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Fritzell, S., Gähler, M. & Fransson, E. (2020). Child living arrangements following separation and mental health of parents in Sweden. SSM - Population Health, 10, Article ID 100511.
Open this publication in new window or tab >>Child living arrangements following separation and mental health of parents in Sweden
2020 (English)In: SSM - Population Health, ISSN 2352-8273, Vol. 10, article id 100511Article in journal (Refereed) Published
Abstract [en]

Father involvement and joint physical custody in post-separation families are increasingly common. In Sweden, 35 percent of the children of separated parents live equally much with both parents. Since parenthood is gendered, the associations between child living arrangement and parental health may vary between women and men. This study analyzes the association between children's living arrangement and mental health of parents, and how this interacts with material and social circumstances. Drawing on The Swedish Survey of Living Conditions (ULF) 2008-2013, the association between child living arrangements and mental health (worry/anxiety) of parents in five family structures: two biological parents, reconstituted with joint or main/sole custody arrangements, single with joint physical custody, and single with main or sole custody, were analyzed. Data on 9,225 mothers and fathers with resident children aged 0-17 were analyzed by logistic regressions for average marginal effects adjusting for socio-demographic, socio-economic and social factors. Analyses of interaction effects were made using the synergy index. Substantial family type differences were found in mental health between two biological parent family and all other family types for mothers, and two biological parent family and single parents for fathers. For the single mothers, the higher risk for worry and anxiety was still found following controls for socioeconomic factors. For fathers, the only differences that remained following control for socioeconomic factors was that of single fathers with children in joint physical custody. Interaction effects were found for the combination of single motherhood and non-employment, indicating a higher risk of mental health problems for single mothers (both with joint and sole custody), than would be expected from a simple addition of these exposures, suggesting that this is a vulnerable group. The results indicate that joint custody is associated with higher risk for worry and anxiety for the parents, especially for mothers both re-partnered and single, but also for single fathers.

Keywords
Alternate living, Anxiety, Cross-sectional, Father, Mother, Shared custody, Sweden, Worry
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-404649 (URN)10.1016/j.ssmph.2019.100511 (DOI)31799363 (PubMedID)
Available from: 2020-02-25 Created: 2020-02-25 Last updated: 2020-02-25Bibliographically approved
Wikman, A., Axfors, C., Iliadis, S. I., Cox, J., Fransson, E. & Skalkidou, A. (2019). Characteristics of women with different perinatal depression trajectories. Journal of Neuroscience Research
Open this publication in new window or tab >>Characteristics of women with different perinatal depression trajectories
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2019 (English)In: Journal of Neuroscience Research, ISSN 0360-4012, E-ISSN 1097-4547Article in journal (Refereed) Epub ahead of print
Abstract [en]

Maternal perinatal depression (PND), a common mental disorder with a prevalence of over 10%, is associated with long-term health risks for both mothers and offspring. This study aimed at describing characteristics related to background and lifestyle, pregnancy, delivery, and postpartum of different PND trajectories defined according to the onset of depressive symptoms. Participants were drawn from a large population-based cohort study in Uppsala, Sweden (n = 2,466). Five trajectory groups of depressive symptom onset were created using the Edinburgh Postnatal Depression Scale ≥13 (pregnancy) or ≥12 points (postpartum): (a) healthy (60.6%), (b) pregnancy depression (8.5%), (c) early postpartum onset (10.9%), (d) late postpartum onset (5.4%), and (e) chronic depression (14.6%). In multinomial logistic regressions, the associations between trajectories and the included characteristics were tested using the healthy trajectory as reference. Background characteristics (younger age, lower education, unemployment) were primarily associated with pregnancy depression and chronic depression. Characteristics associated with all PND trajectories were smoking prior to pregnancy, migraine, premenstrual mood symptoms, intimate partner violence, interpersonal trauma, negative delivery expectations, pregnancy nausea, and symphysiolysis. Nulliparity, instrumental delivery, or a negative delivery experience was associated with early postpartum onset. Postpartum factors (e.g., infantile colic, lack of sleep, low partner support, and bonding difficulties) were associated with early and late postpartum onset together with chronic depression. The findings suggest that different PND trajectories have divergent characteristics, which could be used to create individualized treatment options. To find the most predictive characteristics for different PND trajectories, studies with even larger and more diverse samples are warranted.

