| 1. |
- Andre, Malin, et al.
(författare)
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A study of primary care physicians rating their immigrant patients pain intensity
- 2013
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Ingår i: European Journal of Pain. - : Elsevier. - 1090-3801 .- 1532-2149. ; 17:1, s. 132-139
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Tidskriftsartikel (refereegranskat)abstract
- Background Few studies focus on how physicians evaluate pain in foreign-born patients with varying cultural backgrounds. This study aimed to compare pain ratings [visual analogue scale (VAS) 0100] done by Swedish primary care physicians and their patients, and to analyse which factors predicted physicians higher ratings of pain in patients aged 1845 years with long-standing disabling back pain. Methods The two physicians jointly carried out the somatic and psychiatric diagnostic evaluations and alternated as consulting doctor or observer. One-third of the consultations were interpreted. Towards the end of the consultations, the patients rated their pain intensity right now (patients VAS). After the patient had left, the two physicians independently rated how much pain they thought the patient had, without looking at the patients VAS score. The mean of the two doctors VAS values (physicians VAS) for each patient was used in the logistic regression calculations of odds ratios (OR) in main effect models for physicians VAS above median (md) with patients sex, education, origin, depression, psychosocial stress and pain sites as explanatory variables. Results Physicians VAS values were significantly lower (md 15) than patients VAS (md 66; women md 73, men md 52). The ratings showed no significant association with whether the physician was acting as consultant or observer. The higher physician VAS was only predicted by findings of multiple pain sites. Conclusions Physicians appear to overlook psychological and emotional aspects when rating the pain of patients from other cultural backgrounds. This finding highlights a potential problem in multicultural care settings.
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| 2. |
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| 3. |
- Kalliokoski, Paul, et al.
(författare)
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Long-term adherence and effects on grip strength and upper leg performance of prescribed supplemental vitamin D in pregnant and recently pregnant women of Somali and Swedish birth with 25-hydroxyvitamin D deficiency : a before-and-after treatment study
- 2016
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Muscular weakness and severe vitamin D deficiency is prevalent in Somali (veiled) pregnant women, Sweden. The study aims here were to explore adherence to prescribed supplemental vitamin D in new mothers with vitamin D deficiency and its effects on grip strength and upper leg performance in Somali (target group TG) and Swedish women (reference group RG) from spring through winter.Methods: A before-and after study was designed. A cross-sectional sample of women in antenatal care with serum 25-OHD <= 50 nmol/L were prescribed one or two tablets daily (800 or 1600 IU vitamin D3 with calcium) for 10 months. Reminders were made by Somali nurses (TG) or Swedish doctors (RG). Baseline and 10 month measurements of plasma nmol/L 25-OHD, maximal grip strength held for 10 s (Newton, N) and ability to squat (yes; no) were done. Total tablet intake (n) was calculated. Outcome variables were changes from baseline in grip strength and ability to squat. Predicting variables for change in grip strength and ability to squat were calculated using linear and binary regression in final models. Undetectable 25-OHD values (< 10 nmol/L) were replaced with '9' in statistic calculations.Results: Seventy-one women (46 TG, 1/3 with undetectable baseline 25-OHD; 25 RG) participated. At the 10-month follow up, 17% TG and 8% RG women reported having refrained from supplement. Mean 25-OHD increased 16 to 49 nmol/L (TG) and 39 nmol/L to 67 nmol/L (RG), (both p < 0.001). Grip strength had improved from 153 to 188 N (TG) (p < 0.001) and from 257 to 297 N (RG) (p = 0.003) and inability to squat had decreased in TG (35 to 9, p < 0. 001). Intake of number of tablets predicted increased grip strength (B 0.067, 95% CI 0.008-0.127, p = 0.027). One tablet daily (> 300 in total) predicted improved ability to squat (OR 16; 95% CI 1.8-144.6).Conclusions: Adherence to supplemental vitamin D and calcium should be encouraged as an even moderate intake was associated to improved grip strength and upper leg performance, which was particularly useful for the women with severe 25-OHD deficiency and poor physical performance at baseline.
