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1.	Bränström, Richard, et al. (författare) Physical activity following a breast cancer diagnosis : Implications for self-rated health and cancer-related symptoms 2015 Ingår i: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 19:6, s. 680-5 Tidskriftsartikel (refereegranskat)abstract PURPOSE: Studies have consistently shown an association between physical activity and increased health and well-being after a cancer diagnosis. Nevertheless, large proportions of breast cancer survivors do not meet recommended levels of physical activity. The aim of this study was to describe physical activity levels during the first two years after being diagnosed with breast cancer, and to explore the predictive ability of physical inactivity on longer-term self-rated health, physical symptoms, and psychological distress.METHOD: Study participants were women recently having had a first breast cancer surgery at one of the three main hospitals in Stockholm between 2007 and 2009. A total of 726 women were included and responded to six questionnaire assessments during the 24 months following diagnosis.RESULTS: Less than one third of the participants were sufficiently physically active at baseline. Physical activity decreased after surgery, increased at 8 month follow-up, and subsequently decreased slightly during the subsequent follow-up period. Physical inactivity was related to reduced health, increased symptoms such as pain, depression, and anxiety.CONCLUSION: This study provides additional support for the beneficial consequences of being physically active after a breast cancer diagnosis and highlights a potential target for intervention. This study provides additional support showing that being physically active even at a very low level seems to result in health benefits. Physical activity should be encouraged among patients treated for breast cancer.
2.	Eriksson, Henrik, 1967-, et al. (författare) From a nurse educator to a university specialized in health sciences : The emergence of public health science 2017. - 2 Ingår i: 50 Years of Professional Public Health Workforce Development. - Etterbeek, Brussels : The Association of Schools of Public Health in the European Region (ASPHER). ; , s. 112-114 Bokkapitel (övrigt vetenskapligt/konstnärligt)
3.	Gottvall, Maria, 1980-, et al. (författare) Health-related quality of life among Syrian refugees resettled in Sweden 2020 Ingår i: Quality of Life Research. - : Springer. - 0962-9343 .- 1573-2649. ; 29:2, s. 505-514 Tidskriftsartikel (refereegranskat)abstract Purpose The main purpose of this study was to assess health-related quality of life (HRQoL) among Syrian refugees resettled in Sweden. Further, we wanted to investigate whether sex, age, education, area of residence, cohabitation and social support were associated with HRQoL in this population. Methods This is a cross-sectional study including 1215 Syrian refugees from a randomly selected sample frame resettled in Sweden between the years 2011 and 2013. HRQoL was measured by the EQ-5D-5L descriptive system, and EQ-5D-5L index values were calculated. Associations between sex, age, education, area of residence, cohabitation, social support and EQ-5D-5L were investigated using multiple linear regression analysis. Results Depression/anxiety was the most commonly (61.9%) reported EQ-5D-5L problem among the group of Syrian refugees. The mean EQ-5D-5L index value was found to be 0.754. Male sex, younger age, cohabitation and social support were found associated with a higher EQ-5D-5L index score. Conclusions Our results concerning long-lasting health problems among the study population indicate that there is a profound need for policies and interventions promoting refugees' health. Our results also show that social support, a modifiable factor, is relevant to refugees' overall health, pointing to the importance of public health interventions and policies targeting the facilitation, mobilization and enhancing of refugees' social support.
4.	Gottvall, Maria, 1980-, et al. (författare) Social support attenuates the link between torture exposure and post-traumatic stress disorder among male and female Syrian refugees in Sweden 2019 Ingår i: BMC International Health and Human Rights. - : Springer Science and Business Media LLC. - 1472-698X. ; 19:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND:The aim of this study is threefold: (i) to establish the psychometric properties and gender invariance of ENRICHD Social Support Inventory (ESSI), which was used for the first time in the present study in the population of Syrian refugees resettled in Sweden; (ii) to assess whether gender moderates the associations between social support, exposure to torture and PTSD; (iii) to assess whether social support mediates the association between exposure to torture and PTSD, and whether this mediation is in turn moderated by gender.METHODS:Data from a cross-sectional and population-based study of a random sample of Syrian refugees (n = 1215) resettled in Sweden 2011-2013 was analyzed within a Structural Equation Modeling (SEM) framework.RESULTS:Our results indicate adequate fit and gender invariance for a unidimensional model of ESSI. Exposure to torture was associated with lower social support (B = -0.22, p < 0.01) and with higher odds ratio (OR) for PTSD (OR 2.52, 95% Confidence interval (CI) 1.83-3.40). Furthermore, higher social support was associated with less likelihood for PTSD (B = -0.56, p < 0.001). Social support partially mediated the effect of torture exposure on PTSD (OR 1.13, 95% bias corrected bootstrap CI 1.06-1.26). Gender did not moderate this pattern.CONCLUSION:The results indicate that social support attenuates the link between torture exposure and PTSD, and may function as a protective factor for PTSD among both torture-exposed refugee men and women.
5.	Helgesson, Magnus, et al. (författare) Disability pension and mortality in individuals with specific somatic and mental disorders : examining differences between refugees and Swedish-born individuals 2021 Ingår i: Journal of Epidemiology and Community Health. - : BMJ Publishing Group Ltd. - 0143-005X .- 1470-2738. ; 75:8, s. 721-728 Tidskriftsartikel (refereegranskat)abstract Background More than half a million refugees have arrived to Sweden during the last decade. The aim was to investigate differences between refugees and Swedish-born individuals regarding different specific somatic and mental disorders, and subsequent disability pension and mortality. Methods All refugees (n=239 742) and Swedish-born individuals (n=4 133 898), aged 19-60 years, resident in Sweden on 31st of December in 2009 were included in this population-based prospective cohort study. Data from six nationwide Swedish registers were linked by the unique anonymised identification number. HRs with 95% CIs were computed for disability pension and mortality 2010-2013 by Cox regression models. Results Compared with their Swedish-born counterparts with mental or somatic diagnoses, refugees with these diagnoses had a higher risk of subsequent disability pension and a lower risk of mortality. Highest estimates for disability pension were seen for refugees with neoplasm (HR: 1.72; 95% CI: 1.56 to 1.91), musculoskeletal disorders (HR: 1.57; 95% CI: 1.47 to 1.67), diseases of the circulatory system (HR: 1.33; 95% CI: 1.22 to 1.45), depressive disorders (HR: 1.31; 95% CI: 1.21 to 1.41) and diabetes mellitus (HR: 1.30; 95% CI: 1.15 to 1.47). The risk of mortality was lowest for refugees with regard to bipolar disorders (HR: 0.37; 95% CI: 0.16 to 0.82), post-traumatic stress disorder (HR: 0.37; 95% CI: 0.25 to 0.54) and least pronounced in regard to neoplasm (HR: 0.69; 95% CI: 0.61 to 0.77) compared with Swedish-born with similar disorders. Conclusion Refugees have a generally higher risk of disability pension compared with Swedish-born with specific somatic and mental disorders. Despite this, refugees with all specific disorders have lower risk estimates of mortality, probably due to a healthy selection. The higher risk of disability pension might therefore be due to other causes besides poor health.
6.	Helgesson, Magnus, 1974-, et al. (författare) Labour-market marginalisation after a mental diagnosis among natives and immigrants living in Sweden 2016 Ingår i: European Journal of Public Health. - : OXFORD UNIV PRESS. - 1101-1262 .- 1464-360X. ; 26 Tidskriftsartikel (refereegranskat)
7.	Helgesson, Magnus, et al. (författare) Labour-market marginalisation after mental disorders among young natives and immigrants living in Sweden 2017 Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 17:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The aim was to investigate the associations between mental disorders and three different measures of labour-market marginalisation, and differences between native Swedes and immigrants.METHODS: The study comprised 1,753,544 individuals, aged 20-35 years, and resident in Sweden 2004. They were followed 2005-2011 with regard to disability pension, sickness absence (≥90 days) and unemployment (≥180 days). Immigrants were born in Western countries (Nordic countries, EU, Europe outside EU or North-America/Oceania), or in non-Western countries (Africa, Asia or South-America). Mental disorders were grouped into seven subgroups based on a record of in- or specialised outpatient health care 2001-2004. Hazard ratios (HRs) with 95% confidence intervals (CIs) were computed by Cox regression models with both fixed and time-dependent covariates and competing risks. We also performed stratified analyses with regard to labour-market attachment.RESULTS: Individuals with mental disorders had a seven times higher risk of disability pension, a two times higher risk of sickness absence, and a 20% higher risk of unemployment than individuals without mental disorders. Individuals with personality disorders and schizophrenia/non-affective psychoses had highest risk estimates for having disability pension and long-term sickness absence, while the risk estimates of long-term unemployment were similar among all subgroups of mental disorders. Among persons with mental disorders, native Swedes had higher risk estimates for disability pension (HR:6.6; 95%CI:6.4-6.8) than Western immigrants (4.8; 4.4-5.2) and non-Western immigrants (4.8; 4.4-5.1), slightly higher risk estimates for sickness absence (2.1;2.1-2.2) than Western (1.9;1.8-2.1), and non-Western (1.9;1.7-2.0) immigrants but lower risk estimates for unemployment (1.4;1.3-1.4) than Western (1.8;1.7-1.9) and non-Western immigrants (2.0;1.9-2.1). There were similar risk estimates among sub-regions within both Western and non-Western countries. Stratification by labour-market attachment showed that the risk estimates for immigrants were lower the more distant individuals were from gainful employment.CONCLUSIONS: Mental disorders were associated with all three measures of labour-market marginalisation, strongest with subsequent disability pension. Native Swedes had higher risk estimates for both disability pension and sickness absence, but lower risk estimates for unemployment than immigrants. Previous labour-market attachment explained a great part of the association between immigrant status and subsequent labour-market marginalisation.
