| 1. |
- de Villemereuil, Pierre, et al.
(author)
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Fluctuating optimum and temporally variable selection on breeding date in birds and mammals
- 2020
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In: Proceedings of the National Academy of Sciences of the United States of America. - : NATL ACAD SCIENCES. - 0027-8424 .- 1091-6490. ; 117:50, s. 31969-31978
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Journal article (peer-reviewed)abstract
- Temporal variation in natural selection is predicted to strongly impact the evolution and demography of natural populations, with consequences for the rate of adaptation, evolution of plasticity, and extinction risk. Most of the theory underlying these predictions assumes a moving optimum phenotype, with predictions expressed in terms of the temporal variance and auto-correlation of this optimum. However, empirical studies seldom estimate patterns of fluctuations of an optimum phenotype, precluding further progress in connecting theory with observations. To bridge this gap, we assess the evidence for temporal variation in selection on breeding date by modeling a fitness function with a fluctuating optimum, across 39 populations of 21 wild animals, one of the largest compilations of long-term datasets with individual measurements of trait and fitness components. We find compelling evidence for fluctuations in the fitness function, causing temporal variation in the magnitude, but not the direction of selection. However, fluctuations of the optimum phenotype need not directly translate into variation in selection gradients, because their impact can be buffered by partial tracking of the optimum by the mean phenotype. Analyzing individuals that reproduce in consecutive years, we find that plastic changes track movements of the optimum phenotype across years, especially in bird species, reducing temporal variation in directional selection. This suggests that phenological plasticity has evolved to cope with fluctuations in the optimum, despite their currently modest contribution to variation in selection.
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| 2. |
- Axen, Iben, et al.
(author)
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Misinformation, chiropractic, and the COVID-19 pandemic
- 2020
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In: Chiropractic and Manual Therapies. - : BioMed Central (BMC). - 2045-709X. ; 28:1
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Journal article (other academic/artistic)abstract
- Background: In March 2020, the World Health Organization elevated the coronavirus disease (COVID-19) epidemic to a pandemic and called for urgent and aggressive action worldwide. Public health experts have communicated clear and emphatic strategies to prevent the spread of COVID-19. Hygiene rules and social distancing practices have been implemented by entire populations, including 'stay-at-home' orders in many countries. The long-term health and economic consequences of the COVID-19 pandemic are not yet known.Main text: During this time of crisis, some chiropractors made claims on social media that chiropractic treatment can prevent or impact COVID-19. The rationale for these claims is that spinal manipulation can impact the nervous system and thus improve immunity. These beliefs often stem from nineteenth-century chiropractic concepts. We are aware of no clinically relevant scientific evidence to support such statements. We explored the internet and social media to collect examples of misinformation from Europe, North America, Australia and New Zealand regarding the impact of chiropractic treatment on immune function. We discuss the potential harm resulting from these claims and explore the role of chiropractors, teaching institutions, accrediting agencies, and legislative bodies.Conclusions: Members of the chiropractic profession share a collective responsibility to act in the best interests of patients and public health. We hope that all chiropractic stakeholders will view the COVID-19 pandemic as a call to action to eliminate the unethical and potentially dangerous claims made by chiropractors who practise outside the boundaries of scientific evidence.
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| 3. |
- Bohman, Tony, et al.
(author)
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Prognosis of patients with whiplash-associated disorders consulting physiotherapy : development of a predictive model for recovery
- 2012
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In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 13
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Journal article (peer-reviewed)abstract
- BACKGROUND: Patients with whiplash-associated disorders (WAD) have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists. Therefore, we aimed to develop a prediction model for the recovery of WAD in a cohort of patients who consulted physical therapists within six weeks after the injury.METHODS: Our cohort included 680 adult patients with WAD who were injured in Saskatchewan, Canada, between 1997 and 1999. All patients had consulted a physical therapist as a result of the injury. Baseline prognostic factors were collected from an injury questionnaire administered by Saskatchewan Government Insurance. The outcome, global self-perceived recovery, was assessed by telephone interviews six weeks, three and six months later. Twenty-five possible baseline prognostic factors were considered in the analyses. A prediction model was built using Cox regression. The predictive ability of the model was estimated with concordance statistics (c-index). Internal validity was checked using bootstrapping.RESULTS: Our final prediction model included: age, number of days to reporting the collision, neck pain intensity, low back pain intensity, pain other than neck and back pain, headache before collision and recovery expectations. The model had an acceptable level of predictive ability with a c-index of 0.68 (95% CI: 0.65, 0.71). Internal validation showed that our model was robust and had a good fit.CONCLUSIONS: We developed a model predicting recovery from WAD, in a cohort of patients who consulted physical therapists. Our model has adequate predictive ability. However, to be fully incorporated in clinical practice the model needs to be validated in other populations and tested in clinical settings.
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| 4. |
- Cancelliere, Carol, et al.
(author)
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Protocol for a systematic review of prognosis after mild traumatic brain injury : an update of the WHO Collaborating Centre Task Force findings
- 2012
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In: Systematic Reviews. - : Springer Science and Business Media LLC. - 2046-4053. ; :1, s. 17-
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Journal article (peer-reviewed)abstract
- Background: Mild traumatic brain injury (MTBI) is a major public-health concern and represents 70-90% of all treated traumatic brain injuries. The last best-evidence synthesis, conducted by the WHO Collaborating Centre for Neurotrauma, Prevention, Management and Rehabilitation in 2002, found few quality studies on prognosis. The objective of this review is to update these findings. Specifically, we aim to describe the course, identify modifiable prognostic factors, determine long-term sequelae, and identify effects of interventions for MTBI. Finally, we will identify gaps in the literature, and make recommendations for future research.Methods: The databases MEDLINE, PsychINFO, Embase, CINAHL and SPORTDiscus were systematically searched (2001 to date). The search terms included 'traumatic brain injury', 'craniocerebral trauma', 'prognosis', and 'recovery of function'. Reference lists of eligible papers were also searched. Studies were screened according to pre-defined inclusion and exclusion criteria. Inclusion criteria included original, published peer-reviewed research reports in English, French, Swedish, Norwegian, Danish and Spanish, and human participants of all ages with an accepted definition of MTBI. Exclusion criteria included publication types other than systematic reviews, meta-analyses, randomized controlled trials, cohort studies, and case-control studies; as well as cadaveric, biomechanical, and laboratory studies. All eligible papers were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers performed independent, in-depth reviews of each eligible study, and a third reviewer was consulted for disagreements. Data from accepted papers were extracted into evidence tables, and the evidence was synthesized according to the modified SIGN criteria.Conclusion: The results of this study form the basis for a better understanding of recovery after MTBI, and will allow development of prediction tools and recommendation of interventions, as well as informing health policy and setting a future research agenda.
