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Aims: To study differences in cardiovascular prevention and hypertension management in primary care in men and women, with comparisons between public and privately operated primary health care (PHC)., Methods: We used register data from Region Stockholm on collected prescribed medication and registered diagnoses, to identify patients aged 30 years and above with hypertension. Age-adjusted logistic regression was used to calculate odds ratios (ORs) with 99% confidence intervals (99% CIs) using public PHC centers as referents., Results: In total, 119,267 patients with a registered hypertension diagnosis at their primary care center were included; 58,239 men and 61,028 women. In terms of co-morbidities and medications, there were some differences between privately and publicly run PHC: registered diagnosis of dementia, which was higher at private PHC, age-adjusted OR 1.80 (1.24-2.69). For lifestyle counseling, privately run PHC had a higher rate of registered counseling for tobacco 1.17 (1.06-1.29), physical activity 1.13 (1.06-1.17), unhealthy diet 1.08 (1.04-1.13), and counseling according to highest prioritized level of advice stated by national guidelines 1.14 (1.09-1.18). Differences in comorbidities between men and women were found, with higher frequencies of coronary heart disease, congestive heart failure, atrial fibrillation, stroke, diabetes, and gout among men. Regarding antihypertensive treatment, women received less treatment of calcium channel blockers and ACE inhibitors, but more of angiotensin receptor blockers., Conclusions: These findings highlight the need for targeted preventive efforts in PHC, especially for male patients, to address disparities in cardiovascular health outcomes. Small differences in preventive measures between public and privately run PHC suggest generally consistent care across healthcare ownership models., Competing Interests: Declarations. Ethics approval and consent to participate: This study received ethical approval from Zhongshan Hospital, Fudan University (B2021-605). The online questionnaire includes a checkbox for respondents to make sure whether they give their voluntary informed consent before their involvement. The study was conducted in accordance with the Declaration of Helsinki. All authors gave their consent for publication. Ethical approval was obtained from the Ethics Review Authority, number 2020–07076 with an amendment 2121-06102-02. Consent to Participate declarations from the participants were not applicable as we used data from health record register, however, the use of these data was approved from Ethics Review in Stockholm. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Aims: Although individuals with lower socio-economic position (SEP) have a higher prevalence of mental health problems than others, there is no conclusive evidence on whether mental healthcare (MHC) is provided equitably. We investigated inequalities in MHC use among adults in Stockholm County (Sweden), and whether inequalities were moderated by self-reported psychological distress., Methods: MHC use was examined in 31,433 individuals aged 18-64 years over a 6-month follow-up period, after responding to the General Health Questionnaire-12 (GHQ-12) in 2014 or the Kessler Six (K6) in 2021. Information on their MHC use and SEP indicators, education, and household income, were sourced from administrative registries. Logistic and negative binomial regression analyses were used to estimate inequalities in gained MHC access and frequency of outpatient visits, with psychological distress as a moderating variable., Results: Individuals with lower education or income levels were more likely to gain access to MHC than those with high SEP, irrespective of distress levels. Education-related differences in gained MHC access diminished with increasing distress, from a 74% higher likelihood when reporting no distress (odds ratio, OR = 1.74 [95% confidence interval, 95% CI: 1.43-2.12]) to 30% when reporting severe distress (OR = 1.30 [0.98-1.72]). Comparable results were found for secondary care but not primary care i.e., lower education predicted reduced access to primary care in moderate-to-severe distress groups (e.g., OR = 0.63 [0.45-0.90]), and for physical but not digital services. Income-related differences in gained MHC access remained stable or increased with distress, especially for secondary care and physical services., Conclusions: Overall, individuals with lower education and income used MHC services more than their counterparts with higher socio-economic status; however, low-educated individuals faced inequities in primary care and underutilized non-physician services such as visits to psychologists.

Aim: Primary prevention of cardiovascular disease (CVD) relies on effective risk stratification to guide interventions. Current models, primarily developed using regression analysis, can lead to inaccurate estimates when applied to external populations. This study evaluates the utility of cluster analysis as an alternative method for developing CVD risk stratification models, comparing its performance with established CVD risk prediction models., Methods: Using data from 3,416 individuals (mean age of 66 years and no prior CVD) followed for an average of 5.2 years for incidence of CVD, we developed a risk stratification model using cluster analysis based on established CVD risk factors. We compared our model to the Systematic Coronary Risk Evaluation (SCORE2), the Pooled Cohort Equations (PCE) and the Predicting Risk of Cardiovascular Disease Events (PREVENT) models. We used Poisson and Cox regression to compare CVD risk between risk categories in each model. Predictive accuracy of the models was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and C-statistic., Results: During the study, 161 CVD events were detected. The high-risk cluster had a sensitivity of 59.0%, a PPV of 7.5% a specificity of 64.2% and NPV of 96.9% to predict CVD. Compared to the high-risk groups of the SCORE2, PCE and PREVENT, the high-risk cluster had a high sensitivity and NPV, but a low specificity and PPV. No statistically significant differences were found in C-statistic between models., Conclusions: Cluster analysis performed comparably to existing models and identified a larger high-risk group that included more individuals who developed CVD, though with more false positives. Further studies in larger, diverse cohorts are needed to validate the clinical utility of cluster analysis in CVD risk stratification., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Functional abdominal pain disorders (FAPDs) are common in young people and are characterized by persistent or recurrent abdominal symptoms without apparent structural or biochemical abnormalities. FAPDs are associated with diminished quality of life, school absence, increased health care use, and comorbid anxiety and depression. Exposure-based