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  • 1.
    Abdi, Saida
    et al.
    Univ Minnesota Twin Cities, Minneapolis, MN 55414 USA..
    Akinsulure-Smith, Adeyinka M.
    CUNY City Coll, New York, NY USA.;CUNY, New York, NY USA..
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Fazel, Mina
    Univ Oxford, Oxford, England..
    Ellis, B. Heidi
    Harvard Med Sch, Boston, MA USA..
    Gillespie, Sarah
    Univ Minnesota Twin Cities, Minneapolis, MN 55414 USA..
    Juang, Linda P.
    Univ Potsdam, Potsdam, Germany..
    Betancourt, Theresa S.
    Boston Coll, Sch Social Work, Chestnut Hill, MA USA..
    Promoting positive development among refugee adolescents2023In: Journal of research on adolescence, ISSN 1050-8392, E-ISSN 1532-7795, Vol. 33, no 4, p. 1064-1084Article, review/survey (Refereed)
    Abstract [en]

    Of the estimated 35.3 million refugees around the world (UNHCR, Figures at a Glance, 2022), approximately 50% are children under the age of 18. Refugee adolescents represent a unique group as they navigate developmental tasks in an unstable and often threatening environment or in resettlement contexts in which they often face marginalization. In addition to physiological, social, and psychological changes that mark adolescence, refugee youth often face traumatic experiences, acculturative stress, discrimination, and a lack of basic resources. In this consensus statement, we examine research on refugee adolescents' developmental tasks, acculturative tasks, and psychological adjustment using Suarez-Orozco and colleague's integrative risk and resilience model for immigrant-origin children and youth proposed by Suarez-Orozco et al. Finally, we discuss recommendations-moving from proximal to more distal contexts.

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  • 2.
    Ahlqvist, Viktor H.
    et al.
    Karolinska Inst, Dept Global Publ Hlth, S-11365 Stockholm, Sweden..
    Ekström, Lucas D.
    Karolinska Inst, Dept Global Publ Hlth, S-11365 Stockholm, Sweden.;Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden..
    Jónsson-Bachmann, Egill
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Karolinska Inst, Dept Global Publ Hlth, S-11365 Stockholm, Sweden..
    Tynelius, Per
    Karolinska Inst, Dept Global Publ Hlth, S-11365 Stockholm, Sweden.;Reg Stockholm, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Madley-Dowd, Paul
    Univ Bristol, Ctr Acad Mental Hlth, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England..
    Neovius, Martin
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden..
    Magnusson, Cecilia
    Karolinska Inst, Dept Global Publ Hlth, S-11365 Stockholm, Sweden.;Reg Stockholm, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Berglind, Daniel
    Karolinska Inst, Dept Global Publ Hlth, S-11365 Stockholm, Sweden.;Reg Stockholm, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Caesarean section and its relationship to offspring general cognitive ability: a registry-based cohort study of half a million young male adults2022In: Evidence-Based Mental Health, ISSN 1362-0347, E-ISSN 1468-960X, Vol. 25, p. 7-14Article in journal (Refereed)
    Abstract [en]

    Background: A relationship between caesarean section and offspring cognitive ability has been described, but data are limited, and a large-scale study is needed.

    Objective: To determine the relationship between mode of delivery and general cognitive ability.

    Methods: A cohort of 579 244 singleton males, born between 1973 and 1987 who conscripted before 2006, were identified using the Swedish population-based registries. Their mode of delivery was obtained from the Swedish Medical Birth registry. The outcome measure was a normalised general cognitive test battery (mean 100, SD 15) performed at military conscription at around age 18.

    Findings: Males born by caesarean section performed poorer compared with those born vaginally (mean score 99.3 vs 100.1; adjusted mean difference -0.84; 95% CI -0.97 to -0.72; p<0.001). Both those born by elective (99.3 vs 100.2; -0.92; 95% CI -1.24 to -0.60; p<0.001) and non-elective caesarean section (99.2 vs 100.2; -1.03; 95% CI -1.34 to -0.72; p=0.001), performed poorer than those born vaginally. In sibling analyses, the association was attenuated to the null (100.9 vs 100.8; 0.07; 95% CI -0.31 to 0.45; p=0.712). Similarly, neither elective nor non-elective caesarean section were associated with general cognitive ability in sibling analyses.

    Conclusion: Birth by caesarean section is weakly associated with a lower general cognitive ability in young adult males. However, the magnitude of this association is not clinically relevant and seems to be largely explained by familial factors shared between siblings.

    Clinical implication: Clinicians and gravidas ought not to be concerned that the choice of mode of delivery will impact offspring cognitive ability.

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  • 3.
    Al Adhami, Maissa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, SWEDESD - Sustainability Learning and Research Centre. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Berglund, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Wångdahl, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    A cross-sectional study of health and well-being among newly settled refugee migrants in Sweden–The role of health literacy, social support and self-efficacy2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 12, article id e0279397Article in journal (Refereed)
    Abstract [en]

    Structural barriers such as inadequate housing, lack of employment opportunities, and discrimination are known to adversely affect the health of newly settled refugee migrants. However, these barriers remain largely unresolved and unaddressed. Thus, there is a need to better understand how other factors, such as individual-level health resources, may influence health and mitigate ill health in the early post-migration phase. In this study, we aimed to explore the relationship between health outcomes and individual health resources including health literacy, social support, and self-efficacy in newly settled refugee migrants. Survey data was collected from 787 refugee migrants in Sweden. Logistical regression analysis showed that limited health literacy, lack of emotional support, and low self-efficacy were consistently associated with poor health outcomes. Demographic variables such as gender, education, and type of residence permit were not as imperative. Individual-level health resources may play an important role in the general and psychological well-being of newly settled migrants. Promoting health literacy and facilitating the attainment of social support may buffer for structural challenges in the establishment phase and enhance the prospects of later health and social integration.

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  • 4.
    Al Adhami, Maissa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Research and Learning for Sustainable Development and Global Health (SWEDESD), Department of Women’s and Children’s Health, Uppsala University , Hammarskjölds väg 14B, 752 37 Uppsala , Sweden.
    Durbeej, Natalie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Daryani, Achraf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Wångdahl, Josefin
    Aging Research Center, Karolinska Institutet and Stockholm University , Tomtebodavägen 18 A, 171 65 Stockholm , Sweden.
    Larsson, Elin C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, SWEDESD - Sustainability Learning and Research Centre. Department of Women’s and Children’s Health, Karolinska Institutet , Tomtebodavägen 18A, 171 77 Stockholm , Sweden;Department of Global Public Health, Karolinska Institutet , Tomtebodavägen 18 A, 171 65 Stockholm , Sweden.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Can extended health communication improve newly settled refugees’ health literacy? A quasi-experimental study from Sweden2024In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 39, no 2Article in journal (Refereed)
    Abstract [en]

    Structural and contextual factors such as limited work and housing opportunities negatively affect the health and well-being of newly settled refugee migrants in receiving high-income countries. Health promotion initiatives aiming at strengthening health and integration have been tried out within the Swedish Introduction program for refugee migrants. However, longitudinal evaluations of these interventions are rare. The aim of the current study was to compare the effectiveness of a regular and an extended civic orientation course with added health communication and examine whether the latter would improve self-rated health and psychological well-being, health literacy and social capital among newly settled refugee migrants in Sweden. Pre- and post-assessment questionnaires were collected from the intervention group receiving the extended course (n = 143) and a control group receiving the regular course (n = 173). Linear mixed models and chi-square analyses showed a significant increase with a small effect size (0.21) in health literacy in the intervention group. However, there were no significant changes in emotional and practical support, general self-rated health or psychological well-being. The findings indicate that added health communication provided embedded in the civic orientation course can increase health literacy. However, further longitudinal studies are needed to confirm the sustainability of the observed effect and examine whether these short-term improvements in health literacy translate to long-term advances in health and integration.

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  • 5.
    Al Adhami, Maissa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Global Health Research on Implementation and Sustainability. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hjelm, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Wångdahl, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Larsson, Elin C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Global Health Research on Implementation and Sustainability. Karolinska Inst, Dept Womens & Childrens Hlth, SE-17177 Stockholm, Sweden..
    "This course is like a compass to us": a qualitative study on newly settled migrants' perceptions of civic and health orientation in Sweden2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 1606Article in journal (Refereed)
    Abstract [en]

    Background Migrants face structural, socio-political barriers in their resettlement processes that negatively affect their health. Migration also adversely impacts resources such as social capital and health literacy that are of importance for health and integration into society. Hence, there is a need for health promotion in the early post-migration phase. In Sweden, newly settled refugee migrants who have received a residence permit are offered an Introduction programme including a civic orientation course. The program is intended to facilitate access to the labour market and promote integration. The aim of the study was to explore participants' perceptions and experiences of a civic orientation course with added health communication. Methods We performed six focus group discussions: two in Arabic, two in Farsi and two in Somali. The discussions were facilitated by native speaking moderators. Participants were 32 men and women recruited from civic orientation classes in the county of Stockholm. We used an interview guide with semi-structured questions. The data were analysed using a method for content analysis for focus group discussions. Results Three main categories were identified: (1) 'The course gives valuable information but needs adjustments', which includes that the civic and health orientation is needed earlier, during the asylum phase, and that planning and course content need adjustments. (2) 'The health communication inspired participants to focus on their health', which includes that the health communication was useful and inspired uptake of healthier habits. (3) 'Participation in the course promoted independence and self-confidence', which includes that the course gave insights into society and values in Sweden, and promoted independence and new social contacts. Conclusion This study adds knowledge about the users' perspectives on the potential of civic orientation to promote the health and integration of newly settled migrants, describing ways in which civic orientation with added health communication promoted health and empowerment. However, the content and delivery of the course need adjustment to better fit the migrants' life situations and varying pre-existing knowledge.

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  • 6.
    Al Adhami, Maissa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, SWEDESD - Sustainability Learning and Research Centre.
    Wångdahl, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Solna, Sweden.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Åkerman, Eva
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    ”Putting words to their feelings”: civic communicators’ perceptions and experiences of an in-depth course on mental health for newly settled refugee migrants in Sweden2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 510Article in journal (Refereed)
    Abstract [en]

    Background: Newly settled refugee migrants face psychological stressors stemming from pre-, during- and post-migration experiences. In Sweden, mental health promotion is part of the health module in the civic orientation classes for newly settled refugee migrants. Training courses are offered to civic communicators to facilitate communication about mental health; however, the training is seldom evaluated. In the current study, we aim to explore civic communicators’ perceptions and experiences of an in-depth mental health training course in relation to observed needs among newly settled refugee migrants. 

    Method: We interviewed ten civic communicators that had partaken in the in-depth training course on mental health. All respondents had prior migratory experience and worked as civic communicators in their native languages. The interviews were semi-structured and data were analyzed using thematic analysis.

    Results: Three themes were identified: (1) Intertwined mental health needs related to migration, (2) Multi-layered barriers to addressing mental health, and (3) Becoming aware of the mental health journey. One overarching theme was arrived at through synthesizing the three themes ‘Acquired new tools to lead reflective conversations about mental health and well-being’. 

    Conclusion: The in-depth mental health training course led to the attainment of new knowledge and new tools enabling civic communicators to lead reflective conversations about mental health and well-being with newly settled refugee migrants. Mental health needs were related to pre- and post-migration experiences. Barriers to talking about mental health included stigma and a lack of arenas to promote the mental health of refugee migrants. Increasing knowledge among communicators can facilitate the promotion of mental self-help capacity and resilience among newly settled refugee migrants.

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  • 7.
    Alaie, Iman
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ramklint: Child and Adolescent Psychiatry.
    Philipson, Anna
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Copeland, William E.
    Department of Psychiatry, Vermont Center for Children, Youth, and Families, University of Vermont, Burlington, USA.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ramklint: Child and Adolescent Psychiatry.
    Bohman, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ramklint: Child and Adolescent Psychiatry.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ramklint: Child and Adolescent Psychiatry. Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Adolescent depression and adult labor market marginalization: a longitudinal cohort study2022In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 31, no 11, p. 1799-1813Article in journal (Refereed)
    Abstract [en]

    Adolescent depression is linked to adult ill-health and functional impairment, but recent research suggests that individual/contextual factors might account for this association. This study aimed to test whether the clinical heterogeneity of adolescent depression is related to marginalization from the labor market across early to middle adulthood. Data were drawn from the Uppsala Longitudinal Adolescent Depression Study, a community-based cohort initially assessed with structured clinical interviews at age 16-17. The cohort (n = 321 depressed; n = 218 nondepressed) was followed up after 2+ decades through linkage to nationwide population-based registries. Outcomes included consecutive annual data on unemployment, work disability, social welfare recipiency, and a composite marginalization measure, spanning from age 21 to 40. Longitudinal associations were examined using logistic regression analysis in a generalized estimating equations modeling framework. Subsequent depressive episodes and educational attainment in early adulthood were explored as potential pathways. The results showed that adolescent depression was associated with adult marginalization outcomes, but the strength of association varied across depressed subgroups. Adolescents with persistent depressive disorder had higher odds of all outcomes, including the composite marginalization measure (adjusted OR = 2.0, 95% CI = 1.4-2.7, p < 0.001), and this was partially (31%) mediated by subsequent depressive episodes in early adulthood. Exploratory moderation analysis revealed that entry into tertiary education mitigated the association with later marginalization, but only for adolescents with episodic major depression. In conclusion, the risk for future labor market marginalization is elevated among depressed adolescents, particularly those presenting with persistent depressive disorder. Targeted interventions seem crucial to mitigate the long-lasting impact of early-onset depression.

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  • 8.
    Alaie, Iman
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Philipson, Anna
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hagberg, Lars
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Moller, Margareta
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Arinell, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Päären, Aivar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Olsson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Bohman, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Inst, Karolinska Inst KIND, Dept Womens & Childrens Hlth, Ctr Neurodev Disorders,Pediat Neuropsychiat Unit, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Ctr Psychiat Res, Stockholm, Sweden.
    Uppsala Longitudinal Adolescent Depression Study (ULADS)2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 3, article id e024939Article in journal (Refereed)
    Abstract [en]

    Purpose: To present the Uppsala Longitudinal Adolescent Depression Study, initiated in Uppsala, Sweden, in the early 1990s. The initial aim of this epidemiological investigation was to study the prevalence, characteristics and correlates of adolescent depression, and has subsequently expanded to include a broad range of social, economic and health-related long-term outcomes and cost-of-illness analyses.