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| 5. |
- Cancelliere, Carol, et al.
(author)
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Systematic review of prognosis and return to play after sport concussion : results of the international collaboration on mild traumatic brain injury prognosis
- 2014
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In: Archives of Physical Medicine and Rehabilitation. - : Elsevier. - 0003-9993 .- 1532-821X. ; 95:3, Suppl, s. S210-S229
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Research review (peer-reviewed)abstract
- ObjectiveTo synthesize the best available evidence on prognosis after sport concussion.Data SourcesMEDLINE and other databases were searched (2001–2012) with terms including “craniocerebral trauma” and “sports.” Reference lists of eligible articles were also searched.Study SelectionRandomized controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 concussion cases.Data ExtractionEligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed and extracted data from accepted studies into evidence tables.Data SynthesisEvidence was synthesized qualitatively according to modified SIGN criteria, and studies were categorized as exploratory or confirmatory based on the strength of their design and evidence. After 77,914 records were screened, 52 articles were eligible for this review, and 24 articles (representing 19 studies) with a low risk of bias were accepted. Our findings are based on exploratory studies of predominantly male football players at the high school, collegiate, and professional levels. Most athletes recover within days to a few weeks, and American and Australian professional football players return to play quickly after mild traumatic brain injury. Delayed recovery appears more likely in high school athletes, in those with a history of previous concussion, and in those with a higher number and duration of postconcussion symptoms.ConclusionsThe evidence concerning sports concussion course and prognosis is very preliminary, and there is no evidence on the effect of return-to-play guidelines on prognosis. Our findings have implications for further research. Well-designed, confirmatory studies are urgently needed to understand the consequences of sport concussion, including recurrent concussion, across different athletic populations and sports.
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| 6. |
- Cancelliere, Carol, et al.
(author)
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Systematic review of return to work after mild traumatic brain injury : results of the international collaboration on mild traumatic brain injury prognosis
- 2014
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In: Archives of Physical Medicine and Rehabilitation. - : Elsevier. - 0003-9993 .- 1532-821X. ; 95:3, Suppl, s. S201-S209
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Research review (peer-reviewed)abstract
- ObjectiveTo synthesize the best available evidence on return to work (RTW) after mild traumatic brain injury (MTBI).Data SourcesMEDLINE and other databases were searched (2001–2012) with terms including “craniocerebral trauma” and “employment.” Reference lists of eligible articles were also searched.Study SelectionControlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to assess RTW or employment outcomes in at least 30 MTBI cases.Data ExtractionEligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed and extracted data from accepted studies into evidence tables.Data SynthesisEvidence was synthesized qualitatively according to modified Scottish Intercollegiate Guidelines Network criteria and prioritized according to design as exploratory or confirmatory. After 77,914 records were screened, 299 articles were found eligible and reviewed; 101 (34%) of these with a low risk of bias were accepted as scientifically admissible, and 4 of these had RTW or employment outcomes. This evidence is preliminary and suggests that most workers RTW within 3 to 6 months after MTBI; MTBI is not a significant risk factor for long-term work disability; and predictors of delayed RTW include a lower level of education (<11y of formal education), nausea or vomiting on hospital admission, extracranial injuries, severe head/bodily pain early after injury, and limited job independence and decision-making latitude.ConclusionsOur findings are based on preliminary evidence with varied patient characteristics and MTBI definitions, thus limiting firm conclusions. More well-designed studies are required to understand RTW and sustained employment after MTBI in the longer term (≥2y post-MTBI).
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| 7. |
- Chen, Kenneth, et al.
(author)
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Recommendations for Core Outcome Domain Set for Whiplash Associated Disorders (CATWAD)
- 2019
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In: Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 35:9, s. 727-736
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Journal article (peer-reviewed)abstract
- Objective: Inconsistent reporting of outcomes in clinical trials of treatments for Whiplash Associated Disorders (WAD) hinders effective data pooling and conclusions that can be drawn about the effectiveness of tested treatments. The aim of this study was to provide recommendations for core outcome domains that should be included in clinical trials of WAD. Methods: A three-step process was used. 1) A list of potential core outcome domains were identified from the published literature; 2) Researchers, health care providers, patients and insurance personnel participated and rated the importance of each domain via a three round Delphi survey. A priori criteria for consensus were established; 3) Experts comprising researchers, health care providers and a consumer representative participated in a multidisciplinary consensus meeting that made final decisions on the recommended core outcome domains. Results: The literature search identified 63 potential core domains. 223 participants were invited to partake in the Delphi surveys with 41.7% completing Round 1, 45.3% Round 2 and 51.4% Round 3. Eleven core domains met the criteria for inclusion across the entire sample. After the expert consensus meeting, six core domains were recommended: Physical Functioning, Perceived Recovery, Work and Social Functioning, Psychological Functioning, Quality of Life and Pain. Discussion: A 3-step process was used to recommend core outcome domains for clinical trials in WAD. Six core domains were recommended: Physical Functioning, Perceived Recovery, Work and Social Functioning, Psychological Functioning, Quality of Life and Pain. The next step is to determine the outcome measurement instruments for each of these domains.
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| 8. |
- Edlund, Klara, et al.