internet-delivered cognitive behavioral therapy (ICBT) has demonstrated efficacy in alleviating abdominal symptoms and improving quality of life. However, a deeper understanding of effect mechanisms and identification of possible additional treatment targets could refine treatment., Objective: This protocol paper aims to describe a study focusing on children and adolescents undergoing ICBT for FAPDs, aiming to further investigate the underlying mechanisms of effect., Methods: Children (8-12 years), adolescents (13-17 years) with FAPDs, and their respective parents will be included for 10 weeks for ICBT. First, detailed trajectories of effect are examined through a randomized single-case design study involving 6 children and 6 adolescents (substudy 1). Following this, an open-ended explorative pilot study with 30 children and 30 adolescents explores potential illness-related cognitive biases and interoceptive accuracy before and after treatment (substudy 2). Finally, spanning across these 2 substudies, including all parents from substudies 1 and 2, we will assess parental distress and illness worries before and after treatment, and how these factors impact the treatment adherence and outcomes of the child or adolescent (substudy 3)., Results: Recruitment of participants began in June 2022 and is finalized for substudy 1 and ongoing for substudies 2 and 3. Recruitment is expected to be completed by January 2025, with final data collection during April 2025., Conclusions: The findings have the potential to contribute to the ongoing improvement of specialized psychological treatment for FAPDs in young people., Trial Registration: ClinicalTrials.gov NCT05237882; https://clinicaltrials.gov/study/NCT05237882; ClinicalTrials.gov NCT05486585; https://clinicaltrials.gov/study/NCT05486585; OSF Registries osf.io/c49k7; https://osf.io/c49k7., International Registered Report Identifier (irrid): DERR1-10.2196/58563., (©Eva Skovslund Nielsen, Karen Kallesøe, Tine Bennedsen Gehrt, Ellen Bjerre-Nielsen, Maria Lalouni, Lisbeth Frostholm, Marianne Bonnert, Charlotte Ulrikka Rask. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 07.01.2025.)

Background and Objective: Organised prostate cancer (PCa) testing (OPT) was introduced in Sweden to gain knowledge in preparation for a potential national PCa screening programme. This study aims to explore men's opinions regarding the OPT invitation letters and the attitudes influencing their decision to participate in or decline OPT., Methods: We conducted semi-structured telephone interviews with 30 men (nine participants and 21 non-participants) from Stockholm County who received OPT invitations. We employed an abductive thematic analysis, a reflexive process of identifying theoretical explanations of emerging patterns, to identify themes in men's responses., Key Findings and Limitations: Informants found the invitation letters informative and appreciated the screening opportunity, but suggested improvements regarding conciseness and clarity about the risks and benefits of testing. Barriers to participation included lack of time or motivation, fear of discovering illness, inaccessibility, and distrust of health care or medical procedures. Facilitators included a desire to confirm or rule out PCa, and taking advantage of the available screening opportunity. Limitations include the study's single-county focus and a potential recall bias affecting responses., Conclusions and Clinical Implications: Men's attitudes towards OPT participation are multifaceted. While men appreciate screening opportunities, practical considerations as well as personal and psychological factors influence their participation decisions. To improve informed decision-making, OPT communication should be clear about the benefits and risks, and accessibility and logistical challenges should be addressed. Enhancing understanding and reducing fears are essential for refining screening practices and aligning these with men's needs., Patient Summary: Men value the option for prostate cancer screening, but face barriers such as low motivation and fear of a cancer diagnosis. Clear communication could improve their understanding of screening and encourage informed decision-making regarding participation in organised prostate cancer testing. Improved accessibility to testing could enhance participant opportunity., (© 2024 The Author(s).)

Background: A large proportion of individuals experience functional impairment in everyday life due to climate worry. However, the current understanding of this functional impairment is limited by the use of suboptimal measures. Furthermore, it is not known whether functional impairment due to climate worry affects pro-environmental behaviors (PEBs) or whether individuals who experience such impairment perceive a need for support. The aims of the current study were (1) to extend previous research using an established measure of functional impairment (the Work and Social Adjustment Scale, WSAS), (2) to explore the associations between climate worry, functional impairment, and PEBs, and (3) to describe the characteristics and the perceived need for support of individuals with functional impairment due to climate worry., Methods: A cross-sectional survey targeting adult individuals who experience climate worry. Participants were recruited nationally in Sweden between September and October 2022. The survey included measures of climate worry severity, climate worry frequency, functional impairment, PEBs, depressive symptoms, sleep problems, and questions related to perceived need for support., Results: A total of 1221 adults (75% women, mean age 46.3 years) were included in the analyses. Multivariate structural equation modeling revealed that climate worry severity and frequency were significantly associated with PEBs (β = 0.34 and β = 0.45, respectively). Climate worry frequency was associated with functional impairment (β = 0.41). Functional impairment was only marginally associated with PEBs (β = 0.05). Approximately 40% of the sample (n = 484) reported a high frequency and high severity of climate worry. Among these, one-third (n = 153) scored above the cutoff for significant impairment on the WSAS. Individuals in this group (high severity and frequency of climate worry as well as significant functional impairment) were more likely to experience depressed mood and sleep problems and were more interested in receiving support, specifically concerning strategies for worry management and sustainable behavior change., Conclusions: Using an established measure of functional impairment, we found an association of climate worry with functional impairment and PEBs. Importantly, as there is a perceived need for support in individuals with impairment due to climate worry, interventions targeting this specific subgroup should be developed., Competing Interests: Declarations. Ethics approval and consent to participate: All participants provided informed consent prior to study participation. Due to the anonymity and nonexperimental nature of the data collection procedures, this study was exempt from ethical review according to the Swedish Ethics Review Act. