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1.	Lozano, Rafael, et al. (författare) Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017 2018 Ingår i: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138 Tidskriftsartikel (refereegranskat)abstract Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.
2.	Stanaway, Jeffrey D., et al. (författare) Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017 2018 Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1923-1994 Tidskriftsartikel (refereegranskat)abstract Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk- outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.
3.	Murray, Christopher J. L., et al. (författare) Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017 2018 Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1995-2051 Tidskriftsartikel (refereegranskat)abstract Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation.
4.	Fullman, Nancy, et al. (författare) Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016 2018 Ingår i: The Lancet. - : Lancet Publishing Group. - 1474-547X .- 0140-6736. ; 391:10136, s. 2236-2271 Tidskriftsartikel (refereegranskat)
5.	Abbafati, Cristiana, et al. (författare) 2020 Tidskriftsartikel (refereegranskat)
6.	Feigin, Valery L., et al. (författare) Global, regional, and national burden of stroke and its risk factors, 1990-2019 : a systematic analysis for the Global Burden of Disease Study 2019 2021 Ingår i: Lancet Neurology. - : Elsevier. - 1474-4422 .- 1474-4465. ; 20:10, s. 795-820 Tidskriftsartikel (refereegranskat)abstract Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12.2 million (95% UI 11.0-13.6) incident cases of stroke, 101 million (93.2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6.55 million (6.00-7.02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11.6% [10.8-12.2] of total deaths) and the third-leading cause of death and disability combined (5.7% [5.1-6.2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70.0% (67.0-73.0), prevalent strokes increased by 85.0% (83.0-88.0), deaths from stroke increased by 43.0% (31.0-55.0), and DALYs due to stroke increased by 32.0% (22.0-42.0). During the same period, age-standardised rates of stroke incidence decreased by 17.0% (15.0-18.0), mortality decreased by 36.0% (31.0-42.0), prevalence decreased by 6.0% (5.0-7.0), and DALYs decreased by 36.0% (31.0-42.0). However, among people younger than 70 years, prevalence rates increased by 22.0% (21.0-24.0) and incidence rates increased by 15.0% (12.0-18.0). In 2019, the age-standardised stroke-related mortality rate was 3.6 (3.5-3.8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3.7 (3.5-3.9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62.4% of all incident strokes in 2019 (7.63 million [6.57-8.96]), while intracerebral haemorrhage constituted 27.9% (3.41 million [2.97-3.91]) and subarachnoid haemorrhage constituted 9.7% (1.18 million [1.01-1.39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79.6 million [67.7-90.8] DALYs or 55.5% [48.2-62.0] of total stroke DALYs), high body-mass index (34.9 million [22.3-48.6] DALYs or 24.3% [15.7-33.2]), high fasting plasma glucose (28.9 million [19.8-41.5] DALYs or 20.2% [13.8-29.1]), ambient particulate matter pollution (28.7 million [23.4-33.4] DALYs or 20.1% [16.6-23.0]), and smoking (25.3 million [22.6-28.2] DALYs or 17.6% [16.4-19.0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.
7.	Griswold, Max G., et al. (författare) Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016 2018 Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 392:10152, s. 1015-1035 Tidskriftsartikel (refereegranskat)abstract Background: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.Methods: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.Findings: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week.Interpretation: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.
8.	Naghavi, Mohsen, et al. (författare) Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 2015 Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 385:9963, s. 117-171 Tidskriftsartikel (refereegranskat)abstract Background Up-to-date evidence on levels and trends for age-sex-specifi c all-cause and cause-specifi c mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specifi c all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specifi c causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute diff erences between countries decreased but relative diff erences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative diff erences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specifi c mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.
9.	Forouzanfar, Mohammad H, et al. (författare) Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013 : a systematic analysis for the Global Burden of Disease Study 2013. 2015 Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 386:10010, s. 2287-2323 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.FUNDING: Bill & Melinda Gates Foundation.
10.	2019 Tidskriftsartikel (refereegranskat)
11.	Wang, Haidong, et al. (författare) Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015 : the Global Burden of Disease Study 2015. 2016 Ingår i: The lancet. HIV. - : Elsevier. - 2352-3018. ; 3:8, s. e361-e387 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015.METHODS: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification.FINDINGS: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections.INTERPRETATION: Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030.
12.	Wang, Haidong, et al. (författare) Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015 2016 Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1459-1544 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.METHODS: We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).FINDINGS: Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.INTERPRETATION: At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.
13.	Mokdad, Ali H., et al. (författare) Diabetes mellitus and chronic kidney disease in the Eastern Mediterranean Region : findings from the Global Burden of Disease 2015 study 2018 Ingår i: International Journal of Public Health. - : SPRINGER BASEL AG. - 1661-8556 .- 1661-8564. ; 63, s. 177-186 Tidskriftsartikel (refereegranskat)abstract We used findings from the Global Burden of Disease 2015 study to update our previous publication on the burden of diabetes and chronic kidney disease due to diabetes (CKD-DM) during 1990-2015. We extracted GBD 2015 estimates for prevalence, mortality, and disability-adjusted life years (DALYs) of diabetes (including burden of low vision due to diabetes, neuropathy, and amputations and CKD-DM for 22 countries of the EMR from the GBD visualization tools. In 2015, 135,230 (95% UI 123,034-148,184) individuals died from diabetes and 16,470 (95% UI 13,977-18,961) from CKD-DM, 216 and 179% increases, respectively, compared to 1990. The total number of people with diabetes was 42.3 million (95% UI 38.6-46.4 million) in 2015. DALY rates of diabetes in 2015 were significantly higher than the expected rates based on Socio-demographic Index (SDI). Our study showed a large and increasing burden of diabetes in the region. There is an urgency in dealing with diabetes and its consequences, and these efforts should be at the forefront of health prevention and promotion.
14.	Kassebaum, Nicholas J., et al. (författare) Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015 2016 Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 388:10053, s. 1603-1658 Tidskriftsartikel (refereegranskat)abstract Background Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. Findings Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs off set by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2.9 years (95% uncertainty interval 2.9-3.0) for men and 3.5 years (3.4-3.7) for women, while HALE at age 65 years improved by 0.85 years (0.78-0.92) and 1.2 years (1.1-1.3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. Interpretation Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum.
15.	Vos, Theo, et al. (författare) Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 2015 Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 386:9995, s. 743-800 Tidskriftsartikel (refereegranskat)abstract Background Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Methods Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries. Findings Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2.4 billion and 1.6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537.6 million in 1990 to 764.8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114.87 per 1000 people to 110.31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21.1% in 1990 to 31.2% in 2013. Interpretation Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.
16.	Afshin, Ashkan, et al. (författare) Health Effects of Overweight and Obesity in 195 Countries over 25 Years 2017 Ingår i: New England Journal of Medicine. - : MASSACHUSETTS MEDICAL SOC. - 0028-4793 .- 1533-4406. ; 377:1, s. 13-27 Tidskriftsartikel (refereegranskat)abstract BACKGROUND Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. METHODS We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015. RESULTS In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease. CONCLUSIONS The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem.