(author)
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Sustainable UNiversity Life (SUN) study : Protocol for a prospective cohort study of modifiable risk and prognostic factors for mental health problems and musculoskeletal pain among university students
- 2022
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In: BMJ Open. - : BMJ. - 2044-6055. ; 12:4
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Mental health problems and musculoskeletal pain are common health problems among young adults including students. Little is known about the aetiology and prognosis of these problems in university students. We aim to determine the role of personal, sociodemographic, academic and environmental factors for risk and prognosis of symptoms of depression, anxiety and stress as well as musculoskeletal pain in university students. The constructs that will be studied are based on the biopsychosocial model and psychopathology associated with disabling pain. This model acknowledges illness to consist of interrelated mechanisms categorised into biological, psychological, environmental and social cues.METHODS AND ANALYSIS: This cohort study aims to recruit around 5000 Swedish full-time students. Data will be collected using five online surveys during one academic year. A subgroup (n=1851) of the cohort, recruited before the COVID-19 pandemic, receive weekly text messages with three short questions assessing mood, worry and pain, sent through the web-based platform SMS-track . Statistical analyses will include Kaplan-Meier estimates, Cox regression analyses, multinomial logistic regression analyses and generalised estimating equations. We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up.PROTOCOL AMENDMENTS: Due to opportunity and timing of the study, with relevance to the outbreak of the COVID-19 pandemic, this study further aims to address mental health problems, musculoskeletal pain and lifestyle in university students before and during the pandemic.ETHICS AND DISSEMINATION: The Sustainable UNiversity Life study was approved by the Swedish ethics authority (2019-03276; 2020-01449). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications.TRIAL REGISTRATION NUMBER: NCT04465435.
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| 9. |
- Fantin, Nicholas J., et al.
(author)
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The Canada-France Imaging Survey : Reconstructing the Milky Way Star Formation History from Its White Dwarf Population
- 2019
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In: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 887:2
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Journal article (peer-reviewed)abstract
- As the remnants of stars with initial masses less than or similar to 8M(circle dot), white dwarfs contain valuable information on the formation histories of stellar populations. In this paper, we use deep, high-quality, u-band photometry from the Canada-France Imaging Survey, griz photometry from Pan-STARRS1, as well as proper motions from Gaia DR2, to select 25,156 white dwarf candidates over similar to 4500 deg(2) using a reduced proper motion diagram. We develop a new white dwarf population synthesis code that returns mock observations of the Galactic field white dwarf population for a given star formation history, while simultaneously taking into account the geometry of the Milky Way (MW), survey parameters, and selection effects. We use this model to derive the star formation histories of the thin disk, thick disk, and stellar halo. Our results show that the MW disk began forming stars (11.3 +/- 0.5) Gyr ago, with a peak rate of (8.8 +/- 1.4) M-circle dot yr(-1) at (9.8 +/- 0.4) Gyr, before a slow decline to a constant rate until the present day-consistent with recent results suggesting a merging event with a satellite galaxy. Studying the residuals between the data and best-fit model shows evidence for a slight increase in star formation over the past 3 Gyr. We fit the local fraction of helium-atmosphere white dwarfs to be (21 +/- 3)%. Incorporating this methodology with data from future wide-field surveys such as the Large Synoptic Survey Telescope, Euclid, The Cosmological Advanced Survey Telescope for Optical and ultraviolet Research, and the Wide Field Infrared Survey Telescope should provide an unprecedented view into the formation of the MW at its earliest epoch through its white dwarfs.
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| 10. |
- Hohenschurz-Schmidt, David, et al.
(author)
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Recommendations for the development, implementation, and reporting of control interventions in efficacy and mechanistic trials of physical, psychological, and self-management therapies : the CoPPS Statement
- 2023
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In: BMJ. British Medical Journal. - : BMJ Publishing Group Ltd. - 0959-8146 .- 0959-535X. ; 381, s. e072108-
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Journal article (peer-reviewed)abstract
- Control interventions (often called "sham," "placebo," or "attention controls") are essential for studying the efficacy or mechanism of physical, psychological, and self-management interventions in clinical trials. This article presents core recommendations for designing, conducting, and reporting control interventions to establish a quality standard in non-pharmacological intervention research. A framework of additional considerations supports researchers' decision making in this context. We also provide a reporting checklist for control interventions to enhance research transparency, usefulness, and rigour.
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| 11. |
- Hung, Ryan, et al.
(author)
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Systematic Review of the Clinical Course, Natural History, and Prognosis for Pediatric Mild Traumatic Brain Injury : Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis
- 2014
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In: Archives of Physical Medicine and Rehabilitation. - : Elsevier. - 0003-9993 .- 1532-821X. ; 95:3, Suppl, s. S174-S191
-
Research review (peer-reviewed)abstract
- ObjectiveTo synthesize the best available evidence on prognosis after pediatric mild traumatic brain injury (MTBI).Data SourcesWe searched MEDLINE, Embase, PsycINFO, CINAHL, and SPORTDiscus (2001–2012), as well as reference lists of eligible articles, and relevant systematic reviews and meta-analyses.Study SelectionControlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 MTBI pediatric cases. After 77,914 records were screened for the entire review, 299 studies were eligible and assessed for scientific rigor.Data ExtractionEligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed each study and extracted data from accepted articles into evidence tables.Data SynthesisEvidence from 25 accepted articles was synthesized qualitatively according to SIGN criteria, and prognostic information was prioritized according to design as exploratory or confirmatory. Most studies show that postconcussion symptoms and cognitive deficits resolve over time. Limited evidence suggests that postconcussion symptoms may persist in those with lower cognitive ability and intracranial pathology on neuroimaging. Preliminary evidence suggests that the risk of epilepsy is increased for up to 10 years after MTBI; however, there is insufficient high-quality evidence at this time to support this link.ConclusionsCommon post-MTBI symptoms and deficits in children are not specific to MTBI and appear to resolve with time; however, limited evidence suggests that children with intracranial pathology on imaging may experience persisting symptoms or deficits. Well-designed, long-term studies are needed to confirm these findings.
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| 12. |
- Jacobs, Craig L, et al.
(author)
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Musculoskeletal Injury in Professional Dancers: Prevalence and Associated Factors: An International Cross-Sectional Study.
- 2016
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In: Clinical Journal of Sport Medicine. - 1536-3724.