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The use of low-value care (LVC) is a persistent challenge in health care. Health technology reassessment (HTR) assesses the effects of technologies currently used in the health care system to guide optimal use of these technologies. Consequently, HTR holds promises for identifying and reducing, i.e., de-implementing, the use of LVC. There is limited research on how HTR is executed to support the de-implementation of LVC and whether and how HTR outcomes are translated into practical application. The aim of this study is to investigate how HTR is conducted to facilitate de-implementation of LVC and to investigate how the results of HTR are received and acted on in health care settings., Methods: This study is a qualitative interview study with representatives from health technology assessment agencies (n = 16) that support the regional health care organizations in Sweden and with representatives from the health care organizations (n = 7). Interviews were analysed with qualitative content analysis., Results: We identified three overarching categories for how HTR facilitates de-implementation of LVC and how the results are received and acted on in health care settings: (1) involving key stakeholders to facilitate de-implementation of LVC in identifying potential LVC practices, having criteria for accepting HTR targets, ascertaining high-quality reports and disseminating the reports; (2) actions taken by health care organization to de-implement LVC by priority setting and decision-making, networking between health care organizations and monitoring changes in the use of LVC practices; and (3) sustaining use of LVC by not questioning continued use, continued funding of LVC and by creating opinion against de-implementation., Conclusions: Evidence is not enough to achieve de-implementation of LVC. This has made health technology assessment agencies and health care organizations widen the scope of HTR to encompass strategies to facilitate de-implementation, including involving key stakeholders in the HTR process and taking actions to support de-implementation. Despite these efforts, there can still be resistance to de-implementation of LVC in passive forms, involving continued use of the practice and more active resistance such as continued funding and opinion-making opposing de-implementation. Knowledge from implementation and de-implementation research can offer guidance in how to support the execution phase of HTR., Competing Interests: Declarations. Ethics approval and consent to participate: The study was reviewed by the Swedish Ethical Review Authority, which judged that approval was not required under Swedish national law [reference number 2019:02467]. All participants were treated in accordance with ethical guidelines. Written informed consent was obtained from all study participants. Consent for publication: Informed written consent was obtained from all study participants. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Parents' low health literacy (HL) has negative impacts on child health. Parental interventions may improve parents' HL and thus impact child health positively., Objectives: This study aimed to gain knowledge about associations between parents' comprehensive HL (CHL) and child health after an extended postnatal home visiting program in Swedish multicultural, disadvantaged settings compared to parents receiving regular child healthcare (CHC)., Materials and Methods: This quasi-experimental study used a case-control sampling method to recruit first-time parents through two CHC centres in Stockholm (2017-2020). Participants (N = 151) were interviewed twice through structured questionnaires when their child was <2 months and 15-18 months old. HLS-EU-Q16 assessed parents' CHL. Children's medical records (0-18 months) were reviewed regarding breastfeeding, children's exposure to smoking, language development and healthcare utilisation. Data were analysed with regression models and non-parametric tests., Results: No significant association was found between parents' CHL and child health. However, significantly fewer unplanned visits to the CHC centre were observed among children (0-18 months) in the intervention group irrespective of CHL, compared with children to parents with improved CHL in the comparison group (F = 3.856, p = 0.011)., Conclusions: Postnatal home visiting interventions practicing proportional universalism and family-centred care may reduce unplanned visits within CHC in disadvantaged settings despite parents' CHL. Further studies with long-term follow-up are suggested to explore associations between parents' CHL and child health., Trial Registration: As a clinical study (not a clinical trial) with appropriate ethical permission with participants' consents, this study was retrospectively registered (18 February 2020) in the ISRCTN registry (ISRCTN10336603)., (© 2024 The Author(s). Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Gender differences in pain reporting and prevalence have been demonstrated. As gender of examiner also affects reporting of pain on palpation, the aim of this study was to evaluate the effects of examiner gender on palpation performance using three different palpation methods. Examiners of both genders were instructed on the correct technique for each palpation method by either a female or male instructor. The target was to achieve a pressure of 100 kPa, corresponding to the 1 kg of force for muscle palpation described in the diagnostic criteria for temporomandibular disorders (DC/TMD). All examiners performed traditional palpation with the index finger, palpation with a palpometer, and a novel bimanual palpation with visual feedback, in a randomized order. The examiner's gender, and its interaction with the gender of the instructor did not significantly affect magnitude, accuracy, or precision of the pressure applied. The method of palpation was the only factor that significantly impacted all metrics. The palpometer achieved the lowest palpation magnitude (mean pressure applied = 113.7  kPa, 95% CI: 109.8-117.6), the highest accuracy (absolute difference = 15.7  kPa, 95% CI: 12.3-19.1), and the highest precision (mean coefficient of variation = 6.8, 95% CI: 6.0-7.6), followed by bimanual palpation and traditional palpation. The results suggest that gender differences in pain reporting in patients are not likely to be a result of the technical aspects associated with the gender of the examiner. Instead, these differences may be attributed to other factors, such as sociocultural influences., (© 2024 The Author(s). European Journal of Oral Sciences published by John Wiley & Sons Ltd on behalf of Scandinavian Division of the International Association for Dental Research.)

