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Background: The Swedish Primary Health Care (PHC) system has, like in other European countries, undergone a gradual transition towards marketization and privatization, most distinctly through a 2010 choice reform. The reform led to an overall but regionally heterogenous expansion of private PHC providers in Sweden, and with evidence also pointing to possible inequities in various aspects of PHC provision. Evidence on the reform's impact on population-level primary health care performance and equity in performance remains scarce. The present study therefore aimed to examine whether the increase in private provision after the reform impacted on population-average rates of avoidable hospitalizations, as well as on corresponding socioeconomic inequities. Methods: This register-based study used a multiple-group interrupted time-series design for the study period 2001-2017, with the study population (N = 51 million observations) randomly drawn from the total Swedish population aged 18-85 years. High, medium, and low implementing comparison groups were classified by tertiles of increase in private PHC providers after the reform. PHC performance was measured by avoidable hospitalizations, and socioeconomic position by education and income. Interrupted time series analysis based on individual-level data was used to estimate the reform impact on avoidable hospitalization risk, and on inequities through the Relative Index of Inequality (RII). Results: All three comparisons groups displayed decreasing risk of avoidable hospitalizations but increasing socioeconomic inequities across the study period. Compared to regions with little change in provision after the reform, regions with large increase in private provision saw a steeper decrease in avoidable hospitalizations after the reform (relative risk (95%): 1.6% (1.1; 2.1)), but at the same time steeper increase in inequities (by education: 2.0% (0.1%; 4.0); by income: 2.2% (-0.1; 4.3)). Conclusions: The study suggests that the

Aims: To assess the association between experiences of discrimination and mental health among the Sámi population in Sweden. Methods: Cross-sectional study among the self-identified Sámi population living in Sweden in 2021, registered in the electoral roll of the Sámi Parliament, the reindeer mark register and the ‘Labour statistics based on administrative sources’. The analysis was based on a final sample of 3658 respondents aged between 18 and 84 years. Adjusted prevalence ratios aPRs for psychological distress (Kessler scale), self-reported anxiety and depression were estimated for four different forms of discrimination (direct experience of discrimination, offended because of ethnicity, historical trauma, and combined discrimination). Results: Higher aPRs of psychological distress, anxiety and depression were observed in women experiencing direct discrimination because of their ethnicity, having been offended because of their ethnicity, and those with a family history of discrimination. Among men, higher aPRs for psychological distress were observed in those experiencing the four different forms of discrimination, but not for anxiety. Depression was only detected in the case of having been offended. Adding experiences of discrimination was associated with a higher prevalence of negative outcomes for all the indicators in women and for psychological distress in men. Conclusions: The observed association between experiences of discrimination and mental health problems would support a gender approach when considering ethnic discrimination in public health policies concerning the Sámi in Sweden.

Objectives: Targeted social distancing measures were widely implemented for nursing home residents when the extremely high coronavirus disease 2019 mortality in this setting became apparent. However, there is still scarce rigorous research examining how the pandemic and accompanying social distancing measures affected loneliness in this group. This prospective nationwide Swedish study of nursing home residents aimed to examine the impact on loneliness of the early phase of the pandemic and of a national visiting ban at nursing homes. Methods: A panel was selected from a total population survey of all nursing home residents in Sweden March–May 2019 and 2020 (N = 11,782; age range 70–110 years; mean age 88.2 years; 71% women). Prospective pretest–posttest and controlled interrupted time series (ITS) designs were employed, with time trends estimated by date of returned questionnaire. Generalized linear models were used for estimation of effects, adjusting for demographic-, survey-, and health-related covariates. Results: Loneliness prevalence increased from 17% to 19% from 2019 to 2020 (risk ratio, RR (95% confidence interval, CI) = 1.104 (1.060; 1.150)), but which was explained by self-reported health (RR (95% CI) = 1.023 (0.982; 1.066)). No additional impact of the visiting ban on loneliness trends was found in the ITS analyses (RR (95% CI) = 0.984 (0.961; 1.008)). Discussion: The moderate but health-dependent increased risk of loneliness, and the lack of impact of the nationwide visiting ban at nursing homes, suggests that this ostensibly vulnerable group of nursing home residents also shows signs of resilience, at least during the early phase of the pandemic.

Whereas assessing health is a mandatory feature of environmental impact assessments (EIAs) in Sweden, health impacts are often vaguely described, making their health preventive role meaningless. In 2006, a mine was planned in the reindeer grazing lands of a Sámi community in northern Sweden. While an EIA was conducted in 2013, health was superficially addressed. The aim of this study was to describe and reflect on the health impact assessment (HIA) process that assessed the potential health risks and/or benefits that the mine establishment could bring to the Sámi community.The classic five steps of an HIA are presented. The literature review showed a scarcity of studies regarding HIA on mining in indigenous territories. Participants in the study were currently experiencing negative psychosocial health effects and described potential adverse social and health effects originating from the loss of their traditional way of life.Despite certain challenges, this study proved that it is possible to conduct a comprehensive HIA in the context of Sámi health research. Given that mining in Sweden occurs mostly in Sámi territory and the adverse health effects found in this study, the lack of comprehensive HIAs on mining projects in Sweden raises serious concerns.