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The purpose of the study was to determine the prevalence and factors associated with injury in professional ballet and modern dancers, and assess if dancers are reporting their injuries and explore reasons for not reporting injuries. DESIGN: Cross-sectional study. SETTING: Participants were recruited from nine professional ballet and modern dance companies in Canada, Denmark, Israel, and Sweden. PARTICIPANTS: Professional ballet and modern dancers. INDEPENDENT VARIABLES: Sociodemographic variables included age, sex, height, weight, and before-tax yearly or monthly income. Dance specific characteristics included number of years in present dance company, number of years dancing professionally, number of years dancing total, and rank in the company. MAIN OUTCOME MEASURES: Self-reported injury and Self-Estimated Functional Inability because of Pain. RESULTS: A total of 260 dancers participated in the study with an overall response rate of 81%. The point prevalence of self-reported injury in professional ballet and modern dancers was 54.8% (95% CI, 47.7-62.1) and 46.3% (95% CI, 35.5-57.1), respectively. Number of years dancing professionally (OR = 4.4, 95% CI, 1.6-12.3) and rank (OR = 2.4, 95% CI, 1.2-4.8) were associated with injury in ballet dancers. More than 15% of all injured dancers had not reported their injury and their reasons for not reporting injury varied. CONCLUSIONS: The prevalence of injury is high in professional dancers with a significant percentage not reporting their injuries for a variety of reasons. Number of years dancing and rank are associated with injury in professional ballet dancers.
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| 13. |
- Johansson, Fred
(author)
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Aspects of the aetiology of mental health problems among university students
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Mental disorders are among the leading causes of years lost due to disability in young people globally. Students are no exception, both mental disorders and mental health problems are common among university students with dramatic increases reported in recent years. The aetiology of mental disorders and mental health problems is generally assumed to be multicausal, with factors at different levels contributing to their development. Given the complexity of the causal network underlying mental health problems, it has been argued that a clear causal framework is needed when studying the aetiology of mental health problems. This thesis aimed to investigate some aspects of the potential aetiology of mental health problems among university students. Specifically, it focuses on four exposures at the psychosocial level presented in four studies: 1) the coronavirus disease (COVID-19) pandemic, 2) poor sleep quality, 3) procrastination and 4) sexual harassment and sexual violence. In addition to the discussion provided in each respective paper, this thesis discusses limitations and possible interpretations of our results from a modern causal inference perspective.The four studies of this thesis are based on The Sustainable University Life (SUN) cohort. The SUN cohort followed 4262 university students from eight universities in and around Stockholm, Sweden, with web-surveys at five time-points over one year.In Study I, we aimed to determine the mean trajectories of depression, anxiety, and stress symptoms among university students in Stockholm before and during the first months of the COVID-19 pandemic. For this, we included a subsample of 1836 university students that entered the SUN cohort before the outbreak of the COVID-19 pandemic, and were followed during the months before the pandemic, during the first wave of the pandemic and in the summer, months following the first wave of the pandemic. We found that mean depression, anxiety, and stress symptom levels were largely stable during the first wave compared to the months before the pandemic and decreased slightly during the following summer months. Our results indicate that mean levels of mental health symptoms did not change much during the early phase of the pandemic compared to before the pandemic.In Study II, we aimed to determine whether sleep quality statistically interacts cross-sectionally with loneliness, risky alcohol use, perfectionistic concerns and/or physical inactivity in relation to depressive symptoms in university students. We conducted a cross-sectional study using baseline-data from all 4262 participants in the SUN cohort. We found that while all factors were associated with depressive symptoms, only perfectionistic concerns interacted with sleep quality in its relation to depression. This interaction was quite weak and explainedonly a small proportion of the variance in depressive symptoms. Overall, we did not find support for our hypothesis that poor sleep quality could interact with several different potential risk factors for depressive symptoms.In Study III, we aimed to evaluate the associations between procrastination and sixteen subsequent health outcomes (including mental health symptoms, disabling pain, lifestyle behaviours and psychosocial health factors), measured 9 months later, among university students. We used data from all participants responding to the first follow-up in the SUN cohort (n=3525) and found that procrastination was related to several subsequent health outcomes, including symptoms of depression, anxiety and stress, while controlling for multiple potential confounders. Although we cannot rule out non-causal explanations for these associations, the results indicate that procrastination could have an effect on health outcomes among students, but that it is likely to be rather small for any specific health outcome.In Study IV, we investigated the impact of recent exposure to different forms of sexual harassment and sexual violence; 1) unwanted sexual attention, 2) offensive sexual remarks, 3) presentation or distribution of sexist material, 4) uncomfortable touching, 5) being offered benefits for sex and 6) sex against ones will, along with a wide definition of sexual harassment: sexual harassment (wide subjective definition) on levels of depression and anxiety symptoms three, six and nine months later, for women and men, respectively. We conducted a cohort study using data from all women and men responding to the first follow-up in the SUNcohort (n= 3503). Our results showed that women recently exposed to 1) sexual harassment (wide definition), 2) unwanted sexual attention and 3) sex against ones will showed higher subsequent levels of depression and/or anxiety symptoms. The general trend was that all exposures were related to higher symptom levels at three months, but that this difference between exposed and unexposed diminished over time, although these trends are uncertain with wide confidence intervals. The exception was exposure to sex against ones will, where exposed showed elevated symptom levels throughout the follow-up period. For men, the estimates were uncertain overall, and we refrain from interpreting these results. Our results indicate that recent exposure to different forms of sexual harassment and sexual violence may impact later depression and anxiety symptoms among women, and that there could be differences in the strength and long-term impact on mental health between different forms of sexual harassment and sexual violence. Again, we cannot, with certainty rule out non-causal reasons for these associations.Interpreting any of these results as causal effects rests on multiple assumptions, which are discussed in the thesis. Determination of causal effects preferably relies on triangulation of results from different studies with different methodology. Overall, however, I believe that this thesis has strengthened the evidence that procrastination and sexual harassment and sexual violence may be causes of mental health problems among university students. An equally important finding, is that mental health seemed rather stable during COVID-19 pandemic, indicating that the pandemic may not have caused increased mental health problems on the group level.
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| 14. |
- Johansson, Fred, et al.