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| 4. |
- Kalliokoski, Paul, 1965-, et al.
(författare)
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Physical performance and 25-hydroxyvitamin D : a cross-sectional study of pregnant Swedish and Somali immigrant women and new mothers
- 2013
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background:Severe vitamin D deficiency can impair muscle strength. The study aims were to examine physical performance in the hands and upper legs, and analyze plasma 25-hydroxyvitamin D (25(OH) D) concentrations in women with presumably low (veiled, Somali-born) and high levels (unveiled, Swedish-born).Methods:Women (n = 123, 58% Swedish) enrolled at a Swedish antenatal clinic, latitude 60 degrees N, were recruited. Plasma 25(OH) D was analyzed, measured as nmol/L, then categorized as <10 = undetectable, 10-24, 25-49, 50-74 or >75. Muscle strength was tested: maximal hand grip strength (in Newtons, N), and upper leg performance (categorized as able/unable to perform squatting, standing on one leg, standing from a chair, and lifting their hips). Social and anthropometric data were collected. Non-parametric statistics tested the data for differences in their ability to perform the tests across 25(OH) D categories. Undetectable values (< 10 nmol/L) were replaced with '9' in the linear correlation statistics. A final main effect model for grip strength (in N) was calculated using stepwise linear regression for independent variables: country of birth, 25(OH) D levels, age, height, weight, physical activity, lactation status, parity, and gestational age.Results:Somali participants (35%) had 25(OH) D levels of < 10 nmol/L, and 90% had < 25 nmol/L; 10% of Swedish participants had < 25 nmol/L of 25(OH) D, and 54% had < 50 nmol/L. Somali women had a relatively weak grip strength compared with Swedish women: median 202 N (inter-quartile range 167-246) vs. median 316 N (inter-quartile range 278-359), respectively. Somali women were also weak in upper leg performance: 73% were unable to squat, 29% unable to stand on one leg, and 21% could not lift their hips (not significant across 25(OH) D categories); most Swedish women could perform these tests. In the final model, grip strength (N) was significantly associated with 25(OH) D levels (B 0.94, p=0.013) together with Somali birth (B -63.9, p<0.001), age (B 2.5, p=0.02) and height (B 2.6, p=0.01).Conclusions:Many Somali women had undetectable/severely low 25(OH) D concentrations and pronounced hand and upper leg weakness; grip strength was strongly associated with 25(OH) D. Maternity health care personnel should be aware of this increased frequency and manage care accordingly.
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| 5. |
- Kalliokoski, Paul, 1965-, et al.
(författare)
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Positive impact on vitamin D related lifestyle of medical advice in pregnant Somali-born women and new mothers : a mixed method study in Swedish primary care
- 2021
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundA previous study showed that pregnant women/new mothers especially Somali-born and some Swedish-born had extremely low vitamin D levels and poor physical performance. Our study aimed to examine vitamin D related lifestyle, attitudes and behaviour before and after brief information about vitamin D, with special long-term focus on Somali-born women.MethodsA cohort of 91 pregnant women/new mothers having serum hydroxyvitamin D (S-25-OHD)<= 50nmol/L (n=51 Somali-born with one third <10nmol/L of S-25-OHD) in primary health care in Sweden was targeted for intervention. Brief individual oral and visual information on vitamin D was given by doctors at baseline and after four and ten months. Questionnaires with ordinal scales on vitamin D related lifestyle of food, clothing, and outdoor activities were distributed on all occasions. Focus-group interviews with 15 women from the target-group were performed after two years. A Somali interpreter was available.ResultsVeiled clothing, indoor living, and a low intake of milk, cheese, and fatty fish were common in the target group. Consumption pattern had increased significantly among the Somali-born women at the four-month follow-up but declined to non-significant levels at the ten-month follow-up. The focus-group interviews showed improved understanding of vitamin D deficiency, symptoms and attitudes, but varying applied behaviours related to sun exposure. Sun exposure for the children and increased fish consumption was the most evident positive results.ConclusionsVitamin D related lifestyle, attitudes and behaviour improved in a Somali-born group of pregnant women/new mothers with severe vitamin D deficiency. The preventive measures suggested in our study may have impact on public health in relation to bone and muscle strength and immunity especially in vitamin D deficiency risk groups.
