depressant prescription within a 6-month period. We used multiple logistic regression analysis to analyse the socio-economic factors associated with early discontinuation. Results: We identified 6536 individuals (26.1%) as early discontinuers. Early discontinuation was less common among women [odds ratio (OR) = 0.82; 95% confidence intervals (CI) 0.75–0.87] and in those with at least two years of higher education (OR = 0.71; 95% CI 0.61–0.83), whereas it was more common among those born outside Sweden (OR = 1.76; 95% CI 1.48–2.10) and those who received social assistance (OR = 1.26; 95% CI 1.11–1.44). Compared with selective serotonin re-uptake inhibitors, SSRI, early discontinuation was more common among individuals who started treatment with a tri-cyclic anti-depressant, TCA, (OR = 2.58; 95% CI 2.24–2.98) or an anti-depressant other than SSRIs, TCAs or selective serotonin-norepinephrine re-uptake inhibitors/norepinephrine (noradrenaline) re-uptake inhibitors (OR = 2.90; 95% CI 2.05–4.10). Conclusion: Early discontinuation occurred more commonly among social assistance recipients and those with immigrant background, suggesting that those groups might require greater support when initiating anti-depressant therapy. [ABSTRACT FROM PUBLISHER]

Why do some local governments deliver public services directly while others rely on providers from the private sector? Previous literature on local contracting out and on the privatization of state-owned enterprises have offered two competing interpretations on why center-right governments rely more on private providers. Some maintain that center-right politicians contract out more because, like Adam Smith, they believe in market competition. Others claim that center-right politicians use privatization in a Machiavellian fashion; it is used as a strategy to retain power, by 'purchasing' the electoral support of certain constituencies. Using a unique dataset, which includes the political attitudes of over 8,000 Swedish local politicians from 290 municipalities for a period of 10 years, this paper tests these ideological predictions together with additional political economy factors which have been overlooked in previous studies, such as the number of veto players. Results first indicate support for the Machiavellian interpretation, as contracting out increases with electoral competition. Second, irrespective of ideological concerns, municipalities with more veto players in the coalition government contract out fewer services. [ABSTRACT FROM AUTHOR]

Background Drug-related morbidity (DRM) is common and to some extent preventable, and associated with considerable costs in patients attending hospital. In outpatients and in the general public corresponding data are limited, but pharmacists' expert opinion has suggested high rates of DRM also in US ambulatory care. It is unknown if the results are applicable in Sweden today. Objective To estimate the proportions of patients with DRM and preventable DRM and the cost-of-illness (COI) of DRM in Sweden based on pharmacists' expert opinion. Setting Swedish healthcare. Method The study applied a conceptual model of DRM based on a decision tree. An expert panel of pharmacists determined the probabilities of therapeutic outcomes of medication therapy. The COI analysis included direct costs from the healthcare perspective. Sensitivity analyses were performed for variations in probabilities and pathway costs. Main outcome measure DRM included new medical problems (adverse drug reactions, drug dependence and intoxications) and therapeutic failures (insufficient effects of medicines and morbidity due to untreated indication). Results The expert panel estimated that 61 ± 14 % (mean ± SD) of all patients attending healthcare suffered from DRM, of which 29 ± 8 % suffered from new medical problems, 18 ± 6 % from therapeutic failures, and 15 ± 7 % from a combination of both. The DRM was considered preventable in 45 ± 15 % of the patients with DRM. The estimated COI was EUR 997 per patient attending healthcare, corresponding to an annual cost of EUR 6,600 million to the Swedish healthcare system. The COI ranged from EUR 490 to EUR 1,314 when varying the participants' probabilities of DRM and clinical outcomes from the first to the third quartile. Of the pathway costs, the COI was most sensitive to variation in the cost of prolonged hospital stay (COI range EUR 953-1,306). Conclusion According to pharmacists' expert opinion, a large proportion of patients in Sweden experience DRM and preventable DRM, and the estimated COI of DRM is extensive. Since observational studies have not addressed the burden of DRM to the general public, this study adds the pharmacists' perception on DRM. Other healthcare professionals' perceptions on DRM need to be investigated in future studies. [ABSTRACT FROM AUTHOR]

Aims: To analyse clinical characteristics and treatment results in unselected type 2 diabetes mellitus (T2DM) patients, with non-pharmacological treatment as well as the most commonly used pharmacological glucose-lowering treatment regimens, in everyday clinical practice. Methods: In this population-based cross-sectional study, information was linked from the Swedish National Diabetes Register, Prescribed Drug Register and Patient Register. T2DM patients with non-pharmacological treatment and T2DM patients continuously using the 12 most common pharmacological treatment regimens were included in the study (n = 163121). Results: There were statistically significant differences in clinical characteristics between the groups. Patients with insulin-based treatment regimens had the longest duration of diabetes and more cardiovascular risk factors than the T2DM-population in general. The proportion of patients reaching HbA1c ≤7% varied between 70.1% (metformin) and 25.0% [premixed insulin (PMI) + SU) in patients with pharmacological treatment. 84.8% of the patients with non-pharmacological treatment reached target. Compared to patients on metformin, patients on other pharmacological treatments had a lower likelihood, with hazard ratios ranging from 0.58; 95% confidence interval (CI), 0.54-0.63 to 0.97;0.94-0.99, of having HbA1c ≤7% (adjusted for covariates). Patients on insulin-based treatments had the lowest likelihood, while non-pharmacological treatment was associated with an increased likelihood of having HbA1c ≤7%. Conclusion: This nation-wide study shows insufficiently reached treatment goals for haemoglobin A1c (HbA1c) in all treatment groups. Patients on insulin-based treatment regimens had the longest duration of diabetes, more cardiovascular risk factors and the highest proportions of patients not reaching HbA1c target. [ABSTRACT FROM AUTHOR]