    Participants: The source population was first-year students (aged 16-17) in upper-secondary schools in Uppsala during 1991-1992, of which 2300 (93%) were screened for depression. Adolescents with positive screening and sex/age-matched peers were invited to a comprehensive assessment. A total of 631 adolescents (78% females) completed this assessment, and 409 subsequently completed a 15year follow-up assessment. At both occasions, extensive information was collected on mental disorders, personality and psychosocial situation. Detailed social, economic and health-related data from 1993 onwards have recently been obtained from the Swedish national registries for 576 of the original participants and an age-matched reference population (N=200 000).

    Findings to date: The adolescent lifetime prevalence of a major depressive episode was estimated to be 11.4%. Recurrence in young adulthood was reported by the majority, with a particularly poor prognosis for those with a persistent depressive disorder or multiple somatic symptoms. Adolescent depression was also associated with an increased risk of other adversities in adulthood, including additional mental health conditions, low educational attainment and problems related to intimate relationships.

    Future plans: Longitudinal studies of adolescent depression are rare and must be responsibly managed and utilised. We therefore intend to follow the cohort continuously by means of registries. Currently, the participants are approaching mid-adulthood. At this stage, we are focusing on the overall long-term burden of adolescent depression. For this purpose, the research group has incorporated expertise in health economics. We would also welcome extended collaboration with researchers managing similar datasets.

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  • 9.
    Alaie, Iman
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Anna, Philipson
    Faculty of Medicine and Health, Örebro University.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Margareta, Möller
    Faculty of Medicine and Health, Örebro University.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Psychiatry, University hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Bohman, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Södersjukhuset, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Lars, Hagberg
    Faculty of Medicine and Health, Örebro University.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Adolescent depression, early psychiatric comorbidities, and adult welfare burden: A 25-year longitudinal cohort studyManuscript (preprint) (Other academic)
  • 10.
    Alaie, Iman
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ramklint: Child and Adolescent Psychiatry.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Philipson, Anna
    Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ramklint: Child and Adolescent Psychiatry.
    Möller, Margareta
    Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Cervenka: Psychiatry.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ramklint: Child and Adolescent Psychiatry.
    Bohman, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ramklint: Child and Adolescent Psychiatry.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hagberg, Lars
    Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ramklint: Child and Adolescent Psychiatry. Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Adolescent depression, early psychiatric comorbidities, and adulthood welfare burden: a 25-year longitudinal cohort study2021In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 56, no 11, p. 1993-2004Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Depression at all ages is recognized as a global public health concern, but less is known about the welfare burden following early-life depression. This study aimed to (1) estimate the magnitude of associations between depression in adolescence and social transfer payments in adulthood; and (2) address the impact of major comorbid psychopathology on these associations.

    METHODS: This is a longitudinal cohort study of 539 participants assessed at age 16-17 using structured diagnostic interviews. An ongoing 25-year follow-up linked the cohort (n = 321 depressed; n = 218 nondepressed) to nationwide population-based registries. Outcomes included consecutive annual data on social transfer payments due to unemployment, work disability, and public assistance, spanning from age 18 to 40. Parameter estimations used the generalized estimating equations approach.

    RESULTS: Adolescent depression was associated with all forms of social transfer payments. The estimated overall payment per person and year was 938 USD (95% CI 551-1326) over and above the amount received by nondepressed controls. Persistent depressive disorder was associated with higher recipiency across all outcomes, whereas the pattern of findings was less clear for subthreshold and episodic major depression. Moreover, depressed adolescents presenting with comorbid anxiety and disruptive behavior disorders evidenced particularly high recipiency, exceeding the nondepressed controls with an estimated 1753 USD (95% CI 887-2620).

    CONCLUSION: Adolescent depression is associated with considerable public expenditures across early-to-middle adulthood, especially for those exposed to chronic/persistent depression and psychiatric comorbidities. This finding suggests that the clinical heterogeneity of early-life depression needs to be considered from a longer-term societal perspective.

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  • 11.
    Al-Nasir, Jasmine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Belancic, Andrej
    Clin Hosp Ctr Rijeka, Dept Clin Pharmacol, Rijeka 51000, Croatia.;Univ Rijeka, Fac Med, Dept Basic & Clin Pharmacol Toxicol, Rijeka 51000, Croatia..
    Palcevski, Dora
    Clin Hosp Ctr Rijeka, Dept Internal Med, Rijeka 51000, Croatia..
    Dyar, Oliver J.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    2015 versus 2021: Self-Reported Preparedness to Prescribe Antibiotics Prudently among Final Year Medical Students in Sweden2024In: Antibiotics, E-ISSN 2079-6382, Vol. 13, no 4, article id 303Article in journal (Refereed)
    Abstract [en]

    Cross-sectional surveys have found variations in how prepared medical students feel to prescribe antibiotics responsibly, but insights are lacking on the stability of these outcomes. In a 2015 survey, final-year Swedish medical students reported very high preparedness levels across a comprehensive range of relevant curriculum topics. We repeated this survey in 2021 to assess the stability of previous findings and to capture the potential impacts of the COVID-19 pandemic. Final-year students in 2015 and 2021 at all seven Swedish medical schools were eligible to participate in an online survey covering curricula topics, teaching methods and COVID-19 impacts (2021). Eligible students received email invitations and reminders from local coordinators. Students from six of seven medical schools participated in both surveys, with response rates of 24.1% (309/1281) in 2021 and 21.3% (239/1124) in 2015. The average global preparedness was 77.0% and 83.2%, respectively (p < 0.001), with lower preparedness levels in 24/27 curriculum topics in 2021. Students at certain universities reported COVID-19 impacts on antibiotic prescribing education (format, duration and perceived quality). Self-reported preparedness levels have fallen slightly but remain high compared with 2015 levels in other European countries. Students consistently reported lower preparedness in specific topics; improvement efforts should consider focusing on these areas, particularly in the context of the ongoing implementation of programmes leading to a full licence upon graduation.

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  • 12.
    Andren, Per
    et al.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    de la Cruz, Lorena Fernandez
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Isomura, Kayoko
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Lenhard, Fabian
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Hall, Charlotte L.
    Univ Nottingham, Inst Mental Hlth Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Inst Mental Hlth, Sch Med Mental Hlth & Clin Neurosci, NIHR MindTech MedTech Cooperat, Innovat Park,Triumph Rd, Nottingham, England..
    Davies, E. Bethan
    Univ Nottingham, Inst Mental Hlth Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Inst Mental Hlth, Sch Med Mental Hlth & Clin Neurosci, NIHR MindTech MedTech Cooperat, Innovat Park,Triumph Rd, Nottingham, England..
    Murphy, Tara
    UCL Great Ormond St Inst Child Hlth ICH, 30 Guilford St, London WC1N 1EH, England.;Great Ormond St Hosp Children NHS Fdn Trust, Psychol & Mental Hlth Serv, Great Ormond St, London, England..
    Hollis, Chris
    Univ Nottingham, Inst Mental Hlth Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Inst Mental Hlth, Sch Med Mental Hlth & Clin Neurosci, NIHR MindTech MedTech Cooperat, Innovat Park,Triumph Rd, Nottingham, England.;Univ Nottingham, Div Psychiat & Appl Psychol, Inst Mental Hlth, NIHR Nottingham Biomed Res Ctr, Nottingham, England..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Bottai, Matteo
    Karolinska Inst, Inst Environm Med, Unit Biostat, Stockholm, Sweden..
    Serlachius, Eva
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Andersson, Erik
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Mataix-Cols, David
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Efficacy and cost-effectiveness of therapist-guided internet-delivered behaviour therapy for children and adolescents with Tourette syndrome: study protocol for a single-blind randomised controlled trial2021In: Trials, E-ISSN 1745-6215, Vol. 22, article id 669Article in journal (Refereed)
    Abstract [en]

    Background: Treatment guidelines recommend behaviour therapy (BT) for patients with Tourette syndrome (TS) and chronic tic disorder (CTD). However, BT is rarely accessible due to limited availability of trained therapists and long travel distances to specialist clinics. Internet-delivered BT has the potential of overcoming these barriers through remote delivery of treatment with minimal therapist support. In the current protocol, we outline the design and methods of a randomised controlled trial (RCT) evaluating an internet-delivered BT programme referred to as BIP TIC. The trial's primary objective is to determine the clinical efficacy of BIP TIC for reducing tic severity in young people with TS/CTD, compared with an active control intervention. Secondary objectives are to investigate the 12-month durability of the treatment effects and to perform a health economic evaluation of the intervention.

    Methods: In this single-blind superiority RCT, 220 participants (9-17 years) with TS/CTD throughout Sweden will be randomised to 10-12 weeks of either therapist-supported internet-delivered BT based on exposure with response prevention (BIP TIC) or therapist-supported internet-delivered education. Data will be collected at baseline, 3 and 5 weeks into the treatment, at post-treatment, and 3, 6, and 12 months post-treatment. The primary endpoint is the 3-month follow-up. The primary outcome is tic severity as measured by the Yale Global Tic Severity Scale - Total Tic Severity Score. Treatment response is operationalised as scores of "Very much improved" or "Much improved" on the Clinical Global Impression - Improvement scale, administered at the primary endpoint. Outcome assessors will be blind to treatment condition at all assessment points. A health economic evaluation of BIP TIC will be performed, both in the short term (primary endpoint) and the long term (12-month follow-up). There are no planned interim analyses.

    Discussion: Participant recruitment started on 26 April 2019 and finished on 9 April 2021. The total number of included participants was 221. The final participant is expected to reach the primary endpoint in September 2021 and the 12-month follow-up in June 2022. Data analysis for the primary objective will commence after the last participant reaches the primary endpoint.

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  • 13.
    Andren, Per
    et al.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden.;Lund Univ, Dept Clin Sci, Lund, Sweden..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Ringberg, Helene
    Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Wachtmeister, Vera
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Warnström, Moa
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Isomura, Kayoko
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Aspvall, Kristina
    Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Lenhard, Fabian
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden..
    Hall, Charlotte L.
    Univ Nottingham, Natl Inst Hlth & Care Res MindTech MedTech Coopera, Sch Med, Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Natl Inst Hlth & Care Res Nottingham Biomed Res Ct, Inst Mental Hlth, Mental Hlth & Clin Neurosci, Nottingham, England..
    Davies, E. Bethan
    Univ Nottingham, Natl Inst Hlth & Care Res MindTech MedTech Coopera, Sch Med, Mental Hlth & Clin Neurosci, Nottingham, England..
    Murphy, Tara
    UCL, Great Ormond St Inst Child Hlth, London, England.;Great Ormond St Hosp Sick Children, Psychol & Mental Hlth Serv, Great Ormond St, London, England..
    Hollis, Chris
    Univ Nottingham, Natl Inst Hlth & Care Res MindTech MedTech Coopera, Sch Med, Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Natl Inst Hlth & Care Res Nottingham Biomed Res Ct, Inst Mental Hlth, Mental Hlth & Clin Neurosci, Nottingham, England..
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Bottai, Matteo
    Karolinska Inst, Inst Environm Med, Unit Biostat, Stockholm, Sweden..
    Serlachius, Eva
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Lund Univ, Dept Clin Sci, Lund, Sweden..
    Andersson, Erik
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    de la Cruz, Lorena Fernandez
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Mataix-Cols, David
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden.;Lund Univ, Dept Clin Sci, Lund, Sweden..
    Internet-Delivered Exposure and Response Prevention for Pediatric Tourette Syndrome: 12-Month Follow-Up of a Randomized Clinical Trial2024In: JAMA Network Open, E-ISSN 2574-3805, Vol. 7, no 5, article id e248468Article in journal (Refereed)
    Abstract [en]

    Importance: Behavior therapy is a recommended intervention for Tourette syndrome (TS) and chronic tic disorder (CTD), but availability is limited and long-term effects are uncertain.

    Objective: To investigate the long-term efficacy and cost-effectiveness of therapist-supported, internet-delivered exposure and response prevention (ERP) vs psychoeducation for youths with TS or CTD.

    Design, Setting, And Participants: This 12-month controlled follow-up of a parallel group, superiority randomized clinical trial was conducted at a research clinic in Stockholm, Sweden, with nationwide recruitment. In total, 221 participants aged 9 to 17 years with TS or CTD were enrolled between April 26, 2019, and April 9, 2021, of whom 208 (94%) provided 12-month follow-up data. Final follow-up data were collected on June 29, 2022. Outcome assessors were masked to treatment allocation throughout the study.

    Interventions: A total of 111 participants were originally randomly allocated to 10 weeks of therapist-supported, internet-delivered ERP and 110 participants to therapist-supported, internet-delivered psychoeducation.

    Main Outcomes And Measures: The primary outcome was within-group change in tic severity, measured by the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS), from the 3-month follow-up to the 12-month follow-up. Treatment response was defined as 1 (very much improved) or 2 (much improved) on the Clinical Global Impression-Improvement scale. Analyses were intention-to-treat and followed the plan prespecified in the published study protocol. A health economic evaluation was performed from 3 perspectives: health care organization (including direct costs for treatment provided in the study), health care sector (additionally including health care resource use outside of the study), and societal (additionally including costs beyond health care [eg, parent's absenteeism from work]).

    Results: In total, 221 participants were recruited (mean [SD] age, 12.1 [2.3] years; 152 [69%] male). According to the YGTSS-TTSS, there were no statistically significant changes in tic severity from the 3-month to the 12-month follow-up in either group (ERP coefficient, -0.52 [95% CI, -1.26 to 0.21]; P = .16; psychoeducation coefficient, 0.00 [95% CI, -0.78 to 0.78]; P > .99). A secondary analysis including all assessment points (baseline to 12-month follow-up) showed no statistically significant between-group difference in tic severity from baseline to the 12-month follow-up (coefficient, -0.38 [95% CI, -1.11 to 0.35]; P = .30). Treatment response rates were similar in both groups (55% in ERP and 50% in psychoeducation; odds ratio, 1.25 [95% CI, 0.73-2.16]; P = .42) at the 12-month follow-up. The health economic evaluation showed that, from a health care sector perspective, ERP produced more quality-adjusted life years (0.01 [95% CI, -0.01 to 0.03]) and lower costs (adjusted mean difference -$84.48 [95% CI, -$440.20 to $977.60]) than psychoeducation at the 12-month follow-up. From the health care organization and societal perspectives, ERP produced more quality-adjusted life years at higher costs, with 65% to 78% probability of ERP being cost-effective compared with psychoeducation when using a willingness-to-pay threshold of US $79 000.