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| 6. |
- Kalliokoski, Paul, 1965-
(författare)
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Vitamin D, muscle strength, prolonged labour, Caesarean sections and lifestyle : Clinical and intervention studies in pregnant Somali and Swedish women and new mothers
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Long-term severe vitamin D deficiency may cause osteomalacia with muscle weakness, pain, soft bones, cramps and eventually death. In a pilot study, I found many Somali women to be vitamin D deficient and very weak. This raised my interest and resulted in the research questions regarding if and how this weakness was linked to vitamin D deficiency, if it could be treated with simple lifestyle advice and supplementation, and if pronounced deficiency could cause serious birth outcomes due to prolonged labour?Study I showed that 90% of pregnant Somali women (n = 52) and new mothers from primary antenatal care suffered from vitamin D deficiency with pronounced muscular weakness and signs of skeletal degradation, compared with 10% of the Swedish women (n = 71). Handgrip strength was predicted by vitamin D levels.Study II showed that vitamin D supplementation among those with insufficient levels at baseline reversed deficiency and skeletal degradation. Furthermore, increased strength in hands and legs was predicted by the amount of supplement intake.Study III aimed to investigate the vitamin D levels and the birth outcomes of cesarean sections and assisted birth for prolonged labour. A directed acyclic graph was established to adjust for covariates. A causal effect of critically low (unmeasurable) vitamin D levels on the outcomes of caesarean sections, emergency caesarean sections and assisted birth for prolonged labour was found with the increased odds of four, nine and six times to one for the birth outcomes, respectively.Lifestyle associated with vitamin D may concern many due to risk of low sun exposure, for example, when working long office hours, engaging in excessive computer gaming, using sunscreen, wearing veiled clothes, or when having special diets like vegan food.It is important to monitor individuals in primary- and antenatal care with muscle weakness and risk factors for vitamin D deficiency, especially in the high-risk group of Somali pregnant women and new mothers.
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| 7. |
- Löfvander, Monica, et al.
(författare)
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A case-control study of self-reported health, quality-of-life and general functioning among recent immigrants and age- and sex-matched Swedish-born controls
- 2014
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 42:8, s. 734-742
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To examine whether new immigrants had inferior quality-of-life, well-being and general functioning compared with Swedish age- and sex-matched controls.Methods: A prospective case-control study was designed including immigrants from non-European countries, 18-65 years of age, with recent Permanent Permits to Stay (PPS) in Sweden, and age- and sex-matched Swedish-born (SB) persons from the general population in Västmanland County, Sweden. The General Health Questionnaire (GHQ-12), the brief version of the World Health Organization Quality-of-Life (WHOQOL-BREF) Scale and the General Activity Functioning Assessment Scale (GAF) from DSM-IV were posted (SB), or applied in personal interviews (PPS) with interpreters. Differences between the PPS and SB groups were measured using McNemar's test and Wilcoxon signed-rank test conducted separately for observations at baseline, 6- and 12-month follow-up.Results: There were 93 pairs (mean age 36 years). Persons from Somalia (67%) and Iraq (27%) dominated the PPS group. The differences between the groups were statistically significant for all time points for the Psychological health and Social relationship domains of WHOQOL-BREF, and for the baseline and 6-month follow-up time points of GHQ-12 where the PPS-group had a higher degree of well-being, health and quality-of-life than the SB. This tendency applied for both sexes in the immigrant group.Conclusions: These new immigrants did not have inferior physical or psychological health, quality-of-life, well-being or social functioning compared with their age- and sex-matched Swedish born pairs during a 1-year follow-up. Thus, there is reason to advocate immigrants' fast integration into society.
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| 8. |
- Löfvander, Monica, 1949-, et al.