17.	Al Nima, Ali, et al. (författare) The ABC of happiness: Validation of the tridimensional model of subjective well-being (affect, cognition, and behavior) using Bifactor Polytomous Multidimensional Item Response Theory 2024 Ingår i: Heliyon. - : CELL PRESS. - 2405-8440. ; 10:2 Tidskriftsartikel (refereegranskat)abstract Background: Happiness is often conceptualized as subjective well-being, which comprises people's evaluations of emotional experiences (i.e., the affective dimension: positive and negative feelings and emotions) and judgements of a self-imposed ideal (i.e., the cognitive dimension: life satisfaction). Recent research has established these two dimensions as primary parts of a higher order factor. However, theoretical, conceptual, and empirical work suggest that people's evaluations of harmony in their life (i.e., the sense of balance and capacity to behave and adapt with both acceptance and flexibility to inter- and intrapersonal circumstances) constitutes a third dimension (i.e., the behavioral dimension). This tridemensional conceptualization of subjective well-being has recently been verified using Unidimensional Item Response Theory (UIRT) and Classical Test Theory (CTT). Here, we use a recently developed and more robust approach that combines these two methods (i.e., Multidimensional Item Response Theory, MIRT) to simultaneously address the complex interactions and multidimensionality behind how people feel, think, and behave in relation to happiness in their life. Method: A total of 435 participants (197 males and 238 females) with an age mean of 44.84 (sd = 13.36) responded to the Positive Affect Negative Affect Schedule (10 positive affect items, 10 negative affect items), the Satisfaction with Life Scale (five items), and the Harmony in life Scale (five items). We used Bifactor-Graded Response MIRT for the main analyses. Result: At the general level, each of the 30 items had a strong capacity to discriminate between respondents across all three dimensions of subjective well-being. The investigation of different parameters (e.g., marginal slopes, ECV, IECV) strongly reflected the multidimensionality of subjective well-being at the item, the scale, and the model level. Indeed, subjective well-being could explain 64 % of the common variance in the whole model. Moreover, most of the items measuring positive affect (8/10) and life satisfaction (4/5) and all the items measuring harmony in life (5/5) accounted for a larger amount of variance of subjective well-being compared to that of their respective individual dimensions. The negative affect items, however, measured its own individual concept to a lager extent rather than subjective well-being. Thus, suggesting that the experience of negative affect is a more independent dimension within the whole subjective well-being model. We also found that specific items (e.g., “Alert”, “Distressed”, “Irritable”, “I am satisfied with my life”) were the recurrent exceptions in our results. Last but not the least, experiencing high levels in one dimension seems to compensate for low levels in the others and vice versa. Conclusion: As expected, the three subjective well-being dimensions do not work separately. Interestingly, the order and magnitude of the effect by each dimension on subjective well-being mirror how people define happiness in their life: first as harmony, second as satisfaction, third as positive emotions, and fourth, albeit to a much lesser degree, as negative emotions. Ergo, we argue that subjective well-being functions as a complex biopsychosocial adaptive system mirroring our attitude towards life in these three dimensions (A: affective dimension; B: behavioral dimension; C: cognitive dimension). Ergo, researchers and practitioners need to take in to account all three to fully understand, measure, and promote people's experience of the happy life. Moreover, our results also suggest that negative affect, especially regarding high activation unpleasant emotions, need considerable changes and further analyses if it is going to be included as a construct within the affective dimension of a general subjective well-being factor.
18.	Al Nima, Ali, et al. (författare) The happiness-increasing strategies scales and well-being in a sample of Swedish adolescents 2013 Ingår i: International Journal of Happiness and Development. - : INDERSCIENCE ENTERPRISES LTD. - 2049-2790 .- 2049-2804. ; 1:2, s. 196-211 Tidskriftsartikel (refereegranskat)abstract In an adolescent sample, the present study examines the factor structure of the happiness-increasing strategies scales (H-ISS) found by Tkach and Lyubomirsky (2006), gender differences, and the relationship between the strategies and subjective and psychological well-being measured a year after the H-ISS. A principal axis factoring using an oblique rotation procedure estimated the eight factors, which partially differed from those found earlier: social interaction, mental control, partying, religion, self-directed, instrumental goal pursuit, active leisure, and prevented activities. Girls used social interaction, mental control, partying, and religion more frequently than boys. Boys scored higher in prevented activities. The strategies accounted for 34% of the variance in life satisfaction, 43% of positive affect, 18% of negative affect, and 28% of psychological well-being. The study suggests that, with slight modifications, the H-ISS can be used among adolescents to measure individual differences in behaviour that increase positive experiences over time.
19.	Al Nima, Ali (författare) The Measurement of Subjective Well-Being: Item Response Theory, Classical Test Theory, and Multidimensional Item Response Theory 2022 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract For over 35 years, modern science has conceptualized happiness as subjective well-being, which has until recently been understood as a dual construct consisting of an affective component (positive and negative affect) and a cognitive component (life satisfaction). Nevertheless, for the last five years, theoretical work and both quantitative and qualitative empirical work have suggested that the concept of subjective well-being omits both a lay and an Eastern way of understanding happiness. For instance, laypeople primarily define manifestations of happiness in terms of psychological balance and harmony, rather than just affect and satisfaction. The question is whether, rather than constituting a dual general construct, these three components (i.e., affect, life satisfaction, and harmony in life) form a tridimensional model of subjective well-being. In three studies, 1962 participants self-reported their experience of different positive and negative emotions (Positive Affect Negative Affect Schedule), their satisfaction with life in relation to their own self-imposed ideal (Satisfaction with Life Scale), and their experience of harmony in life (Harmony in Life Scale). The responses were analyzed using unidimensional item response theory (Study 1), classical test theory (Study 2), and multidimensional item response theory (Study 3). In general, in all three studies the 30 subjective well-being items in the model displayed good psychometric properties. However, Studies 1 and 3 showed that there was less reliability for respondents with extreme latent scores in all subjective well-being dimensions. At the item level, all three studies indicated that specific items need to be modified, added, or removed. Second, at the scale level, the subjective well-being instruments have the capability to measure a good portion of people’s happiness but lack the capability to measure subjective well-being among individuals who are extremely happy or extremely unhappy. Moreover, at the model level, the results indicate that the best way to conceptualize subjective well-being is as a latent construct with three dimensions (i.e., affective, cognitive, and behavioral) and four components (i.e., positive affect, negative affect, life satisfaction, and harmony in life) in which a person’s unique response to each item is directly influenced by her global subjective well-being, but at the same time also by her affective experience, sense of life satisfaction, and sense of harmony in life. In Study 3 specifically, the results indicate that people’s levels in each subjective well-being component can compensate for low and high levels in any of the other components. In other words, this is a clear indication of the tridimensional nature of subjective well-being. For people in general, actively affecting emotions, cognitions, and behavior might help to develop sustainable happiness, resilience, and an outlook of unity even amidst the current and future challenges of the twenty-first century.