    Conclusions And Relevance: There were no statistically significant changes in tic severity from the 3-month through to the 12-month follow-up in either group. The ERP intervention was not superior to psychoeducation at any time point. While ERP was not superior to psychoeducation alone in reducing tic severity at the end of the follow-up period, ERP is recommended for clinical implementation due to its likely cost-effectiveness and support from previous literature.

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  • 14.
    Andrén, Per
    et al.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Holmsved, Moa
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Ringberg, Helene
    Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Wachtmeister, Vera
    Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Isomura, Kayoko
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Aspvall, Kristina
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Lenhard, Fabian
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden..
    Hall, Charlotte L.
    Univ Nottingham, Queens Med Ctr, Sch Med, Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Sch Med, Natl Inst Hlth & Care Res MindTech MedTech Cooper, Inst Mental Hlth,Div Psychiat & Appl Psychol, Innovat Pk,Triumph Rd, Nottingham, England.;Univ Nottingham, Natl Inst Hlth & Care Res Nottingham Biomed Res C, Inst Mental Hlth Mental Hlth & Clin Neurosci, Innovat Pk, Nottingham, England..
    Davies, E. Bethan
    Univ Nottingham, Queens Med Ctr, Sch Med, Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Sch Med, Natl Inst Hlth & Care Res MindTech MedTech Cooper, Inst Mental Hlth,Div Psychiat & Appl Psychol, Innovat Pk,Triumph Rd, Nottingham, England..
    Murphy, Tara
    UCL, Great Ormond St Inst Child Hlth, London, England.;Great Ormond St Hosp Children Natl Hlth Serv Fdn, Psychol & Mental Hlth Serv, Great Ormond St, London, England..
    Hollis, Chris
    Univ Nottingham, Queens Med Ctr, Sch Med, Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Sch Med, Natl Inst Hlth & Care Res MindTech MedTech Cooper, Inst Mental Hlth,Div Psychiat & Appl Psychol, Innovat Pk,Triumph Rd, Nottingham, England.;Univ Nottingham, Natl Inst Hlth & Care Res Nottingham Biomed Res C, Inst Mental Hlth Mental Hlth & Clin Neurosci, Innovat Pk, Nottingham, England..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Bottai, Matteo
    Karolinska Inst, Inst Environm Med, Unit Biostat, Stockholm, Sweden..
    Serlachius, Eva
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Lund Univ, Med Fac, Dept Clin Sci, Child & Adolescent Psychiat, Lund, Sweden..
    Andersson, Erik
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    de la Cruz, Lorena Fernandez
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Mataix-Cols, David
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Therapist-Supported Internet-Delivered Exposure and Response Prevention for Children and Adolescents With Tourette Syndrome: A Randomized Clinical Trial2022In: JAMA Network Open, E-ISSN 2574-3805, Vol. 5, no 8, article id e2225614Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: The availability of behavior therapy for individuals with Tourette syndrome (TS) and chronic tic disorder (CTD) is limited.

    OBJECTIVE: To determine the efficacy and cost-effectiveness of internet-delivered exposure and response prevention (ERP) for children and adolescents with TS or CTD.

    DESIGN, SETTING, AND PARTICIPANTS: This single-masked, parallel group, superiority randomized clinical trial with nationwide recruitment was conducted at a research clinic in Stockholm, Sweden. Out of 615 individuals assessed for eligibility, 221 participants meeting diagnostic criteria for TS or CTD and aged 9 to 17 years were included in the study. Enrollment began in April 2019 and ended in April 2021. Data were analyzed between October 2021 and March 2022.

    INTERVENTIONS: Participants were randomized to 10 weeks of therapist-supported internet-delivered ERP for tics (111 participants) or to therapist-supported internet-delivered education for tics (comparator group, 110 participants).

    MAIN OUTCOMES AND MEASURES: The primary outcome was change in tic severity from baseline to the 3-month follow-up as measured by the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS). YGTSS-TTSS assessors were masked to treatment allocation. Treatment response was operationalized as a score of 1 ("Very much improved") or 2 ("Much improved") on the Clinical Global Impression-Improvement scale.

    RESULTS: Data loss was minimal, with 216 of 221 participants (97.7%) providing primary outcome data. Among randomized participants (152 [68.8%] boys; mean [SD] age, 12.1 [2.3] years), tic severity improved significantly, with a mean reduction of 6.08 points on the YGTSS-TTSS in the ERP group (mean [SD] at baseline, 22.25 [5.60]; at 3-month follow-up, 16.17 [6.82]) and 5.29 in the comparator (mean [SD] at baseline, 23.01 [5.92]; at 3-month follow-up, 17.72 [7.11]). Intention-to-treat analyses showed that the 2 groups improved similarly over time (interaction effect, -0.53; 95% CI, -1.28 to 0.22; P = .17). Significantly more participants were classified as treatment responders in the ERP group (51 of 108 [47.2%]) than in the comparator group (31 of 108 [28.7%]) at the 3-month follow-up (odds ratio, 2.22; 95% CI. 1.27 to 3.90). ERP resulted in more treatment responders at little additional cost compared with structured education. The incremental cost per quality-adjusted life-year gained was below the Swedish willingness-to-pay threshold, at which ERP had a 66% to 76% probability of being cost-effective.

    CONCLUSIONS AND RELEVANCE: Both interventions were associated with clinically meaningful improvements in tic severity, but ERP led to higher response rates at little additional cost.

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  • 15.
    Ascencao, Raquel
    et al.
    Univ Lisbon, Fac Med, Lab Farmacol Clin & Terapeut, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Nogueira, Paulo
    Univ Nova Lisboa, Escola Nacl Saude Publ, Lisbon, Portugal..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Henriques, Adriana
    Nursing Res Innovat & Dev Ctr Lisbon CIDNUR, Nursing Sch Lisbon, Lisbon, Portugal..
    Costa, Andreia
    Univ Lisbon, Fac Med, Inst Saude Ambiental ISAMB, Lisbon, Portugal..
    Adverse drug reactions in hospitals: population estimates for Portugal and the ICD-9-CM to ICD-10-CM crosswalk2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 1222Article in journal (Refereed)
    Abstract [en]

    BackgroundAdverse drug reactions (ADR), both preventable and non-preventable, are frequent and pose a significant burden. This study aimed to produce up-to-date estimates for ADR rates in hospitals, in Portugal, from 2010 to 2018. In addition, it explores possible pitfalls when crosswalking between ICD-9-CM and ICD-10-CM code sets for ADR identification.MethodsThe Portuguese Hospital Morbidity Database was used to identify hospital episodes (outpatient or inpatient) with at least one ICD code of ADR. Since the study period spanned from 2010 to 2018, both ICD-9-CM and ICD-10-CM codes based on previously published studies were used to define episodes. This was an exploratory study, and descriptive statistics were used to provide ADR rates and summarise episode features for the full period (2010-2018) as well as for the ICD-9-CM (2010-2016) and ICD -10-CM (2017-2018) eras.ResultsBetween 2010 and 2018, ADR occurred in 162,985 hospital episodes, corresponding to 1.00% of the total number of episodes during the same period. Higher rates were seen in the oldest age groups. In the same period, the mean annual rate of episodes related to ADR was 174.2/100,000 population. The episode rate (per 100,000 population) was generally higher in males, except in young adults (aged '15-20', '25-30' and '30-35' years), although the overall frequency of ADR in hospital episodes was higher in females.ConclusionsDespite the ICD-10-CM transition, administrative health data in Portugal remain a feasible source for producing up-to-date estimates on ADR in hospitals. There is a need for future research to identify target recipients for preventive interventions and improve medication safety practices in Portugal.

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  • 16.
    Aspvall, Kristin
    et al.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.
    Andersson, Erik
    Karolinska Inst, Dept Clin Neurosci, Div Psychol, Stockholm, Sweden.
    Lenhard, Fabian
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.
    Melin, Karin
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Gothenburg, Sweden;Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Child & Adolescent Psychiat Specialized Unit, Gothenburg, Sweden.
    Norlin, Lisa
    Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Child & Adolescent Psychiat Specialized Unit, Gothenburg, Sweden.
    Wallin, Lena
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Gothenburg, Sweden;Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Child & Adolescent Psychiat Specialized Unit, Gothenburg, Sweden.
    Silverberg-Morse, Maria
    Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Bottai, Matteo
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Mataix-Cols, David
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.
    Serlachius, Eva
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.
    Stepped Care Internet-Delivered vs Face-to-Face Cognitive-Behavior Therapy for Pediatric Obsessive-Compulsive Disorder A Trial Protocol for a Randomized Noninferiority Trial2019In: JAMA Network Open, E-ISSN 2574-3805, Vol. 2, no 10, article id e1913810Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Internet-delivered cognitive behavior therapy is an effective treatment for children and adolescents with obsessive-compulsive disorder and has the potential to markedly increase access to treatment for patients while being cost-effective for health care organizations. OBJECTIVE To investigate whether internet-delivered cognitive behavior therapy implemented within a stepped care model is noninferior to, and cost-effective compared with, the gold standard of face-to-face cognitive behavior therapy for pediatric obsessive-compulsive disorder. DESIGN, SETTING, AND PARTICIPANTS Multicenter, single-blind, randomized clinical noninferiority trial implemented at 2 specialist pediatric obsessive-compulsive disorder clinics in Stockholm and Gothenburg, Sweden. Participants are 152 children and adolescents aged 7 to 17 years with obsessive compulsive disorder, recruited through the 2 clinics and online self-referral. Patients will be randomized 1:1 to the stepped care intervention or face-to-face therapy. Blind evaluations will be conducted after treatment and at 3-month and 6-month follow-ups. At the 6-month follow-up (primary end point), noninferiority will be tested and resource use will be compared between the 2 treatment groups. Data will be analyzed according to intention-to-treat principles. INTERVENTION Patients randomized to stepped care will first receive internet-delivered cognitive behavior therapy for 16 weeks; patients who are classified as nonresponders 3 months after treatment completion will receive additional face-to-face therapy. The control group will receive 16 weeks of face-to-face cognitive behavior therapy immediately following randomization and nonresponders at the 3-month follow-up will, as in the stepped care group, receive additional face-to-face therapy. MAIN OUTCOMES AND MEASURES Noninferiority is defined as a 4-point difference on the primary outcome measure (Children's Yale-Brown Obsessive Compulsive Scale). DISCUSSION Recruitment started October 6, 2017, and was completed May 24, 2019. Results from the primary end point will be available by May 2020. The naturalistic follow-ups (1, 2, and 5 years after the end of treatment) will continue to 2025. There are no interim analyses planned or stopping rules for the trial.

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  • 17.
    Aspvall, Kristina
    et al.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Solna, Sweden.;Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Andersson, Erik
    Karolinska Inst, Div Psychol, Dept Clin Neurosci, Stockholm, Sweden..
    Melin, Karin
    Univ Gothenburg, Inst Hlth & Care Sci, Sahlgrenska Acad, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Gothenburg, Region Vastra G, Sweden..
    Norlin, Lisa
    Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Gothenburg, Region Vastra G, Sweden..
    Eriksson, Viktor
    Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Vigerland, Sarah
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Solna, Sweden.;Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Jolstedt, Maral
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Solna, Sweden.;Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Silverberg-Mörse, Maria
    Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Wallin, Lena
    Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Gothenburg, Region Vastra G, Sweden.;Univ Gothenburg, Inst Neurosci & Physiol, Sahlgrenska Acad, Gothenburg, Sweden..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Bottai, Matteo
    Karolinska Inst, Div Biostat, Inst Environm Med, Stockholm, Sweden..
    Lenhard, Fabian
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Solna, Sweden..
    Mataix-Cols, David
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Solna, Sweden.;Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Serlachius, Eva
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Solna, Sweden.;Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Effect of an Internet-Delivered Stepped-Care Program vs In-Person Cognitive Behavioral Therapy on Obsessive-Compulsive Disorder Symptoms in Children and Adolescents: A Randomized Clinical Trial2021In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 325, no 18, p. 1863-1873Article in journal (Refereed)
    Abstract [en]

    Importance: In most countries, young people with obsessive-compulsive disorder have limited access to specialist cognitive behavioral therapy (CBT), a first-line treatment.

    Objective: To investigate whether internet-delivered CBT implemented in a stepped-care model is noninferior to in-person CBT for pediatric obsessive-compulsive disorder.

    Design, Setting and Participants: A randomized clinical noninferiority trial conducted at 2 specialist child and adolescent mental health clinics in Sweden. Participants included 152 individuals aged 8 to 17 years with obsessive-compulsive disorder. Enrollment began in October 2017 and ended in May 2019. Follow-up ended in April 2020.

    Interventions: Participants randomized to the stepped-care group (n=74) received internet-delivered CBT for 16 weeks. Nonresponders at the 3-month follow-up were then offered a course of traditional face-to-face treatment. Participants randomized to the control group (n=78) immediately received in-person CBT for 16 weeks. Nonresponders at the 3-month follow-up received additional face-to-face treatment.

    Main Outcomes and Measures: The primary outcome was the masked assessor-rated Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score at the 6-month follow-up. The scale includes 10 items rated from 0(no symptoms) to 4(extreme symptoms), yielding a total score range of 0 to 40, with higher scores indicating greater severity. Assessors were masked to treatment allocation at pretreatment, posttreatment, 3-month follow-up, and 6-month follow-up assessments. The predefined noninferiority margin was 4 points on the CY-BOCS.