8.	Helgesson, Magnus, et al. (författare) Labour market marginalisation among refugees from different countries of birth : a prospective cohort study on refugees to Sweden 2019 Ingår i: Journal of Epidemiology and Community Health. - : BMJ Publishing Group Ltd. - 0143-005X .- 1470-2738. ; 73:5, s. 407-415 Tidskriftsartikel (refereegranskat)abstract Background: The aim was to elucidate if the risk of labour market marginalisation (LMM), measured as long-term unemployment, long-term sickness absence, disability pension and a combined measure of these three measures, differed between refugees and non-refugee migrants with different regions of birth compared with native Swedes.Methods: All non-pensioned individuals aged 19-60 years who were resident in Sweden on 31 December 2009 were included (n= 4 441 813, whereof 216 930 refugees). HRs with 95% CIs were computed by Cox regression models with competing risks and time-dependent covariates with a follow-up period of 2010-2013.Results: Refugees had in general a doubled risk (HR: 2.0, 95% CI 1.9 to 2.0) and non-refugee migrants had 70% increased risk (HR: 1.7, 95% CI 1.7 to 1.7) of the combined measure of LMM compared with native Swedes. Refugees from Somalia (HR: 2.7, 95% CI 2.6 to 2.8) and Syria (HR: 2.5, 95% CI 2.5 to 2.6) had especially high risk estimates of LMM, mostly due to high risk estimates of long-term unemployment (HR: 3.4, 95% CI 3.3 to 3.5 and HR: 3.2, 95% CI 3.1 to 3.2). African (HR: 0.7, 95% CI 0.6 to 0.7) and Asian (HR: 1.0, 95% CI 1.0 to 1.1) refugees had relatively low risk estimates of long-term sickness absence compared with other refugee groups. Refugees from Europe had the highest risk estimates of disability pension (HR: 1.9, 95% CI 1.8 to 2.0) compared with native Swedes.Conclusion: Refugees had in general a higher risk of all measures of LMM compared with native Swedes. There were, however, large differences in risk estimates of LMM between subgroups of refugees and with regard to type of LMM. Actions addressing differences between subgroups of refugees is therefore crucial in order to ensure that refugees can obtain as well as retain a position on the labour market.
9.	Helgesson, Magnus, et al. (författare) Trajectories of work disability and unemployment among young adults with common mental disorders 2018 Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 18 Tidskriftsartikel (refereegranskat)abstract BackgroundLabour-market marginalisation (LMM) and common mental disorders (CMDs) are serious societal problems. The aims were to describe trajectories of LMM (both work disability and unemployment) among young adults with and without CMDs, and to elucidate the characteristics associated with these trajectories.MethodsThe study was based on Swedish registers and consisted of all individuals 19-30years with an incident diagnosis of a CMD in year 2007 (n=7245), and a matched comparison group of individuals without mental disorders during the years 2004-07 (n=7245). Group-based trajectory models were used to describe patterns of LMM both before, and after the incident diagnosis of a CMD. Multinomial logistic regressions investigated the associations between sociodemographic and medical covariates and the identified trajectories.ResultsTwenty-six percent (n=1859) of young adults with CMDs followed trajectories of increasing or constant high levels of work disability, and 32 % (n=2302) followed trajectories of increasing or constant high unemployment. In the comparison group, just 9 % (n=665) followed increasing or constant high levels of work disability and 21 % (n=1528) followed trajectories of increasing or constant high levels of unemployment. A lower share of young adults with CMDs followed trajectories of constant low levels of work disability (n=4546, 63%) or unemployment (n=2745, 38%), compared to the level of constant low work disability (n=6158, 85%) and unemployment (n=3385, 50%) in the comparison group. Remaining trajectories were fluctuating or decreasing. Around 50% of young adults with CMDs had persistent levels of LMM at the end of follow-up. The multinomial logistic regression revealed that educational level and comorbid mental disorders discriminated trajectories of work disability, while educational level, living area and age determined differences in trajectories of unemployment (R-difference(2)=0.02-0.05, p<0.001).ConclusionsA large share, nearly 50%, of young adults with CMDs, substantially higher than in the comparison group of individuals without mental disorders, display increasing or high persistent levels of either work disability or unemployment throughout the follow-up period. Low educational level, comorbidity with other mental disorders and living in rural areas were factors that increased the probability for LMM.
10.	Jaghult, Susanna, et al. (författare) Stress as a trigger for relapses in IBD : A case-crossover study 2013 Ingår i: Gastroenterology Research. - : Elmer Press, Inc.. - 1918-2805 .- 1918-2813. ; 6:1, s. 10-16 Tidskriftsartikel (refereegranskat)abstract Background: It is important to identify factors that influence the risk of relapses in inflammatory bowel disease. Few studies have been conducted and with limited methodology. This prospective case-crossover study, aims to examine whether perceived stress has a short-term acute effect, namely whether it acts as a trigger, on the risk of relapse in inflammatory bowel disease.Methods: Sixty patients with inflammatory bowel disease and in remission were included. The case-crossover design was employed, which is an epidemiological design developed to study triggers for acute events and diseases. To collect information regarding symptoms and potential trigger factors, such as perceived stress, a structured diary was constructed. The participants were instructed to fill in the diary daily during six months. Fifty patients completed the study.Results: The analysis showed an effect for high level of perceived stress. Being exposed to “quite a lot” of stress, yield an increase in risk for relapse during the forthcoming day (OR = 4.8, 95% CI 1.09 - 21.10). No statistically increased risk for lower levels of perceived stress was found, although elevated effect estimates were found for “some” stress.Conclusion: This study supports earlier findings regarding perceived stress as an important factor in triggering relapses in IBD. However, this is the first case-crossover study performed to explore the trigger risk of stress in this population. Further investigations with larger patient samples are needed to confirm the findings.
11.	Janczewska, Izabella, et al. (författare) Clinical application of the multigene analysis test in discriminating between ulcerative colitis and Crohn's disease : a retrospective study 2012 Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 47:2, s. 162-9 Tidskriftsartikel (refereegranskat)abstract Abstract Methods. The newly described - multigene analysis test (DiBiCol) identifying 7 inflammatory bowel disease (IBD)-specific genes in colonic mucosal biopsy differentiating between ulcerative colitis (UC) and Crohn's disease (CD) with active inflammation - is a new addition to existing methods with a higher stated sensitivity and specificity. Method biopsy material from 78 patients with a complicated course diagnosed as most probably UC in 38, CD in 18 and inflammatory bowel disease unclassified (IBDU) in 22 were investigated by DiBiCol. Results. DiBiCol showed a pattern consistent with CD in 13 patients with UC and led to change of diagnosis in 3 patients and a strong suggestion of CD in 8 patients. A total of 2 patients remained as UC. DiBiCol showed a pattern of UC in 4 patients of 18 with CD leading to a changing of diagnosis to UC in 3 patients, but the fourth remained as CD. In 22 patients with IBDU DiBiCol showed a pattern consistent with UC in 7 cases and with CD in 13 cases. A new evaluation 1 year after the DiBiCol allowed the assessment of clinical diagnosis in 10 patients confirmed in 9 of 10 patients by DiBiCol. In patients with acute flare of colitis the clinical diagnosis corresponded in 10 of 12 UC and in 5 of 6 CD cases. Summary. Adopting the DiBiCol test led to a change of the primary diagnosis in a significant number of patients with the initial diagnosis of UC and CD and suggested a clinically probable diagnosis in most of the patients with IBDU and in those with an acute flare of colitis.