20.	Amato, Clara, et al. (författare) A Ternary Model in the Prediction of Life Satisfaction in a Swedish Sample of Psychiatric Patients: Cognitions Around Material, Social, and Personal Resources 2019 Ingår i: 3rd Biennial International Convention of Psychological Science. Paris, France. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract We used a ternary model to investigate which antecedents influenced psychiatric patients’ judgments of life satisfaction. Although cognitions around material resources (e.g., economy) influenced life satisfaction, only cognitions around social (e.g., friends) and personal (e.g., outlook on own health and illness) resources remained significant when the whole model was tested.
21.	Amato, Clara, et al. (författare) Job Satisfaction Leads to Better Health By Improving Psychiatric Patients’ Outlook on Their Illness 2019 Ingår i: 3rd Biennial International Convention of Psychological Science. Paris, France. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract We found that psychiatric patients with regular or supported employment, compared to psychiatric patients without it, reported higher levels of health. More important, job satisfaction was related to not feeling prevented in daily life by their mental illness, which in turn lead to better health.
22.	Amato, Clara, et al. (författare) Modus Operandi and Affect in Sweden: The Swedish Version of the Regulatory Mode Questionnaire 2017 Ingår i: PeerJ. - : PeerJ. - 2167-8359. ; 5:e4092, s. 1-24 Tidskriftsartikel (refereegranskat)abstract Background: The Regulatory Mode Questionnaire (RMQ) is the most used and international well-known instrument for the measurement of individual differences in the two self-regulatory modes: locomotion (i.e., the aspect of self-regulation that is concerned with movement from state to state) and assessment (i.e., the comparative aspect of self-regulation). The aim of the present study was to verify the independence of the two regulatory modes, as postulated by the Regulatory Mode Theory (Kruglanski, Thompson, Higgins, Atash, Pierro, Shah & Spiegel, 2000), and the psychometric properties of the RMQ in the Swedish context. Furthermore, we investigated the relationship between regulatory modes (locomotion and assessment) and affective well-being (i.e., positive affect and negative affect). Method: A total of 655 university and high school students in the West of Sweden (males = 408 females = 242, and 5 participants who didn’t report their gender; agemean = 21.93±6.51) responded to the RMQ and the Positive Affect Negative Affect Schedule. We conducted two confirmatory factor analyses using structural equation modeling (SEM). A third SEM was conducted to test the relationship between locomotion and assessment to positive affect and negative affect. Results: The first analyses confirmed the unidimensional factor structure of locomotion and assessment and both scales showed good reliability. The assessment scale, however, was modified by dropping item 10 (“I don’t spend much time thinking about ways others could improve themselves.”) because it showed low loading (.07, p =.115). Furthermore, the effect of locomotion on positive affect was stronger than the effect of assessment on positive affect (Z = -15.16, p < .001), while the effect of assessment on negative affect was stronger than the effect of locomotion on negative affect (Z = 10.73, p < .001). Conclusion: The factor structure of the Swedish version of the RMQ is, as Regulatory Mode Theory suggests, unidimensional and it showed good reliability. The scales discriminated between the two affective well-being dimensions. We suggest that the Swedish version of the RMQ, with only minor modifications, is a useful instrument to tap individual differences in locomotion and assessment. Hence, the present study contributes to the validation of the RMQ in the Swedish culture and adds support to the theoretical framework of self-regulatory mode.
23.	Amato, Clara, et al. (författare) Newly Graduated Nurses' Learning Work Climate, Health, Resilience, and Burnout Symptoms 2020 Ingår i: 32nd Association for Psychological Science Annual Convention. Chicago, Illinois, USA. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract The results provide an indication of important learning work climate factors associated to newly graduated nurses’ health, ability to cope successfully in adverse circumstances (i.e., resilience), and burnout symptoms. It is, however, plausible that there is an interconnection between personal vulnerability, learning climate, and health (Stoyanov & Cloninger, 2011).
24.	Amato, Clara, et al. (författare) The Effect of Having a Job on Life Satisfaction Among Psychiatric Patients: The Mediation Role of Physical and Psychological Health 2019 Ingår i: 3rd Biennial International Convention of Psychological Science. Paris, France.. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract We found that psychiatric patients who have regular or supported employment, compared to psychiatric patients without it, report higher levels of life satisfaction. More important, having a job leads to higher levels of physical and psychological health, which in turn explain psychiatric patients’ life satisfaction.
25.	Andersson Arntén, Ann-Christine, 1954, et al. (författare) Police Personnel Affective Profiles : Differences in Perceptions of the Work Climate and Motivation 2016 Ingår i: Journal of Police and Criminal Psychology. - : Springer. - 0882-0783 .- 1936-6469. ; 31:1, s. 2-14 Tidskriftsartikel (refereegranskat)abstract The affective profile model was used to investigate individual differences in police personnel perceptions about the working climate and its influences on motivation. The Positive Affect, Negative Affect Schedule (PANAS) was used to assign police personnel, sworn and non-sworn (N = 595), to four affective profiles: self-fulfilling, low affective, high affective, and self-destructive. The work climate was assessed using the Learning Climate Questionnaire (Management Relations and Style, Time, Autonomy and Responsibility, Team Style, Opportunities to Develop, Guidelines on How to do the Job, and Contentedness). Motivation was evaluated using a modified version (to refer specifically to the individual’s work situation) of the Situational Motivation Scale (intrinsic motivation, external regulation, identified regulation, and amotivation). Self-fulfilling individuals scored higher on all work climate dimensions compared to the other three groups. Compared to low positive affect profiles, individuals with profiles of high positive affect scored higher in intrinsic motivation and identified regulation. Self-destructive individuals scored higher in amotivation. Different aspects of the work climate were related to each motivation dimension among affective profiles. Police personnel may react to their work environment depending on their affective profile. Moreover, the extent to which the work influences police personnel’s motivation is also related to the affective profile of the individual. © 2015, The Author(s).