    Results: Among the 152 randomized participants (mean age, 13.4 years; 94 [62%] females), 151 (99%) completed the trial. At the 3-month follow-up, 34 participants (46%) in the stepped-care group and 23 (30%) in the in-person CBT group were nonresponders. At the 6-month follow-up, the CY-BOCS score was 11.57 points in the stepped-care group vs 10.57 points in the face-to-face treatment group, corresponding to an estimated mean difference of 0.91 points ([1-sided 97.5% CI, -infinity to 3.28]; P for noninferiority=.02). Increased anxiety (30%-36%) and depressive symptoms (20%-28%) were the most frequently reported adverse events in both groups. There were 2 unrelated serious adverse events (1 in each group).

    Conclusions and Relevance: Among children and adolescents with obsessive-compulsive disorder, treatment with an internet-delivered CBT program followed by in-person CBT if necessary compared with in-person CBT alone resulted in a noninferior difference in symptoms at the 6-month follow-up. Further research is needed to understand the durability and generalizability of these findings.

  • 18.
    Aspvall, Kristina
    et al.
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Nobels Vag 9, S-17165 Stockholm, Sweden.;Stockholm Hlth Care Serv, Stockholm, Sweden..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Lenhard, Fabian
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Nobels Vag 9, S-17165 Stockholm, Sweden..
    Melin, Karin
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Reg Vastra Gotaland, Gothenburg, Sweden..
    Norlin, Lisa
    Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Reg Vastra Gotaland, Gothenburg, Sweden..
    Serlachius, Eva
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Nobels Vag 9, S-17165 Stockholm, Sweden.;Stockholm Hlth Care Serv, Stockholm, Sweden..
    Mataix-Cols, David
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Nobels Vag 9, S-17165 Stockholm, Sweden.;Stockholm Hlth Care Serv, Stockholm, Sweden..
    Andersson, Erik
    Karolinska Inst, Dept Clin Neurosci, Div Psychol, Nobels Vag 9, S-17165 Stockholm, Sweden..
    Cost-effectiveness of Internet-Delivered vs In-Person Cognitive Behavioral Therapy for Children and Adolescents With Obsessive-Compulsive Disorder2021In: JAMA Network Open, E-ISSN 2574-3805, Vol. 4, no 7, article id e2118516Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: Therapist-guided, internet-delivered cognitive behavioral therapy is an effective treatment option for children and adolescents with obsessive-compulsive disorder, but to our knowledge, its cost-effectiveness compared with traditional in-person treatment has not been established.

    OBJECTIVE: To evaluate the cost-effectiveness of guided internet-delivered cognitive behavioral therapy implemented within a stepped-care model compared with in-person cognitive behavioral therapy for young people with obsessive-compulsive disorder.

    DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation of a randomized noninferiority trial conducted at 2 specialist obsessive-compulsive disorder clinics in Sweden enrolled 152 children and adolescents aged 8 to 17 years with obsessive-compulsive disorder, mainly through clinician referrals (110 [72%]). Recruitment began October 6, 2017, and ended May 24, 2019. Follow-up ended April 14, 2020.

    INTERVENTIONS: Participants were randomly assigned to receive either guided internet-delivered cognitive behavioral therapy or in-person cognitive behavioral therapy during a 16-week period. At the 3-month follow-up, nonresponders in both groups were offered additional in-person cognitive behavior therapy sessions.

    MAIN OUTCOMES AND MEASURES: Health outcomes were treatment response rates (primary outcome), remission rates, and quality-adjusted life-years. Cost data were collected before treatment, after treatment, at 3-month follow-up, and at 6-month follow-up (primary end point) and are presented in 2020 US dollars. The differences in incremental costs and health outcomes were compared between the groups and presented from the health care professional, health care sector, and societal perspectives.

    RESULTS: A total of 152 participants (94 girls [62%]; mean [SD] age, 13.4 [2.5] years) were randomized; 151 (99%) completed the trial. At the 6-month follow-up, 50 of 74 participants (68%) in the stepped-care group and 52 of 77 participants (68%) in the in-person cognitive behavioral therapy groupwere classified as treatment responders (odds ratio, 1.00 [95% CI, 0.51-1.98]; P=.99). Health economic analyses showed that the stepped-care group used fewer therapist resources than the in-person cognitive behavioral therapy group, resulting in a mean cost savings of $2104 (95% CI, $1202-$3006) per participant for the full study period of 10 months, corresponding to a relative savings of 39%. The cost savings remained largely comparable when taking wider health care sector and societal perspectives.

    CONCLUSIONS AND RELEVANCE: This study suggests that, for young people with obsessive-compulsive disorder, a low-cost digital intervention followed by in-person treatment for nonresponders was cost-effective compared with in-person cognitive behavior therapy alone.

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  • 19.
    Axford, Nick
    et al.
    University of Plymouth.
    Bjornstad, Gretchen
    University of Exeter Medical School.
    Matthews, Justin
    University of Exeter.
    Heilmann, Sarah
    Erasmus University Rotterdam.
    Raja, Anam
    University of Oxford.
    Ukoumunne, Obioha
    University of Exeter.
    Berry, Vashti
    University of Exeter.
    Wilkinson, Tom
    Devon Partnership NHS Trust.
    Timmons, Luke
    Stand Together.
    Hobbs, Tim
    Dartington Service Design Lab.
    Eames, Tim
    University of Exeter.
    Kallitsoglou, Angeliki
    University of Roehampton.
    Blower, Sarah
    University of York.
    Warner, Georgina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    The effectiveness of a therapeutic parenting program for children aged 6–11 years with behavioral or emotional difficulties: Results from a randomized controlled trial2020In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 117, article id 105245Article in journal (Refereed)
    Abstract [en]

    Objective

    The aim of the study was to evaluate the implementation and effectiveness of a therapeutic parenting program that targets parents of children aged 6 to 11 years identified as having behavioral and emotional difficulties. The intervention comprises two parts, delivered sequentially: a 10–12-week group-based program for all parents, and one-to-one sessions for up to 12 weeks with selected parents from the group-based element.

    Methods/Design

    In a randomized controlled trial, 264 participants were allocated to the Inspiring Futures program (intervention) or services as usual (control) arms with follow-up assessments at 16 (post-group program) and 32 (post-one-to-one sessions) weeks. The primary outcome was the parent-rated Strengths and Difficulties Questionnaire (SDQ) Total Difficulties score at 32 weeks. Secondary outcomes included parent-rated SDQ subscales, parent coping strategies, empathy in parenting and parenting skills.

    Results

    All 264 participants were included in outcome analyses. There was no statistically significant effect on SDQ Total Difficulties (standardized mean difference: −0.07; 95% CI: −0.30 to 0.16; p = 0.54). There were no sub-group effects. Only 1 of 40 comparisons between the trial arms for secondary outcomes across both follow-ups was statistically significant at the 5% level. The mean number of group sessions attended by intervention arm participants was 6.1 (out of 10 to 12) and only 1 in 20 intervention arm participants received one-to-one support. Independent observation indicated scope to improve fidelity in terms of adherence, quality and participant responsiveness.

    Conclusions

    The intervention is not more effective than services as usual at improving targeted outcomes. This may be related, in part, to implementation issues but arguably more to the inability of a non-behavioral intervention to improve caregiving adequately, particularly when it is not targeted at new parents who have experienced trauma or deprivation early in life or subsequently.

  • 20.
    Axford, Nick
    et al.
    University of Plymouth.
    Bjornstad, Gretchen
    University of Exeter Medical School.
    Matthews, Justin
    University of Exeter.
    Whybra, Laura
    Dartington Service Design Lab.
    Berry, Vashti
    University of Exeter.
    Ukoumunne, Obioha
    University of Exeter.
    Hobbs, Tim
    Dartington Service Design Lab.
    Wrigley, Zoe
    Cardiff University.
    Brook, Lucy
    Devon Partnership NHS Trust.
    Taylor, Rod
    University of Exeter Medical School.
    Eames, Tim
    University of Exeter Medical School.
    Kallitsoglou, Angeliki
    University of Roehampton.
    Blower, Sarah
    University of York.
    Warner, Georgina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    The Effectiveness of a Community-Based Mentoring Program for Children Aged 5–11 Years: Results from a Randomized Controlled Trial2020In: Prevention Science, ISSN 1389-4986, E-ISSN 1573-6695Article in journal (Refereed)
    Abstract [en]

    The study, a two-arm, randomized controlled, parallel group, superiority trial, aimed to evaluate the implementation and effectiveness of a 12-month one-to-one volunteer mentoring program designed to improve behavioral and emotional outcomes in children aged 5 to 11 years who have teacher- and parent/carer-reported behavioral difficulties. Participants were 246 children (123 intervention, 123 control; mean age 8.4 years; 87% boys) in five sites in London, UK, scoring in the “abnormal” range on the teacher-rated Strengths and Difficulties Questionnaire (SDQ) Total Difficulties measure and in the “borderline” or abnormal range on the parent-rated SDQ Total Difficulties measure. Randomization on a 1:1 ratio took place using a computer-generated sequence and stratifying by site. Data collectors and statisticians were blind to participant allocation status. Outcome measures focused on parent- and teacher-rated child behavior and emotions, and child-rated self-perception and hope. Intention-to-treat analysis on all 246 randomized participants (using imputed data where necessary) showed that at post-intervention (16 months after randomization), there were no statistically significant effects on the primary outcome—parent-rated SDQ Total Difficulties (adjusted standardized mean difference = − 0.12; 95% CI: −0.38 to 0.13; p = 0.33)—or any secondary outcomes. Results from complier average causal effect (CACE) analysis using the primary outcome indicated the intervention was not effective for children who received the recommended duration of mentoring. Exploratory analyses found no sub-group effects on the primary outcome. The article concludes that the mentoring program had no effect on children’s behavior or emotional well-being, and that program content needs revising to satisfactorily address key risk and protective factors.

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  • 21. Axford, Nick
    et al.
    Warner, Georgina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hobbs, Tim
    Heilmann, Sarah
    Raja, Anam
    Berry, Vashti
    Ukoumunne, Obioha C
    Matthews, Justin
    Eames, Tim
    Kallitsoglou, Angeliki
    Blower, Sarah
    Wilkinson, Tom
    Timmons, Luke
    Bjornstad, Gretchen
    The effectiveness of the Inspiring Futures parenting programme in improving behavioural and emotional outcomes in primary school children with behavioural or emotional difficulties: study protocol for a randomised controlled trial.2018In: BMC Psychology, E-ISSN 2050-7283, Vol. 6, no 1, article id 3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a need to build the evidence base of early interventions promoting children's health and development in the UK. Malachi Specialist Family Support Services ('Malachi') is a voluntary sector organisation based in the UK that delivers a therapeutic parenting group programme called Inspiring Futures to parents of children identified as having behavioural and emotional difficulties. The programme comprises two parts, delivered sequentially: (1) a group-based programme for all parents for 10-12 weeks, and (2) one-to-one sessions with selected parents from the group-based element for up to 12 weeks.

    METHODS/DESIGN: A randomised controlled trial will be conducted to evaluate Malachi's Inspiring Futures parenting programme. Participants will be allocated to one of two possible arms, with follow-up measures at 16 weeks (post-parent group programme) and at 32 weeks (post-one-to-one sessions with selected parents). The sample size is 248 participants with a randomisation allocation ratio of 1:1. The intervention arm will be offered the Inspiring Futures programme. The control group will receive services as usual. The aim is to determine the effectiveness of the Inspiring Futures programme on the primary outcome of behavioural and emotional difficulties of primary school children identified as having behavioural or emotional difficulties.

    DISCUSSION: This study will further enhance the evidence for early intervention parenting programmes for child behavioural and emotional problems in the UK.

    TRIAL REGISTRATION: Current Controlled Trials ISRCTN32083735 . Retrospectively registered 28 October 2014.

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  • 22.
    Baghdasaryan, Zara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Lampa, Elin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Osman, Fatumo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Högskolan Dalarna, Department of Health and Welfare.
    Let us understand each other and work together in the child’s best interest’ – Exploring the narratives of newly arrived refugee parents in Sweden2021In: International Journal of Intercultural Relations, ISSN 0147-1767, E-ISSN 1873-7552, Vol. 81, p. 226-235Article in journal (Refereed)
    Abstract [en]

    Complex and multi-layered socio-economic and cultural challenges face refugee parents resettling in a new country. The aim of this study was to describe refugee mothers and fathers & rsquo; experiences of parenthood by lifting up their own voices, illuminating the challenges they face and laying the basis for designing interventions to provide well-informed and culturally tailored support pro-grammes for families in need.

    The study combined narrative research with focus group discussions with 50 refugee mothers and fathers in Sweden. Data were analysed inductively using thematic analysis. The main theme identified: Navigating the changing landscape of parenthood, captured refugee parents & rsquo; experiences of navigating their parenthood through the new socio-political, cultural, and economic setting in Sweden.

    The study results demonstrated how acculturation challenges undermined the role of parents, threatened the family cohesion and led to alienation of children from their parents. Despite the plethora of challenges faced by families, parents struggling to navigate two differing cultural paradigms, envisioned a path of dialogue and reconciliation between newcomers and the host society as a way to foster true integration and understanding between immigrant and native communities.

  • 23.
    Bartels, Sara Laureen
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Johnsson, Sophie, I
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Boersma, Katja
    Örebro Univ, Ctr Hlth & Med Psychol CHAMP, Sch Law Psychol & Social Work, Örebro, Sweden..
    Flink, Ida
    Örebro Univ, Ctr Hlth & Med Psychol CHAMP, Sch Law Psychol & Social Work, Örebro, Sweden..
    McCracken, Lance
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Petersson, Suzanne
    Linnaeus Univ, Dept Med & Optometry, Kalmar, Sweden.;Maastricht Univ, Alzheimer Ctr Limburg, Sch Mental Hlth & Neurosci, Maastricht, Netherlands..
    Christie, Hannah L.
    Maastricht Univ, Dept Psychiat & Neuropsychol, Sch Mental Hlth & Neurosci, Maastricht, Netherlands..
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Simons, Laura E.
    Stanford Univ, Dept Anaesthesiol Perioperat & Pain Med, Sch Med, Stanford, CA USA..
    Onghena, Patrick
    Katholieke Univ Leuven, Res Grp Methods Individual & Cultural Differences, Leuven, Belgium..
    Vlaeyen, Johan W. S.
    Katholieke Univ Leuven, Res Grp Hlth Psychol, Leuven, Belgium.;Maastricht Univ, Res Grp Expt Hlth Psychol, Maastricht, Netherlands..
    Wicksell, Rikard K.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Capio St Goran Hosp, Pain Clin, Stockholm, Sweden..
    Development, evaluation and implementation of a digital behavioural health treatment for chronic pain: study protocol of the multiphase DAHLIA project2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 4, article id e059152Article in journal (Refereed)
    Abstract [en]

    Introduction: Chronic pain affects about 20%-40% of the population and is linked to mental health outcomes and impaired daily functioning. Pharmacological interventions are commonly insufficient for producing relief and recovery of functioning. Behavioural health treatment is key to generate lasting benefits across outcome domains. However, most people with chronic pain cannot easily access evidence-based behavioural interventions. The overall aim of the DAHLIA project is to develop, evaluate and implement a widely accessible digital behavioural health treatment to improve well-being in individuals with chronic pain.