(author)
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Associations Between Procrastination and Subsequent Health Outcomes Among University Students in Sweden
- 2023
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In: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 6:1
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Journal article (peer-reviewed)abstract
- Importance Procrastination is prevalent among university students and is hypothesized to lead to adverse health outcomes. Previous cross-sectional research suggests that procrastination is associated with mental and physical health outcomes, but longitudinal evidence is currently scarce.Objective To evaluate the association between procrastination and subsequent health outcomes among university students in Sweden.Design, Setting, and Participants This cohort study was based on the Sustainable University Life study, conducted between August 19, 2019, and December 15, 2021, in which university students recruited from 8 universities in the greater Stockholm area and Örebro were followed up at 5 time points over 1 year. The present study used data on 3525 students from 3 time points to assess whether procrastination was associated with worse health outcomes 9 months later.Exposure Self-reported procrastination, measured using 5 items from the Swedish version of the Pure Procrastination Scale rated on a Likert scale from 1 (“very rarely or does not represent me”) to 5 (“very often or always represents me”) and summed to give a total procrastination score ranging from 5 to 25.Main Outcomes and Measures Sixteen self-reported health outcomes were assessed at the 9-month follow-up. These included mental health problems (symptoms of depression, anxiety, and stress), disabling pain (neck and/or upper back, lower back, upper extremities, and lower extremities), unhealthy lifestyle behaviors (poor sleep quality, physical inactivity, tobacco use, cannabis use, alcohol use, and breakfast skipping), psychosocial health factors (loneliness and economic difficulties), and general health.Results The study included 3525 participants (2229 women [63%]; mean [SD] age, 24.8 [6.2] years), with a follow-up rate of 73% (n = 2587) 9 months later. The mean (SD) procrastination score at baseline was 12.9 (5.4). An increase of 1 SD in procrastination was associated with higher mean symptom levels of depression (β, 0.13; 95% CI, 0.09-0.17), anxiety (β, 0.08; 95% CI, 0.04-0.12), and stress (β, 0.11; 95% CI, 0.08-0.15), and having disabling pain in the upper extremities (risk ratio [RR], 1.27; 95% CI, 1.14-1.42), poor sleep quality (RR, 1.09, 95% CI, 1.05-1.14), physical inactivity (RR, 1.07; 95% CI, 1.04-1.11), loneliness (RR, 1.07; 95% CI, 1.02-1.12), and economic difficulties (RR, 1.15, 95% CI, 1.02-1.30) at the 9-month follow-up, after controlling for a large set of potential confounders.Conclusions and Relevance This cohort study of Swedish university students suggests that procrastination is associated with subsequent mental health problems, disabling pain, unhealthy lifestyle behaviors, and worse psychosocial health factors. Considering that procrastination is prevalent among university students, these findings may be of importance to enhance the understanding of students’ health.
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| 15. |
- Johansson, Fred, et al.
(author)
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Depression, anxiety and stress among Swedish university students before and during six months of the COVID-19 pandemic : A cohort study
- 2021
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In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 49:7, s. 741-749
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Journal article (peer-reviewed)abstract
- AIMS: The COVID-19 pandemic has had a profound effect on societies and citizens worldwide, raising concerns about potential mental health impacts. We aimed to describe trajectories of depression, anxiety and stress symptoms during the COVID-19 outbreak compared to before the outbreak, and to determine if trajectories were modified by pre-pandemic loneliness, poor sleep quality and mental health problems.METHODS: We conducted a cohort study with 1836 Swedish university students entering the study before 13 March 2020, the onset of the pandemic, with follow-ups within three (FU1) and six months (FU2) of the outbreak. Generalized Estimating Equations were used to estimate mean differences in symptom levels over time-periods, and to estimate potential effect modifications.RESULTS: We found small differences in mean levels of the depression, anxiety and stress scale (DASS-21) over time. Compared to before the pandemic, depression increased by 0.25 points of 21 (95% CI: 0.04 to -0.45) at FU1 and decreased by 0.75/21 (95% CI:-0.97 to -0.53) at FU2. Anxiety decreased from baseline to FU1 by 0.09/21 (95% CI: -0.24 to -0.07) and by 0.77/21 (95% CI: -0.93 to -0.61) to FU2. Stress decreased from baseline to FU1 by 0.30/21 (95% CI: -0.52 to -0.09) and by 1.32/21 (95% CI: -1.55 to -1.09) to FU2. Students with pre-pandemic loneliness, poor sleep quality or pre-pandemic mental health problems did not have worse trajectories of mean mental health symptoms.CONCLUSIONS: Symptom levels were relatively stable during the first three months of the pandemic, while there was a slight decrease during the summer months, probably due to seasonality effects.
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| 16. |
- Johansson, Fred, et al.
(author)
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Depression, anxiety and stress among Swedish university students during the second and third waves of COVID-19 : A cohort study
- 2021
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In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 49:7, s. 750-754
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Journal article (peer-reviewed)abstract
- AIMS: This study aims to describe the mean trajectories of depression, anxiety and stress symptoms among Swedish university students before and during the second and third waves of the COVID-19 pandemic.METHODS: We recruited 1835 participants in September 2020, of whom 81% provided follow-ups in December 2020-January 2021 and 77% provided follow-ups in March-April 2021. The short-form Depression, Anxiety and Stress Scale was used to measure mental health symptoms. Generalized estimating equations were used to estimate the mean differences in symptom levels over the three time periods.RESULTS: Compared with September, mean depression was 0.91 points of 21 higher (95% confidence interval (CI) 0.70-1.13) in December 2020-January 2021 and 0.66 points higher (95% CI 0.43-.88) in March-April 2021. Anxiety levels were 0.20 points higher (95% CI 0.05-0.34) in December 2020-January 2021 and 0.17 points higher (95% CI 0.02-0.33) in March-April 2021. Stress levels were 0.21 points higher (95% CI 0.00-0.41) in December 2020-January 2021 and 0.16 points lower (95% CI -0.38 to 0.05) in March-April 2021.CONCLUSIONS: Our results indicate relatively stable levels of mental health among Swedish university students during the second and third waves of COVID-19 compared with before the second wave. Mean depression symptom scores increased slightly, but the importance of this small increase is uncertain.
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| 17. |
- Johansson, Fred, et al.