12.	Jäghult, Susanna, et al. (författare) Factor structures of the Swedish version of the RFIPC : investigating the validity of measurements of IBD patient's worries and concerns 2010 Ingår i: Gastroenterology Research. - : Elmer Press, Inc.. - 1918-2805. ; 3:5, s. 191-200 Tidskriftsartikel (refereegranskat)abstract Background: Worries and concerns of patients with IBD comprise an important negative factor in their HRQOL. The Rating Form of Inflammatory Bowel Disease Patient Concerns (RFIPC) was developed to describe the nature and degree of the worries and concerns of IBD patients. In the original version, the specific issues of worries are divided into four separate factors. These factors provide useful information about HRQOL and the kind of worries and concerns which are most important to the patient. However, the Swedish version of the RFIPC is often scored using a single sum score, implying that all the specific issues of worries stem from a single general worry factor. The aim of this study was to validate the factor structure of the Swedish version of the RFIPC.Methods: A sample consisting of 195 patients with IBD filled out the RFIPC. Confirmatory factor analysis was performed to examine fit of three hypothesized models of factor structure. Spearman’s correlation and Mann-Whitney analysis were used to follow up the results.Results: The single-factor model displayed poor fit indices. The four-factor model marked substantive improvement, but still remains inadequate. The final four-factor model permitting correlated error terms between some items displayed the most adequate fit. Conclusions: The factorial structure of the RFIPC, as suggested in the original version, was able to be replicated with a slight modification in the Swedish version. The separate factors identified in this structure provide more detailed information about the worries and concerns of IBD patients as these components of worries are different related to HRQOL and general health.
13.	Jäghult, Susanna, et al. (författare) Identifying predictors of low health-related quality of life among patients with inflammatory bowel disease : comparison between Crohn's disease and ulcerative colitis with disease duration 2011 Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 20:11-12, s. 1578-1587 Tidskriftsartikel (refereegranskat)abstract Aim. To identify predictors of low health-related quality of life among patients with inflammatory bowel disease and make a comparison between Crohn's disease and ulcerative colitis with disease duration. Background. Studies have shown that patients with inflammatory bowel disease rate their health-related quality of life lower, as compared with a general population. Design. Survey. Methods. In this study, 197 patients in remission were included and divided into a Crohn's disease group and an ulcerative colitis group. Each group was also divided into separate groups whether the patients had short disease duration or long disease duration. Generic instruments, combined with disease-specific questionnaires, were used for measuring health-related quality of life. Results. The analysis showed a non-significant effect for diagnosis, but a significant effect for disease duration showing that the patients with short disease duration had lower scores of health-related quality of life compared with patients with long disease duration. A significant interaction between diagnosis and disease duration was also revealed. Conclusion. Patients with longer disease duration experienced a better health-related quality of life than patients with short disease duration. Patients with Crohn's disease and short disease duration have the lowest health-related quality of life and are in greatest need of education and support. Relevance to clinical practice. It is important to identify which patients' are in the greatest need of education and support.
14.	Jäghult, S, et al. (författare) Stress as a trigger for relapses in IBD : a case-crossover study Tidskriftsartikel (refereegranskat)
15.	Kidayi, Paulo L, et al. (författare) Cross-Cultural Adaptation and Psychometric Properties of the Swahili Version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR45 among Breast Cancer Patients in Tanzania 2023 Ingår i: Healthcare. - : MDPI. - 2227-9032. ; 11:18 Tidskriftsartikel (refereegranskat)abstract Breast cancer is the most frequent cancer in women in Africa and contributes to premature death and poor quality of life. This study aimed to determine the validity, reliability, and psychometric properties of the Swahili version of EORTC QLQ-BR45 among women with breast cancer in Tanzania. A cross-sectional study design with non-probability convenience sampling was employed. Data were collected in two tertiary hospitals and one national cancer institute; 414 participants completed the EORTC-QLQ-C-30 and EORTC-QLQ-BR45. The reliability of QLQ-BR45 was measured using Cronbach's alpha and McDonald's Omega coefficients. The factor structure of EORTC QLQ-BR45 was assessed using confirmatory factor analysis. The internal consistencies for the five dimensions were all above 0.7 indicating satisfaction, except for systemic therapy side effects with a marginal value of 0.594 and significant correlations between the dimensions of QLQ-C30 and BR45. The final model fit well to the data, with the comparative fit index = 0.953, Tucker-Lewis index = 0.947, root mean square error of approximation = 0.041 (90% CI: 0.035, 0.046), and standardized root mean square residual = 0.072. In conclusion, the QLQ BR45 Swahili version displayed good reliability, validity, and psychometric properties and can be used in Swahili-speaking Sub-Saharan countries.
16.	Lauffs, Monica, et al. (författare) Cross-cultural adaptation of the Swedish version of Readiness for Interprofessional Learning Scale (RIPLS) 2008 Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 42:4, s. 405-411 Tidskriftsartikel (refereegranskat)abstract Context Interprofessional learning activities in health care are being gradually introduced on an international basis and therefore cross-cultural and internationally collaborative research into the outcomes of these activities is needed. Hence, it is necessary not only to translate research instruments into the language of the culture in which they are to be used, but also to adapt them culturally if they are to fulfil the testing purposes for which they are intended. It is also necessary to test a translated instrument in order to ensure that it retains its intended psychometric properties.Methods In the present study, the Readiness for Interprofessional Learning Scale (RIPLS) was adapted for use in a Swedish student population. Cross-cultural adaptation was performed according to recommended guidelines. The Swedish version was tested on a group of students from various health care professions (n = 214). Cronbach’s alpha coefficient was adopted to ensure internal consistency.Results Minor discrepancies during the different translation processes were identified and corrected. Confirmatory factor analysis suggests that the model had an acceptable fit, implying that the factor structure of the scale did not undergo any significant changes by being subjected to translation. The psychometric qualities of the instrument were comparable with those of the English-language version.Conclusions This study presents the cross-cultural adaptation of the RIPLS and demonstrates that its subscale Teamwork and Collaboration is the only reliable subscale. The other 2 subscales (Professional Identity, and Roles and Responsibilities) probably require further scrutiny and development, at least in the Swedish population.
17.	Lundh, Lars-Gunnar, et al. (författare) Perfectionism and Insomnia 1994 Ingår i: Scandinavian Journal of Behaviour Therapy. - : Informa UK Limited. - 0284-5717. ; 23:1, s. 3-18 Tidskriftsartikel (refereegranskat)abstract The relationship between perfectionism and insomnia was studied by means of a shortened version of Frost et al's (1990) Multidimensional Perfectionism Scale (MPS-20). In the first study, an age- and sex-stratified sample of 383 randomly selected individuals from Uppsala, Sweden answered the MPS-20 and a number of questions about their sleep. Within this normal sample, perfectionism correlated with degree of sleep problem, and with an increased concern over the adverse consequences of insufficient sleep. In the second study, the MPS-20 was administered to a consecutive series of 70 patients with persistent insomnia from a sleep disorders clinic. This group was found to have significantly higher scores than the normals on perfectionism, and especially on the subscales Concern over Mistakes and Personal Standards. Within the insomnia group, patients with a concomitant diagnosis of major depression differed from the non-depressed insomniacs by having higher scores on the subscale Doubts about Action. Although these studies show a correlation between perfectionism and insomnia, they do not demonstrate a causal relationship. It is hypothesized that perfectionism (high personal standards and high concern over mistakes) may serve as a predisposing factor for the development of persistent insomnia.
18.	Lundh, Lars-Gunnar, et al. (författare) The role of personal standards in clinically significant perfectionism : a person-oriented approach to the study of patterns of perfectionism 2008 Ingår i: Cognitive Therapy and Research. - : Springer Science and Business Media LLC. - 0147-5916 .- 1573-2819. ; 32:3, s. 333-50 Tidskriftsartikel (refereegranskat)abstract Clinically significant perfectionism is defined as patterns of perfectionism which are over-represented in clinical samples and under-represented in non-clinical samples. The present study contrasted two hypotheses about what characterizes clinically significant perfectionism: the two-factor theory and perfectionism/acceptance theory. First, a person-oriented approach by means of cluster analysis was used to identify typical patterns of perfectionism. These clusters were then cross-tabulated with two clinical samples (patients with social phobia and patients with panic disorder) and a non-clinical sample. The results showed that patterns of clinically significant perfectionism combined high Concern over Mistakes (CM) and Doubts about Action (DA) with high Personal Standards (PS) (and to a lesser extent also high Organization)--which is consistent with perfectionism/acceptance theory, but at odds with the two factor theory. The results illustrate the value of a person-oriented methodological approach as a complement to the traditional variable-oriented approach.
19.	Lundin, Andreas, et al. (författare) Discriminant validity of the 12-item version of the general health questionnaire in a Swedish case-control study 2017 Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 71:3, s. 171-179 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The 12-item version of the General Health Questionnaire (GHQ-12) is widely used as a proxy for Affective Disorders in public health surveys, although the cut-off points for distress vary considerably between studies. The agreement between the GHQ-12 score and having a clinical disorder in the study population is usually unknown.AIMS: This study aimed to assess the criterion validity and to determine the sensitivity and specificity of the GHQ-12 in the Swedish population.METHODS: This study used 556 patient cases surveyed in specialized psychiatric care outpatient age- and sex-matched with 556 controls from the Stockholm Health Survey. Criterion validity for two scoring methods of GHQ-12 was tested using Receiver Operating Characteristics (ROC) analyses with Area Under the Curve (AUC) as a measure of agreement. Reference standard was (1) specialized psychiatric care and (2) current depression, anxiety or adjustment disorder.RESULTS: Both the Likert and Standard GHQ-12 scoring method discriminated excellently between individuals using specialized psychiatric services and healthy controls (Likert index AUC = 0.86, GHQ index AUC = 0.83), and between individuals with current disorder from healthy controls (Likert index AUC = 0.90, GHQ index AUC = 0.88). The best cut-off point for the GHQ index was ≥4 (sensitivity = 81.7 and specificity = 85.4), and for the Likert index ≥14 (sensitivity = 85.5 and specificity = 83.2).CONCLUSIONS: The GHQ-12 has excellent discriminant validity and is well suited as a non-specific measure of affective disorders in public mental health surveys.