(författare)
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Allmänmedicin
- 2014
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Ingår i: Allmänmedicin. - : Studentlitteratur AB. ; , s. 985-988
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Sedan början av 1980-talet har antalet invandrare och flyktingari Sverige ökat så mycket att det numera hör till vardagenatt allmänläkarna har patienter som talar ett främmandespråk, har annan kulturbakgrund samt annan endemi (tabell5.5.1). Oroligheter i världen bidrog till det högsta antalet asylsökandei Sverige 2012 sedan 1992 (figur 5.5.1). Totalt sökte44 000 asyl i Sverige 2012, flest män. År 2010 beviljades entredjedel av 30 000 asylsökande ett uppehållstillstånd attjämföra med de totalt 105 000 personer som fick uppehållstillståndi Sverige.
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| 9. |
- Löfvander, Monica, et al.
(författare)
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Chronic Severe Sleep Problems among Non-Nordic Immigrants : Data from a Population Postal Survey in Mid-Sweden
- 2020
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:21
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Tidskriftsartikel (refereegranskat)abstract
- Sweden has a large population of both recent and established immigrants with high prevalence of risk factors for ill health. Here, we aimed to explore the prevalence of chronic severe sleep problems (CSSP) among non-Nordic-born persons, and to evaluate the risk for CSSP when fully adjusted for covariates. Our additional hypothesis was that lengthier time since immigration would reduce the risk for CSSP. We used data from a large-population postal survey covering life and health issues among inhabitants in mid-Sweden. Relationship between different countries of birth and CSSP was assessed in logistic analyses for more severe and longstanding pain, sex, employment, mental disability, gastrointestinal problems, and length of stay (short, middle time, and up to ten years of stay). Persons of non-Nordic birth reported significantly more often CSSP, regardless of short or long-term stay. Our findings indicate that non-Nordic birth, regardless of residence time and covariates, was an independent and significant predictor for CSSP. The findings may contribute to increasing awareness in healthcare personnel to recognize chronic sleep problems among immigrant patients. Thus, our study might contribute to developing strategies to enhance health for minorities.
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| 10. |
- Löfvander, Monica, docent, 1949-
(författare)
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Demenssjukdomar över språk-och kulturgränser
- 2022. - 1
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Ingår i: Hälsa och Mångfald - ett kliniskt perspektiv. - Stockholm : Liber. - 9789147142835 ; , s. 191-201
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Bokkapitel (refereegranskat)abstract
- Oavsett kulturell ooch språklig bakgrund är symtombilden den typiska för demenssjukdomar. Det som kan variera är de närståendes orsaksförklaringar och reaktioner men sällan på något distinkt kulturspecifikt sätt. Kapitlet behandlar också bland annat riskfaktorer för demenssjukdomar, trauma och differentialdiagnostik mellan demenssjukdomar och PTSD
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| 11. |
- Löfvander, Monica
(författare)
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Illness, disease, sickness : clinical factors, concepts of pain and sick leave patterns among immigrants in primary health care : effects of different therapeutic approaches
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The outer framework for this thesis is the high rate of disability pensions among some immigrant groups in Sweden. The general aim for the research has been to understand the phenomena of illness, disease and sickness certification in immigrants from a primary care perspective and to test the effects on well-being and sickness certification of different therapeutic approaches. The research has been done step-wise and has mainly been of an inductive character. The first project is a descriptive, intervention study of sickness, disease and psychosocial patterns in 105 consecutive, first-time health service visitors of Greek and Swedish origin with a ten year follow-up. In the second project, concepts of backache were explored in 15 consecutive Greek patients on long-term sick leave and 21 healthy members of a Greek cultural association. The third project, comprising 92 persons aged 25-45 years, consists of explorative studies of clinical factors, psychosocial stressors, sick leave patterns with a three year follow-up and concepts of pain in the framework of a rehabilitation programme with two randomised treatment groups. Psychiatric ratings were performed according to the CPRS (first project) and DSM-III-R (third project). Criteria from the DSM-III were used for assessing psychosocial stressors and social functioning. Global ratings