Introduction: Healthcare in Sweden is moving towards a more person-centred approach in which patients are respected as capable individuals with unique needs. Partnership, the co-creation of health plans, and documentation are core components of this approach. The ambulance service is medical- and task-oriented, possibly placing it in conflict with the goals of person-centred care (PCC)., Aim: To explore how nurses in the Swedish ambulance service describe PCC., Method: A qualitative interview study with eight nurses who served as facilitators for implementing ambulance PCC. Data was analysed using content analysis., Findings: The analysis resulted in the main category Ambulance PCC is diffuse but applicable and in the three categories: Do good based on an ethical approach, Assemble the patient's narrative from multiple sources and Create and agree on a plan., Conclusion: Ambulance PCC is perceived as a diffuse concept, with unclear translation into practice. The findings highlight the need to determine appropriate levels of care, manage technical equipment without disrupting communication and embody attributes such as calmness and empathy. Despite its ambiguity, ambulance PCC was seen as applicable across all care stages, although requiring adjustments based on urgency, individual circumstances and care setting., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The OMERACT Composite Working Group hosted a workshop at OMERACT 2023 to explore the complexities of weighting components in the development of composite outcomes. This study presents the methodology and findings of this workshop, exploring the complexities of weighting the individual components of composite outcome measures., Methods: The workshop featured a multifaceted program, beginning with a plenary session that introduced the concept of composite outcomes, shared a patient's journey with rheumatic disease through a narrative, illustrated a composite outcome for Osteoarthritis Flares, and outlined the five domains selected for this composite outcome. A breakout exercise engaged participants in ranking and assigning weights to these domains, followed by group discussions to reach a consensus on weights. The workshop concluded with another plenary session that discussed various weighting approaches, including discrete choice and conjoint analysis from the ANCA-Associated Vasculitis working group, and outlined future directions for research on composite outcome methods., Results: The breakout exercise revealed the challenges in assigning relative importance to different domains, highlighting the variability in participant perspectives. Consensus discussions highlighted the diversity in approaches to weighting, the need for appropriate methods to determine domain weights and the impact of such weights on the interpretation of composite scores., Conclusion: The OMERACT 2023 workshop underscored the significance of a systematic approach to weighting components in composite outcome development. It highlighted the complexity of achieving consensus on the importance of domains and the role of incorporating the perspectives of patient research partners in this process. Future research directions include refining weighting methodologies, moving composites through the OMERACT Filter and enhancing understanding of their implications for clinical trials. The findings contribute to the ongoing discourse on optimizing composite outcome measures in rheumatology and beyond, advocating for a balanced integration of scientific rigour and patient-centeredness in their development., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Peter Tugwell receives consulting fees from Reformulary Group for providing independent medical consultation professional services to the firms listed in this section. Participation on a Data Safety Monitoring Board or Advisory Board for UCB Biopharma GmbH & SPRL Parexel International Prahealth Sciences. Is an independent Committee Member for clinical trial Data Safety Monitoring Boards for FDA approved trials being conducted by: UCB Biopharma GmbH & SPRL Parexel International Prahealth Sciences Other financial or non-financial interests with Abbvie, Astra Zenaca, Aurinia, BMS, Centrexion, GSK, Horizon Pharma Inc, Janssen, Novartis, Pfizer & Sparrow. He is [unpaid] Chair of the Management Group of a registered non-profit independent medical research organization, OMERACT, whose goal is to improve and advance the health outcomes for patients suffering from musculoskeletal conditions. OMERACT receives arms-length funding from 8 companies. Dorcas Beaton has an unpaid leadership role as a member of the Management team at OMERACT, co-chair of the methods group, and technical advisory group of OMERACT. Maarten de Wit receives consulting fees from Evidera (Patient Partner Advisory Council), honoraria from UCB 2022, 2023 for facilitating a workshop. Sara Monti received consulting fees from CLS-Vi for AstraZeneca All other authors have no conflicts to declare., (Copyright © 2024. Published by Elsevier Inc.)

Background: Managing postoperative setting, regarding pain and anxiety after cesarean delivery is crucial for the mother's recovery, her emotional well-being, mother-infant bonding and initiating breastfeeding. Although some research have suggested that aromatherapy with lavender essential oil can be effective in reducing pain and anxiety in various medical settings, the efficacy of lavender aromatherapy in the postoperative setting after cesarean delivery is less well-studied. We aimed to assess the effectiveness of lavender essential oil therapy in the management of pain and anxiety after cesarean delivery., Methods: This was a monocentric randomized controlled double-blind trial conducted over a period of five months during 2023. A hundred women undergoing c-sections under spinal anesthesia were enrolled and randomly assigned; using block randomization of 4 items per block with allocation ratio 1:1, into two groups: The aromatherapy group (receiving inhaled Lavender essential oil) versus the placebo group (receiving distilled water instead). The primary outcomes were pain (at rest and after mobilization) and anxiety levels and after the intervention. This trial was registered on clinical-trials.org (NCT06387849)., Results: A total of 100 women were included (50 women in each group aromatherapy and the placebo group). The two groups were comparable regarding baseline characteristics and pre-intervention parameters with no statistically significant difference. After the intervention, the pain at rest (38,76 ± 22,9 vs. 23,84 ± 18,01; p < 0.001), the pain after mobilization (60,28 ± 23,72 vs. 40,12 ± 22,18; p < 0.001), and degree of anxiety (46,76 ± 6,59 vs. 44,3 ± 5,17; p = 0.03) were all significantly lower in the aromatherapy group. No adverse effects were reported by participants in both groups., Conclusion: Aromatherapy using Lavender essential oil is effective in reducing pain and anxiety after cesarean delivery without adverse effects., Competing Interests: Declarations. Ethics Approval and Consent to Participate: The study protocol was approved by the local Institutional Review Board (approval no. 03/2023). This trial was registered on clinical-trials.org (NCT06387849) on April 2024. Competing Interests: The authors declare no competing interests. All included women gave their informed written consent to take part in the study after explaining its purpose., (© 2024. The Author(s).)