(author)
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Strengths of associations between depressive symptoms and loneliness, perfectionistic concerns, risky alcohol use and physical activity across levels of sleep quality in Swedish university students : A cross-sectional study
- 2023
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In: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 32:2
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Journal article (peer-reviewed)abstract
- Previous research shows that sleep quality may interact with some other predictors of depression, such that poor sleep could strengthen the association between these factors and depression. We aimed to determine the presence of statistical interactions between sleep quality and loneliness, risky alcohol use, perfectionistic concerns and/or physical inactivity in relation to depressive symptoms. Further, we aimed to describe the functional form of the statistical interactions and associations. We used a cross-sectional design and included 4262 Swedish university students. All measures were self-reported, sleep quality was measured with the Pittsburgh Sleep Quality Index, and depressive symptoms with the short-form Depression, Anxiety and Stress Scale. Regression models of increasing complexity (linear and non-linear, with and without interactions) were compared to determine the presence of associations and statistical interactions, and to explore the best functional form for these associations and interactions. Out-of-sample R2 from repeated cross-validation was used to select the final models. We found that sleep quality was associated with depressive symptoms in all final models. Sleep quality showed a linear interaction with perfectionistic concerns in relation to depressive symptoms, such that perfectionistic concerns were more strongly associated with depressive symptoms when sleep quality was poor. Loneliness, risky alcohol use and physical inactivity were non-linearly associated with depressive symptoms but did not interact with sleep quality. We concluded that out of the four examined variables, only perfectionistic concerns interacted with sleep quality in relation to depressive symptoms. This interaction was weak and explained little of the overall variance in depressive symptoms.
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| 18. |
- Jull, Gwendolen A, et al.
(author)
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Toward optimal early management after whiplash injury to lessen the rate of transition to chronicity
- 2011
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In: Spine. - 0362-2436 .- 1528-1159. ; 36:25 Suppl, s. S335-S342
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Journal article (peer-reviewed)abstract
- STUDY DESIGN: Expert debate and synthesis of research to inform future management approaches for acute whiplash disorders.OBJECTIVE: To identify a research agenda toward improving outcomes for acute whiplash-injured individuals to lessen the incidence of transition to chronicity.SUMMARY OF BACKGROUND DATA: International figures are concordant, estimating that 50% of individuals recover from pain and disability within 3 to 6 months of a whiplash injury. The remainder report continuing symptoms up to 1 to 2 years or longer postinjury. As no management approach to date has improved recovery rates, new clinical/research directions are required for early management of whiplash-injured patients.METHODS: A group of multidisciplinary researchers critically debated evidence and current research concerning whiplash from biological, psychological, and social perspectives toward informing future research directions for management of acute whiplash.RESULTS: It was recognized that effective treatments for acute whiplash are constrained by a limited understanding of causes of whiplash-associated disorders. Acute whiplash presentations are heterogeneous leading to the proposal that a research priority was development of a triage system based on modifiable prognostic indicators and clinical features to better inform individualized early management decisions. Other priorities identified included researching effective early pain management for individuals presenting with moderate to high levels of pain; development of best education/information for acute whiplash; testing the efficacy of stratified and individualized rehabilitation, researching modes of delivery considering psychosocial modulators of pain and disability; and the timing, nature, and mode of delivery of cognitive-behavioral therapies. Directions were highlighted for future biomechanical research into injury prevention.CONCLUSION: The burden of whiplash injuries, the high rate of transition to chronicity, and evidence of limited effects of current management on transition rates demand new directions in evaluation and management. Several directions have been proposed for future research, which reflect the potential multifaceted dimensions of an acute whiplash disorder.
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| 19. |
- Mills, James A., et al.
(author)
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Archiving Primary Data : Solutions for Long-Term Studies
- 2015
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In: Trends in Ecology & Evolution. - : Elsevier BV. - 0169-5347 .- 1872-8383. ; 30:10, s. 581-589
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Journal article (peer-reviewed)abstract
- The recent trend for journals to require open access to primary data included in publications has been embraced by many biologists, but has caused apprehension amongst researchers engaged in long-term ecological and evolutionary studies. A worldwide survey of 73 principal investigators (PIs) with long-term studies revealed positive attitudes towards sharing data with the agreement or involvement of the PI, and 93% of PIs have historically shared data. Only 8% were in favor of uncontrolled, open access to primary data while 63% expressed serious concern. We present here their viewpoint on an issue that can have non-trivial scientific consequences. We discuss potential costs of public data archiving and provide possible solutions to meet the needs of journals and researchers.
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| 20. |
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| 21. |
- Nordin, Margareta, et al.
(author)
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EuroSpine Task Force on Research: support for spine researchers.
- 2015
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In: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. - : Springer Science and Business Media LLC. - 1432-0932. ; 24:12, s. 2709-2712
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Journal article (other academic/artistic)
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| 22. |
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| 23. |
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| 24. |
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| 25. |
- Onell, Clara, et al.
(author)
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Dietary habits in adolescent male and female handball players : the Swedish Handball Cohort
- 2023
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In: BMJ Open sport & exercise medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 9:4
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Journal article (peer-reviewed)abstract
- ObjectivesThis cross-sectional study aimed to describe dietary habits in Swedish adolescent handball players and differences with respect to sex and school grade.MethodsParticipants in the Swedish Handball Cohort answered a web-survey assessing adherence to sports nutrition recommendations for meal frequency and meal timing, and the Nordic Nutrition Recommendations (NNR) for fruits/vegetables and fish/seafood, food exclusions and use of dietary supplements. Differences with respect to sex and school grade were estimated with generalised linear models, generating prevalence ratios (PR) with 95% CIs.ResultsA total of 1040 participants (16.6 +/- 0.9 years, 51% males) were included. Overall, 70% and 90%, respectively, met recommendations for meal frequency and meal timing, whereas adherence to recommended carbohydrate intake during training/game was met by 17%. Adherence to the NNR for fruits/vegetables and fish/seafood was met by 16% and 37%, respectively. Twenty-eight per cent reported using dietary supplements. Females reported lower frequency of meals, especially morning snacks (-0.6 days/week (95% CI -0.3 to -0.9)) and evening snacks (-0.8 days/week (95% CI -0.5 to -1.1)), higher prevalence of exclusions due to intolerances (PR 1.66 (95% CI 1.31 to 2.01)) and other reasons (PR 1.36 (95% CI 1.08 to 1.64)), higher adherence to the NNR for fruits/vegetables (PR 2.30 (95% CI 1.98 to 2.62)) and use of micronutrient supplements (PR 1.72 (95% CI 1.43 to 2.00)) compared with males. Only small differences were observed between school grades.ConclusionsSwedish adolescent handball players' dietary habits are fairly in accordance with sports nutrition recommendations but not the NNR. Females appear to display more restrictive habits than males.