of work incapacity were made jointly by the researchers. Self-rated work ability and ratings of pain behaviour were included in the third project. Concepts of pain were explored in thematic interviews. In the first project, a majority had pain complaints. In contrast to the Swedes, the Greeks exhibited a passive pain behaviour. Half the Greeks, but only few Swedes, had a mostly mild depressive/dysphoric illness often associated with psychosocial stressors. Counselling sessions with a Greek psychotherapist were generally not accepted by the Greeks. Regarding work incapacitating diseases, the Greeks had chronic pain and depression and the Swedes had other psychiatric disorders or chronic pain. In spite of small differences in work incapacity between the ethnic groups, the Greeks were more often on long-term sick leave, a difference that increased over a ten year period. In the second project, the concepts about backache among the Greek interviewees were found to centre around the idea of a deteriorating disorder as the cause of persistent pain; a disorder inevitably leading to invalidity if the sufferer should deliberately aggravate the pain. The pain was also linked to much worrying, often shared by the whole family. Chronic, benign pain, depressive disorders, pain anxiety, psychosocial stressors and subjective work incapacity were also common among the immigrants in the third project. In addition to physiotherapy and doctors' reassurance about the benignity of the pain, interviews and dialogue sessions about pain were included in one of the randomised groups. The interviews revealed two patterns of pain concepts. One consisted of notions about a deteriorating disease along with worries for future disability; the other of vague ideas, concentrating on the immediacy of pain. After the programme, pain anxiety and depressive symptoms had decreased, and self-rated work ability had increased significantly more among the interviewees than in the control group. Self-rated work ability was a good predictor for returning to work and for staying at work the following years. In summary, pain anxiety was at the core of the illness, disease and sickness patterns of the immigrants in the research projects. Pain interviews and dialogue sessions about pain may reduce pain anxiety and depressive mood, increase self-rated work ability, and increase the prospects of successful rehabilitation back to work.
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| 12. |
- Löfvander, Monica, et al.
(författare)
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Mortality among immigrant patients 20-45 years of age with chronic back pain in primary care in Sweden : A 15-year follow-up cohort study
- 2020
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Ingår i: Journal of Back and Musculoskeletal Rehabilitation. - 1053-8127 .- 1878-6324. ; 33:5, s. 801-809
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mortality rates among immigrant patients undergoing rehabilitation for musculoskeletal backache are unknown.OBJECTIVE: To study the association between marital status, severe psychosocial strain, receiving long-term time-limited sickness allowance (TLSA) and all-cause mortality (ACM) in a cohort of immigrants aged 20-45 years with long-standing backache in Sweden.METHODS: We studied 318 patients (92% foreign-born, 76% non-European) of known marital status on sick-leave for musculoskeletal backache. They were followed up for ACM until 2015. Socio-demographic data, TLSA and psychosocial strain, including major depression, severe psychosocial stressors and pessimistic thoughts, were analysed using multiple-imputation Cox regression.RESULTS: Over a mean (standard deviation) follow-up time of 15 (5.0) years, 11 (3.5%) participants died. At baseline, 34% were unmarried, 19% were receiving TLSA, and 71% had ⩾ 1 psychosocial strain component (38% depression; 47% severe stressors; 35% pessimistic thoughts). After concomitant risk factors were adjusted for, being unmarried and receiving TLSA were associated with higher mortality by factors of 6.2 (p= 0.005) and 5.8 (p= 0.006), respectively. Psychosocial strain was only significantly associated with higher mortality in the unadjusted analyses.CONCLUSIONS: Being unmarried and receiving TLSA were associated with significantly higher ACM in this highly marginalized group of immigrant patients.
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| 13. |
- Löfvander, Monica, 1949-
(författare)
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Neuropatisk smärta kan handläggas på tio minuter
- 2009
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 106:4, s. 212-213
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Handläggningen av smärtpatienter blir allt mer komplex men tidspressen inom vården blir allt större. För att kunna upprätthålla en god behandlingskvalitet krävs enkla, pålitliga och praktiska riktlinjer för behandling av patienter med långvarig smärta. I synnerhet kan neuropatisk smärta vara svår att diagnostisera och behandla.