The teratogenic potential of valproate in pregnancy is well established; however, evidence regarding the long-term safety of other antiseizure medications (ASMs) during pregnancy remains limited. Using routinely collected primary care data from the UK and nationwide Swedish registries to create a cohort of 3,182,773 children, of which 17,495 were exposed to ASMs in pregnancy, we show that those exposed to valproate were more likely to receive a diagnosis of autism, intellectual disability, and ADHD, when compared to children not exposed to ASMs. Additionally, children exposed to topiramate were 2.5 times more likely to be diagnosed with intellectual disability (95% CI: 1.23-4.98), and those exposed to carbamazepine were 1.25 times more likely to be diagnosed with autism (95% CI: 1.05-1.48) and 1.30 times more likely to be diagnosed with intellectual disability (95% CI: 1.01-1.69). There was little evidence that children exposed to lamotrigine in pregnancy were more likely to receive neurodevelopmental diagnoses. While further research is needed, these findings may support considering safer treatment alternatives well before conception when clinically appropriate., Competing Interests: Competing interests T.T. has received support to the EURAP pregnancy registry from Accord, Eisai, GSK, UCB, Bial, Sanofi, GW Pharma, Teva, Angelini Pharma, Zentiva, SF Group, Glenmark and personal fees from Eisai, Sanofi, UCB and Angelini Pharma outside the submitted work. BL reports receiving consulting fees from Beasley Allen Law Firm, Patterson Belknap Webb & Tyler LLP and AlphaSights. None of the above entities had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The remaining authors have no conflicts of interest., (© 2024. The Author(s).)

Background: As prevalence of tobacco use falls, socioeconomic inequalities in tobacco use are increasing in many high-income countries. Evidence is lacking on the effect of preventive interventions on socioeconomic inequalities in smoking initiation among adolescents. We evaluated whether a multicomponent school-based prevention programme with parental involvement has differential effects on smoking initiation across socioeconomic groups and affects the magnitude of socioeconomic inequalities in smoking initiation., Methods: A secondary analysis of data from a 3-year cluster randomised controlled trial, the TOPAS study, conducted in Sweden from 2018 to 2021. Schools were randomised either to the full programme (Tobacco-Free Duo, T-DUO) or minimal intervention (EDU). The analysis was conducted according to intention to treat for the primary outcome, the probability of remaining a non-user of cigarettes at the end of compulsory school (ages 15-16). Parents' educational attainment was the socioeconomic variable. Differential effects were analysed by comparing adolescents exposed to T-DUO with those exposed to EDU within each socioeconomic group. The effect of the intervention on the magnitude of inequalities was analysed by comparing several measures of absolute and relative inequalities between T-DUO and EDU., Results: At the end of follow-up, the full programme had a similar, at most moderate effect on smoking initiation in all socioeconomic groups (relative risk 1.13 (95% CI 1.02 to 1.25) in the middle group). The programme did not significantly affect the magnitude of inequalities (Slope Index of Inequality difference 1.49 (95% CI -15.34 to 18.32))., Discussion: Socioeconomic inequalities in smoking initiation remain substantial. Our results indicate the absence of an effect of the programme T-DUO on these inequalities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: HPV infection is well-recognized as a cause of nearly all cases of cervical cancer. There are currently three prophylactic HPV vaccines; a bivalent (Cervarix), a quadrivalent (Gardasil), and a nonavalent vaccine (Gardasil- 9). With the recent rollout of HPV vaccines in Nigeria, it is imperative to understand potential barriers and facilitators to its uptake., Objectives: The objectives of this study were to evaluate the awareness, perception, and willingness to accept HPV vaccine and explore enablers and barriers to HPV vaccine uptake among adolescents and caregivers., Methods: Four focus group discussions were conducted with adolescents from public and private secondary schools in Plateau, 4 with the parents of adolescents, and one IDI with the head of ANCOPSS. Each FGD had between 8-12 participants. Interviews were recorded and notes were taken. The interviews were transcribed, codes were generated and analysis was conducted using a thematic framework approach with NVIVO version 11 software., Results: Most participants demonstrated inadequate knowledge and poor perception of HPV and the vaccine. Girls were willing to accept the vaccine, while boys saw it as a female problem. Parents had limited knowledge but expressed willingness to allow their children to be vaccinated. The fear of side effects, poor vaccine quality, and lack of parental approval were major barriers expressed by the girls while myths and misconceptions regarding the vaccine interference with fertility and as a means of population control were significant barriers on the parts of the parents., Conclusion: Low awareness and poor perception of HPV vaccine exist among adolescents and caregivers. Long-term individual and community-level interventions are needed to provide accurate information address knowledge gaps and promote inclusive access., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Objective: In Sweden, the prevalence of daily smoking has decreased substantially over the past few decades. However, a socioeconomic divide is evident, contributing to health inequities. The current study focuses on the needs, facilitators, and barriers in relation to quitting smoking among individuals in disadvantaged areas and explores their perception of digital tools for smoking cessation., Method: Semi-structured interviews were conducted with 30 participants in Stockholm County between 2022 and 2023. Participants were recruited through health care centres, dental clinics, and civil society actors. A thematic analysis was performed., Results: Two cross-cutting main themes were identified; 1) Motivational factors and barriers in smoking cessation, including the subthemes "health, concern for loved ones