Keywords
depression, depressive disorder, mental disorders, mothers, postpartum, pregnancy, self-reports
National Category
Obstetrics, Gynecology and Reproductive Medicine Psychiatry
Identifiers
urn:nbn:se:uu:diva-378699 (URN)10.1002/jnr.24390 (DOI)30723972 (PubMedID)
Available from: 2019-03-08 Created: 2019-03-08 Last updated: 2019-04-11Bibliographically approved
Danielson, M., Månsdotter, A., Fransson, E., Dalsgaard, S. & Larsson, J.-O. (2019). Clinicians' attitudes toward standardized assessment and diagnosis within child and adolescent psychiatry. Child and Adolescent Psychiatry and Mental Health, 13, Article ID 9.
Open this publication in new window or tab >>Clinicians' attitudes toward standardized assessment and diagnosis within child and adolescent psychiatry
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2019 (English)In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 13, article id 9Article in journal (Refereed) Published
Abstract [en]

Background: There is a strong call for clinically useful standardized assessment tools in everyday child and adolescent psychiatric practice. The attitudes of clinicians have been raised as a key-facilitating factor when implementing new methods. An explorative study was conducted aimed to investigate the clinicians' attitudes regarding standardized assessments and usefulness of diagnoses in treatment planning.

Methods: 411 mental health service personnel working with outpatient and inpatient assessment and treatment within the specialist child and adolescent mental health services, Stockholm County Council were asked to participate in the study, of which 345 (84%) agreed answer a questionnaire. The questionnaire included questions regarding Attitudes toward Standardized Assessment and Utility of Diagnosis. Descriptive analyses were performed and four subscales were compared with information from a similar study in US using the same instruments. The demographic and professional characteristics (age, working years, gender, education, profession, management position, involvement in assessment, level of service) in terms of prediction of attitudes were studied by univariate and multivariate linear regressions.

Results: Overall, the clinicians had quite positive attitudes and were more positive compared to a similar study conducted in the US earlier. There were differences in attitudes due to several characteristics but the only characteristic predicting all subscales was type of profession (counselor, nurse, psychiatrist, psychologist, other), with counselors being less positive than other groups.

Conclusion: The overall positive attitudes toward standard assessment are of importance in the development of evidence-based practice and our study implies that clinicians in general value and are willing to use standardized assessment. Nevertheless, there are specific issues such as adequate training and available translated assessment instrument that need to be addressed. When implementing new methods in practice, there are general as well as specific resistances that need to be overcome. Studies in different cultural settings are of importance to further extend the knowledge of what is general and what is specific barriers.

Keywords
Implementation, Mental health service, Standardized assessment, Utility
National Category
Psychiatry Pediatrics
Identifiers
urn:nbn:se:uu:diva-404680 (URN)10.1186/s13034-019-0269-0 (DOI)30792803 (PubMedID)
Available from: 2020-02-25 Created: 2020-02-25 Last updated: 2020-02-25Bibliographically approved
Axfors, C., Bränn, E., Henriksson, H. E., Hellgren, C., Kallak, T. K., Fransson, E., . . . Skalkidou, A. (2019). Cohort profile: the Biology, Affect, Stress, Imaging and Cognition (BASIC) study on perinatal depression in a population-based Swedish cohort. BMJ Open, 9(10), Article ID e031514.
Open this publication in new window or tab >>Cohort profile: the Biology, Affect, Stress, Imaging and Cognition (BASIC) study on perinatal depression in a population-based Swedish cohort
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 10, article id e031514Article in journal (Refereed) Published
Abstract [en]

PURPOSE: With the population-based, prospective Biology, Affect, Stress, Imaging and Cognition (BASIC) cohort, we aim to investigate the biopsychosocial aetiological processes involved in perinatal depression (PND) and to pinpoint its predictors in order to improve early detection.

PARTICIPANTS: From September 2009 to November 2018, the BASIC study at Uppsala University Hospital, Sweden, has enrolled 5492 women, in 6478 pregnancies, of which 46.3% first-time pregnancies and with an average age of 31.5 years. After inclusion around gestational week 16-18, participants are followed-up with data collection points around gestational week 32, at childbirth, as well as three times postpartum: after 6 weeks, 6 months and 1 year. At the last follow-up, 70.8% still remain in the cohort.

FINDINGS TO DATE: In addition to internet-based surveys with self-report instruments, participants contribute with biological samples, for example, blood samples (maternal and from umbilical cord), biopsies (umbilical cord and placenta) and microbiota samples. A nested case-control subsample also takes part in cognitive and emotional tests, heart rate variability tests and bioimpedance tests. Subprojects have identified various correlates of PND of psychological and obstetric origin in addition to factors of the hypothalamic-pituitary-adrenal axis and immune system.