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| 14. |
- Löfvander, Monica
(författare)
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Pain drawings, interpreter support and clinical findings among immigrant patients on sick leave in Swedish primary health care
- 2019
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Ingår i: Primary Health Care Research and Development. - : Cambridge University Press. - 1463-4236 .- 1477-1128. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate the spread of pain and its correlates among immigrant patients on sick leave.Background: Backache, outspread pain and sick-leave questions are problematic to handle primary health care, especially in multicultural settings.Methods: Two hundred and thirty-five patients 20-45 years on paid sick leave (59% women, 93% foreign-born, mostly non-Europeans). Many had little formal education. One-third had professional interpreter support. The patients pointed out on their bodies where they felt pain. This information was transferred on a pain drawing [pain drawing fields (PDFs) 0-18] by a doctor. Major depression and psychosocial stressors were assessed using Diagnostic and Statistical Manual of Mental Disorders. Nociceptive locations for pain were established (pain-sites 0-18). Dependent variable was the number of PDFs. Independent variables were social data, sick leave, interpreter, depression, stress levels and number of pain sites. Calculations were done using descriptive methods and multi-variable linear regression in full models, by gender.Findings: Many patients had depression (51% women versus 32% men). A majority were exposed to psychosocial stressors. Women had more PDFs, in median 5 [inter-quartile ranges (IQR) 4-8] versus men 3 (IQR 2-5), and also more pain sites, in median 3 (IQR 2-5) versus men in median 2 (IQR 1-3). For men, the regression calculations revealed that numbers of PDFs associated only with increasing numbers of pain sites (B 0.871 P < 0.001). For women, this association was weaker (B 0.364, P < 0.001), with significant values also for age (B 0.103) and sick leave > one year (B 0.767, P = 0.010), and a negative predicting value for interpreter support (B -1.198, P < 0.043). To conclude, PDFs associated often with somatic findings but varied much among the women. This implies potential problems regarding cause, function and sick leave questions. However, support by professional interpreters may facilitate a shared understanding with immigrant women having long-standing pain.
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| 15. |
- Löfvander, Monica, docent, 1949-
(författare)
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Somatoforma smärtsyndrom i multikulturell vård
- 2014
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Ingår i: Allmänmedicin. ; :3, s. 39-41
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Smärtsyndrom med svår funktionsnedsättning men utan kliniska fynd har under många år fascinerat mig och mina kollegor på Rinkeby vårdcentral i Stockholm. Två somatoforma syndrom har tydlig socio-kulturell koppling medan aggravation och simulering är mer medvetna handlingsmönster som finns överallt inom vården, både förr och nu. Dysfunktionell smärtpresentation kan vara ett sätt att kommunicera, och kognitivt inriktade samtal om smärtans natur kan medföra minskat smärtbeteende.
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| 16. |
- Löfvander, Monica, 1949-
(författare)
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Transkulturell Allmänmedicin
- 2008
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Ingår i: Socialmedicinsk Tidskrift. - 0037-833X .- 2000-4192. ; :5, s. 398-408
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Patient-doctor encounters are rich in cultural context. Primary care consultationshave special framings where language and culture might differ largelybetween patients and care-givers. In such situations, the health professionalsneed extra skills to elucidate overt or covert messages from the patients.One skill is how to use professional interpreters. Other useful tools arethe ability to identify one-self as a cultural person and a know-how about themigration process but also to recognize idioms of distress, family structuresand patients’ explanatory models of illness.
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| 17. |
- Stromberg, Ranja, et al.