26.	Andersson Arntén, Ann-Christine, 1954, et al. (författare) The Affective Profile Model in Swedish Police Personnel: Work Climate and Motivation 2014 Ingår i: 26th Association for Psychological Science Annual Convention. San Francisco, California, USA. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract ABSTRACT The study showed that police personnel perceive the work environment depending on their affective profile, these perceptions in turn influence motivation differently for each profile. A positive view on the work environment and intrinsic motivation being related to an affective profile depicted as high positive affect and low negative affect. SUPPORTING SUMMARY Background: The work climate (i.e., employees’ perceptions of how they are treated and managed in their organization) is important when the organizations try to motivate employees to allocate and enhance their efforts into their work. The affective profile model offers something unique over and above the single dimensional framework of affectivity by taking into account how positive (PA) and negative affectivity (NA) interact; these interaction can be used to investigate individual differences in perceptions about the working climate and its influences on motivation. Method: We used the Positive Affect, Negative Affect Schedule to categorize police personnel (N = 595) in four affective profiles: Self-fulfilling (high PA and low NA), low affective (low PA and low NA), high affective (high PA and high NA), and self-destructive (low PA and high NA). Individuals’ perceptions of the work climate were assessed using the Learning Climate Questionnaire which measures seven dimensions: management relations and style, time, autonomy and responsibility, team style, opportunities to develop, guidelines on how to do the job, and contentedness. Finally, we used the Situational Motivation Scale to measure four motivation dimensions: intrinsic motivation, external regulation, identified regulation, and amotivation. Results: Results show that self-fulfilling individuals scored higher on all work climate compared to the other three groups. Regarding motivation, profiles with high PA (self-fulfilling and high affective) scored higher in internal motivation and identified regulation than the profiles with low PA. Self-destructive individuals scored higher in amotivation compared to the other three profiles. Different aspects of the work climate were related to each motivation dimension among affective profiles. Conclusions: These results suggest that individuals may react to the work environment depending on their affective profile. Moreover, how the work environment influences police personnel’s motivation is also a function of the individuals’ distinct affective profile.
27.	Brantmark, Anette, et al. (författare) Hälsa, sysselsättningoch levnadsvanor : Brukarundersökning av funktionshinder och funktionsnedsättningar och dess stödresurser i Blekinge 3 (BUFUS 3) 2018 Rapport (övrigt vetenskapligt/konstnärligt)abstract BakgrundFolkhälsan i Sverige har blivit bättre men det finns skillnader i hälsa mellan olika grupper. Tobak, alkohol, fysisk aktivitet och kostvanor är levnadsvanor som har betydelse för hälsan. Personer som tillhör någon av de tre personkretsarna inom Lagen om stöd och service till vissa funktionshindrade (LSS) blir ofta exkluderade från studier varför det är svårt att beskriva hälsa och skillnader i levnadsvanor som har betydelse för hälsan i denna grupp. En tidigare brukarundersökning (BUFUS 1) beskriver förekomsten av sysselsättning och hälsa hos personer som har personlig assistans varför syftet med denna undersökning var att skapa en ökad förståelse kring eventuella samband mellan hälsa, sysselsättning och levnadsvanor i en större grupp dvs. personer med funktionsnedsättning som har beslut om LSS-insatser i Blekinge. Syftet var också att få kunskap om hur personer (LSS 1 och 2) beskrev områden som var betydelsefulla för hälsan.MetodTotalundersökning bland vuxna (18-64 år) och äldre (65 år och äldre) med beslut om LSS-insats, innefattande en tvärsnittstudie (n=574) och en kvalitativ intervjustudie (n=27). Data har analyserats med beskrivande statistik och regressionsanalys samt innehållsanalys.ResultatHälsan skilde sig signifikant mellan de tre LSS-grupperna. Färre personer som tillhör LSS 3 skattade sin hälsa som bra jämfört med övriga (LSS 1 och 2). Bland vuxna som tillhör LSS 1 och 2 hade sysselsättning och fysisk aktivitet betydelse för hälsan medan för vuxna som tillhör LSS 3 hade enbart fysisk aktivitet betydelse för hälsan. Fler personer, som tillhör LSS 3 hade fler läkarkontakter jämfört med övriga men oavsett grupp hade läkarkontakt en betydelse för hälsan.SlutsatsFysisk aktivitet har storbetydelse för hälsa hosvuxna personer oavsett LSS-tillhörighet. Det finns en medvetenhet om vad som behövs för att må bra och att ha någonstans att gå till utanför bostaden har positiv inverkan på hälsan. Det finns skillnader i självskattad hälsa i de olikaLSS-grupperna, och förekommande skillnader i den självskattade hälsa kan vara möjlighet till aktivitet. Modellen som visade att aktivitet förklarar hälsa i grupperna, förklarade dock enbart en liten del av variationen av hälsa. Det behövs fler studier som tar hänsyn tillandra faktorer än de som använts i denna undersökning för att kunna förstå vad som är av betydelse för personernas hälsa i olika ålders-och LSS grupper.
28.	Cloninger, Kevin M., et al. (författare) The Health Effects of Anthropedia’s Well-Being Coaching: A 6-Month Pilot Study Among Long-Term Unemployment Swedish Young Adults 2019 Ingår i: 3rd Biennial International Convention of Psychological Science, Paris, France. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract In recent years Sweden had an increased number of asylum seekers entering the country. Asylum seeking can affect the physical and mental health of individuals due to prolonged application processes and waiting times which can lead to inactivity. Physical inactivity is one of the leading risk factors leading to noncommunicable diseases and overall mortality. The Public Health Report Blekinge 2014 states that groups with low socioeconomic status are less likely to be physically active in comparison with groups with a high socioeconomic status. Physical activity contributes to physical and mental well-being, and increases the possibilities for creating social networks as well as being part of the society. The project “Health for Everybody” (Hälsa för Alla) offers physical and cultural activities to approximately 300 refugees who have been granted asylum in the Blekinge region. The activities are conducted with the help of physical trainers, testing staff and community workers. In its current format each group of 20 to 30 refugees is offered training once a week for a 10-week period. The participants’ physical and psychological health and lifestyle habits are measured before and after the program through bioimpedance, physical conditioning tests and self-reports of psychological aspects related to health and lifestyle. We examined the health effects of cultural activities and Well-Being Coaching among long-term unemployed Swedish young adults. While individuals receiving cultural activities only showed a slight decrease in anxiety, those receiving Well-Being Coaching showed significant increases in subjective well-being and decreases in depression, anxiety, and sense of defeat and entrapment.
29.	Cloninger, Kevin M., et al. (författare) The Prevalence of Personality (Temperament and Character) Profiles among Swedish Newly Graduated Nurses 2020 Ingår i: 32nd Association for Psychological Science Annual Convention. Chicago, Illinois, USA. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Personal vulnerability (i.e., specific personality profiles) is a major factor for burnout among helping professionals. Compared to the general population, 80% of Swedish newly graduated nurses reported high Reward Dependence (i.e., being sentimental, warm, attached, and dependent) and 95% reported low Self-Directedness (i.e., being blaming, aimless, helpless, defensive, and unfulfilled).