Background: Testing evidence-based interventions (EBIs) outside of their home country has become increasingly commonplace. There is a need for theoretically guided research on how to best create and test the effects of culturally adapted interventions. Objective: To illustrate how the field might raise the scientific and practical value of future effectiveness and dissemination trials of culturally adapted interventions, as well as to provide support for theoretically informed research on this subject to take greater root. Methods: Nine theories that offer guidance on how to adapt existing EBIs for a new cultural group were summarized and evaluated. Results: Commonalities among the selected theories included a focus on the need for collaboration as part of the adaptation process and shared emphasis on taking systematic steps to select an intervention to adapt, as well as calls for adaptations to be guided by specific types of empirical studies. Among the theories, variability existed in terms of what constituted an adaptation. Conclusions: As EBIs go global, intervention adaptation promises to be the subject of substantial future scholarly attention. There is a need to develop systematic evidence-based methods that allow for some degree of adaptation, while still bringing about EBIs' desired benefits. [ABSTRACT FROM AUTHOR]

Endotoxins are microbiological agents which ubiquitously exist in an indoor environment, and are believed to be causal agents for a number of diseases. This study investigated the indoor levels and determinants of endotoxins and their impact on asthma and allergy diseases among Swedish pre-school children. House dust samples from 390 homes of 198 case children with asthma and allergy and 202 healthy control children were collected in the Dampness Building and Health (DBH) study. House dust endotoxin levels in the child's bedroom and living rooms ranged from 479–188,000 EU/g dust and from 138–942,000 EU/g dust, respectively. Pet-keeping and agricultural activities were significantly associated with the higher endotoxin concentration levels in indoor dust. Endotoxins in theindoor environment did not associate to asthma and allergy diseases in the children. However, we found an association between endotoxins and the presence of disease symptoms in the sub-group of families without indoor pets. [ABSTRACT FROM PUBLISHER]

Most studies studying dampness as a risk factor for asthma are of a cross-sectional design. The aim of this study was to investigate if the association between moisture-related problems indoor and asthma found in cross-sectional questionnaire data can be confirmed in longitudinal analyses. The Dampness in Building and Health (DBH) study started in 2000 in Varmland, Sweden, with a baseline questionnaire to all children aged 1-5 y (n = 14,077) and five years later a follow-up questionnaire was distributed to children aged 6-8 y (n = 7,509). Moisture-related problems that were associated with asthma in cross-sectional analysis decreased or disappeared in the longitudinal analysis. However, the association between reports of moldy odor in the homes at baseline and incident asthma remained and became stronger. Our results suggest that cross-sectional data showing associations between moisture-related problems in homes and asthma in children partly can be explained by reporting bias. [ABSTRACT FROM AUTHOR]

Objectives: To describe the use and evaluate the effectiveness of different lipid lowering therapies in unselected patients with type 1 and type 2 diabetes in clinical practice. Design: Observational population-based study using the personal identification number to link information from the National Diabetes Register, the Prescribed Drug Register and the Patient register in Sweden. All patients in the NDR aged 18-75 years with diabetes more than one year were eligible, but only patients starting any lipid lowering treatment with at least three prescriptions 1 July 2006-30 June 2007 were included (n = 37182). The mean blood lipid levels in 2008 and reductions in LDL cholesterol were examined. Results: Blood lipid levels were similar in patients treated with simvastatin, atorvastatin and rosuvastatin, showing similar lipid lowering effect as currently used. Users of pravastatin, fluvastatin, ezetimib and fibrate more seldom reach treatment goals. Moderate daily doses of the statins were used, with 76% of simvastatin users taking 20 mg or less, 48% of atorvastatin users taking 10 mg, 55% of pravastatin users taking 20 mg, and 76% of rosuvastatin users taking 5 or 10 mg. Conclusions: This observational study shows that the LDL-C levels in patients taking simvastatin, atorvastatin or rosuvastatin are very similar as currently used, as well as their LDL-C lowering abilities. There is potential to intensify lipid lowering treatment to reduce the remaining high residual risk and achieve better fulfilment of treatment goals, since the commonly used doses are only low to moderate. [ABSTRACT FROM AUTHOR]

Aims: Modifiable risk factors for cardiovascular disease include overweight, which is prevented by healthy diet and physical activity. Recently settled migrants may have varying levels of exposure to health information. Therefore, the objectives of this study were to explore the associations between self-reported information on healthy diet and on physical activity and overweight and the possible modification of this association by educational level among recently settled Iraqi migrants in Sweden. Methods: Cross-sectional data were collected through a postal questionnaire in Arabic and analysed by means of logistic regression. Dummy variables were created in order to assess the possible modification by educational level on the association between health information and overweight. Results: After adjustments for potential confounders, associations were found between overweight and not having received information on healthy diet (OR 1.56, 95% CI 1.07—2.27) and physical exercise (OR 1.58, 95% CI 1.07—2.32). Educational level modified these associations, so that the impact on overweight by information was much more evident among those with a high level of education. Conclusions: The findings showed that overweight was associated to perceived lack of health information among recently settled Iraqi migrants. It may be easier for migrants with high education to seek, receive, and understand health-related information. Migrants with low education may be more traditional in, for example, their diet and therefore less likely to be overweight. Culturally adapted information may therefore not be relevant for them. The broader context of the social determinants of health needs to be considered when planning interventions for migrants. [ABSTRACT FROM PUBLISHER]