(författare)
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Mortality in depressed and non-depressed primary care Swedish patients : a 12-year follow-up cohort study
- 2013
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 30:5, s. 514-519
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Tidskriftsartikel (refereegranskat)abstract
- Data regarding mortality among depressed patients in Swedish primary care is limited. We compared mortality in a cohort of depressed and non-depressed patients at long-term follow-up and compared these values with standardized mortality rates (SMRs) in the Swedish population. Hazards ratios (HRs) for the relationship between death and depression, psychosocial factors and lifestyle were analysed, and we explored the proportion of unnatural causes of deaths. Mortality was studied in a cohort of 124 depressed and 280 non-depressed patients 12 years after being diagnosed with depression in primary care. Mortality and the mortality rates and SMRs in depressed and non-depressed patients were compared by gender. Cox regression was applied to calculate HRs for the risk of dying for explanatory variables, including depression, psychosocial factors and lifestyle. A larger number of depressed patients, 11% (n 14), compared with non-depressed patients, 4% (n 12), died (P 0.008), with significantly higher values among depressed men (P 0.014). SMRs did not differ from those of the Swedish population. Depression was the only variable associated with a significantly elevated risk of death (HR, 3.34; 95% CI, 1.388.08). Nearly one-third of deaths had unnatural causes when alcohol-related deaths were included. This study underlines the importance of careful follow-up of all depressed patients mental and physical health and the intervention on unhealthy lifestyles. Large primary care database studies are needed to explore the association between depression, co-morbid somatic diseases, lifestyle and mortality.
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| 18. |
- Strömberg, Ranja, et al.
(författare)
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Psychosocial stressors and depression at a Swedish primary health care centre. A gender perspective study.
- 2011
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 12, s. 120-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Psychosocial stress may account for the higher prevalence of depression in women and in individuals with a low educational background. The aim of this study was to analyse the association between depression and socio-demographic data, psychosocial stressors and lifestyle circumstances from a gender perspective in a relatively affluent primary care setting.METHODS: Patients, aged 18- 75 years, visiting a drop-in clinic at a primary care health centre were screened with Beck's Depression Inventory (BDI). The physicians used also targeted screening with BDI. A questionnaire on socio-demographic data, psychosocial stressors and use of alcohol and tobacco was distributed. Among patients, who scored BDI ≥ 10, DSM-IV-criteria were used to diagnose depression. Of the 404 participants, 48 men and 76 women were diagnosed with depression. The reference group consisted of patients with BDI score <10, 187 men and 93 women. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CI) as being depressed were calculated for the psychosocial stressors and lifestyle circumstances, separately for men and women. Multiple logistic regression analyses were used to determine the age-adjusted main effect models for men and women.RESULTS: The same three psychosocial stressors: feeling very stressed, perceived poor physical health and being dissatisfied with one's family situation were associated with depression equally in men and women. The negative predictive values of the main effect models in men and women were 90.7% and 76.5%, respectively. Being dissatisfied with one's work situation had high ORs in both men and women. Unemployment and smoking were associated with depression in men only.CONCLUSIONS: Three questions, frequently asked by physicians, which involve patient's family and working situation as well as perceived stress and physical health, could be used as depression indicators in early detection of depression in men and women in primary health care.
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| 19. |
- Taloyan, Marina, et al.
(författare)
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Depression and gender differences among younger immigrant patients on sick leave due to chronic back pain : a primary care study
- 2014
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Ingår i: Primary Health Care Research and Development. - 1463-4236 .- 1477-1128. ; 15:1, s. 5-14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mental ill-health and pain are major causes for disability compensation in female adults in Sweden. Aims: The aims of this study were to (1) analyse gender differences in the prevalence of depression among immigrant patients with chronic back pain and (2) explore whether factors such as age, marital status, educational level, religious faith, number of children and number of diagnosed pain sites could explain these differences. Methods: The study sample consisted of 245 sick-listed primary care patients in consecutive order aged 18 through 45 years with a median duration of sick leave of 10 months for back pain and participating in a rehabilitation programme. Explanatory variables included physicians' diagnosed pain sites, age, marital status, education, number of children and religious affiliation. Predictive factors for depression were analysed using logistic regression. Findings: The women differed significantly from the men in three aspects: they were less educated, had more children and had more multiple pain sites, that is, 68% versus 45%. In the age-adjusted model, women were twice as likely to have depression (odds ratio (OR) 2.1). Regardless the gender, those with intermediate education of 9-11 years had the lowest odds of outcome compared with those with,0-8 years and >= 12 years education. Finally, after adjusting for all explanatory variables, the ORs of depression for women decreased to a non-significant level (OR 1.8; 95% confidence interval (CI) 0.94-3.43). Furthermore, regardless of the gender, those with multiple pain sites had twice higher odds (OR 2.04; 95% CI 1.11-3.74) of depression than those with fewer pain sites. Conclusion: Gender differences in odds of depression in our study could be explained by a higher prevalence of diagnosed multiple pain sites in women. This calls for tailor-made treatments that focus on the pain relief needs of immigrant women with low education and chronic back pain.