and economic aspects" and "emotional, environmental, and cultural barriers" and 2) Benefits and limitations of a digital tool for smoking cessation, including the subthemes"important/relevant features in a digital app" and "limitations of digital support"., Conclusions: The results reveal that most participants want to quit smoking but perceive it as difficult. The study highlights the importance of addressing social disparities in smoking and the need for accessible smoking cessation support. While mobile apps are viewed as promising for smoking cessation by some of the participants, scepticism exists among others. Moving forward, personalized approaches that integrate digital tools with traditional methods for smoking cessation can be important to reduce smoking prevalence. Ensuring accessibility of effective smoking cessation support for all is a key public health interest., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Aims: The transition from adolescence to young adulthood, often referred to as 'emerging adulthood', is a challenging period in life, and mental health problems are common. Although a large number of studies have shown that social support is linked with fewer mental health problems, few longitudinal studies have examined these associations during this life phase. The aim of the current study was to examine the associations between perceived social support from different sources - family, friends and significant other - at age 17-18 and symptoms of depression and anxiety at age 20-21., Methods: Data were obtained from the cohort study Futura01 based on a Swedish national sample of adolescents attending grade 9 in 2016/2017. We used survey information from 2019 (age 17-18) and 2022 (age 20-21) and linked registry information ( N =2722). Symptoms of depression and anxiety were measured by the Patient Health Questionnaire-4 (PHQ-4) at age 20-21. Perceived social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS) at age 17-18. Control variables included sociodemographic characteristics and indicators of mental health problems at age 17-18. Binary logistic regressions were performed., Results: When mutually adjusting for all sources of perceived social support, family support at age 17-18 had inverse associations with symptoms of both depression and anxiety at age 20-21. Perceived support from friends was associated with subsequent symptoms of anxiety only., Conclusions: Perceived social support can be a protective factor against mental health problems in emerging adulthood. The family serves a particularly important source of social support., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

The mental health of university students has become a significant cause for worry and public health concerns globally. Studies suggest that many mental health problems for example, depression, anxiety, phobia, suicidal behaviour, and substance use disorder among others, typically arise within the age bracket of 15-25 years, which coincides with the period when many individuals are pursuing higher education. Implementing structural interventions and broad organizational reforms to address student mental health has proven to be advantageous. The potential benefits that can be achieved from investing in students' mental health are improved academic performance, student success and a reduction in discontinuous school enrolment or dropout especially in resource-limited environments. This report presents a research-based multidisciplinary mental health program being implemented at a Nigerian University called the University of Ilorin Tertiary Institution Mental Health Programme (Unilorin TIM Healthcare Programme), aimed at addressing the mental health needs of tertiary institution students. The programme which incorporates preventive education such as enlightenment programs on campus, workshops on stress management, resilience building and coping strategies, amongst other initiatives has recorded significant benefits with positive feedback from the beneficiaries. It is hoped that it will be a model for other institutions within and outside Nigeria. Newborn jaundice (NNJ), especially due to ABO incompatibility, is a major global health concern. Phototherapy is the standard treatment, with exchange transfusions reserved for severe cases. However, in some babies these therapies may be ineffective, requiring additional immunomodulatory treatments. Limited access to these., (Copyright © 2024 Nigerian Medical Association.)

Context: There are uncertainties regarding to what extent poor vision and distracting tasks reduce balance and associate with fracture risk., Objective: To investigate the associations between body sway assessed under different visual and multitasking conditions and later risk of fractures in older adults., Design: Cohort study., Setting: Umeå municipality, Sweden., Patients or Other Participants: N=5,437 community-dwelling 70-year-old individuals who participated in a population-based health examination., Main Outcome Measure: Body sway at baseline was measured using a Wii balance board in the lateral and anterior-posterior direction during three different tests, including with eyes open, dual-tasking, and eyes closed. Fractures during follow-up were ascertained using nationwide registers., Results: During a mean (range) follow-up of 4.8 (0.0-10.6) years, 348 women (12.3%) and 149 men (5.7%) sustained a fracture. In women, both anterior-posterior sway velocity (hazard ratio [HR], 1.05 95% CI, 1.01-1.08, per mm/s increase) and variation in sway velocity (HR, 1.05, 95% CI, 1.01-1.09, per standard deviation [SD] increase) during dual-tasking testing were associated with higher risk of fracture after adjustment for covariates. During testing with eyes closed, all measures of lateral sway were associated with the risk of fracture (P<0.01 for all). In men, variation in lateral (HR, 1.03, 95% CI, 1.00-1.07 per SD increase) and anterior-posterior sway velocity (HR 1.05, 95% CI, 1.01-1.10 per SD increase) during dual-tasking testing were associated with higher risk of fracture., Conclusions: Higher body sway velocity and larger variation in sway velocity were associated with higher risk of fractures in both 70-year-old men and women, especially under more challenging testing conditions., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms.)