20.	Löfvenmark, Caroline, et al. (författare) Evaluation of an educational programme for family members of patients living with heart failure : a randomised controlled trial 2013 Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 22:1-2, s. 115-126 Tidskriftsartikel (refereegranskat)abstract Aims and objectives. To evaluate the effect of a group-based multi-professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study. Background. When a person is diagnosed with heart failure, the daily life of the family members is also affected. Design. Randomised controlled trial. Methods. A total of 128 family members were randomly assigned to participate in a multi-professional educational programme or a control group. Analysis of variance and regression analysis were used. Results. There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety (p < 0.001, R2 = 0.35) and depression (p = 0.021, R2 = 0.37). Younger family members were found to have a higher quality of life (p < 0.01). Conclusion. Improved disease-related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members. Relevance to clinical practice. Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members.
21.	Lööf, Helena, et al. (författare) Development and psychometric testing of the Swedish version of the Body Awareness Questionnaire 2013 Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 69:7, s. 1643-1651 Tidskriftsartikel (refereegranskat)abstract Aim This paper is a report of the development and psychometric testing of the Swedish version of the Body Awareness Questionnaire to measure bodily focus of attention. Background The Body Awareness Questionnaire has been identified as an instrument with excellent psychometric properties within the concept of body awareness. It has been used in both research and clinical settings in different contexts. However, a validated Swedish version is not available. Method A cross-sectional design was applied for adaptation of the Body Awareness Questionnaire and psychometric validation. Data were collected between autumn 2009 and spring 2011 from 120 patients diagnosed with rheumatoid arthritis, and from 120 students. The concurrent think aloud' method was used in a pre-test to determine the usability of the questionnaire. Cronbach's alpha was used to test the internal consistency, and confirmatory factor analysis was performed to test the construct validity. Results According to the confirmatory factor analysis, neither the one-factor model nor the four-factor model tested in this study fulfilled the pre-specified criteria in accordance with the Comparative Fit Index, Standardized Root Mean Squared Residual and the Root Mean Square Error of Approximation. The value of Cronbach's alpha for the Swedish version of the Body Awareness Questionnaire was satisfactory. Conclusion Our results indicate that the two models tested in this study do not provide a good fit to the observed data. Further refinement and testing of the Swedish version of the Body Awareness Questionnaire is therefore required. The concept of body awareness may be useful in the management of chronic disease and can be addressed in nursing.
22.	Lööf, Helena, et al. (författare) "Pain and fatigue in adult patients with rheumatoid arthritis : association with demographic factors, disease related factors, body awareness, emotional and psychosocial factors" 2012 Ingår i: Arthritis and Rheumatism. - 0004-3591 .- 1529-0131. ; 64:10 (suppl), s. 671-672 Tidskriftsartikel (refereegranskat)
23.	Lööf, Helena, et al. (författare) Pain and fatigue in adult patients with rheumatoid arthritis : Association with body awareness, demographic, disease-related, emotional and psychosocial factors 2013 Ingår i: Open Journal of Nursing. - : Scientific Research Publishing. - 2162-5336 .- 2162-5344. ; 3:2, s. 293-300 Tidskriftsartikel (refereegranskat)abstract Background: Patients and clinicians report pain and fatigue as key outcome measures in rheumatoid arthritis. Fatigue and pain are a major concern to patients. Aim: The objective of this study was to examine fatigue and pain in adult patients with rheumatoid arthritis (RA) and to investigate the association between pain and fatigue with body awareness, demographic, disease-related, emotional and psychosocial factors.Method: Data were collected from a sample of patients with RA (n = 120) recruited from a Rheumatology clinic in a large university hospital in Stockholm, Sweden. Eligible for inclusion were patients between 20 - 80 years of age and with a confirmed diagnosis of RA. Fatigue was measured using the Multidimensional Assessment of Fatigue (MAF) scale, while the Visual Analogue Scale (VAS) was used to assess components of pain. A multiple stepwise regression analysis was performed to evaluate factors related to fatigue and pain. In the first step a univariate analysis of variance (ANOVA) was used for all relevant independent factors. In the next step backwards stepwise regression was applied.Result: Fatigue was significantly associated with the Disease Activity Score 28-joints (DAS 28) (p = 0.049), the Body Awareness Questionnaire (BAQ) (p = 0.006), the Positive Affect (PA) scale (p = 0.008) and no smoking (p = 0.021). Pain was significantly associated with the EuroQol EQ-5D (p = 0.008) and the DAS 28 (p = 0.001). The adjusted R-square was 28.6% for fatigue and 50.0% for pain. Conclusion: This study clearly demonstrates that fatigue and pain in patients with RA appear to be associated with disease-related factors. Furthermore, fatigue was related to body awareness and emotional factors, and pain was related to health related quality of life.
24.	Lööf, Helena, et al. (författare) Psychometric testing of the body awareness questionnaire in an Swedish sample of patients diagnosed with rheumatoid arthritis 2012 Ingår i: Annals of the Rheumatic Diseases. - 0003-4967 .- 1468-2060. ; 71:Suppl 3, s. 734- Tidskriftsartikel (refereegranskat)
25.	Malm, Andreas, et al. (författare) The refugee post-migration stress scale (RPMS) - development and validation among refugees from Syria recently resettled in Sweden 2020 Ingår i: Conflict and Health. - : BioMed Central (BMC). - 1752-1505. ; 14 Tidskriftsartikel (refereegranskat)abstract Background: Despite the growing recognition of the impact of post-resettlement factors on the mental health of refugees, a clear definition of the concept of post-migration stress, as well as an updated, valid instrument for assessing the construct, are still lacking. The aim of the current study was to develop and validate the Refugee Post-Migration Stress Scale (RPMS), a concise, multi-dimensional instrument for assessing post-migration stress among refugees.Results: Based on a review of previous research and observations from a refugee trauma clinic, a preliminary 24-item instrument was developed, covering seven hypothesized domains of post-migration stress: perceived discrimination, lack of host country specific competences, material and economic strain, loss of home country, family and home country concerns, social strain, and family conflicts.In the context of a population-based survey of mental health among refugees from Syria recently resettled in Sweden (n = 1215), the factorial structure of the RPMS was investigated. Confirmatory Factor Analysis revealed slightly insufficient fit for the initial theorized multi-domain model. Exploratory Factor Analysis in four iterations resulted in the omission of three items and an adequate fit of a 7-factor model, corresponding to the seven hypothesized domains of post-migration stress. To assess concurrent validity, correlational analyses with measures of anxiety, depression, post-traumatic stress disorder (PTSD), and mental wellbeing were carried out. All domains of post-migration stress showed significant correlations with anxiety, depression, and PTSD scores, and significant negative correlations with mental wellbeing scores.Conclusions: The newly developed RPMS appears to be a valid instrument for assessing refugee post-migration stress. Our findings that post-migration stress primarily relating to social and economic factors seems to be associated with mental ill health among refugees is in line with previous research.
26.	Manhica, Hélio, 1981- (författare) Mental health, substance misuse and labour market participation in teenage refugees in Sweden – A longitudinal perspective 2017 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Aim: To fill the knowledge gap about the importance of contextual factors after resettlement on mental health, substance misuse and labour market participation among young refugees who immigrate to Sweden as teenagers. Methods: Register studies in national registers of national cohorts of young refugees, unaccompanied and accompanied, who settled in Sweden as teenagers. Studies 1-4 used Cox regression models to study the risks of psychiatric care consumption and substance misuse, while Study 5 used multinomial regression to study position on the labour. These findings were compared with peers from the same birth cohorts in the general Swedish population and non-European intercountry adoptees (Studies 2 and 5). Results: The overall results suggest that young accompanied and unaccompanied refugees were more likely to be admitted to psychiatric inpatient and compulsory hospital care, but not outpatient care, with refugees born in the Horn of Africa and Iran having the highest risk (Study 1). Young accompanied and unaccompanied refugees also had higher risk of hospitalization and criminal conviction associated with substance misuse (Study 3). Longer duration of residence in Sweden was associated with increased risks of outpatient care (Study 1) and hospitalization related to substance misuse (studies 3 and 4). These increase risks of young refugees were associated with their socioeconomic living conditions (Studies 3 and 4), but risk factors associated with the country of origin of the refugee population and the intercountry adoptees were more important determinants of schizophrenia than socioeconomic conditions in Sweden (Study 2). Young accompanied and unaccompanied refugees and intercountry adoptees had a lower likelihood of being in full employment than native Swedes with comparable levels of education. Secondary education, however, increased employment chances and reduced the risk of being neither employed nor in education or training (Study 5). Conclusion: Evidence suggests that several groups of young refugees are at higher risk of mental health problems and substance misuse. They also face employment disadvantages and barriers to psychiatric care in the early stages of developing a psychiatric disorder.