FUTURE PLANS: In parallel with the completion of data collection (final follow-up November 2019), BASIC study data are currently analysed in multiple subprojects. Since 2012, we are conducting an ongoing follow-up study on the participants and their children up to 6 years of age (U-BIRTH). Researchers interested in collaboration may contact Professor Alkistis Skalkidou (corresponding author) with their request to be considered by the BASIC study steering committee.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
cohort study, mother-child relations, pituitary-adrenal system, postpartum depression, pregnancy, psychoneuroimmunology
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-404667 (URN)10.1136/bmjopen-2019-031514 (DOI)31641004 (PubMedID)
Funder
Swedish Research Council, 523-2014-2342Swedish Research Council, 523-2014-07605Swedish Research Council, 521-2013-2339Göran Gustafsson Foundation for promotion of scientific research at Uppala University and Royal Institute of TechnologyMarianne and Marcus Wallenberg FoundationStiftelsen Söderström - Königska sjukhemmetSwedish Society of MedicineForte, Swedish Research Council for Health, Working Life and WelfareFredrik och Ingrid Thurings Stiftelse
Available from: 2020-02-25 Created: 2020-02-25 Last updated: 2020-03-27Bibliographically approved
Henriksson, H. E., White, R. A., Iliadis, S. I., Fransson, E., Papadopoulos, F., Sundström Poromaa, I. & Skalkidou, A. (2019). Spring peaks and autumn troughs identified in peripheral inflammatory markers during the peripartum period. Scientific Reports, 9, Article ID 15328.
Open this publication in new window or tab >>Spring peaks and autumn troughs identified in peripheral inflammatory markers during the peripartum period
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 15328Article in journal (Refereed) Published
Abstract [en]

Seasonal variations have recently been described in biomarkers, cell types, and gene expression associated with the immune system, but so far no studies have been conducted among women in the peripartum period. It is of note that pregnancy complications and outcomes, as well as autoimmune diseases, have also been reported to exhibit seasonal fluctuations. We report here a clear-cut seasonal pattern of 23 inflammatory markers, analysed using proximity-extension assay technology, in pregnant women. The inflammatory markers generally peaked in the spring and had a trough in the autumn. During the postpartum period we found seasonality in one inflammatory marker, namely monocyte chemotactic protein 4 (MCP-4). Our findings suggest that seasonal variations in peripheral inflammatory markers are only observed during pregnancy. The results of this study could be valuable to professionals working within the field of immunology-related areas, and provide insight for the understanding of obstetric complications.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-381420 (URN)10.1038/s41598-019-51527-9 (DOI)000492825800038 ()31653981 (PubMedID)
Funder
Swedish Society of Medicine, 523-2014-2342 521-2013-2339Marianne and Marcus Wallenberg Foundation, MMW2011.0115Swedish Research Council, 523-2014-2342Swedish Research Council, 521-2013-2339
Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-11-29Bibliographically approved
Bergström, M., Sarkadi, A., Hjern, A. & Fransson, E. (2019). "We also communicate through a book in the diaper bag"-Separated parents' ways to coparent and promote adaptation of their 1-4 year olds in equal joint physical custody. PLoS ONE, 14(4), Article ID e0214913.
Open this publication in new window or tab >>"We also communicate through a book in the diaper bag"-Separated parents' ways to coparent and promote adaptation of their 1-4 year olds in equal joint physical custody
2019 (English)In: PLoS ONE, E-ISSN 1932-6203, Vol. 14, no 4, article id e0214913Article in journal (Refereed) Published
Abstract [en]