Background and Aims: In coronavirus disease 2019 (COVID-19) patients, several serum biomarkers have been identified. Upon intensive care unit (ICU) admission, these laboratory markers become more crucial to distinguish between patients with severe cases of COVID-19. It might assist doctors in predicting the course of illnesses and treating patients appropriately. This work was to investigate the role of biomarkers in patients with COVID-19 classification admitted to the hospital and identified by reverse transcription polymerase chain reaction (RT-PCR)., Methods: Peripheral blood sample was taken from COVID-19 cases isolated on admission to determine C-reactive protein (CRP), D-dimer, Fibrinogen, neutrophil-lymphocyte ratio (NLR), leukocytes CRP ratio (LeCR), lymphocyte-CRP ratio (LCR), interleukin-6 (IL6), leukocytes interleukin 6 ratio (LeIL6), systemic inflammatory index (SII), platelet-to-lymphocyte ratio (PLR), and tissue plasminogen activator inhibitor one (tPAI-1). Follow-up for IL6, Ferritin, D-dimer, and tPAI-1 were determined on the 3 rd and 7 th days., Results: Comparisons of severity revealed that hypertension, chronic obstructive pulmonary disease (COPD), and Ischemia were major risk factors in COVID-19 patients. There was a statistically significant difference between the test groups for fibrinogen (p < 0.000), IL6 (p < 0.009), LeCR (p < 0.006), and LCR (p < 0.011)., Conclusion: Based on laboratory test findings at the time of ICU admission, we can distinguish severe cases of COVID-19., Competing Interests: The authors declare no competing interests in this work., (© 2024 Salman et al.)

Introduction: People who smoke are at higher risk of Coronavirus Disease-2019 (COVID-19) hospitalizations and deaths and might benefit greatly from high COVID-19 vaccination coverage. Studies on tobacco use and COVID-19 vaccine uptake in the general population are lacking., Aims and Methods: We conducted a cohort study utilizing linked data from 42 935 participants from two national surveys in Finland (FinSote 2018 and 2020). Exposures were smoking and smokeless tobacco (snus) use. The primary outcome was the uptake of two COVID-19 vaccine doses. Secondary outcomes were the uptake of one COVID-19 vaccine dose; three COVID-19 vaccine doses; time between the first and second dose; and time between the second and third dose. We examined the association between tobacco use and COVID-19 vaccine uptake and between-dose spacing in Finland., Results: People who smoke had a 7% lower risk of receiving two COVID-19 vaccine doses (95% confidence interval [CI] = 0.91; 0.96) and a 14% lower risk of receiving three doses (95% CI = 0.78; 0.94) compared to never smokers. People who smoked occasionally had a lower risk of receiving three vaccine doses. People who currently used snus had a 28% lower uptake of three doses (95% CI = 0.56; 0.93) compared to never users but we did not find evidence of an association for one or two doses. We did not find evidence of an association between tobacco use and spacing between COVID-19 vaccine doses., Conclusions: People who smoke tobacco products daily, occasionally, and use snus had a lower uptake of COVID-19 vaccines. Our findings support a growing body of literature on lower vaccination uptake among people who use tobacco products., Implications: People who smoke or use snus might be a crucial target group of public health efforts to increase COVID-19 vaccinations and plan future vaccination campaigns., Clinical Trials Registration Number: NCT05479383., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: A rise in absenteeism among healthcare workers (HCWs) was recorded during the COVID-19 pandemic, mostly attributed to SARS-CoV-2 infections. However, evidence suggests that COVID-19 vaccine-related side effects may have also contributed to absenteeism during this period. This study aimed to synthesize the evidence on the prevalence of absenteeism related to COVID-19 vaccine side effects among HCWs. Methods: The inclusion criteria for this review were original quantitative studies of any design, written in English, that addressed absenteeism related to the side effects of COVID-19 vaccines among HCWs. Four databases (PubMed, Scopus, Embase, and the Web of Science) were searched for eligible articles on 7 June 2024. The risk of bias was assessed using the Newcastle-Ottawa scale. Narrative synthesis and a meta-analysis were used to synthesize the evidence. Results: Nineteen observational studies with 96,786 participants were included. The pooled prevalence of absenteeism related to COVID-19 vaccine side effects was 17% (95% CI: 13-20%), while 83% (95% CI: 80-87%) of the vaccination events did not lead in any absenteeism. Study design, sex, vaccination dose, region, and vaccine type were identified as significant sources of heterogeneity. Conclusions: A non-negligible proportion of HCWs were absent from work after reporting side effects of the COVID-19 vaccine. Various demographic factors should be considered in future vaccination schedules for HCWs to potentially decrease the burden of absenteeism related to vaccine side effects. As most studies included self-reported questionnaire data, our results may be limited due to a recall bias. Other: The protocol of the study was preregistered in the PROSPERO database (CRD42024552517).

Background: Social and emotional development are important aspects of young children's well-being but can be difficult to assess during the first years of life. The Ages and Stages Questionnaire: Social-Emotional Second Edition (ASQ:SE-2) is a parent-rated assessment tool for child socioemotional development between 1 and 72 months of age. In this study, we examined the psychometric properties of this instrument in 18-month-old Swedish children., Methods: Data from 586 Swedish-speaking parents of 18-month-old children were included. In addition to the ASQ:SE-2, parents also completed the Social-Emotional Assessment/Evaluation Measure (SEAM), and the child's socioemotional development was assessed by a nurse at the Child Health Services. We used exploratory factor analysis and Rasch methodology to explore dimensionality and item properties of the ASQ:SE-2. Furthermore, we used Pearson and Spearman rank correlations to study associations with the SEAM and the nurse assessment., Results: An exploratory factor analysis suggested a one-factor model for the ASQ:SE-2 items. However, several items showed weak factor loadings, and a final scale including 18 of the original 29 items was further explored. The Rasch analysis revealed problems with targeting, and the final scale showed acceptable reliability only in the 22% with the highest levels of socioemotional difficulties. The total score of the final version showed a strong association with the parent-rated SEAM but a weak association with the nurse observations. We labeled the reduced 18-item scale Social Interaction., Conclusions: The results of this study highlight that the original Swedish version of the ASQ:SE-2 for 18-month-old children may not be an adequate tool for assessing social and emotional competencies in a normal population since acceptable reliability was reached only in children with the greatest difficulties (above the 78th percentile). In conclusion, the suggested 18-item version works best either as a screening instrument for problems with social interaction or as a continuous measure of such problems in children with high levels of social interaction difficulties., (© 2024. The Author(s).)