27.	Manhica, Hélio, et al. (författare) Social participation, mental health in refugees and asylum seekers : A scoping review 2018 Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 28:Suppl. 4, s. 482-482 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
28.	Nahlén Bose, Catarina, et al. (författare) Adaptation of Coping Effectiveness Training for Patients With Heart Failure and Patient-Reported Experience of the Intervention 2020 Ingår i: Journal of Patient Experience. - : Sage Publications. - 2374-3735 .- 2374-3743. ; 7:6, s. 1054-1061 Tidskriftsartikel (refereegranskat)abstract Although patients with chronic heart failure (CHF) often experience psychological distress, psychosocial aspects are not an integral part of their treatment and care. The aim is to describe the adaptation of Coping Effectiveness Training for patients with CHF and the participants? reported experiences. The intervention workbook and manual were translated into Swedish and adapted for patients with CHF. Patient-reported experience from 33 of 35 participants, that had completed the psychosocial intervention, was measured with an evaluation form consisting of closed and open-ended questions. Most participants thought they benefited from the intervention, were pleased with the structure and did not want to add anything to the program. The benefits experienced were learning how to cope with the illness and meeting other people to share and discuss experiences. There was a variation concerning the group process of how much direction should be given during the discussions. Overall, unique data from patient-reported experience measure showed that the participants were satisfied with the psychosocial intervention, applied for the first time to patients with CHF.
29.	Nahlen Bose, Catarina, et al. (författare) Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure : the Brief COPE Restructured 2015 Ingår i: Cardiology Research. - : Elmer Press, Inc.. - 1923-2829 .- 1923-2837. ; 6:2, s. 239-248 Tidskriftsartikel (refereegranskat)abstract Background: Individuals with chronic heart failure (CHF) need to cope with both the physical limitations and the psychological impacts of the disease. Since some coping strategies are beneficial and others are linked to increased mortality and worse health-related quality of life (HRQoL), it is important to have a reliable and valid instrument to detect different coping styles. Brief COPE, a self-reporting questionnaire, has been previously used in the context of CHF. There is, however, currently a lack of consensus about the theoretical or empirical foundations for grouping the multiple coping strategies assessed by Brief COPE into higher order categories of coping. The main purpose of this study was to examine the structure of Brief COPE, founded on the higher order grouping of its subscales in order to establish an assessment model supported by theoretical considerations. Furthermore, the associations between these higher order categories of coping and HRQoL were examined to establish the predictive validity of the selected model in the context of CHF.Method: One hundred eighty-three patients diagnosed with CHF were recruited at a heart failure outpatient clinic or at a cardiac ward. Self-reported questionnaires were filled in to measure coping strategies and HRQoL. Confirmatory factor analyses were performed to investigate different hierarchical structures of Brief COPE found in the literature to assess coping strategies in patients with CHF. Regression analyses explored associations of aggregated coping strategies with HRQoL.Results: A four factorial structure of Brief COPE displayed the most adequate psychometric properties, consisting of problem focused coping, avoidant coping, socially supported coping and emotion focused coping. Avoidant coping was associated with worse HRQoL in CHF.Conclusions: This study provides support for a four-factor model of coping strategies in patients with CHF. This could facilitate assessment of coping both in clinical and research settings.
30.	Nahlen Bose, Catarina (författare) Coping and emotional well-being in patients with chronic heart failure 2015 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background: Chronic heart failure (CHF) is a serious illness, with a profound impact on the patient. Poor health-related quality of life (HRQoL) as well as anxiety and depression are prevalent in CHF and predict mortality and rehospitalization, yet, psychosocial factors are infrequently treated and cared for.Aim: To gather scientific evidence on illness perception and coping strategies to predict emotional well-being in patients with CHF and to establish a measurement model of coping strategies. Furthermore, to evaluate a nurse-led psychoeducational intervention, Coping Effectiveness Training (CET) adapted for patients with CHF.Methods: Studies I-III were cross sectional. Study IV was a randomized controlled trial aimed to improve emotional well-being (one-year follow-up). All studies used patient reported outcome measures and clinical data via medical journals.Results: Younger age and male gender were associated with higher levels of alcohol usage and/or drugs to cope, p < 0.01. Poor sense of coherence was associated with maladaptive coping (I). A four factorial model of Brief COPE displayed the best psychometric properties (II). Avoidant coping influenced negative affect (NA) (I), worse HRQoL (II) and greater anxiety and depression (III). CET (IV) improved personal control in the intervention group (IG) compared to the control group (CG), p = 0.036. Improved scores for the IG were detected in emotional well-being and HRQoL, p = ns. The IG demonstrated reduced NA, p = 0.022, excluding cases with clinical anxiety and depression. Time to cardiovascular readmission or death was non-significantly lower in the IG vs the CG (Hazard ratio 0.58 [0.29-1.18]) adjusted p = 0.135.Conclusions: Personal resources seemed to influence the coping strategies used by patients with CHF. Avoidant coping had an adverse influence on emotional wellbeing and illness perception in CHF. The perceived sense of control and illness burden were of importance for emotional well-being. A CET intervention for patients with CHF increased sense of control over the illness. CET also reduced NA in patients with no or mild symptoms of anxiety and depression.
31.	Nahlen Bose, Catarina, et al. (författare) Evaluation of a Coping Effectiveness Training intervention in patients with chronic heart failure : a randomized controlled trial 2016 Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 15:7, s. 537-548 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Impaired emotional well-being has detrimental effects on health outcomes in patients with chronic heart failure (CHF).AIMS:To evaluate a nurse-led Coping Effectiveness Training (CET) group intervention for patients with CHF. It was hypothesized that CET would increase emotional well-being (primary outcome) and health-related quality (HRQoL) of life and improve clinical outcomes. Furthermore, changes in appraisal and coping as mediators of the intervention effect were examined.METHODS: Participants were randomized to either control group (n=51) receiving standard health care or CET intervention group (n=52). Self-assessments of positive affect, negative affect, depression, anxiety, HRQoL, illness perception, coping strategies and social support were performed pre- and post-intervention and after six weeks, six months and 12 months. Time to death and hospitalizations were measured during the entire follow-up (median 35 months, interquartile range 11 months).RESULTS: No significant improvements for emotional well-being and HRQoL in the intervention group compared with the control group were found. After excluding patients with clinical anxiety and depression at baseline the intervention group had significantly lower negative affect (p = 0.022). There were no significant differences regarding cardiovascular events between the groups. The intervention group had greater sense of control over their illness in the short-term (p = 0.036).CONCLUSION: CET intervention was found to increase sense of control over the illness in the short term. Psychosocial support programmes, like CET, for patients with CHF is currently lacking evidence for implementing in clinical practice. However, the results provide a basis for future studies with a modified CET intervention design and increased study size.
32.	Nahlen Bose, Catarina, et al. (författare) Implementation of coping effectiveness training in patients with chronic heart failure : participants evaluations indicate psychosocial benefits 2015 Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 14:S1, s. S10-S10 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
33.	Nahlen Bose, Catarina, et al. (författare) Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failure Annan publikation (övrigt vetenskapligt/konstnärligt)
34.	Nahlen Bose, Catarina, et al. (författare) Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failure 2016 Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 30:4, s. 704-713 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: Emotional distress in patients with chronic heart failure (CHF) predicts mortality, hospital readmission and quality of life. The patient's avoidant coping style and beliefs about the disease have been linked to emotional distress in CHF. However, the pattern and transmitting effects of these variables are indefinite.AIM: This study aimed to examine the links between and the potential mediating role of illness perceptions and avoidant coping style on depression and anxiety in patients with CHF.METHOD: Self-assessment data from 103 patients with CHF were subjected to path analysis in two hypothesised models. The outcome measures were coping styles, illness perception, anxiety and depression.RESULTS: Avoidant coping had a direct adverse effect on anxiety and depression. The perception of symptom burden and personal control, significantly mediated the effect between avoidant coping and anxiety and depression.CONCLUSIONS: Avoidant coping style appears to influence not only emotional distress, but also a malignant symptom perception and low sense of control over the illness.