30.	Cloninger, Kevin M., et al. (författare) Well-Being Coaching Training: Character, Resilience and Well-Being 2018 Ingår i: 9th European Conference on Positive Psychology. Budapest, Hungary. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Background: The level of stress in the 21st century is increasing the risk for lifestyle and stress-related illness in all populations, including health care professionals who have the double burden of their personal problems and those of their patients. Between 2009 and 2014, psychiatric diagnoses, including burnout, have doubled in health care populations like nurses, doctors, and psychotherapists [1]. In order to help others, health care professionals have the need of a variety of tools and approaches to work on their own resilience, health, and well-being. The Anthropedia Foundation in collaboration with the Center for Well-Being at Washington University in St. Louis developed a specialized training that is person-centered, interdisciplinary, and biopsychosocial in orientation. This training can be integrated into existing professions or used independently. The training program has been designed to increase three character dimensions (self-directedness, cooperativeness, and self-transcendence) that have been shown to lead to increases in physical and mental health, resilience, and overall well-being [2-4]. Aim: The purpose of this study was to investigate whether well-being training was effective in increasing character scores in the training participants. Method: 50 trainees were given the Positive and Negative Affect Schedule, the Satisfaction with Life Scale, and the Temperament and Character Inventory before and after the one-year training. Paired t-tests were performed to examine significant differences. Results: Analyses showed significant differences in the Temperament and Character Inventory subscales of self-acceptance (t = 2.2, df = 49, p < .05, Cohen’s D = 0.77), empathy (t = 2.6, df = 49, p < .05, Cohen’s D = 0.90), moral reasoning (t = 3.17, df = 49, p < .01, Cohen’s D = 1.11), and the scale of self-transcendence (t = 2.98, df = 49, p < .01, Cohen’s D = 1.04). There was a marginal increase in positive emotions (t = 1.18, df = 49, p < .05) and life satisfaction (t = 1.57, df = 49, p < .05), and a marginal decrease in negative emotions (t = 1.26, df = 49, p < .05). Conclusions: Results suggest that the training methodology increased subjective well-being, as well as self-directedness (self-acceptance), cooperativeness (empathy and moral reasoning), and self-transcendence. Cross-cultural studies on these character dimensions have demonstrated strong relationships between increases in character development and perceived social support, perceived health, and resilience [2-4]. In other words, the well-being coaching training increases sustainable global health, resilience and psychological well-being, and not simply hedonic well-being. The coaching is more intensive since it is one-on-one, thus we expect the effect on subjective well-being and character to be even greater for coachees.
31.	Fahlgren, Elin, et al. (författare) Person-centered osteopathic practice: patients’ personality (body, mind, and soul) and health (Ill-being and well-being) 2015 Ingår i: PeerJ. - : PeerJ. - 2167-8359. ; 3:e1349, s. 1-37 Tidskriftsartikel (refereegranskat)abstract Background. Osteopathic philosophy and practice are congruent with the biopsychosocial model, a patient-centered approach when treating disease, and the view of the person as a unity (i.e., body, mind, and soul). Nevertheless, a unity of being should involve a systematic person-centered understanding of the patient’s personality as a biopsychosociospiritual construct that influences health (i.e., well-being and ill-being). We suggest Cloninger’s personality model, comprising temperament (i.e., body) and character (i.e., mind and soul), as a genuine paradigm for implementation in osteopathic practice. As a first step, we investigated (1) the relationships between personality and health among osteopathic patients, (2) differences in personality between patients and a control group, and (3) differences in health within patients depending on the presenting problem and gender. Method. 524 osteopathic patients in Sweden (age mean = 46.17, SD = 12.54, 388 females and 136 males) responded to an online survey comprising the Temperament and Character Inventory and measures of health (well-being: life satisfaction, positive affect, harmony in life, energy, and resilience; ill-being: negative affect, anxiety, depression, stress, and dysfunction and suffering associated to the presenting problem). We conducted two structural equation models to investigate the association personality-health; graphically compared the patients’ personality T-scores to those of the control group and compared the mean raw scores using t-tests; and conducted two multivariate analyses of variance, using age as covariate, to compare patients’ health in relation to their presenting problem and gender. Results. The patients’ personality explained the variance of all of the well-being (R2 between .19 and .54) and four of the ill-being (R2 between .05 and .43) measures. Importantly, self-transcendence, the spiritual aspect of personality, was associated to high levels of positive emotions and resilience. Osteopathic patients, compared to controls, scored higher in six of the seven personality dimensions. These differences were, however, not considerably large (divergences in T-scores were <1 SD, Cohen’s d between 0.12 and 0.40). Presenting problem and gender did not have an effect on any of the health measures. Conclusion. The patient’s personality as a ternary construct (i.e., body, mind, and soul), which is in line with osteopathy, is associated to both well-being and ill-being. The lack of substantial differences in personality between patients and controls implies that the patients had not any personality disorders. Hence, osteopaths might, with proper education, be able to coach their patients to self-awareness. The lack of differences in health variables between osteopathic patients with different presenting problems suggests that practitioners should focus on the person’s health regardless of the type of presenting problem.
32.	G. Moraga, Fernando R., et al. (författare) Sex and dark times’ strategy: The Dark Triad and time perspective 2017 Ingår i: PsyCh Journal. - : Wiley. - 2046-0252 .- 2046-0260. ; 6:1, s. 98-99 Tidskriftsartikel (refereegranskat)abstract We investigated the effect of sex on associations between dark traits and time perspective dimensions. Responses by partici- pants (N = 338) to the Short Dark Triad Inventory and the Zimbardo Time Perspective Inventory showed that while sex was involved in different time perspective associations of Machiavellianism, psychopathy, and narcissism, it did not moderate the dark times’ strategy.
33.	Garcia, Danilo, 1973, et al. (författare) A Pilot Study on Newly Graduated Nurses' Personal Vulnerability for Burnout 2019 Ingår i: 31st Association for Psychological Science Annual Convention. Washington, D.C., USA. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Nurses’ work is characterized by overload and hard decisions. Despite 80% of new ly graduated nurses being socially warm and dedicated, 72.97% lacked purpose and meaning and felt ineffective and disconnected from the rest of the world. Moreover, 51.70% had a personality profile with high risk for burnout and ill-being.
34.	Garcia, Danilo, 1973, et al. (författare) A Pilot Study on Resilience (Harm Avoidance, Persistence, and Self-directedness) among Swedish Newly Graduated Nurses 2019 Ingår i: 3rd Biennial International Convention of Psychological Science, Paris, France. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract A Resilient profile is low in Harm Avoidance (i.e., relaxed, confident, and optimistic) and high in Persistence (i.e., industrious, perseverant, and hard-working) and Self-Directedness (i.e., responsible, reliable, self-acceptant, goal-oriented, and resourceful). We found that, compared to the general population, only 6.90% of Swedish newly graduated nurses had a resilient profile.