Previous research has suggested an unexpected negative association between smoking and susceptibility to COVID-19. This study, drawing on population-based data from three Nordic countries-Sweden, Norway, and Finland-aims to investigate this association further, capitalizing on diversity introduced by different containment measures. The objective of this research was to examine the association between cigarette smoking and snus (smokeless tobacco) use and the risk of confirmed COVID-19 infection. A pooled analysis integrating original data from 547,685 participants across three countries. We used a multiple imputation approach based on conditional probabilities to impute the systematically missing covariates. The associations between tobacco use and COVID-19 infection were assessed, controlling for potential confounding factors. Current cigarette smokers had a lower risk of a confirmed COVID-19 case, whereas there was an increased risk among snus users. Our sensitivity analysis confirmed that the associations between tobacco use and COVID-19 infection risk are robust, remaining consistent regardless of whether covariate imputation was applied. Findings support a negative association between smoking and SARS-CoV-2 infection, but not the hypothesis that nicotine may be protective against the risk of contracting SARS-CoV-2 infection., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association.)

Introduction: Interviews are central to many qualitative studies in health professions education (HPE). However, researchers often struggle to elicit rich data and engage diverse participants who may find this strategy exclusionary. Elicitation techniques are strategies tailored to address these challenges, enhancing oral conversations through other forms of interaction-for example, participant photography and neighbourhood walks. These strategies are tailored to elicit the rich data needed to address complex problems and meaningfully engage participants. Unfortunately, guidance on these techniques is scattered across literatures from diverse fields. In this synthesis, we offer an overview of the elicitation techniques available and advice about how to choose between them., Methods: We conducted an integrative review, drawing on methodological literature from across the health and social sciences. Our interdisciplinary searches yielded 3056 citations. We included 293 citations that were methodologically focused and discussed elicitation techniques used in interviews with adults. We then extracted specific elicitation techniques, summarising each technique to capture key features, as well as strengths and weaknesses. From this, we developed a framework to help researchers identify challenges in their interview-based research and to select elicitation techniques that address their challenges., Results: To enrich data, researchers might seek to shift conversations away from participants' entrenched narratives, to externalise conversations on sensitive topics, or to elicit affect, tacit knowledge or contextual details. When empowering participants, researchers might seek to increase equity between the researcher and participant or foster interview accessibility across diverse participant populations., Discussion: When chosen with study goals in mind, elicitation techniques can enrich interview data. To harness this potential, we need to re-conceptualise interviews as co-production of knowledge by researcher(s) and participant(s). To make interviews more equitable and accessible, we need to consider flexibility so that each participant can engage in ways that best suit their needs and preferences., (© 2024 The Author(s). Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Introduction: The number of adolescents seeking professional help for depression is increasing and, despite advances in treatment, large unmet treatment needs remain. In the current protocol, we describe the design and methodology of a randomised controlled trial (RCT) to evaluate the clinical efficacy of two forms of internet-delivered behavioural activation (I-BA), with and without therapist support, in reducing depressive symptoms, compared with treatment as usual (TAU). Secondary objectives include examining the 12-month maintenance of the treatment effects and conducting a health economic evaluation of the interventions., Methods and Analysis: In this single-blinded RCT, we aim to include 215 participants aged 13-17 years with mild to moderate depression who will be randomised (1:1:1 ratio) to 10 weeks of either therapist-guided or self-guided I-BA, or TAU provided by regular mental health clinics. Data will be collected at baseline, weekly for the initial 10 weeks, post-treatment and at 3 and 12-month follow-ups. The primary endpoint is the 3-month follow-up. The primary outcome is blinded clinician-rated severity of depressive symptoms, measured by the Children's Depression Rating Scale-Revised. Treatment response is defined as a score of 'Much improved' or 'Very much improved' on the Clinical Global Impression-Improvement Scale, administered at the primary endpoint. Outcome assessors will be blinded to treatment conditions at all assessment points. A health economic evaluation of I-BA will be performed, both in the short term (primary endpoint) and the long term (12-month follow-up)., Ethics and Dissemination: Ethical approval was obtained from the Swedish Ethical Review Authority in June 2021. The final participant was enrolled on 3 May 2024 and expected to reach the primary endpoint by November 2024. The results of this study will be disseminated through publication in peer-reviewed journals, presented at conferences and communicated to healthcare providers and the public., Trial Registration Number: NCT04977856., Competing Interests: Competing interests: DM-C receives royalties for contributing articles to UpToDate, outside the current work. DM-C and ES are part owners of Scandinavian E-Health AB. Scandinavian E-Health AB was not involved in the funding, design, interpretation of study results or writing of the manuscript., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)