35.	Nahlén, Catarina, et al. (författare) Coping, sense of coherence and the dimensions of affect in patients with chronic heart failure 2010 Ingår i: European Journal of Cardiovascular Nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. - : Oxford University Press (OUP). - 1873-1953 .- 1474-5151. ; 9:2, s. 118-25 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Living with chronic heart failure has an impact on several important dimensions of an individual's life. A patient's use of coping strategies may influence his or her health condition and emotional well-being. AIM: To investigate factors that may relate to the coping strategies used by individuals with chronic heart failure and how the coping strategies are associated with positive and negative affect. METHODS: A cross-sectional research design was used. The participants provided demographic data and filled out three questionnaires: Sense of Coherence scale, Brief COPE and Positive Affect Negative Affect Schedule. RESULTS: No differences in relation to coping strategies were found with regard to New York Heart Association class. Substance use was associated with gender and age. Sense of coherence was negatively associated with denial, behavioural disengagement, venting and self-blame, and positively associated with acceptance. It was found that avoidant coping positively and sense of coherence negatively, predicted negative affect. Problem focused coping positively predicted positive affect. Socially supported coping predicted both negative and positive affect. CONCLUSION: The present study found that the employment of different coping strategies and sense of coherence had an impact on affect and therefore also the emotional well-being among patients with chronic heart failure.
36.	Niederkrotenthaler, Thomas, et al. (författare) The role of refugee status and mental disorders regarding subsequent labour market marginalisation : a register study from Sweden 2020 Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer. - 0933-7954 .- 1433-9285. ; 55, s. 697-704 Tidskriftsartikel (refereegranskat)abstract PURPOSE: This study aimed to assess the role of refugee status and specific mental disorders regarding subsequent labour market marginalisation.METHODS: Prospective cohort study of all refugees (n = 216,930) and Swedish-borns (n = 3,841,788), aged 19-60 years, and resident in Sweden in 2009. Hazard ratios (HRs) with 95% Confidence Intervals (CIs) for long-term unemployment (> 180 days) and disability pension (DP) were calculated with Cox regression analyses.RESULTS: Mental disorders were more prevalent in refugees compared to Swedish-born individuals, with greatest differences seen for post-traumatic stress disorder (PTSD; refugees 1.3%; Swedish-born individuals 0.1%). Regarding long-term unemployment, refugees without a mental disorder had an adjusted HR (aHR) of 2.68 (95% CI 2.65-2.71) compared to Swedish-born individuals without mental disorders, which was above the aHR of refugees (aHR 2.33, 95% CI 2.29-2.38) and Swedish-born individuals (aHR 1.44, 95% CI 1.43-1.45) with mental disorders. Regarding DP, compared to Swedish-born individuals without mental disorders, the aHRs were 1.44 (95% CI 1.34-1.54) for refugees without, but 6.11 (95% CI 5.84-6.39) for refugees with mental disorders. Swedish-born individuals with mental disorder had an aHR of 3.96 (95% CI 3.85-4.07). With regard to specific disorders, the aHRs for refugees, as compared to Swedish-born individuals without mental disorders, were markedly increased for all disorders (e.g. PTSD: long-term unemployment aHR: 2.03 (95% CI 1.89-2.18); DP 7.07 (95% CI 6.42-7.78).CONCLUSION: Mental disorders are more prevalent in refugees than in Swedish-born individuals but do not appear to increase their risk of long-term unemployment. Refugee status and mental disorders strongly contribute to the risk of DP, indicating that factors beyond medical considerations contribute to their granting of DP.
37.	Niemi, Maria, et al. (författare) A Scoping Review and Conceptual Model of Social Participation and Mental Health among Refugees and Asylum Seekers 2019 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 16:20 Forskningsöversikt (refereegranskat)abstract Social participation plays a key role in the integration of refugees and asylum seekers into their host societies, and is also closely tied to the mental health of those populations. The aim of this scoping review was to study how the concept of social participation is described in empirical research, and how it is associated with mental health outcomes.METHODS: In total, 64 studies were identified through searches in PubMed, PsycInfo, and Sociological Abstracts. These studies describe various forms of social participation among refugees and asylum seekers, and 33 of them also addressed various forms of mental health outcomes.RESULTS: The identified studies described forms and conditions of social participation-both in the host country and transnationally-that could be synthesized into three broad dimensions: (1) Regulatory frameworks, conditions and initiatives; (2) Established societal organizations and social structures; and (3) Community organized groups. Each of these consisted of several sub-domains. The identified dimensions of social participation were also associated with psychosocial well-being and decreased psychological distress.CONCLUSIONS: There is a need for policies to enable and support the participation of refugees and asylum seekers in various dimensions of social structures in host societies. Social participation enhances resilience, re-establishes social lives, and acts as a protective factor against poor mental health outcomes.
38.	Nilsson, Henrik, et al. (författare) Physical activity, post-traumatic stress disorder, and exposure to torture among asylum seekers in Sweden : a cross-sectional study. 2021 Ingår i: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 21:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Forced migrant populations have high rates of trauma-related ill health, including post-traumatic stress disorder (PTSD). Physical activity (PA) is well-established as an effective stress reliever, while insufficient PA is associated with adverse effects on both mental and physical health. The aim of this study was to examine the prevalence of different levels of PA and its association with PTSD symptom severity, controlled for exposure to torture, among asylum seekers in Sweden.METHODS: A cross-sectional survey study, with data from 455 asylum seekers, originating from Afghanistan, Eritrea, Iraq, Somalia, and Syria, residing at large housing facilities across Sweden. Level of PA was assessed by the Exercise Vital Sign and categorized as; Inactive, Insufficient PA, and Sufficient PA. Prevalence estimates for proportions of different levels of PA were calculated. Analysis of variance were conducted to determine the association between levels of PA and PTSD symptom severity, measured by the Harvard Trauma Questionnaire. Multivariable logistic regression analysis was performed to determine the contribution of PA on PTSD beyond sex, age, and exposure to torture.RESULTS: About half of the participants (53.3, 95% CI: 48.6-58.1) met the recommendations for Sufficient PA. One third of the participants (33.3, 95% CI: 28.7-37.8) were insufficiently engaged in PA, and 13.4% (95% CI: 10.1-16.7) were inactive. There was a significant difference in PTSD symptom severity between groups of asylum seekers with different levels of PA (F(2, 316) = 23.15, p < .001). When controlling for sex, age, and exposure to torture, Sufficient PA was found to be associated with less PTSD symptom severity compared to both Insufficient PA (B = 0.297, SE = 0.086, p < .001) and Inactive (B = 0.789, SE = 0.104, p < .001).CONCLUSIONS: Insufficient PA was common among the asylum seekers and our findings suggest that more PA is highly associated with lower PTSD symptom severity. An increased focus on assessment and promotion of PA is justified and discussed as particularly pertinent considering the much extended time of asylum-seeking processes. The results support previous evidence of PA as a potentially important factor in the context of PTSD and forced migrants' health.
39.	Nilsson, Henrik, et al. (författare) Trauma-afflicted refugees' experiences of participating in physical activity and exercise treatment : a qualitative study based on focus group discussions 2019 Ingår i: European Journal of Psychotraumatology. - : Informa UK Limited. - 2000-8198 .- 2000-8066. ; 10:1 Tidskriftsartikel (refereegranskat)abstract Background: Refugees with prolonged and repeated experiences of trauma, often in combination with post-migration living difficulties, are subjected to severe levels of stress and stress-related ill health, including post-traumatic stress disorder (PTSD). Physical activity (PA) is well-established as an effective stress reliever. However, the effect of PA and exercise has received scarce attention in the context of PTSD, and particularly in the field of refugees’ health.Objective: The objective of this study was to explore the experience of participation in PA and exercise as part of the treatment for trauma-afflicted refugees.Method: An explorative qualitative research design was used. Six focus group discussions were conducted with 33 female and male participants that had experience of group-based PA and exercise treatment. The gathered data was analysed by qualitative content analysis.Results: The analysis resulted in one over-arching theme reflecting the participants overall experience of PA and exercise as a process of building resilience. Participants experienced improvements in both physical and mental health domains. Increased self-awareness and self-confidence were seen as additional important benefits, and the interruption of daily stressors provided a sense of relief and recovery. The treatment group settings were experienced as becoming a vehicle for overcoming social fear and isolation, which also carried an empowering and strength-building impact over to participants’ family life and social relationships. Treatment characteristics were experienced as highly supportive and often referred to as the basis of other positive experiences and perceived health benefits.Conclusions: The result of this study outlines a detailed account of trauma-afflicted refugees’ experiences and preferences of PA and exercise-based treatment from a broad range of perspectives. These findings provide a starting point for future research in this field and indicate a particular need for both research and intervention development to include the real-life impact of participating in such treatments.