35.	Garcia, Danilo, 1973, et al. (författare) A Pilot Study on Temperament (Novelty Seeking, Harm Avoidance, and Reward Dependence) among Swedish Newly Graduated Nurses 2019 Ingår i: 3rd Biennial International Convention of Psychological Science, Paris, France. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract One factor for burnout vulnerability among nurses is their temperament profile. Compared to the general population, about 80% of Swedish newly graduated nurses were sentimental, warm, dedicated, attached, and dependent (i.e., high Reward Dependence) and 50% were worrying, pessimistic, doubtful, shy and low in energy (i.e., high Harm Avoidance).
36.	Garcia, Danilo, 1973, et al. (författare) Autonomy and Responsibility as a Dual Construct: Swedish Police Personnel’s Stress, Energy, and Motivation 2017 Ingår i: International Journal of Police Science and Management. - : SAGE Publications. - 1461-3557 .- 1478-1603. ; 19:3, s. 195-204 Tidskriftsartikel (refereegranskat)abstract Law enforcement demands self-management, intrinsic motivation, high energy levels, and tolerance to stress. The concept of self-management might involve both autonomy and responsibility. Autonomy and responsibility, however, are often considered and measured as the same construct even thought at a conceptual level they can be seen as a separate dual construct. Our aims were (1) to investigate the duality of the concept autonomy and responsibility and (2) to investigate this hypothesized dual construct’s association to stress and energy and motivation dimensions among Swedish police personnel. Employees (N = 617; males = 318, females = 292) from five Swedish police departments participated in the study. Autonomy and responsibility were assessed using one of the scales in the Learning Climate Questionnaire, motivation using a modified version of the Situational Motivation Scale, and stress and energy using the Stress/Energy Questionnaire. We conducted a confirmatory factor analysis and two structural equation models. The confirmatory factor analysis discerned two separate subscales that we defined as autonomy (e.g., “I feel free to organize my work the way I want to”) and responsibility (e.g., “We are not encouraged to take responsibility for our own learning”). Autonomy predicted both stress and energy, but only one dimension of motivation, that is, amotivation. Responsibility predicted energy and three of four motivations dimensions: intrinsic motivation, external regulation, and amotivation. Hence, we suggest that the notion of autonomy and responsibility as a dual independent construct seems to be meaningful in the investigation of police personnel’s motivation, stress, and energy.
37.	Garcia, Danilo, 1973, et al. (författare) Bring Balance to the Force! A Biopsychosocial Model of Subjective Well-Being 2020 Ingår i: The International Journal of Person Centered Medicine. - 2043-7730 .- 2043-7749. ; 10:2, s. 23-32 Tidskriftsartikel (refereegranskat)abstract For over 35 years, the concept of subjective well-being has been understood as composed of two parts: an affective component and a cognitive component. This line of research has led to important contributions with regard to physical, psychological, and social health. In this article, we briefly develop the idea of a biopsychosocial model of subjective well-being: affect, life satisfaction, and harmony in life. We argue that a biopsychosocial perspective on subjective well-being covers all the parts that compose a human being (i.e., body, mind, and psyche) and also corresponds to a person-centered measure of human well-being.
38.	Garcia, Danilo, 1973, et al. (författare) Differences between Affective Profiles in Temperament and Character in Salvadorians: The Self-fulfilling Experience as a Function of Agentic (Self-directedness) and Communal (Cooperativeness) Values 2015 Ingår i: International Journal of Happiness and Development. - 2049-2790 .- 2049-2804. ; 2:1, s. 22-37 Tidskriftsartikel (refereegranskat)abstract Background: We used the affective profiles model to investigate differences in personality with respect to different combinations of Positive (PA) and negative affect (NA). Method: The Positive Affect and Negative Affect Schedule was used to categorize 135 Salvadorians into four affective profiles: self-fulfilling (high PA and Low NA), high affective (high PA and high NA), low affective (low PA and low NA), and self-destructive (low PA and high NA). Personality was measured using the Temperament and Character Inventory-Revised. Results: High NA individuals reported higher levels of Harm Avoidance, while high PA individuals reported higher levels of Persistence. Self-destructives reported lower levels of Self-directedness compared to all profiles, while Cooperativeness was higher only among self-fulfilling individuals. Nevertheless, also low affectives scored high in Self-directedness. Conclusion: The discerned differences in character suggest that the self-fulfilling experience, defined as frequently experiencing positive emotions and infrequently experiencing negative emotions, is a function of agentic values in conjunction with communal values.
39.	Garcia, Danilo, 1973, et al. (författare) Happiness-Increasing Strategies among Affective Profiles 2015 Ingår i: 4th World Congress on Positive Psychology. Lake Buena Vista, Florida, USA.. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract The affective profile model (combinations of high and low positive, PA, and negative affect, NA) was used to investigate differences (N = 1000, age mean = 34.22, sd = 12.73) in Lyubomirsky’s eight clusters of intentional happiness-increasing strategies: Social Affiliation (e.g., “Support and encourage friends”), Partying and Clubbing (e.g., “Drink alcohol”), Mental Control (e.g., “Try not to think about being unhappy”), Instrumental Goal Pursuit (e.g. “Study”), Passive Leisure (e.g. “Surf the internet”), Active Leisure (e.g. “Exercise”), Religion (e.g. “Seek support from faith”), and Direct Attempts (e.g. “Act happy/smile”). The self-fulfilling profile (high PA/low NA) reported more frequent use of Social Affiliation, Instrumental Goal Pursuit, Active Leisure, Religion, and Direct Attempts. The high affective profile (high PA/high NA) reported more frequent use of Social Affiliation (although lower compared to the self-fulfilling profile), Partying and Clubbing, Mental Control, Instrumental Goal Pursuit, Passive Leisure, Active Leisure, Religion, and Direct Attempts (although lower than the self-fulfilling). The low affective profile (low PA/low NA) scored higher, compared to the self-destructive, in Social Affiliation, Active Leisure, and Direct Attempts. The self-destructive profile (low PA/high NA) scored higher in Mental Control (compared to the low affective and self-fulfilling profile) and Passive Leisure (compared to low affective).