    Methods and analysis: The project follows the four phases of the mHealth Agile Development and Evaluation Lifecycle: (1) development and pre-implementation surveillance using focus groups, stakeholder interviews and a business model; (2) iterative optimisation studies applying single case experimental design (SCED) method in 4-6 iterations with n=10 patients and their healthcare professionals per iteration; (3) a two-armed clinical randomised controlled trial enhanced with SCED (n=180 patients per arm) and (4) interview-based post-market surveillance. Data analyses include multilevel modelling, cost-utility and indicative analyses. In October 2021, inter-sectorial partners are engaged and funding is secured for four years. The treatment content is compiled and the first treatment prototype is in preparation. Clinical sites in three Swedish regions are informed and recruitment for phase 1 will start in autumn 2021. To facilitate long-term impact and accessibility, the treatment will be integrated into a Swedish health platform (www.1177.se), which is used on a national level as a hub for advice, information, guidance and e-services for health and healthcare.

    Ethics and dissemination: The study plan has been reviewed and approved by Swedish ethical review authorities. Findings will be actively disseminated through peer-reviewed journals, conference presentations, social media and outreach activities for the wider public.

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  • 24.
    Bendre, Megha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Functional Pharmacology and Neuroscience. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.
    Checknita, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Todkar, Aniruddha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Åslund, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hodgins, Sheilagh
    Univ Montreal, Ctr Rech Inst Natl Psychiat Legale Philippe Pinel, Montreal, PQ, Canada.;Univ Montreal, Dept Psychiat, Montreal, PQ, Canada..
    Nilsson, Kent W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Mälardalen Univ, Sch Hlth Care & Social Welf, Div Publ Hlth Sci, Västerås, Sweden.
    Good parent-child relationship protects against alcohol use in maltreated adolescent females carrying the MAOA-uVNTR susceptibility allele2024In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 15, article id 1375363Article in journal (Refereed)
    Abstract [en]

    Introduction: Risk-allele carriers of a Monoamine oxidase A (MAOA) gene, short-allele (MAOA-S) in males and long-allele (MAOA-L) in females, in the presence of a negative environment, are associated with alcohol misuse. Whether MAOA-S/L alleles also present susceptibility to a positive environment to mitigate the risk of alcohol misuse is unknown. Thus, we assessed the association of the three-way interaction of MAOA, maltreatment, and positive parent-child relationship with alcohol consumption among adolescents.

    Methods: This prospective study included 1416 adolescents (females: 59.88%) aged 16 ̵ 19 years from Sweden, enrolled in the “Survey of Adolescent Life in Västmanland” in 2012. Adolescents self-reported alcohol consumption, maltreatment by a family (FM) or non-family member (NFM), parent-child relationship, and left saliva for MAOA genotyping.

    Results and discussion: We observed sex-dependent results. Females carrying MAOA-L with FM or NFM and a good parent-child relationship reported lower alcohol consumption than those with an average or poor parent-child relationship. In males, the interactions were not significant. Results suggest MAOA-L in females, conventionally regarded as a “risk”, is a “plasticity” allele as it is differentially susceptible to negative and positive environments. Results highlight the importance of a good parent-child relationship in mitigating the risk of alcohol misuse in maltreated individuals carrying genetic risk. However, the interactions were not significant after adjusting to several environmental and behavioural covariates, especially parent’s alcohol use, negative parent-child relationship, and nicotine use (smoking and/or snus), suggesting predictor and outcome intersection. Future studies and frameworks for preventive strategies should consider these covariates together with alcohol consumption. More studies with larger sample sizes are needed to replicate the findings.

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  • 25.
    Bergman, Lina
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Box 23 300, S-14183 Huddinge, Sweden..
    Nilsson, Ulrica
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Box 23 300, S-14183 Huddinge, Sweden.;Karolinska Univ Hosp, Dept Perioperat Med & Intens Care, Stockholm, Sweden..
    Dahlberg, Karuna
    Örebro Univ, Sch Hlth Sci, Fac Med & Hlth, Örebro, Sweden..
    Jaensson, Maria
    Örebro Univ, Sch Hlth Sci, Fac Med & Hlth, Örebro, Sweden..
    Wångdahl, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Health literacy and e-health literacy among Arabic-speaking migrants in Sweden: a cross-sectional study2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, article id 2165Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Health inequities arise when the public cannot access and understand health information in an easy, accessible, and understandable way. Evidence supports that health literacy (HL) is a determinant for health outcomes, and when HL is limited this may have a major impact on morbidity as well as mortality. Migrants are known to have limited HL. Therefore, this study aimed to explore comprehensive health literacy (CHL) and electronic health literacy (eHL) among Arabic-speaking migrants in Sweden.

    METHODS: This was a cross-sectional observational study conducted in Sweden. A total of 703 persons were invited to participate between February and September 2019. Two questionnaires - the Health Literacy Survey European Questionnaire (HLS-EU-Q16) and the eHealth Literacy Scale (eHEALS) - and questions about self-perceived health and Internet use were distributed in Swedish and Arabic. Various statistical analyses were performed to determine the associations for limited CHL and eHL.

    RESULTS: A total of 681 respondents were included in the analysis. Of these, 334 (49%) were native Arabic-speaking migrants and 347 (51%) were native Swedish-speaking residents. CHL and eHL differed between the groups. The Arabic speakers had significantly lower mean sum scores in eHL 28.1 (SD 6.1) vs 29.3 (6.2), p = 0.012 and lower proportion of sufficient CHL 125 (38.9%) vs 239 (71.3%), p < 0.001 compared to Swedish speakers. Multiple regression analysis showed on associations between limited CHL and eHL and being Arabic speaking, less Internet use, and not finding the Internet to be important or useful. Furthermore, longer time spent in Sweden was associated with higher levels of CHL among the Arabic speakers, (OR 0.94, 95% CI 0.91-0.98, p < 0.01).

    CONCLUSIONS: CHL and eHL differ between Arabic-speaking migrants and native Swedish speakers, but also between Arabic speakers who have lived different lengths of time in Sweden. Though it seems that the eHealth literacy is less affected by language spoken, the Internet is suggested to be an appropriate channel for disseminating health information to Arabic-speaking migrants.

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  • 26.
    Bergman, Lina
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Nilsson, Ulrica
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Perioperat Med & Intens Care, Stockholm, Sweden..
    Dahlberg, Karuna
    Orebro Univ, Fac Med & Hlth, Sch Hlth Sci, Orebro, Sweden..
    Jaensson, Maria
    Orebro Univ, Fac Med & Hlth, Sch Hlth Sci, Orebro, Sweden..
    Wångdahl, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Karolinska Inst, Aging Res Ctr, Stockholm, Sweden.;Stockholm Univ, Stockholm, Sweden.;Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Aging Res Ctr, Tomtebodavagen 18A, S-17177 Solna, Sweden.;Stockholm Univ, Tomtebodavagen 18A, S-17177 Solna, Sweden..
    Validity and reliability of the arabic version of the HLS-EU-Q16 and HLS-EU-Q6 questionnaires2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 304Article in journal (Refereed)
    Abstract [en]

    Background Health literacy is an important social determinant of health and affects the ability to make decisions and take action to manage one's health. The purpose of this study was to psychometrically examine the Arabic versions of HLS-EU-Q16 and HLS-EU-Q6 and their response patterns among Arabic-speaking persons in Sweden. Methods By convenience sampling from a variety of settings, a total of 335 participants were invited to participate. The participants completed a self-assessment of comprehensive health literacy by answering the Ar-HLS-EU-Q16 questionnaire, also including the six items for Ar-HLS-EU-Q6. Statistical analysis was guided by The COnsensus-based Standards for the selection of health Measurement Instruments. Floor/ceiling effects, construct, structural and criterion validity, test-retest reliability and internal consistency reliability were analysed. Results In total, 320 participants were included in the psychometric evaluation. Mean age was 42.1 (SD 12.5), 63% (n = 199) were females and 53% (n = 169) had at least 10 years of education. No floor or ceiling effect were found for the Ar-HLS-EU-Q16 or Ar-HLS-EU-Q6. For both instruments, construct validity was confirmed in four out of five expected correlations (weak positive correlation to educational level, self-perceived health, and years in Sweden; moderate positive correlation with higher sum score on the Arabic electronic health literacy scale, and strong positive correlation to higher Ar-HLS-EU-Q16/Ar-HLS-EU-Q6). For Ar-HLS-EU-Q16, the principal component analysis resulted in a three-factor model with all items significantly correlating to only one factor. For Ar-HLS-EU-Q6, the principal component analysis supported a one-factor solution. Criterion validity showed poor agreement between the two questionnaires with a Cohen. 0.58 (p < 0.001). Test-retest reliability showed a substantial agreement, Cohen's. for Ar-HLS-EU-Q16 and Ar-HLS-EU-Q6 were both 0.89. The internal consistency of both versions was acceptable, Cronbach alpha for Arabic-HLS-EU-Q16 was 0.91 and for Arabic-HLS-EU-Q6, 0.79. Split-half reliability was 0.95 and 0.78, respectively. Conclusion The Arabic version of HLS-EU-Q16 shows good psychometric properties, validated in a Swedish setting. The findings can further inform and guide future validation studies in other settings worldwide. Furthermore, the results of the present study did not support criterion validity of Ar-HLS-EU-Q6.

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  • 27.
    Bergsten, Eva L.
    et al.
    Univ Gävle, Fac Hlth & Occupat Studies, Dept Occupat Hlth Sci & Psychol, S-80176 Gävle, Sweden..
    Wijk, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Univ Gävle, Fac Hlth & Occupat Studies, Dept Occupat Hlth Sci & Psychol, S-80176 Gävle, Sweden..
    Hallman, David M.
    Univ Gävle, Fac Hlth & Occupat Studies, Dept Occupat Hlth Sci & Psychol, S-80176 Gävle, Sweden..
    Implementation of Activity-Based Workplaces (ABW)-The Importance of Participation in Process Activities2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 21, article id 14338Article in journal (Refereed)
    Abstract [en]

    Relocation to new office solutions such as activity-based workplaces (ABW) has increased but satisfaction with the ABW among employees varies, and the importance of participation in the relocation process is unclear. This study aimed to examine the association between employees' extent of participation in the implementation process activities and satisfaction with the relocation to ABW. Data were collected from 699 employees in a Swedish governmental agency 3-months prior to, 3-months and 9-months after relocation to the ABW. Questionnaires were used to assess participation in process activities and perceived satisfaction with knowledge about working in ABW, office rules, and information and support during the process. Participation in activities was significantly associated with higher overall satisfaction with knowledge, office rules, information and support, and effects were generally more pronounced as the number of attended activities increased. Satisfaction also increased among non-participants, although without reaching the same levels as participants. Our results show the importance to offer and facilitate a high participation in the relocation process activities to obtain satisfaction with a relocation to ABW.

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  • 28.
    Bergsten, Eva L.
    et al.
    Univ Gävle, Dept Occupat Hlth Sci & Psychol, Fac Hlth & Occupat Studies, S-80176 Gävle, Sweden..
    Wijk, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Univ Gävle, Dept Occupat Hlth Sci & Psychol, Fac Hlth & Occupat Studies, S-80176 Gävle, Sweden..
    Hallman, David M.
    Univ Gävle, Dept Occupat Hlth Sci & Psychol, Fac Hlth & Occupat Studies, S-80176 Gävle, Sweden..
    Relocation to Activity-Based Workplaces (ABW)-Importance of the Implementation Process2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 21, article id 11456Article in journal (Refereed)
    Abstract [en]

    Activity-based workplaces (ABW) have been implemented in many organizations to offer office flexibility and decrease facility costs. Evaluations of the ABW implementation process are rare. The study aimed to examine the ABW relocation process of two offices in a Swedish governmental agency and to explore factors that influence the implementation process and satisfaction with it. Qualitative or quantitative data were collected on process variables (context, recruitment, reach, dose delivered, dose received, satisfaction), barriers and facilitators to the process were explored in focus group interviews, and immediate outcomes (perceived knowledge, understanding office rules, satisfying information and support) were measured by questionnaire before and after the relocation. The evaluation showed that recruitment was unsatisfactory and reach insufficient-and participation in activities was thus low for both offices. However, intended changes improved. Unclear aims of ABW, lack of manager support and, lack of communication were some of the reported barriers to participation, while a well-planned process, work groups, and program activities were facilitators. Thus, to increase satisfaction with the relocation, our results suggest that recruitment should be thoroughly planned, taking these factors into account to increase participation. This knowledge may be useful for planning and designing successful ABW relocations and evaluations.

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  • 29.
    Bergström, Malin
    et al.
    Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Fransson, Emma
    Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden.
    Fabian, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hjern, Anders
    Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 2, p. 294-300Article in journal (Refereed)
    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.