40.	Nilsson, Marie I, et al. (författare) Changes in importance of work and vocational satisfaction during the 2 years after breast cancer surgery and factors associated with this 2016 Ingår i: Journal of cancer survivorship. - : Springer Science and Business Media LLC. - 1932-2259 .- 1932-2267. ; 10:3, s. 564-572 Tidskriftsartikel (refereegranskat)abstract PURPOSE: The purpose of this study is to investigate how women, during the 2 years following breast cancer surgery, rate importance of work and vocational satisfaction, and baseline factors associated with rating over time.METHODS: A prospective cohort study of 692 women aged 20-63 included about 4 weeks after a first breast cancer surgery. Register data on treatment and data from six repeated questionnaires during a 2-year follow-up (at baseline, 4, 8, 12, 18, 24 months) were used in two-way mixed repeated analysis of variance and mixed repeated measures analysis of covariance.RESULTS: The women rated importance of work (m = 3.74; sd 0.88) (maximum 5) and vocational satisfaction (m = 4.30; sd 1.38) (maximum 6) high during the 2 years. Women with planned chemotherapy rated lower vocational satisfaction and especially so at 4 months after inclusion (F 1, 498 = 8.20; p = 0.004). Higher age, better physical, and mental/social work ability at baseline influenced rating of vocational satisfaction. Supportive colleagues was an important covariate that significantly affected ratings of importance of work as well as vocational satisfaction, i.e., women with better support rated on average higher on these outcomes. The effect of chemotherapy disappeared after including the abovementioned baseline covariates.CONCLUSIONS: Women diagnosed with breast cancer in the following 2 years rate importance of work and vocational satisfaction high, which are associated to lower work ability and social support.IMPLICATIONS FOR CANCER SURVIVORS: Work is a very important aspect in life also after a cancer diagnosis, which has to be acknowledged when discussing treatment and rehabilitation plans with women with breast cancer. Furthermore, workplace support needs to be assessed as this is an influential factor.
41.	Nissen, Alexander, et al. (författare) Cohort profile : Resettlement in Uprooted Groups Explored (REFUGE)-a longitudinal study of mental health and integration in adult refugees from Syria resettled in Norway between 2015 and 2017 2020 Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 10:7 Tidskriftsartikel (refereegranskat)abstract PURPOSE: In the field of forced migration and mental health research, longitudinal studies with large sample sizes and rigorous methodology are lacking. Therefore, the Resettlement in Uprooted Groups Explored (REFUGE)-study was initiated in order to enhance current knowledge on mental health, quality of life and integration among adult refugees from Syria resettled in Norway. The main aims of the study are to investigate risk and protective factors for mental ill health in a longitudinal perspective; to trace mental health trajectories and investigate important modifiers of these trajectories and to explore the association between mental health and integration in the years following resettlement. The aims will be pursued by combining data from a longitudinal, three-wave questionnaire survey with data from population-based registries on education; work participation and sick-leave; healthcare utilisation and drug prescription. The goal is to incorporate the data in an internationally shared database, the REFUGE-database, where collaborating researchers may access and use data from the study as well as deposit data from similar studies.PARTICIPANTS: Adult (≥18 years), Syrian citizens who arrived in Norway as quota refugees, asylum seekers or through Norway's family reunion programme between 1 January 2015 and 31 December 2017. Of the initial 9990 sampled individuals for the first wave of the study (REFUGE-I), 8752 were reached by post or telephone and 902 responded (response rate=10.3%).FINDINGS TO DATE: None published.FUTURE PLANS: The REFUGE-cohort study will conduct two additional data collections (2020 and 2021). Furthermore, questionnaire data will be linked to population-based registries after all three waves of data collection have been completed. Registry data will be obtained for time-periods both prior to and after the survey data collection points. Finally, pending ethics approval, we will begin the process of merging the Norwegian REFUGE-cohort with existing datasets in Sweden, establishing the extended REFUGE-database.TRIAL REGISTRATION NUMBER: ClincalTrials.gov Registry (NCT03742128).
42.	Nissen, Alexander, et al. (författare) Mental health in adult refugees from Syria resettled in Norway between 2015 and 2017 : a nationwide, questionnaire-based, cross-sectional prevalence study 2021 Ingår i: European Journal of Psychotraumatology. - : Taylor & Francis. - 2000-8198 .- 2000-8066. ; 12:1 Tidskriftsartikel (refereegranskat)abstract Background The number of forcibly displaced people globally has never been higher, with refugees from Syria constituting the largest displaced population worldwide. Many studies have documented elevated levels of mental health problems in refugee populations, though prevalence estimates of common mental disorders vary considerably between studies, explained both by methodological and contextual factors.Objective Using questionnaire-based screening checklists to approximate the prevalence of and investigate risk factors for post-traumatic stress disorder (PTSD), anxiety and depression among adult refugees from Syria resettled in Norway and to compare estimates with a sister-study in Sweden.Method Cross-sectional survey of a randomly selected sample from the National Population Register in Norway of adult refugees from Syria who were granted residency rights in Norway between 2015 and 2017 (N (sample) = 9,990; n (respondents) = 902). Above-threshold scores on the Harvard Trauma Questionnaire (HTQ) and Hopkins Symptoms Checklist (HSCL-25) defined caseness for PTSD (HTQ>2.06); anxiety (HSCLanxitey>1.75); and depression (HSCLdepression>1.80).Results Weighted, checklist-positive prevalence estimates for PTSD, anxiety and depression were 29.7% (25.4%-34.4%), 30.1% (25.7%-34.9%), and 45.2% (40.6%-49.8%), respectively. Cumulative exposure to potentially traumatic experiences before or during flight was a clear risk factor for all outcomes, and female gender was a risk factor for anxiety and depression, though only in adjusted analyses. The choice of HTQ cut-off to define PTSD caseness (2.5 vs. 2.06) had a notable effect on prevalence estimates. Conclusion In line with prior evidence, the present study suggests adult refugees from Syria resettled in Norway have higher rates of anxiety and depression and markedly higher rates of PTSD compared to general, non-refugee populations, and that this is clearly linked to past traumatic experiences. Prevalence estimates were highly consistent with estimates from the sister-study in Sweden, which used almost identical methodology. Findings underline the importance of screening for and intervening on mental health problems in newly arrived refugees.
43.	Nordhall, Ola (författare) Feeling and Thinking at Work : Personal and Collective Work-Identity Predictions and Formations 2021 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The aim of the present thesis was to investigate emotional and cognitive personal and collective work-identity in predicting employees’ work-related motivation, organizational justice perceptions, general mental health and exhaustion; as well as if psychosocial working conditions might explain some of these relationships. Emotion and cognition in formation of personal and collective work-identity were also investigated. The sample consisted of 768 teachers responding to a questionnaire (Study I-IV) during spring 2016. The results showed that personal work-identity positively predicted self-determined work motivation, accounted for by the emotion component, and collective work-identity positively predicted organizational pay justice, accounted for by the cognition component (Study I). Emotional personal and cognitive collective work-identity positively predicted general mental health and negatively predicted exhaustion. Reversed relationships were found for cognitive personal and emotional collective work-identity (Study II). Teachers’ psychological job demands and resources mediated the relations between emotional and cognitive personal and collective work-identity, respectively, and exhaustion and self-determined work motivation, respectively (Study III). Emotional processes positively predicted cognitive processes, and the emotional profile showed effects on cognitive processes regarding personal work-identity formation, while cognitive processes positively predicted emotional processes, and the cognitive profile showed effects on emotional processes regarding collective work-identity formation (Study IV). In conclusion, emotional and cognitive personal and collective work-identity play significant but different roles in predicting work-related motivation, organizational pay justice as well as general mental health and exhaustion. Also, teachers’ psychosocial working conditions may contribute to explaining some of these associations. Finally, emotion and cognition may play different roles in the formation of personal and collective work-identity.
44.	Nordhall, Ola, et al. (författare) Predicting general mental health and exhaustion : the role of emotion and cognition components of personal and collective work-identity. 2018 Ingår i: Heliyon. - : Elsevier BV. - 2405-8440. ; 4:8 Tidskriftsartikel (refereegranskat)abstract The aim of this study was to investigate relationships between emotion and cognition components of personal and collective work-identity and self-reported general mental health and exhaustion, in Swedish teachers (N = 768). In line with our predictions, we showed that the emotion component of personal work-identity and the cognition component of collective work-identity associated positively with general mental health and negatively with exhaustion. The reverse result was found, however, for the cognition component of personal work-identity and emotion component of collective work-identity. In general, all this indicates that person-work bonding might, to some degree, account for general mental health and exhaustion in employees. In particular, the findings suggest that general mental health and exhaustion may vary symmetrically across the: (1) Type of person-work bonding (personal vs. collective work-identity); and (2) Type of psychological component (emotion vs. cognition) involved in personal- and collective work-identity.
45.	Nordhall, Ola, et al. (författare) Teachers’ personal and collective work-identity predicts exhaustion and work motivation : Mediating roles of psychological job demands and resources 2020 Ingår i: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 11 Tidskriftsartikel (refereegranskat)abstract The aim of this study was to investigate the mediating roles of teachers’ psychological job demands and resources regarding personal and collective work-identity, respectively, and exhaustion and self-determined work motivation, respectively. A total of 2,905 members of a Swedish teacher’s trade union received an online questionnaire by e-mail; 768 individuals answered the questionnaire and so participated in this study. The data were obtained by self-reported measures (e.g., emotional and cognitive components of work-identity, psychological job demands and resources, exhaustion and work motivation) and analyzed by mediation regression analyses. The results showed that teachers’ psychological job demands (prosocial extra-role performance) mediated relationships between cognitive personal work-identity and emotional collective work-identity, respectively, and exhaustion. Teachers’ psychological job resources (educational inspiration) mediated relationships between emotional personal work-identity and cognitive collective work-identity, respectively, and self-determined work motivation. Thus, teachers might be disadvantaged by stronger personal work-related thinking and collective work-related feeling when related to exhaustion, to some extent accounted for by psychological job demands, and they might find advantage in stronger personal work-related feeling and collective work-related thinking when related to work motivation, to some extent accounted for by psychological job resources.