Joint physical custody (JPC) refers to a practice where children with separated parents share their time between the parents' respective homes. Studies on parents' views of JPC for young children are scarce. The aim of this interview study was to explore parents' perceptions on how they experience and practice equally shared JPC for their 1-4 year-olds in Sweden. Forty-six parents (18 fathers and 28 mothers) of 50 children (31 boys and 19 girls) under 5 years of age were interviewed. Parents were recruited through information in the media and represented a broad range of socioeconomic backgrounds, as well as both voluntary and court-ordered custody arrangements. The interviews were semi-structured and analyzed using systematic text condensation. Two themes emerged regarding the research question. In the first theme, Always free, never free, parents described their striving to coparent without a love relationship. While they appreciated the freedom of being a "half-time parent", doing things one's own way, they felt constrained by the long-term commitment to live close to and keep discussing child rearing issues with the ex-partner. Good communication was key and lessened parent's feelings of being cut-off from half of the child's life. When JPC was ordered by court or conflicts were intense, parents tried to have less contact and worried when the children were in the other home. The second theme, Is it right, is it good?, included descriptions of how the parents monitored the child's responses to the living arrangement and made changes to optimize their adjustment. Adaptations included visits for the child with the other parent mid-week, shared meals or adapting schedules. In conclusion, these parents worked hard to make JPC work and cause minimal damage to their children. Most parents were pleased with the arrangements with the notable exception of couples experiencing ongoing conflict.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2019
National Category
Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:uu:diva-382554 (URN)10.1371/journal.pone.0214913 (DOI)000463992600041 ()30970037 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0843
Available from: 2019-05-03 Created: 2019-05-03 Last updated: 2020-02-25Bibliographically approved
Bergström, M., Fransson, E., Wells, M. B., Köhler, L. & Hjern, A. (2018). Children with two homes: Psychological problems in relation to living arrangements in Nordic 2-9 year olds. Scandinavian Journal of Public Health
Open this publication in new window or tab >>Children with two homes: Psychological problems in relation to living arrangements in Nordic 2-9 year olds
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2018 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim: Joint physical custody, children spending equal time in each parents’ respective home after a parental divorce, is particularly common in Nordic compared with other Western countries. Older children have been shown to fare well in this practice but for young children there are few existing studies. The aim of this paper is to study psychological problems in 2- to 9-year-old Nordic children in different family forms. Methods: Total symptom score according to the Strengths and Difficulties Questionnaire as well as scores showing externalizing problems were compared among 152 children in joint physical custody, 303 in single care and 3207 in nuclear families through multiple linear regression analyses. Results: Children in single care had more psychological symptoms than those in joint physical custody (B = 1.08; 95% CI 0.48 to 1.67) and those in nuclear families had the least reported symptoms (B = −0.53; 95% CI −0.89 to −0.17). Externalizing problems were also lower in nuclear families (B = −0.28, 95% CI −0.52 to −0.04) compared with joint physical custody after adjusting for covariates. Conclusions: Young children with non-cohabiting parents suffered from more psychological problems than those in intact families. Children in joint physical custody had a lower total problem score than those in single care after adjusting for covariates. Longitudinal studies with information on family factors before the separation are needed to inform policy of young children’s post-separation living arrangements.

Keywords
Children, preschoolers, psychological problems, divorce, joint physical custody, parental separation, custody, Strengths and Difficulties Questionnaire, Nordic countries
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:uu:diva-357819 (URN)10.1177/1403494818769173 (DOI)
Available from: 2018-08-21 Created: 2018-08-21 Last updated: 2018-08-21
Bränn, E., Fransson, E., White, R. A., Papadopoulos, F. C., Edvinsson, Å., Kamali-Moghaddam, M., . . . Skalkidou, A. (2018). Inflammatory markers in women with postpartum depressive symptoms. Journal of Neuroscience Research
Open this publication in new window or tab >>Inflammatory markers in women with postpartum depressive symptoms
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2018 (English)In: Journal of Neuroscience Research, ISSN 0360-4012, E-ISSN 1097-4547Article in journal (Refereed) Epub ahead of print
Abstract [en]

Postpartum depression (PPD) is a devastating disorder affecting not only more than 10% of all women giving birth, but also the baby, the family, and the society. Compiling evidence suggests the involvement of the immune system in the pathophysiology of major depression; yet, the immune response in perinatal depression is not as well studied. The aim of this study was to investigate the alterations in peripheral levels of inflammatory biomarkers in 169 Swedish women with and without depressive symptoms according to the Edinburgh postnatal depression scale or the M.I.N.I neuropsychiatric interview at eight weeks postpartum. Among the 70 markers analyzed with multiplex proximity extension assay, five were significantly elevated in women with postpartum depressive symptoms in the adjusted LASSO logistic regression analysis: Tumor necrosis factor ligand superfamily member (TRANCE) (OR-per 1 SD increase = 1.20), Hepatocyte growth factor (HGF) (OR = 1.17) Interleukin (IL)-18 (OR = 1.06), Fibroblast growth factor 23 (FGF-23) (OR = 1.25), and C-X-C motif chemokine 1 (CXCL1) (OR 1.11). These results indicate that women with PPD have elevated levels of some inflammatory biomarkers. It is, therefore, plausible that PPD is associated with a compromised adaptability of the immune system.