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  • 30.
    Bergström, Malin
    et al.
    Sachs Children & Youth Hosp, Stockholm, Sweden; Karolinska Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden; Stockholm Univ, Ctr Hlth Equ Studies, CHESS, Stockholm, Sweden.
    Gebreslassie, Mihretab
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hedqvist, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Lindberg, Lene
    Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden; Ctr Epidemiol & Community Med, Stockholm, Sweden.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hjern, Anders
    Sachs Children & Youth Hosp, Stockholm, Sweden; Karolinska Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden; Stockholm Univ, Ctr Hlth Equ Studies, CHESS, Stockholm, Sweden.
    Narrative review of interventions suitable for well-baby clinics to promote infant attachment security and parents' sensitivity2020In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 109, no 9, p. 1745-1757Article, review/survey (Refereed)
    Abstract [en]

    Aim

    The aim of this narrative review was to evaluate the evidence for interventions for children's secure attachment relationships and parents’ caregiving sensitivity that could potentially be implemented in the context of a well‐baby clinic.

    Methods

    Literature search on programmes for parental caregiving sensitivity and secure attachment for infants aged 0‐24 months. Randomised controlled trials (RCTs) published 1995‐2018 with interventions starting from one week postpartum, and with a maximum of 12 sessions (plus potential booster session) were included.

    Results

    We identified 25 studies, of which 22 studied effects of home‐based programmes using video feedback techniques. Positive effects of these interventions in families at risk were found on parental caregiving sensitivity and to a lesser extent also on children's secure or disorganised attachment. The effects of two of these programmes were supported by several RCTs. Three intervention studies based on group and individual psychotherapy showed no significant positive effects. Most of the interventions targeted mothers only.

    Conclusion

    The review found some evidence for positive effects of selective interventions with video feedback techniques for children's secure attachment and strong evidence for positive effects on parental caregiving sensitivity. Important knowledge gaps were identified for universal interventions and interventions for fathers and parents with a non‐Western background.

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  • 31.
    Bergström, Malin
    et al.
    Ctr Hlth Equ Studies, Stockholm, Sweden; Karolinska Inst, Dept Med, Clin Epidemiol, Stockholm, Sweden.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hjern, Anders
    Ctr Hlth Equ Studies, Stockholm, Sweden; Karolinska Inst, Dept Med, Clin Epidemiol, Stockholm, Sweden.
    Hognäs, Robin
    Stockholm Univ, Dept Publ Hlth Sci, Stockholm, Sweden.
    Bergqvist, Kersti
    Ctr Hlth Equ Studies, Stockholm, Sweden.
    Fransson, Emma
    Ctr Hlth Equ Studies, Stockholm, Sweden.
    Importance of living arrangements and coparenting quality for young children's mental health after parental divorce: a cross-sectional parental survey2021In: BMJ Paediatrics Open, E-ISSN 2399-9772, Vol. 5, no 1, article id e000657Article in journal (Refereed)
    Abstract [en]

    Background Parental separation has been associated with adverse child mental health outcomes in the literature. For school-aged children, joint physical custody (JPC), that is, spending equal time in both parents’ homes after a divorce, has been associated with better health and well-being than single care arrangements. Preschool children’s well-being in JPC is less studied. The aim of this study was to investigate the association of living arrangements and coparenting quality with mental health in preschool children after parental separation.

    Methods This cross-sectional population-based study includes 12 845 three-year-old children in Sweden. Mental health was measured by parental reports of the Strength and Difficulties Questionnaire and coparenting quality with a four-item scale. The living arrangements of the 642 children in non-intact families were categorised into JPC, living mostly with one parent and living only with one parent.

    Results Linear regression models, adjusted for sociodemographic confounders, showed an association between increased mental health problems and living mostly and only with one parent (B=1.18; 95% CI 0.37 to 2.00, and B=1.20; 95% CI 0.40 to 2.00, respectively), while children in intact families vs JPC did not differ significantly (B=−0.11; 95% CI −0.58 to 0.36). After adjusting the analyses for coparenting quality, differences in child mental health between the post divorce living arrangements were, however, minimal while children in intact families had more mental health problems compared with JPC (B=0.70; 95% CI 0.24 to 1.15). Factorial analysis of covariance revealed that low coparenting quality was more strongly related to mental health problems for children in intact families and JPC compared with children living mostly or only with one parent.

    Conclusions This study suggests that coparenting quality is a key determinant of mental health in preschool children and thus should be targeted in preventive interventions.

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  • 32.
    Brew, B. K.
    et al.
    Karolinska Inst, Stockholm, Sweden.
    Söderberg, J.
    Karolinska Inst, Stockholm, Sweden.
    Lundholm, C.
    Karolinska Inst, Stockholm, Sweden.
    Holmberg, Kirsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Almqvist, C.
    Karolinska Inst, Stockholm, Sweden.
    Academic achievement of adolescents with asthma and atopic diseases2018In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 73, no Suppl. 105, p. 313-313, article id 580Article in journal (Other academic)
  • 33.
    Brew, Bronwyn K.
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden.;Univ New South Wales, Ctr Big Data Res Hlth, Natl Perinatal Epidemiol & Stat Unit, Kensington, NSW, Australia.;Univ New South Wales, Sch Clin Med, Kensington, NSW, Australia..
    Caffrey Osvald, Emma
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden.;Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Pediat Allergy & Pulmonol Unit, Stockholm, Sweden..
    Gong, Tong
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden..
    Hedman, Anna M.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden..
    Holmberg, Kirsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Larsson, Henrik
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden.;Örebro Univ, Sch Med Sci, Örebro, Sweden..
    Ludvigsson, Jonas F.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden.;Örebro Univ Hosp, Dept Pediat, Örebro, Sweden..
    Mubanga, Mwenya
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden..
    Smew, Awad I.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden..
    Almqvist, Catarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden.;Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Pediat Allergy & Pulmonol Unit, Stockholm, Sweden..
    Paediatric asthma and non-allergic comorbidities: A review of current risk and proposed mechanisms2022In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 52, no 9, p. 1035-1047Article, review/survey (Refereed)
    Abstract [en]

    It is increasingly recognized that children with asthma are at a higher risk of other non-allergic concurrent diseases than the non-asthma population. A plethora of recent research has reported on these comorbidities and progress has been made in understanding the mechanisms for comorbidity. The goal of this review was to assess the most recent evidence (2016-2021) on the extent of common comorbidities (obesity, depression and anxiety, neurodevelopmental disorders, sleep disorders and autoimmune diseases) and the latest mechanistic research, highlighting knowledge gaps requiring further investigation. We found that the majority of recent studies from around the world demonstrate that children with asthma are at an increased risk of having at least one of the studied comorbidities. A range of potential mechanisms were identified including common early life risk factors, common genetic factors, causal relationships, asthma medication and embryologic origins. Studies varied in their selection of population, asthma definition and outcome definitions. Next, steps in future studies should include using objective measures of asthma, such as lung function and immunological data, as well as investigating asthma phenotypes and endotypes. Larger complex genetic analyses are needed, including genome-wide association studies, gene expression-functional as well as pathway analyses or Mendelian randomization techniques; and identification of gene-environment interactions, such as epi-genetic studies or twin analyses, including omics and early life exposure data. Importantly, research should have relevance to clinical and public health translation including clinical practice, asthma management guidelines and intervention studies aimed at reducing comorbidities.

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  • 34.
    Brew, Bronwyn K.
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Soderberg, Joakim
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Lundholm, Cecilia
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Afshar, Soren
    Karolinska Univ Hosp, Dept Med, Div Resp Med, Stockholm, Sweden.
    Holmberg, Kirsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Almqvist, Catarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden;Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Pediat Allergy & Pulmonol Unit, Stockholm, Sweden.
    Academic achievement of adolescents with asthma or atopic disease2019In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 6, p. 892-899Article in journal (Refereed)
    Abstract [en]

    Background

    Over a fifth of children and adolescents suffer with asthma or atopic disease. It is unclear whether asthma impacts academic performance in children and adolescents, and little is known about the association of eczema, food allergy or hayfever and academic performance.

    Objective

    To examine whether asthma, eczema, food allergy or hayfever impacts on adolescent academic performance and to assess the role of unmeasured confounding.

    Methods

    This study used the Childhood and Adolescent Twin Study of Sweden cohort born 1992‐1998. At age 9‐12 years, parents reported on their child's ever or current asthma, eczema, food allergy and hayfever status (n = 10 963). At age 15, linked national patient and medication register information was used to create current and ever asthma definitions including severe and uncontrolled asthma for the same children. Academic outcomes in Grade 9 (age 15‐16 years) included: eligibility for high school (Grades 10‐12), and total mark of the best 16 subject units, retrieved from the Grade 9 academic register. Whole cohort analyses adjusted for known covariates were performed, and co‐twin control analyses to assess unmeasured confounders.

    Results

    There were no associations found for asthma or food allergy at 9‐12 years and academic outcomes in adolescence. In addition, at age 15, there were no statistically significant associations with current, ever, severe or uncontrolled asthma and academic outcomes. Eczema and hayfever at age 9‐12 years were found to be positively associated with academic outcomes; however, co‐twin control analyses did not support these findings, suggesting the main analyses may be subject to unmeasured confounding.

    Conclusion and clinical relevance

    Having asthma or an atopic disease during childhood or adolescence does not negatively impact on academic performance. This information can be used by clinicians when talking with children and parents about the implications of living with asthma or atopic disease.

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  • 35.
    Brooks, Samantha J.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience. Liverpool John Moores Univ, Fac Hlth, Sch Psychol, Liverpool 5E3 3AF, Merseyside, England.;Univ Witwatersrand, Sch Human & Community Dev, Dept Psychol, Neurosci Res Lab NeuRL, Johannesburg, South Africa..
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Uppsala Cty Council, Uppsala, Sweden..
    Schiöth, Helgi B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Schiöth: Functional Pharmacology. Sechenov First Moscow State Med Univ, Inst Translat Med & Biotechnol, Moscow, Russia..
    Titova, Olga E
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Important gender differences in psychosomatic and school-related complaints in relation to adolescent weight status2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, article id 14147Article in journal (Refereed)
    Abstract [en]

    Underweight or overweight in adolescence is linked to several adverse health outcomes. Less evidence exists about the association between weight status and school-related psychosocial characteristics in high income countries. We sought to investigate the relationship between weight status and psychosomatic and school-related complaints with a focus on gender differences. The study is a cohort of 18,462 adolescents (12-19 years; 51% girls) conducted in Sweden. The associations between weight status and psychosomatic and school-related complaints were estimated by binary logistic regression adjusted for several potential confounders. After correction for multiple testing, being underweight or overweight/obese was adversely associated with several psychosomatic and school-related complaints with significant differences between boys and girls. Specifically, underweight boys had higher odds to have psychosomatic complaints than normal-weight boys, while no such associations were observed among underweight girls. Overweight/obese (vs. normal-weight) boys had higher odds to complain about headache, pain in the back/hips, and feeling low. Overweight/obese (vs. normal-weight) girls were more likely to complain about feeling low, anxious/worried and having difficulty in falling asleep (P <= 0.01). In relation to school-related complaints (e.g., being bullied at school and academic failure), greater associations were observed for overweight/obese girls and boys than for underweight adolescents compared with normal-weight peers.

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  • 36.
    Campbell, Kristine A.
    et al.
    Univ Utah, Dept Pediat, Primary Childrens Hosp, Eccles Outpatient Bldg,81 North Mario Capecchi Dr, Salt Lake City, UT 84113 USA..
    Byrne, Kara A.
    Univ Utah, David Eccles Sch Business, Kem C Gardner Policy Inst, 411 East South Temple St, Salt Lake City, UT 84111 USA..
    Thorn, Brian L.
    Univ Utah, Dept Pediat, Primary Childrens Hosp, Eccles Outpatient Bldg,81 North Mario Capecchi Dr, Salt Lake City, UT 84113 USA..
    Abdulahad, Lindsay Shepard
    Univ Utah, Dept Pediat, Primary Childrens Hosp, Eccles Outpatient Bldg,81 North Mario Capecchi Dr, Salt Lake City, UT 84113 USA..
    Davis, R. Neal
    Univ Utah, Dept Pediat, Primary Childrens Hosp, Eccles Outpatient Bldg,81 North Mario Capecchi Dr, Salt Lake City, UT 84113 USA.;Hillcrest Pediat, Intermt Healthcare, 5063 S Cottonwood St,Ste 160, Murray, UT 84157 USA..
    Giles, Lisa L.
    Univ Utah, Dept Pediat, Primary Childrens Hosp, Eccles Outpatient Bldg,81 North Mario Capecchi Dr, Salt Lake City, UT 84113 USA..
    Keeshin, Brooks R.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Univ Utah, Dept Pediat, Primary Childrens Hosp, Eccles Outpatient Bldg,81 North Mario Capecchi Dr, Salt Lake City, UT 84113 USA..
    Screening for symptoms of childhood traumatic stress in the primary care pediatric clinic2024In: BMC Pediatrics, E-ISSN 1471-2431, Vol. 24, article id 217Article in journal (Refereed)
    Abstract [en]

    Background: Childhood traumatic experiences may result in post-traumatic stress disorder. Although pediatricians are encouraged to address these traumas in clinical encounters, measures of childhood traumatic stress have not been adopted by primary care clinicians. In this study, we describe the feasibility and potential utility of the UCLA Brief Screen, a validated screener for childhood traumatic stress symptoms, in pediatric primary care clinics.

    Methods: Children 6-17 years of age presenting for routine well-child care in community-based pediatric clinics were eligible for traumatic stress screening. We described the feasibility and acceptability of screening based on screener adoption by eligible pediatric clinicians. We assessed the potential utility of screening based on prevalence and distribution of potentially traumatic events and traumatic stress symptoms in this general pediatric population. Finally, we compared results of the UCLA Brief Screen with those of the Patient Health Questionnaire-A to evaluate associations between symptoms of traumatic stress, depression, and suicidality among adolescents in this community setting.

    Results: 14/18 (77.8%) pediatric clinicians in two clinics offered an adapted UCLA Brief Screen during 2359/4959 (47.6%) eligible well-child checks over 14 months. 1472/2359 (62.4%) of offered screeners were completed, returned, and scored. One-third (32.5%) of completed screeners captured a potentially traumatic event experience described by either children or caregivers. Moderate to severe traumatic stress symptoms were identified in 10.7% and 5.2% of patients, respectively. Concurrent depression screening revealed that 68.3% of adolescents with depressive symptoms reported a potentially traumatic event (PTE) and 80.5% had concurrent traumatic stress symptoms. Adolescents reporting a PTE were 3.5 times more likely to report thoughts of suicide or self-harm than those without this history.