46.	Nordhall, Ola, et al. (författare) Teachers' personal work-identity predicts emotional exhaustion and work motivation : a mediating role of job demands and resources 2018 Ingår i: FALF KONFERENS 2018. - Gävle : Gävle University Press. - 9789188145284 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract BackgroundTeachers´ psychological job demands (large class sizes, low social support, and expectations to care for pupils, parents and colleagues) are positively related to their emotional exhaustion. Teachers´ psychological job resources (autonomy, mastery of skills, and experiences of their work as incentive and interesting) are positively related to work motivation and engagement, which can be defined as the positive antipode of emotional exhaustion. In addition, job demands and resources may, in general terms, explain the relationships between the employee and different work motivation- and mental illness outcomes.Furthermore, teachers´ personal work-identity comprises cognitive- (coherence, correspondence, mental time, reflection, agency) and emotional- (attachment, belongingness, closeness) components, differently associated with various work-related outcomes. Our previous results show that the cognitive component positively relates to emotional exhaustion, and the emotional one positively relates to self-determined work motivation. These relationships have up to date not been theoretically and practically related to organizational/job characteristic factors, such as, job demands and resources. AimsFirstly, we investigated if a positive relationship between teachers´ cognitive personal work-identity and emotional exhaustion was mediated by psychological job demands. Secondly, we checked for if a positive relationship between teachers´ emotional personal work-identity and self-determined work motivation was mediated by psychological job resources.Methods768 members, representing eleven different local teachers´ trade unions, working in the south and middle part of Sweden replied to a digitized questionnaire measuring cognitive- and emotional components of personal work identity, job demands (prosocial extra-role performances) and resources (educational inspirations), emotional exhaustion and self-determined work motivation. Two mediation analyzes were performed by PROCESS macro for SPSS (version 2.16.3), model 4. ResultsA positive relationship between teachers´ cognitive personal work- identity and emotional exhaustion was mediated by psychological job demands: completely standardized indirect effects: β= .04, 95% CI [.0180, .0650].Also, a positive relationship between teachers´ emotional personal work- identity and self-determined work motivation was positively mediated by psychological job resources: completely standardized indirect effect: β= .09, 95% CI [.0569, .1178].This suggests that, when teachers think (cognitive component of work-identity) more of their work, they will be more emotionally exhausted, but when they feel (emotional component of work-identity) more of their work they will be more motivated to work. Psychological job demands and resources may however and to some extent explain these relationships, respectively.
47.	Nürnberg Damström, D, et al. (författare) A preliminary validation of the Swedish version of the critical-care pain observation tool in adults 2011 Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 55:4, s. 379-386 Tidskriftsartikel (refereegranskat)abstract Background: Assessing pain in critically ill patients can be complicated, especially for those unable to communicate. A recently developed pain assessment tool, the Critical-Care Pain Observation Tool (CPOT), has been shown to be a reliable tool for pain assessment in the Intensive Care Unit (ICU). The aim of the study was to validate the Swedish version of the CPOT. Methods: Conscious and unconscious adults were observed during two procedures: one non-nociceptive procedure (NNP) (arm- and face wash) and one nociceptive procedure (NP) (turning). In total, there were 240 patient assessments pre-, per- and post-procedure performed by two independent staff members at rest, during and 15 min after the different procedures. Measures of interrater reliability, internal consistency and discriminant validity of the CPOT were obtained to examine the properties of the Swedish version of CPOT. Results: The results provide indications of good agreement between the independent raters (ICC=0.84). There was an adequate discriminant validity of the Swedish version of CPOT established by a significant peak for CPOT scores during the NP (per-procedure). There was also a consistent pattern of significant correlations between CPOT and the mean artery pressure (ρ=0.32-0.45). Conclusion: The Swedish version of the CPOT is a suitable instrument for assessing pain in critically ill adults. The overall reliability and validity measures converge with findings from previous studies of the CPOT, but in order to achieve enhanced generalizability of the CPOT, we encourage further evaluation of CPOT in broader groups of critically ill patients.
48.	Nymark, Carolin, et al. (författare) Development and validation of an instrument to assess patients' appraisal, emotions and action tendencies preceding care-seeking in acute myocardial infarction : The PA-AMI questionnaire. 2017 Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 16:3, s. 240-248 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Reducing patient delay for patients afflicted by an acute myocardial infarction is a task of great complexity, which might be alleviated if more factors that influence this delay could be identified. Although a number of self-reported instruments associated with patient delay exist, none of these taps the content of the appraisal process related to patients' subjective emotions.AIM: The aim of this study was to develop and validate a questionnaire aimed at assessing patients' appraisal, emotions and action tendencies when afflicted by an acute myocardial infarction.METHODS: An item pool was generated based on themes conceptualized in a recent qualitative study of acute myocardial infarction patients' thoughts, feelings and actions preceding the decision to seek medical care. The 'Think-Aloud Protocol' and test-retest analysis at item level were performed. The modified item pool was administered to 96 patients when treated for acute myocardial infarction. Explorative factor analysis and principal component analysis with the non-linear iterative partial least squares algorithm were performed to examine the underlying factor structure of the items.RESULTS: The findings indicated three core dimensions corresponding to three subscales, namely, 'symptom appraisal'; 'perceived inability to act'; 'autonomy preservation'. The results demonstrated acceptable measures of reliability and validity CONCLUSIONS: The PA-AMI questionnaire demonstrated satisfactory psychometric properties. Assessment of the included core dimensions may contribute to greater understanding of the appraisal processes for patients afflicted by an acute myocardial infarction.
49.	Nymark, Carolin, et al. (författare) Inability to act was associated with an extended delay prior to care-seeking, in patients with an acute myocardial infarction 2019 Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 18:6, s. 512-520 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The out-of-hospital mortality in patients with acute myocardial infarction remains unchanged in contrast to a decrease in inhospital mortality. Interventions aiming to shorten patient delay have been largely unsuccessful. A deeper understanding is apparently needed on patients' appraisal prior to care-seeking.AIM: To investigate whether appraisal processes influence patient delay, and if the questionnaire 'Patients' appraisal, emotions and action tendencies preceding care seeking in acute myocardial infarction' (PA-AMI) could discriminate between patients with prolonged care-seeking and those with a short delay.METHODS: A cross-sectional study including 326 acute myocardial infarction patients filling out the validated questionnaire PA-AMI. The impact of subscales on delay was analysed by projection to latent structures regression. Discrimination opportunities between patients with short and long delays were analysed by projection to latent structures discriminant analysis.RESULTS: The subscales 'perceived inability to act' and 'symptom appraisal' had a major impact on patient delay ( P<0.0001). 'Perceived inability to act' had its main influence in patients with a delay exceeding 12 hours, and 'symptom appraisal' had its main influence in patients with a delay shorter than one hour.CONCLUSION: Appraisal processes influence patient delay. Acute myocardial infarction patients with a prolonged delay were, besides a low perceived symptom severity and urgency to seek medical care, characterised by a perceived loss of control and ability to act. Therefore, future interventions aimed at decreasing delay should pay attention to appraisal processes, and perceived inability to act may be a sign of a health threat and therefore a signal to seek medical care.
50.	Nymark, Carolin, et al. (författare) Translation, culture adaption and psychometric testing of the MISSCARE Survey - Swedish version 2020 Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 29:23-24, s. 4645-4652 Tidskriftsartikel (refereegranskat)abstract AIM: To translate the MISSCARE Survey into Swedish and establish its validity and reliability by evaluating its psychometric properties.BACKGROUND: Missed nursing care is defined as any aspect of required nursing care that is omitted or delayed. The consequence of missed nursing care is a threat to patient safety. The MISSCARE Survey is an American instrument measuring missed nursing care activities (part A) and its reasons (part B).METHODS: The translation was accomplished according to World Health Organization guidelines, focusing on a culture adaptation. Acceptability, construct validity, test-retest reliability and internal consistency were analysed. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) was used as reporting checklist.RESULTS: The translation and culture adaptation needed several revisions. A total of 126 nurses answered the test and retest which showed acceptability of missing data. The factor analysis revealed a lack of fit to data for the original factorial structure in part B, while further analysis provided results suggesting a modification based on omitting six items. The internal consistency for part B and its subscales showed good results.CONCLUSIONS: The MISSCARE Survey-Swedish version is a reliable and valid instrument, with good psychometric properties.RELEVANCE TO CLINICAL PRACTICE: More reliable language versions of the instrument enable national and international comparisons that could be valuable for nursing managers and/or directors of nursing who are responsible for quality of care and patient safety in the strategic care planning process.

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