Keywords
cytokines, immune system, inflammation, maternal depression, pregnancy, protein markers
National Category
Psychiatry Immunology in the medical area Psychology
Identifiers
urn:nbn:se:uu:diva-362471 (URN)10.1002/jnr.24312 (DOI)30252150 (PubMedID)
Funder
Swedish Research Council, 521-2013-2339Swedish Research Council, 523-2014-2342Marianne and Marcus Wallenberg Foundation, 2011-Skalkidou
Available from: 2018-10-05 Created: 2018-10-05 Last updated: 2018-12-10Bibliographically approved
Gustafsson, A. M., Fransson, E., Dubicke, A., Hjelmstedt, A. K., Ekman-Ordeberg, G., Silfverdal, S.-A., . . . Bohlin, K. (2018). Low levels of anti-secretory factor in placenta are associated with preterm birth and inflammation.. Acta Obstetricia et Gynecologica Scandinavica, 97(3), 349-356
Open this publication in new window or tab >>Low levels of anti-secretory factor in placenta are associated with preterm birth and inflammation.
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2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 3, p. 349-356Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Anti-secretory factor is a protein that regulates secretory and inflammatory processes and preterm birth is associated with inflammation. Therefore, our hypothesis was that anti-secretory factor might play a role in immune reactivity and homeostasis during pregnancy.

MATERIAL AND METHODS: Following spontaneous onset of labor and preterm or term delivery, placenta biopsies were collected. The levels of anti-secretory factor and markers of inflammation (CD68, CD163) and vascularization (CD34, smooth muscle actin) were analyzed by immunohistochemistry.

RESULTS: The 61 placental biopsies included 31 preterm (<37 weeks of gestation) and 30 term (37-41 weeks) samples. The preterm placentas exhibited lower levels of anti-secretory factor (p = 0.008) and larger numbers of CD68-positive cells (p < 0.001) compared to term. Preterm placentas had blood vessel of smaller diameter (p = 0.036) indicative of immaturity. The level of interleukin-6 in cord blood was higher after very preterm than term birth, suggesting a fetal inflammatory response. The placenta level of anti-secretory factor was positively correlated to the length of gestation (p = 0.025) and negatively correlated to the levels of the inflammatory markers CD68 (p = 0.015) and CD163 (p = 0.028).

CONCLUSIONS: Preterm delivery is associated with low levels of anti-secretory factor in placenta. Inflammation, a potential trigger of preterm birth, is more pronounced in the preterm placenta and inversely related to the placental level of anti-secretory factor, suggesting both a link and a potential target for intervention.

Keywords
Anti-secretory factor, inflammation, placenta, preterm birth, vascularization
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-357814 (URN)10.1111/aogs.13282 (DOI)29265188 (PubMedID)
Available from: 2018-08-21 Created: 2018-08-21 Last updated: 2018-11-28Bibliographically approved
Bergström, M., Fransson, E., Fabian, H., Hjern, A., Sarkadi, A. & Salari, R. (2018). Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent. Acta Paediatrica, 107(2), 294-300
Open this publication in new window or tab >>Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 2, p. 294-300Article in journal (Refereed) Published
Abstract [en]

AIM: Joint physical custody (JPC), where children spend about equal time in both parent's homes after parental separation, is increasing. The suitability of this practice for preschool children, with a need for predictability and continuity, has been questioned.

METHODS: In this cross-sectional study, we used data on 3656 Swedish children aged three to five years living in intact families, JPC, mostly with one parent or single care. Linear regression analyses were conducted with the Strengths and Difficulties Questionnaire, completed by parents and preschool teachers, as the outcome measure.

RESULTS: Children in JPC showed less psychological problems than those living mostly (adjusted B 1.81; 95% CI [0.66 to 2.95]) or only with one parent (adjusted B 1.94; 95% CI [0.75 to 3.13]), in parental reports. In preschool teacher reports, the adjusted Betas were 1.27, 95% CI [0.14 to 2.40] and 1.41, 95% CI [0.24 to 2.58], respectively. In parental reports, children in JPC and those in intact families had similar outcomes, while teachers reported lower unadjusted symptom scores for children in intact families.

CONCLUSION: Joint physical custody arrangements were not associated with more psychological symptoms in children aged 3-5, but longitudinal studies are needed to account for potential preseparation differences.

Keywords
Children, Divorce, Joint physical custody, Parental separation, Psychological problems
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology) Public Health, Global Health, Social Medicine and Epidemiology Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:uu:diva-332706 (URN)10.1111/apa.14004 (DOI)000419768200023 ()28880411 (PubMedID)
Funder
Swedish Research Council FormasForte, Swedish Research Council for Health, Working Life and WelfareVINNOVA, 259-2012-68Swedish Research Council
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2018-08-21Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-9010-8522

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