    Conclusions: Results from this pilot study suggest that traumatic stress screening in the pediatric primary care setting may be feasible and may identify and classify mental health symptoms missed with current screening practices for depression. The prevalence of PTEs and traumatic stress symptoms associated with PTEs support the potential utility of a standardized screening in early identification of and response to children with clinically important symptoms of childhood traumatic stress. Future research should evaluate meaningful clinical outcomes associated with traumatic stress screening.

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  • 37. Coscini, Nadia
    et al.
    Heyes, Priya
    Bedford, Helen
    Cohen, Eyal
    D'Aprano, Anita
    Goldfeld, Sharon
    Hargreaves, Dougal
    Loveday, Sarah
    Nejat, Sahar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Roberts, Gehan
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Saunders, Natasha Ruth
    Woolfenden, Susan
    Milner, Kate
    Multicountry review: developmental surveillance, assessment and care by outpatient paediatricians2023In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 108, no 3, p. 153-159Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups.

    METHODS: Multicountry review of national paediatric body guidance related to developmental surveillance, early identification and early childhood intervention together with review of outpatient paediatrician practices for developmental assessment of children aged 0-5 years with/at risk of NDDs. Review included five countries with comparable nationalised universal child healthcare systems (ie, Australia, Canada, New Zealand, Sweden and the UK). Data were collected using a combination of published and grey literature review, supplemented by additional local sources with descriptive review of relevant data points.

    RESULTS: Countries had broadly similar systems for early identification of young children with NDDs alongside universal child health surveillance. However, variation existed in national paediatric guidance, paediatric developmental training and practice, including variable roles of paediatricians in developmental surveillance at primary care level. Data on coverage of developmental surveillance, content and quality of paediatric development assessment practices were notably lacking.

    CONCLUSION: Paediatricians play an important role in ensuring equitable access to early identification and intervention for young children with/at risk of NDDs. However, strengthening paediatric outpatient care of children with NDD requires clearer guidance across contexts; training that is responsive to shifting roles within interdisciplinary models of developmental assessment and improved data to enhance equity and quality of developmental assessment for children with/at risk of NDDs.

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  • 38.
    Costa, Joao
    et al.
    Univ Lisbon, Fac Med, Ctr Estudos Med Baseada Evidencia CEMBE, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Fac Med, Lab Farmacol Clin & Terapeut, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Fac Med, Inst Med Mol, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Alarcao, Joana
    Univ Lisbon, Fac Med, Ctr Estudos Med Baseada Evidencia CEMBE, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Araujo, Francisco
    Hosp Beatriz Angelo, Serv Med, Av Carlos Teixeira 3, P-2674514 Loures, Portugal..
    Ascencao, Raquel
    Univ Lisbon, Fac Med, Ctr Estudos Med Baseada Evidencia CEMBE, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Fac Med, Inst Med Prevent, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Ctr Cardiovasc, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Ctr Acad Med Lisboa, Fac Med, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Caldeira, Daniel
    Univ Lisbon, Fac Med, Lab Farmacol Clin & Terapeut, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Fac Med, Inst Med Mol, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Ctr Cardiovasc, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Ctr Acad Med Lisboa, Fac Med, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Fiorentino, Francesca
    Univ Lisbon, Fac Med, Ctr Estudos Med Baseada Evidencia CEMBE, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Gil, Victor
    Hosp Lusiadas, Unidade Cardiovasc, R Abilio Mendes 12, P-1500458 Lisbon, Portugal.;Univ Lisbon, Ctr Cardiovasc, Fac Med, Dept Med, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Porto, Fac Med, Dept Med, Alameda Prof Hernani Monteiro, P-4200319 Porto, Portugal..
    Gouveia, Miguel
    Univ Catolica Portuguesa, Ctr Estudos Aplicados, Catolica Lisbon Sch Business & Econ, P-1649023 Lisbon, Portugal..
    Lourenco, Francisco
    Univ Lisbon, Fac Med, Ctr Estudos Med Baseada Evidencia CEMBE, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Mello e Silva, Alberto
    Soc Portuguesa Aterosclerose, Av Jose Malhoa 2, P-1070158 Lisbon, Portugal..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Univ Lisbon, Fac Med, Ctr Estudos Med Baseada Evidencia CEMBE, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal.
    Carneiro, Antonio Vaz
    Univ Lisbon, Fac Med, Ctr Estudos Med Baseada Evidencia CEMBE, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Fac Med, Inst Saude Baseada Evidencia, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Borges, Margarida
    Univ Lisbon, Fac Med, Ctr Estudos Med Baseada Evidencia CEMBE, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Fac Med, Lab Farmacol Clin & Terapeut, Av Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Ctr Hosp Lisboa Cent EPE, Unidade Farmacol Clin, Alameda Santo Antonio Capuchos, P-1169050 Lisbon, Portugal..
    The burden of atherosclerosis in Portugal2021In: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, E-ISSN 2058-1742, Vol. 7, no 2, p. 154-162Article in journal (Refereed)
    Abstract [en]

    Aims This article sought to estimate the burden of disease attributable to atherosclerosis in mainland Portugal in 2016.

    Methods and results The burden of atherosclerosis was measured in disability-adjusted life years following the latest 2010 Global Burden of Disease (GBD) methodology. Disability-adjusted life years were estimated as the sum of years of life lost (YLL) with years lived with disability (YLD). The following clinical manifestations of atherosclerosis were included: ischaemic heart disease (IHD) (including acute myocardial infarction, stable angina, and ischaemic heart failure), ischaemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD). Years of life lost were estimated based on all-cause mortality data for the Portuguese population and mortality due to IHD, ICVD, and PAD for the year 2016 sourced from national statistics. Standard life expectancy was sourced from the GBD study. Years lived with disability corresponded to the product of the number of prevalent cases by an average disability weight for all possible combinations of disease. Prevalence data for the different clinical manifestations of atherosclerosis were sourced from epidemiological studies. Disability weights were sourced from the published literature. In 2016, 15123 deaths were attributable to atherosclerosis, which corresponded to 14.3% of overall mortality in mainland Portugal. Disability-adjusted life years totalled 260943, 75% due to premature death (196438 YLL) and 25% due to disability (64505 YLD).

    Conclusion Atherosclerosis entails a high disease burden to society. A large part of this burden would be avoidable if evidence-based effective and cost-effective interventions targeting known risk factors, from prevention to treatment, were implemented.

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  • 39.
    Dahlberg, Anton
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Capturing and addressing preschool children’s emotional and behavioural problems: Using parents’, teachers’ and children’s perspectives2021Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Emotional and behavioural problems (EBP) are among the most common mental health problems in preschool children. EBP are also associated with poor parent mental health. Untreated, EBP can persist or worsen over time. In order to capture and address preschool children’s EBP, we need scientifically valid instruments that can access the perspectives of informants from different contexts of the child. We also need cut-off values for questionnaires assessing EBP that are representative of the population. Parenting support is a recommended intervention for addressing EBP in preschool children. Most parenting support programmes have a solid evidence-base and show positive effects on child EBP and parent wellbeing. However, we need a better understanding of the children’s emotional and relational experiences, especially in relation to their parents. Further, although the implementation of evidence-based interventions is a complex matter with substantial impact on intervention success, few studies assess the implementation process of parenting programmes. 

    The studies constituting this thesis focused on preschool children. The Strengths and Difficulties Questionnaire (SDQ) was assessed for capturing EBP. Study I assessed the construct validity of the SDQ and its five subscales, when rated by fathers and preschool teachers. Confirmatory factor analysis was applied to evaluate construct validity. Results indicated that the SDQ can be used as an instrument to measure EBP in preschool children, rated by parents and preschool teachers. In study II, we established Swedish norms for the SDQ for preschool children. Results suggested lower SDQ cut-offs for Swedish preschool children compared with other countries, and higher cut-offs for boys compared with girls. In study III, preschool children whose parents participated in a parenting programme were interviewed regarding their emotional and relational experiences at home. Data were analysed using qualitative content analysis. The children provided accounts of negative and positive interactions with their parents, elaborately describing a coercive cycle with escalating conflicts and lack of problem resolution. In study IV, the implementation of the parenting programme Triple P in a preschool setting was assessed using the RE-AIM framework. Results indicated a successful implementation that relied on customisation of the programme; assessment of the process from parent, staff, and organisation levels; interdisciplinary collaboration; and continuous work on securing maintenance over time. 

    This thesis provides pieces to a complex puzzle of understanding and addressing child mental health problems, particularly EBP. Assessing EBP from different perspectives and promoting children’s voices are essential, as well as actively working with the implementation of evidence-based programmes.

    List of papers
    1. SDQ in the Hands of Fathers and Preschool Teachers: Psychometric Properties in a Non-clinical Sample of 3-5-Year-Olds
    Open this publication in new window or tab >>SDQ in the Hands of Fathers and Preschool Teachers: Psychometric Properties in a Non-clinical Sample of 3-5-Year-Olds
    2019 (English)In: Child Psychiatry and Human Development, ISSN 0009-398X, E-ISSN 1573-3327, Vol. 50, no 1, p. 132-141Article in journal (Refereed) Published
    Abstract [en]

    The Strengths and Difficulties Questionnaire (SDQ) is a well-established instrument for measuring social and behavioural problems among children, with good psychometric properties for older children, but less validity reports on pre-schoolers. In addition, there is a knowledge gap concerning fathers as informants. The present work is one of the few validity studies to include preschool teachers and the first on preschool children where fathers are included as separate informants. In this study, SDQs were collected from a large community sample (n = 17,752) of children aged 3-5, rated by mothers, fathers, and preschool teachers and analysed using confirmatory factor analysis. Our results revealed acceptable fit for all informant groups and measurement invariance across child gender, child age, and parental education level. Our findings suggest good construct validity of the SDQ for a non-clinical preschool population and imply that it may be used for assessing child behaviour problems from different informant perspectives.

    Keywords
    Confirmatory factor analysis (CFA), Construct validity, Fathers, Preschool children, Strengths and Difficulties Questionnaire (SDQ)
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Psychology
    Identifiers
    urn:nbn:se:uu:diva-355978 (URN)10.1007/s10578-018-0826-4 (DOI)000458372000012 ()29959588 (PubMedID)
    Funder
    Swedish Research Council FormasVINNOVA, 259-2012-68Swedish Research Council
    Available from: 2018-07-10 Created: 2018-07-10 Last updated: 2021-04-20Bibliographically approved
    2. Swedish norms for the Strengths and Difficulties Questionnaire for children 3-5 years rated by parents and preschool teachers
    Open this publication in new window or tab >>Swedish norms for the Strengths and Difficulties Questionnaire for children 3-5 years rated by parents and preschool teachers
    Show others...
    2020 (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 61, no 2, p. 253-261Article in journal (Refereed) Published
    Abstract [en]

    The Strengths and Difficulties Questionnaire (SDQ) is a widespread tool for assessing behavior problems in children and adolescents. Despite being investigated thoroughly concerning both validity and reliability, peer reviewed studies that provide norms, especially for preschool children, are lacking. This paper provides Swedish norms using data from a large community sample of children aged 3-5, based on mothers', fathers', and preschool teacher's ratings. Preschool teachers' ratings were generally lower than parents' ratings, which contradicts some previous studies. Differences between girls and boys were found, suggesting that boys display higher levels of behavior problems. Lower parental education and country of origin outside of Sweden were also associated with more difficulties. Cut-offs are presented for each age group, gender and rater category. Population-specific norms and percentile cut-offs provided in this study facilitate identifying children in need of interventions in paediatric care and enable cross-country comparisons of children's mental health problems. 

    Keywords
    strengths and difficulties questionnaire, Sweden, mental health, norms, preschool children, psychometrics
    National Category
    Pediatrics
    Identifiers
    urn:nbn:se:uu:diva-384320 (URN)10.1111/sjop.12606 (DOI)000502277900001 ()31833080 (PubMedID)
    Available from: 2019-06-04 Created: 2019-06-04 Last updated: 2021-11-30Bibliographically approved
    3. “They yell and I yell back”: Pre-schoolers’ voices from inside the coercive cycle
    Open this publication in new window or tab >>“They yell and I yell back”: Pre-schoolers’ voices from inside the coercive cycle
    (English)In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765Article in journal (Other academic) Submitted
    National Category
    Psychology
    Identifiers
    urn:nbn:se:uu:diva-440007 (URN)
    Available from: 2021-04-13 Created: 2021-04-13 Last updated: 2021-04-20
    4. Successful implementation of parenting support at preschool: An evaluation of Triple P in Sweden
    Open this publication in new window or tab >>Successful implementation of parenting support at preschool: An evaluation of Triple P in Sweden
    Show others...
    2022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 4, article id e0265589Article in journal (Refereed) Published
    Abstract [en]

    Although emotional and behavioural problems among young children are common and, if unaddressed, can lead to multi-facetted problems later in life, there is little research investigating the implementation of parenting programs that target these problems. In this study, the RE-AIM framework was used to evaluate the implementation of the Triple P parenting program in a preschool setting at a medium-sized municipality in Sweden. Reach increased over time, showing an overall increase in participating fathers and parents with lower education. Effectiveness outcomes showed an improvement in emotional and behavioural problems in children and less mental health-related symptoms and higher self-efficacy in parents. Adoption rate was 93.3%. To ensure staff "buy-in", designated coordinators made changes in recruitment procedures, and provided supervision and training to all Triple P practitioners. Implementation adaptations were made, such as minor revisions of parenting strategies and other program content, as well as providing child care during seminars and groups, and setting up weekend-groups. Maintenance assessed through 12 month follow-up data suggested that several child and parent outcomes were maintained over time. Uppsala municipality continues to offer Triple P to parents. The reach, effectiveness, adoption, implementation and maintenance of the program were all satisfactory and demonstrated the suitability of delivering evidence-based parenting support using preschools as an arena.