40.	Garcia, Danilo, 1973, et al. (författare) Hälsa, välbefinnande och ohälsa bland långtidsarbetslösa [Health, Well-Being, and Mental Illness among Long-Term Unemployed] 2020 Ingår i: FoU i Sverige - vad pågår?. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract BAKGRUND: Att vara långtidsarbetslös (d.v.s. ≥ 6 månader) är associerat med psykiatriska problem och 37% högre risk för självmord, förmodligen därför att långtidsarbetslösa har, jämfört med normalbefolkningen, låga nivåer i vissa hälsorelaterade förmågor (d.v.s. Self-Directedness, Cooperativeness, and Self-Transcendence). SYFTE: I två studier undersökte vi olika mått på hälsa, välbefinnande och ohälsa bland långtidsarbetslösa (> 6 månader utan sysselsättning) i relation till kliniska (dvs. patienter diagnostiserade med Anorexia Nervosa) och normalpopulationer. METOD: Unga vuxna som var arbetslösa rekryterades vid början av olika projekt i södra Sverige. Deltagarna i Studie 1 (N1 = 281) svarade på The Public Health Surveillance Well-Being Scale (Bann et al., 2012), som mäter biopsychosocial hälsa: livstillfredsställelse, känsla av syfte och mening, glädje, hopp, tillfredsställelse med familj, vänner och energinivå, samt generell hälsotillstånd. Vi beräknade T-scores för deltagarnas hälsa genom att använda normdata på 5000 individer. Vi jämförde sedan långtidsarbetslösa med individer som hade varit arbetslösa 5 månader eller mindre. I Studie 2 svarade deltagarna (N2 = 266) på mått av subjektivt välbefinnande (dvs. Positive Affect and Negative Affect Schedule, Satisfaction with Life Scale) och ohälsa (dvs. Hospital Anxiety and Depression Scale, Defeat and Entrapment Scales). Deras svar jämfördes med patienter diagnostiserade med Anorexia Nervosa och individer i olika normalpopulationer. RESULTAT: I Studie 1, visade en variansanalys (ANOVA) att det fanns en signifikant medeleffekt (F(5, 247) = 5.91, p < .001, Partial Eta2 = .11) av tid som arbetslös och självrapporterad biopsykosocial hälsa. Precis som förväntat fanns det en signifikant skillnad (p < .001) mellan individer som hade varit arbetssökande i en månad eller mindre (T-Score medelvärde = 48.77) och de som hade varit arbetssökande i sex månader eller mer (T-Score medelvärde = 41.43) Ca. 30% av de individer som var långtidsarbetslösa (d.v.s. ≥ 6 månader) rapporterade nivåer av biopsykosocial hälsa som var 1,5 standardavvikelse eller lägre än normalpopulationen, medan enbart ca. 10% av de som hade varit arbetslösa en månad eller mindre rapporterade så låga nivåer av biopsykosocial hälsa. I Studie 2, rapporterade gruppen av långtidsarbetslösa signifikanta skillnader i positiva emotioner (t = -10.51, df = 199, p < .001, Cohen’s d = 0.77), livstillfredsställelse (t = -13.51, df = 201, p < .001, Cohen’s d = 0.87) och negativa emotioner (t = 12.34, df = 196, p < .001, Cohen’s d = 0.97) än normalpopulationen. Vi hittade inga signifikanta skillnader mellan långtidsarbetslösa och gruppen med Anorexia Nervosa patienter. De långtidsarbetslösa rapporterade även signifikant högre grad av ångest (t = 22.06, df = 204, p < .001, Cohen’s d = 1.70) och depression än normalpopulationen (t = 12.55, df = 204, p < .001, Cohen’s d = .91). Samtliga dessa skillnader var stora (Cohen’s d mellan 0.77-1.70) SLUTSATSER: I Studie 1 var det ca. en tredjedel av de långtidsarbetslösa som rapporterade lika låga nivåer av ohälsa som 15% av normalpopulationen. Studie 2 visade stora skillnader i välbefinnande och ohälsa mellan de långtidsarbetslösa och normalpopulationen. Medan det inte fanns skillnader i välbefinnande mellan långtidsarbetslösa och patienter, hittade vi lägre grader av ohälsa bland patientpopulationer än långtidsarbetslösa. Viktigt att komma ihåg är att avsaknaden av positiva emotioner är ibland en större prediktor av morbiditet och dödlighet än närvaron av negativa emotioner (Cloninger, 2004). Med det sagt, ca. 72% av deltagarna rapporterade nivåer av ångest som var över nivån som forskning indikerar för troligt behöv av psykiatrisk vård. Eftersom problemet är komplext och vi ser även en sårbarhet på individnivå, räcker det inte med att enbart göra arbetsmarknadsinsatser eller enbart göra hälso- och sjukvårdsinsatser. Med andra ord behöver eventuella insatser även fokusera på att påverka/utveckla roten av problemet (dvs. hälsorelaterade förmågor: självinsikt, självacceptans, samarbetsvilja, samhörighet och förmågan att uppleva flow och meningsfullhet) och att reducera stress. Sist men inte minst, med tanke på den graden av ohälsa som individer som är långtidsarbetslösa uppvisar, är det desto viktigare att använda evidensbaserade interventioner eller åtminstone följa upp effekten av insatserna med validerade instrument och metoder. Annars riskerar vi att göra dem immuna till interventioner som kanske skulle hjälpa dem.
41.	Garcia, Danilo, 1973, et al. (författare) IRT analyses of the Swedish Dark Triad Dirty Dozen 2018 Ingår i: Heliyon. - : Elsevier BV. - 2405-8440. ; 4:3 Tidskriftsartikel (refereegranskat)abstract Background: The Dark Triad (i.e., Machiavellianism, narcissism, and psychopathy) can be captured quickly with 12 items using the Dark Triad Dirty Dozen (Jonason and Webster, 2010). Previous Item Response Theory (IRT) analyses of the original English Dark Triad Dirty Dozen have shown that all three subscales adequately tap into the dark domains of personality. The aim of the present study was to analyze the Swedish version of the Dark Triad Dirty Dozen using IRT.Method: 570 individuals (n(males) = 326, n(females) = 242, and 2 unreported), including university students and white-collar workers with an age range between 19 and 65 years, responded to the Swedish version of the Dark Triad Dirty Dozen (Garcia et al., 2017a, b).Results: Contrary to previous research, we found that the narcissism scale provided most information, followed by psychopathy, and finally Machiavellianism. Moreover, the psychopathy scale required a higher level of the latent trait for endorsement of its items than the narcissism and Machiavellianism scales. Overall, all items provided reasonable amounts of information and are thus effective for discriminating between individuals. The mean itemdiscriminations (alphas) were 1.92 for Machiavellianism, 2.31 for narcissism, and 1.99 for psychopathy.Conclusion: This is the first study to provide IRT analyses of the Swedish version of the Dark Triad Dirty Dozen. Our findings add to a growing literature on the Dark Triad Dirty Dozen scale in different cultures and highlight psychometric characteristics, which can be used for comparative studies. Items tapping into psychopathy showed higher thresholds for endorsement than the other two scales. Importantly, the narcissism scale seems to provide more information about a lack of narcissism, perhaps mirroring cultural conditions.
42.	Garcia, Danilo, 1973, et al. (författare) IRT Analyses of the Swedish Version of the Dark Triad Dirty Dozen 2018 Ingår i: 30th APS Annual Convention, San Francisco, CA, USA. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract The Dark Triad Dirty Dozen is one of the quickest ways to measure the Dark Triad. Item Response Theory analyses of the Swedish version showed that all items contributed with substantial information. However, items tapping into psychopathy showed higher thresholds for endorsement than Machiavellianism, and in particular narcissism.