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| 26. |
- Onell, Clara
(author)
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Lifestyle behaviors and musculoskeletal conditions in university students and high school athletes
- 2024
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Doctoral thesis (other academic/artistic)abstract
- Background: Musculoskeletal conditions impose a large burden of disability in young populations. University students are prone to neck and back pain, with potential negative impact on physical, mental, and academic functioning. In adolescent athletes, musculoskeletal injuries are common and may result in discontinued sports participation as well as impaired physical and mental health. University students and adolescent athletes tend to have unhealthy lifestyle behaviors. University students report unhealthy behaviors such as high sitting time, low physical activity levels and unhealthy dietary habits. Adolescent athletes are physically active but tend to have inadequate dietary habits in relation to their physiological demands, including insufficient intakes of total energy and carbohydrates.Identifying modifiable risk factors for musculoskeletal conditions is the first step towards prevention, and knowledge about the role of lifestyle behaviors for these conditions is limited. The overarching purpose with this doctoral thesis was to deepen the knowledge about lifestyle behaviors and their role for the risk of musculoskeletal conditions in university students and high school athletes.Methods, results, and conclusions: Study I and II are based on the Sustainable UNiversity Life (SUN) study, a cohort study including 4262 students at Swedish universities. The participants reported different aspects of health, lifestyle behaviors and attitudes through web-surveys every third month for one year in 2019-2021.In Study I, the aim was to assess changes in lifestyle behaviors during the COVID-19 pandemic, compared to before, in 1877 university students (73% women, mean age 26.5 ± 6.8 years). Physical activity levels, sitting time, meal frequency and risk use of alcohol, tobacco and illicit drugs were measured at a pre-pandemic baseline and at two periods during the first six months of the pandemic, the follow-up 1 (FU1) and follow-up 2 (FU2). Population means and differences with 95% confidence interval (CI) in lifestyle behaviors were calculated with generalized estimating equations. The study found that weekly exercise decreased by -7.7 minutes (95% CI -12.6, -2.8) whereas weekly daily activities increased by 14.2 minutes (95% CI 7.9, 20.5) between the pre-pandemic baseline and FU2. Furthermore, daily sitting time decreased by -1.4 hours (95% CI -1.7, -1.2) during this period. Small changes were observed for meal frequency, whereas for risk use of alcohol, tobacco and illicit drugs, changes were only minor. The conclusion of Study I is that lifestyle behaviors in Swedish university students slightly improved during the first six months of the COVID-19 pandemic compared to before.In Study II, the aim was to assess the association between an unhealthy lifestyle and incident activity-limiting neck/back problems (ALNBP) in university students. Physical inactivity, high sitting time, meal skipping, and risky use of alcohol, tobacco and illicit drugs were combined into an unhealthy lifestyle, categorized as ≥3 unhealthy lifestyle behaviors. A total of 3492 university students (60% women, mean age 24.5 ± 6.0 years) without ALNBP the past three months at baseline were included. Cox regression models were built to assess the association between an unhealthy lifestyle and incident ALNBP, reported as a hazard rate ratio (HRR). Being exposed to an unhealthy lifestyle generated a HRR of 1.35 (95% CI 1.12 to 1.63) of ALNBP, compared to not being exposed to an unhealthy lifestyle. The conclusion of Study II is that an unhealthy lifestyle is associated with incident activity-limiting neck/back problems in university students.Study III and IV are based on the Swedish Handball Cohort (SHC), a cohort study including 1334 adolescent handball players enrolled to a handball-profiled high school in Sweden. Participants responded to a baseline web-survey with questions about current and previous injuries, training, and dietary habits, among others, in the beginning of the handball season in 2020/2021, 2021/2022 and 2022/2023.Participants were monitored weekly throughout the handball season with questions about their amount of handball training and matches the preceding week, sleep habits, injuries, and injury consequences, among others, reported through a mobile application.In Study III, the aim was to describe dietary habits in 1040 adolescent handball players enrolled in the SHC seasons 2020/2021 or 2021/2022 (51% males, mean age 16.6 ± 0.9 years). Differences with respect to sex and school grade were estimated with generalized linear models, generating a prevalence ratio (PR) and 95% CI. Overall, 70% and 90% of the participants met recommendations for meal frequency and meal timing, respectively, whereas adherence to recommended provision of carbohydrates was met by 17%. Sixteen percent adhered to the Nordic Nutrition Recommendations (NNR) for fruits/vegetables of ≥500 grams per week, whereas 37% adhered to the recommendations for fish/seafood of ≥2 times per week. Use of dietary supplements was reported by 28% of the participants, and 20% reported food exclusions due to other reasons than intolerances. Females reported a lower frequency of all meals, especially morning snacks and evening snacks. Also, a higher prevalence of food exclusions was observed in females, with a PR of 1.66 (95% CI 1.31to 2.01) for exclusions due to intolerances and a PR of 1.36 (95% CI 1.08, 1.64) for exclusions due to other reasons. Females also reported a higher adherence to fruits/vegetables recommendations with a PR of 2.30 (95% CI 1.98, 2.62) and use of micronutrient supplements to a larger extent with a PR of 1.72 (95% CI 1.43, 2.00), compared to their male counterparts. Small differences were observed with respect to school grade. The conclusion of Study III is that Swedish adolescent handball players’ dietary habits are somewhat in accordance with sports nutrition recommendations whereas adherence to provision of carbohydrates during matches and the NNR for fruit/vegetables and fish/seafood is low. Females seem to display more restrictive dietary habits compared to males.In Study IV, the aim was to assess the association between dietary habits and incident knee/shoulder injuries in 1144 adolescent handball players in season 2020/2021, 2021/2022 and 2022/2023 of the SHC without a knee or shoulder injury at baseline (1703 player seasons, 53% males, mean age 16.7 ± 0.9 years). Cox regression analyses estimated a HRR with the first event of a knee/shoulder injury as the outcome. A moderate-high nutritional quality, in accordance with the NNR, generated a HRR of 1.46 (95% CI 1.08, 1.98) for knee/shoulder injuries compared to low nutritional quality in adolescent female handball players. Also, ≥2 unfavorable dietary habits in relation to sports nutrition recommendations generated a HRR of 1.38 (95% CI 1.02, 1.86) compared to 1 unfavorable dietary habit in females. For poor meal timing, adjusted analyses generated a HRR of 1.20 (95% CI 0.90, 1.61) in females, compared to adequate meal timing. In adolescent male handball players, analyses generated a HRR of 1.23 (95% CI 0.69, 2.17) for low meal frequency compared to high meal frequency and a HRR of 0.83 (95% CI 0.60, 1.15) for poor meal timing. Menstrual dysfunction was assessed in females with no use of hormonal contraceptives, as a proxy for low energy availability, however, no associations were found between menstrual dysfunction and incident injuries in these females. The conclusion of Study IV is that a moderate-high nutritional quality and having more than one unfavorable dietary habit is associated with higher rate of incident knee/shoulder injuries in adolescent female handball players, while there are no or unprecise associations for meal frequency, meal timing and menstrual dysfunction. In adolescent male handball players, there are no clear associations between dietary habits and incident injuries.Overall conclusion: This doctoral thesis sheds light on aspects of lifestyle behaviors in university students and high school athletes. Population-specific unhealthy lifestyle behaviors are common in university students and high school athletes. These behaviors seem to be of importance for the risk of musculoskeletal conditions.