    Place, publisher, year, edition, pages
    Public Library of Science (PLoS), 2022
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-440008 (URN)10.1371/journal.pone.0265589 (DOI)000791994200046 ()35417460 (PubMedID)
    Funder
    Swedish Research Council FormasSwedish Research CouncilVinnova, 259-2012-68Forte, Swedish Research Council for Health, Working Life and Welfare
    Note

    Title in thesis list of papers: Successful implementation of parenting support at preschool: A process evaluation of Triple P in Sweden

    Available from: 2021-04-13 Created: 2021-04-13 Last updated: 2023-03-23Bibliographically approved
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  • 40.
    Dahlberg, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Fält, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Ghaderi, Ata
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Swedish norms for the Strengths and Difficulties Questionnaire for children 3-5 years rated by parents and preschool teachers2020In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 61, no 2, p. 253-261Article in journal (Refereed)
    Abstract [en]

    The Strengths and Difficulties Questionnaire (SDQ) is a widespread tool for assessing behavior problems in children and adolescents. Despite being investigated thoroughly concerning both validity and reliability, peer reviewed studies that provide norms, especially for preschool children, are lacking. This paper provides Swedish norms using data from a large community sample of children aged 3-5, based on mothers', fathers', and preschool teacher's ratings. Preschool teachers' ratings were generally lower than parents' ratings, which contradicts some previous studies. Differences between girls and boys were found, suggesting that boys display higher levels of behavior problems. Lower parental education and country of origin outside of Sweden were also associated with more difficulties. Cut-offs are presented for each age group, gender and rater category. Population-specific norms and percentile cut-offs provided in this study facilitate identifying children in need of interventions in paediatric care and enable cross-country comparisons of children's mental health problems. 

    Download full text (pdf)
    fulltext
  • 41.
    Dahlberg, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Fängström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    "Daddy comforts me": Young Swedish children’s perspectives on their family relations before and after their parents’ participation in a parenting programme2024In: PLOS ONE, E-ISSN 1932-6203, Vol. 19, no 3, article id e0298075Article in journal (Refereed)
    Abstract [en]

    Despite extensive research assessing parenting support, there is a lack of knowledge about the perspectives of the youngest children. In this study, we explored changes in preschool children's emotional and relational experiences at home before and after their parents participated in a parenting intervention, the Triple P parenting programme. Nine children in total were interviewed, aged 3-6 years, whose parents participated in a group parenting intervention. The interviews were conducted during the first and final group sessions attended by the children's parents. Data were analysed qualitatively, using a longitudinal approach, resulting in a deductive mapping of the children's statements onto four themes, based on the parenting intervention's main objectives. Further, changes in content for each of the four themes were assessed. Before the programme, children described conflicts with siblings, parents' negative emotions, and punitive parenting behaviours. After the programme, sibling conflicts remained, but parents' negative emotions decreased and parent threats and violence ceased. Positive family interactions and quality time increased, along with experiences of tenderness and being comforted. Parents also implemented new strategies such as verbal management and more comforting or soothing behaviours. Clinical implications of the results include promoting positive sibling relationships, emphasising parental self-regulation, encouraging empathy and reconciliation, and highlighting the importance of spending quality time with children. These findings contribute to a better understanding of children's perspectives and provide implications for clinical practice and future research.

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  • 42.
    Dahlberg, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Ghaderi, A.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Validity of Strengths and Difficulties Questionnaire in non-clinical samples of parents and teachers2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27Article in journal (Other academic)
  • 43.
    Dahlberg, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Ghaderi, Ata
    Karolinska Institute.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    SDQ in the Hands of Fathers and Preschool Teachers: Psychometric Properties in a Non-clinical Sample of 3-5-Year-Olds2019In: Child Psychiatry and Human Development, ISSN 0009-398X, E-ISSN 1573-3327, Vol. 50, no 1, p. 132-141Article in journal (Refereed)
    Abstract [en]

    The Strengths and Difficulties Questionnaire (SDQ) is a well-established instrument for measuring social and behavioural problems among children, with good psychometric properties for older children, but less validity reports on pre-schoolers. In addition, there is a knowledge gap concerning fathers as informants. The present work is one of the few validity studies to include preschool teachers and the first on preschool children where fathers are included as separate informants. In this study, SDQs were collected from a large community sample (n = 17,752) of children aged 3-5, rated by mothers, fathers, and preschool teachers and analysed using confirmatory factor analysis. Our results revealed acceptable fit for all informant groups and measurement invariance across child gender, child age, and parental education level. Our findings suggest good construct validity of the SDQ for a non-clinical preschool population and imply that it may be used for assessing child behaviour problems from different informant perspectives.

    Download full text (pdf)
    SDQ in the Hands of Fathers and Preschool Teachers—Psychometric Properties in a Non-clinical Sample of 3–5-Year-Olds
  • 44.
    Dahlberg, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Levin, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Fäldt, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    A higher proportion of children aged 4 years were referred to speech and language therapists after the introduction of a new language screening tool2024In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed)
    Abstract [en]

    Aim: Language difficulties in children can have enduring impacts on their academic and emotional well-being. Consequently, early identification and intervention are critical. This study aimed to investigate the impact of introducing Sprakfyran, a language screening tool, on the identification and referral rates for speech and language assessment compared to the previous method.

    Methods: An observational study was conducted in Gotland, Sweden, using the medical records of 3537 children (53% boys) who were 3-4 years of age. The study period lasted between 5 January 2016 and 29 April 2022, encompassing data collection both before and after the introduction of Sprakfyran.

    Results: Following the introduction of Sprakfyran, 15% failed the screening, compared to 20% with the previous speech test. However, referrals for assessment increased significantly with Sprakfyran, rising to 7% compared to 3% with the speech test.

    Conclusion: The proportion of children who failed the Sprakfyran screening was consistent with findings from previous studies. Children who failed the screening were more likely to be referred for speech and language assessment after the introduction of Sprakfyran. This indicates that Sprakfyran is a clinically relevant tool that promotes children's language development through increased referral rates.

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  • 45.
    Dahlberg, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Levin, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Fäldt, Anna Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Implementation of the Infant-Toddler Checklist in Swedish child health services at 18 months: an observational study2024In: BMJ Paediatrics Open, E-ISSN 2399-9772, Vol. 8, no 1, article id e002406Article in journal (Refereed)
    Abstract [en]

    Background Communication and language disorders are common conditions that emerge early and negatively impact quality of life across the life course. Early identification may be facilitated using a validated screening tool such as the Infant-Toddler Checklist (ITC). We introduced the ITC at the 18-month visit to child health services (CHS) in a Swedish county. Using the RE-AIM implementation framework, this study assessed the implementation of the ITC according to five key dimensions: reach, effectiveness, adoption, implementation and maintenance.

    Methods This observational study used medical records at CHS as data source. Data were collected from children who visited a child health nurse at 17–22 months. The sample included 2633 children with a mean age of 17.8 months, 1717 in the pre-implementation group and 916 in the post implementation group. We calculated the ITC completion rate (reach) and use at each site (adoption). We compared rates of referral to speech and language therapy (effectiveness) before and after implementation of the ITC using OR and 95% CIs. We described actions to facilitate implementation and maintenance of ITC screening over time.

    Results The overall screening rate was 93% (reach) which increased from 80% initially to 94% at the end of the 2-year period (maintenance). All centres used the ITC (adoption). The ITC screen positive rate was 14%. Of children who had reached at least 24 months (n=2367), referral rate was 0.4% pre-implementation versus 6.9% post implementation (OR=18.17, 95% CI 8.15, 40.51, p<0.001) (effectiveness). Implementation strategies included training sessions, collaboration, written and automatic procedures and modifications to the medical records system.

    Conclusion The implementation of the ITC was associated with high reach, higher referral rate, complete adoption, and sustained maintenance over time.

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  • 46.
    Dahlberg, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Fängström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Fabian, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Successful implementation of parenting support at preschool: An evaluation of Triple P in Sweden2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 4, article id e0265589Article in journal (Refereed)
    Abstract [en]

    Although emotional and behavioural problems among young children are common and, if unaddressed, can lead to multi-facetted problems later in life, there is little research investigating the implementation of parenting programs that target these problems. In this study, the RE-AIM framework was used to evaluate the implementation of the Triple P parenting program in a preschool setting at a medium-sized municipality in Sweden. Reach increased over time, showing an overall increase in participating fathers and parents with lower education. Effectiveness outcomes showed an improvement in emotional and behavioural problems in children and less mental health-related symptoms and higher self-efficacy in parents. Adoption rate was 93.3%. To ensure staff "buy-in", designated coordinators made changes in recruitment procedures, and provided supervision and training to all Triple P practitioners. Implementation adaptations were made, such as minor revisions of parenting strategies and other program content, as well as providing child care during seminars and groups, and setting up weekend-groups. Maintenance assessed through 12 month follow-up data suggested that several child and parent outcomes were maintained over time. Uppsala municipality continues to offer Triple P to parents. The reach, effectiveness, adoption, implementation and maintenance of the program were all satisfactory and demonstrated the suitability of delivering evidence-based parenting support using preschools as an arena.

    Download full text (pdf)
    fulltext
  • 47.
    Dahlberg, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Fängström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    'They Yell and I Yell Back': Pre-schoolers' Descriptions of Conflict Laden Interactions at Home2023In: Journal of Child and Family Studies, ISSN 1062-1024, E-ISSN 1573-2843, Vol. 32, no 12, p. 3835-3847Article in journal (Refereed)
    Abstract [en]

    Over the past 50 years, extensive research has been published on the parent–child relationship and parenting. However, there are very few examples where young children are at the centre of attention for describing family dynamics, relationships and conflicts. This study aimed at addressing this research and knowledge gap through exploring the emotional and relational experiences of preschool children whose parents attended a universal parenting programme. Seventeen preschool children aged 3–6 were interviewed, using an emotion-focused, pictorial-based computer assisted interview method. The children’s descriptions of their family relationships were analysed using qualitative content analysis. The children described negative interplay within the families in rich detail, especially experiences where conflicts with parents escalated and were left unresolved. Moments of positive family interactions were described as well, but they were heavily overshadowed by the narratives containing negative parenting. The children also described compensatory behaviours, such as looking for comfort from siblings or pets. The narratives in this study gave a unique insight into the emotional and relational domestic context of children in families seeking universally offered parenting support. Given adequate tools and support, children as young as 3 or 4 years old could provide extensive information about their lives. We urge future research examining parenting or family interventions to include the children’s perspectives.

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  • 48.
    Dahlberg, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Fängström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    “They yell and I yell back”: Pre-schoolers’ voices from inside the coercive cycleIn: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765Article in journal (Other academic)
  • 49.
    Durbeej, Natalie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Abrahamsson, Ninnie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Papadopoulos, Fotios
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Psychiatry.
    Beijer, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Outside the norm: Mental health, school adjustment and community engagement in non-binary youth2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 49, no 5, p. 529-538Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study was to explore the role of self-reported non-binary gender identity in mental health problems, school adjustment, and wish to exert influence on municipal issues in a community sample of adolescents.

    Methods: In a cross-sectional design, data were collected through an anonymous survey in Uppsala County, Sweden, among 8385 students (response rate 58.2%) in grades 7, 9, and 11, aged 13-17 years. The Strengths and Difficulties Questionnaire (SDQ) self-report was used to assess mental health problems. Gender identity was measured with one item and youth were categorized into those who identified as male or female (i.e. binary youth), and those who did or could not identify with either gender (i.e. non-binary youth). Logistic regressions and qualitative content analysis were used to analyse data.

    Results: Youth with non-binary gender identity (n = 137; 1.6%) had higher odds of having mental problems according to the SDQ total score (OR=3.05; 1.77-5.25). The association between non-binary gender identity and mental health problems remained significant after adjusting for confounders. Additionally, compared to their binary peers, the non-binary youth reported more truancy (36.5% vs 49.6%), more often failed a subject (21.5% vs 36.5%), and were more interested in exerting influence on municipal issues such as sociopolitical development, education, municipal services, and drug and alcohol policies (25.3% vs 38.0%).

    Conclusions: Youth with non-binary gender identity constitute a vulnerable population regarding mental health problems and school adjustment. The willingness to exert influence on municipal issues suggests a possible pathway to engagement.

  • 50.
    Durbeej, Natalie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    McDiarmid, Serena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Punamäki, Raija-Leena
    Kankaanpää, Reeta
    Andersen, Arnfinn
    Hilden, Per Kristian
    Verelst, An
    Derluyn, Ilse
    Osman, Fatumo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. School of Education, Health and Social Studies, Dalarna University, 791 88, Falun, Sweden.
    Evaluation of a school-based intervention to promote mental health of refugee youth in Sweden (The RefugeesWellSchool Trial): study protocol for a cluster randomized controlled trial2021In: Trials, E-ISSN 1745-6215, Vol. 22, no 1, article id 98Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sweden is home to a large and growing population of refugee youths who may be at risk of mental health problems such as post-traumatic stress disorder (PTSD). Thus, there is a need for interventions that address mental health problems in these populations. Schools have been identified as an ideal setting for delivering such interventions as they offer a non-stigmatizing space and are often central to young refugees' social networks. The RefugeesWellSchool trial in Sweden will investigate an intervention comprising two programmes: Teaching Recovery Techniques (TRT) and In-service Teacher Training (INSETT), delivered in a school setting, among refugee youth. TRT is a group-based programme for children and adolescents, informed by Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). INSETT is a multi-module course for teachers providing information on trauma and the refugee experience to build teachers' cultural competence and capacity for supporting refugee youths in schools.

    METHODS: This trial employs a cluster randomized-control design with two arms: (1) the intervention arm in which the TRT and INSETT programmes are offered (n = 350), (2) the wait-list control arm (n = 350) in which services are provided as usual until the TRT and INSETT programmes are offered approximately six months later. Data will be collected prior to the intervention, immediately following the intervention, and at three months post-intervention. Outcomes for the trial arms will be compared using linear mixed models or ANCOVA repeated measures as well as the Reliable Change Index (RCI).

    DISCUSSION: This study will provide knowledge about the effectiveness of an intervention comprising two programmes: a group-based programme for youth reporting symptoms of PTSD and a training course for teachers, in order to build their competence and ability to support refugee youths in schools.

    TRIAL REGISTRATION: ISRCTN, ISRCTN48178969 , Retrospectively registered 20/12/2019.

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