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| 20. |
- Taloyan, Marina, et al.
(författare)
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Short-term cognitive-behavioral treatment in multicultural primary care of patients with longstanding backache
- 2013
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Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 54:5, s. 371-375
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Tidskriftsartikel (refereegranskat)abstract
- The efficacy of cognitive-behavioral therapy in multi-cultural primary care patients with longstanding backache is not evaluated. The purpose of this study was to investigate the outcome of a four weekly-treatment given by primary care physicians regarding pain-related worry, depression and severe pain and to determine which social, clinical or gender factors were associated with outcome.The study group consisted of 245 patients in consecutive order from 19 countries, 18 to 45years, entering rehabilitation program because of longstanding backache. Prevalences of pain-related worry and depression and severe pain was counted and compared before and after. Logistic regression was used to calculate the odds (OR; 95% CI) for persistent pain-related worry and/or persistent depression and severe pain (VAS 50). The prevalences of pain-related worry and depression were both significantly lower after treatment (pain-related worry 83% before vs. 38% after; depression 43% before vs. 31% after). Also the number of patients scoring 50 VAS was a little, but significantly, fewer (68% vs. 61%). Use of interpreter doubled the risk of having persistent pain-related worry (OR 2.1; 95% CI 1.1-4.1) but the risk was not significant regarding persistent depression (OR 1.8; 0.6-5.4). The rating of VAS rating 50 after treatment was twice as high, OR 2.3 (95% CI 1.1-4.6) in the 38-45year old age group. To conclude, a focus on pain ideas reduced pain-related worry and depression in these patients with various sociocultural backgrounds and longstanding backache.
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| 21. |
- Wallin, Anne-Marie, et al.
(författare)
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Diabetes : a cross-cultural interview study of immigrants from Somalia.
- 2007
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 16:11C, s. 305-314
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe how diabetic immigrants from Somalia experience everyday life in Sweden and how they manage diabetes-related problems, with inclusion of a gender perspective. Background: To treat and care for minority populations successfully, healthcare staff in Sweden must thoroughly understand the illness experiences of different ethnic groups. However, no studies have so far been reported that focus on immigrants from Somalia with diabetes. Design: Descriptive, qualitative interview study with 19 diabetic adults born in Somalia and now living in Sweden. Method: Cross-cultural interviews with the aid of an interpreter. The transcribed interviews were subjected to qualitative latent content analysis, resulting in sub-themes and themes. Results: Four themes emerged: experience of distress in everyday life; everyday life continues as before; comprehensibility gives a feeling of control; and being compliant. A major finding was the variation in how the participants managed the fasting month of Ramadan. Several participants fasted and did not see the diabetes as an obstacle, others did see it as an obstacle or indicated that fasting was not compulsory for a sick person. Conclusions: This study provides healthcare staff with information about how a minority group experience and manage diabetes. The results indicate the importance of considering cultural background, as well as religious traditions such as Ramadan, in diabetes care. They also indicate that men and women differ in their reaction to diabetes and that care should be adapted to this. Relevance for clinical practice: It is important to develop evidence-based guidelines for diabetes care in ethnic groups that are fasting during Ramadan to prevent complications and promote relevant self-care. Further, the prescribed dietary advice must be culturally appropriate.
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| 22. |
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