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| 27. |
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| 28. |
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| 29. |
- Pico-Espinosa, Oscar Javier, et al.
(author)
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Deep tissue massage, strengthening and stretching exercises, and a combination of both compared with advice to stay active for subacute or persistent non-specific neck pain : A cost-effectiveness analysis of the Stockholm Neck trial (STONE)
- 2020
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In: Musculoskeletal Science and Practice. - : Elsevier. - 2468-7812. ; 46
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Journal article (peer-reviewed)abstract
- Objective To evaluate the cost-effectiveness of deep tissue massage (‘massage’), strengthening and stretching exercises (‘exercises’) or a combination of both (‘combined therapy’) in comparison with advice to stay active (‘advice’) for subacute and persistent neck pain, from a societal perspective.Methods We conducted a cost-effectiveness analysis alongside a four-arm randomized controlled trial of 619 participants followed-up for one year. Health-related quality of life was measured using EQ-5D-3L and costs were calculated from baseline to one year. The interventions were ranked according to quality adjusted life years (QALYs) in a cost-consequence analysis. Thereafter, an incremental cost per QALY was calculated.Results In the cost-consequence analysis, in comparison with advice, exercises resulted in higher QALY gains, and massage and the combined therapy were more costly and less beneficial. Exercises may be a cost-effective treatment compared with advice to stay active if society is willing to pay 17 640 EUR per QALY. However, differences in QALY gains were minimal; on average, participants in the massage group, spent a year in a state of health valued at 0.88, exercises: 0.89, combined therapy: 0.88 and, advice: 0.88.Conclusions Exercises are cost-effective compared to advice given that the societal willingness to pay is above 17 640 EUR per year in full health gained. Massage and a combined therapy are not cost-effective. While exercise appeared to have the best cost/benefit profile, even this treatment had only a modest benefit and treatment innovation is needed. Advice to stay active remains as a good therapeutic alternative from an economical perspective.
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| 30. |
- Skillgate, Eva, et al.
(author)
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Effect of Early Intensive Care on Recovery From Whiplash-Associated Disorders : Results of a Population-Based Cohort Study
- 2016
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In: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993 .- 1532-821X. ; 97:5, s. 739-746
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Journal article (peer-reviewed)abstract
- Objective: To determine whether the results from previous research suggesting that early intensive health care delays recovery from whiplash associated disorders (WADs) were confounded by expectations of recovery and whether the association between early health care intensity and time to recovery varies across patterns of health care. Design: Population-based inception cohort. Setting: All adults (>= 18y) injured in motor vehicle collisions who received treatment from a regulated health professional or reported their injuries to the single provincially administered motor vehicle insurer. Participants: Participants with WAD (N=5204). Self-report visits to physicians, chiropractors, physiotherapists, massage therapists, and other professionals during the first 42 days postcollision were used to define health care intensity. Interventions: Not applicable. Main Outcome Measure: Self-perceived recovery. Results: Individuals with high utilization health care had slower recovery independent of expectation of recovery and other confounders. Compared with individuals who reported low utilization of physician services, recovery was slower for those with high health care utilization, regardless of the type of profession. For instance, those with high physician (hazard rate ratio [HRR] =.56; 95% confidence interval [CI],.42.75), physician and high physiotherapy utilization (BRR=.68; 95% CI,.61.77), physician and high chiropractor utilization (BRR=.74; 95% CI,.64.85), and physician and high massage therapy utilization (HRR=.78; 95% CI,.68.90) had significantly slower recovery. Conclusions: Our study adds to the existing evidence that early intensive care is associated with slower recovery from WAD, independent of expectation of recovery. The results have policy implications and suggest that the optimal management of WADs focuses on reassurance and education instead of intensive care.
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| 31. |
- Van Bulck, Liesbet, et al.
(author)
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Patient-reported outcomes of adults with congenital heart disease from eight European countries : scrutinising the association with healthcare system performance
- 2019
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In: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 18:6, s. 465-473
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Journal article (peer-reviewed)abstract
- Background: Inter-country variation in patient-reported outcomes of adults with congenital heart disease has been observed. Country-specific characteristics may play a role. A previous study found an association between healthcare system performance and patient-reported outcomes. However, it remains unknown which specific components of the countries’ healthcare system performance are of importance for patient-reported outcomes.Aims: The aim of this study was to investigate the relationship between components of healthcare system performance and patient-reported outcomes in a large sample of adults with congenital heart disease.Methods: A total of 1591 adults with congenital heart disease (median age 34 years; 51% men; 32% simple, 48% moderate and 20% complex defects) from eight European countries were included in this cross-sectional study. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviours and quality of life. The Euro Health Consumer Index 2015 and the Euro Heart Index 2016 were used as measures of healthcare system performance. General linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences.Results: Health risk behaviours were associated with the Euro Health Consumer Index subdomains about patient rights and information, health outcomes and financing and access to pharmaceuticals. Perceived physical health was associated with the Euro Health Consumer Index subdomain about prevention of chronic diseases. Subscales of the Euro Heart Index were not associated with patient-reported outcomes.Conclusion: Several features of healthcare system performance are associated with perceived physical health and health risk behaviour in adults with congenital heart disease. Before recommendations for policy-makers and clinicians can be conducted, future research ought to investigate the impact of the healthcare system performance on outcomes further.
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