43.	Garcia, Danilo, 1973, et al. (författare) Italian and Swedish adolescents: differences and associations in subjective well-being and psychological well-being 2017 Ingår i: PeerJ. - : PeerJ. - 2167-8359. ; 5, s. 1-15 Tidskriftsartikel (refereegranskat)abstract Background. One important aspect of subjective judgments about one’s well-being (i.e., subjective well-being: life satisfaction, positive affect, and negative affect) is that cultural features, such as, nationality seem to shape cognitive judgments about the ‘‘the ideal life’’. In this comparative study we examined differences in subjective well-being and psychological well-being between Italian and Swedish adolescents and tested if the relationship between the three constructs of subjective well-being (i.e., satisfaction with life, positive affect, and negative affect) and psychological well-being was moderated by the adolescents’ nationality. Method. Italian (n = 255) and Swedish (n = 277) adolescents answered to the Satisfaction with Life Scale, the Positive Affect Negative Affect Schedule, and Ryff’s Scales of Psychological Well-Being. Differences between samples were tested using a Multiple Analysis of Variance. We also conducted a multiple group analysis (Italy and Sweden) using Structural Equation Modelling to investigate the relationship between all three subjective well-being constructs and psychological well-being. Results. Italian adolescents scored significantly higher in satisfaction with life than Swedish adolescents. Additionally, across countries girls scored significantly higher in negative affect than boys. In both countries all three constructs of subjective well-being were significantly associated to adolescents’ psychological well-being. Nevertheless, while the effect of the relationship between affect and psychological well-being was almost the same across countries, life satisfaction was more strongly related to psychological well-being among Swedish adolescents. Conclusions. The present study shows that there are larger variations between these two cultures in the cognitive construct of subjective well-being than in the affective construct. Accordingly, associations between the cognitive component, not the affective component, of subjective well-being and psychological well-being differ between countries as well.
44.	Garcia, Danilo, 1973, et al. (författare) Patients’ Satisfaction with Swedish Primary Care: Identification of Patient’s Resources and Needs, Trustful Mutual Partnership, and the Co-creation of Coherent Documentation 2019 Ingår i: 31st Association for Psychological Science Annual Convention. Washington, D.C., USA. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract By categorizing items in a primary care nationwide patient survey in three theorized sub-constructs of person-centered care, we found that 57% to 71% of patients’ health care satisfaction was predicted by health care personnel’s ability to identify the patient’s resources and needs, form a partnership, and co-create coherent documentation.
45.	Garcia, Danilo, 1973, et al. (författare) Person-Centered Care 2018 Ingår i: V. Zeigler-Hill & T. Shackelford (Eds.), Encyclopedia of Personality and Individual Differences. - Cham, Switzerland : Springer. Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract Person-centered care is a model for health care that involves a biopsychosocial approach on health (physical, psychological, and social) and the person (body, mind, and psyche; Cloninger, 2004, 2013ab) through the alliance between the one giving care and the one seeking care as equal partners. One of the main aims is to implement a process that goes beyond the diagnostic formulation of identifying a disease state or ill-health, that is, a process of total health status, including ill-being and well-being (Mezzich et al., 2016). A second main aim is to empower the person seeking care to make self-directed informed choices to promote well-being in all planes of her/his life by including her/his subjective narratives, values, and meanings of illness and health as well as personal preferences and choices in treatment and care (Wong & Cloninger, 2010). A third main aim is the promotion of a working alliance in the health care process (Rogers, 1946; Kitwood & Bredin, 1992). This alliance includes the health care personnel, the person seeking the care, significant others, and also other community stakeholders involved in the health care of the person.
46.	Garcia, Danilo, 1973, et al. (författare) Person-Centered Osteopathic Practice using a Biopsychosocialspiritual Model of Personality 2016 Ingår i: 28th Association for Psychological Science Annual Convention. Chicago, Illinois, USA. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract To understand osteopathic patients’ health we propose the implementation of a person-centered approach using Cloninger’s model of personality. Here we investigated the relationship between patients’ personality and well- being, personality differences to controls, and differences in health within patients depending on presenting problem and gender.
47.	Garcia, Danilo, 1973, et al. (författare) Police Personnel’s Affective Profiles: Work Climate and Commitment 2019 Ingår i: 4th Asian Conference of Criminal & Operations Psychology, 9-12 July, Singapore. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract It is widely recognized that individuals’ perception of their work climate strongly influences personnel’s commitment at work. However, little attention has been paid to how individual differences in basic personality or affective profiles moderate this relationship. A total of 359 sworn and non-sworn police personnel answered an online survey comprising the Positive Affect Negative Affect Schedule, the Learning Climate Questionnaire (Management Relations and Style, Time, Autonomy and Responsibility, Team Style, Opportunities to Develop, Guidelines on How to do the Job, and Contentedness), and the Three Commitment Scales (Emotional, Continuance, and Normative). We calculated percentiles in positive and negative affect to cluster participants in four affective profiles with high/low positive affect (PA/pa) and high/low negative affect (NA/na): self-fulfilling (PAna), low affective (pana), high affective (PANA), and self-destructive (paNA). Using a Multiple Analysis of Variance, we demonstrated that personnel with a self-fulfilling profile scored higher on almost all work climate dimensions and in both affective and normative commitment. As expected, by conducting a multiple group Structural Equation Modelling using affective profiles as the moderator, we also showed that the relationship between work climate and commitment was complex. For instance, perceiving opportunities to develop at work predicted being emotionally committed to the organization for individuals with either a self-destructive or a self-fulfilling profile, but by good management relationships among those with a low affective profile. Hence, police leaders need to be aware of employees’ personality in order to know which specific work climate factors will lead to an adaptive and positive work commitment.
48.	Garcia, Danilo, 1973, et al. (författare) Psychometric properties of the Swedish version of the satisfaction with life scale in a sample of individuals with mental illness 2021 Ingår i: PeerJ. - : PeerJ. - 2167-8359. ; 9 Tidskriftsartikel (refereegranskat)abstract Background: Health assessment among individuals with mental health problems often involves measures of ill-being (e.g., anxiety, depression). Health is, however, defined as a state of physical, mental and social well-being and not merely the absence of disease (WHO, 1948, 2001). Hence, in order to address mental illness during the 21st century, we need to develop methods for the prevention, identification and treatment of mental illness; but also, for the promotion, identification, and maintenance of well-being. In this context, over three decades of subjective well-being research have resulted in the development of measures of positive aspects of human life, such as, the Satisfaction with Life Scale (Diener et al., 1985). Our aim was to investigate the psychometric properties of the Satisfaction with Life Scale in a Swedish population of individuals with mental illness using both Classical Test Theory (CTT) and Item Response Theory (IRT). Method: A total of 264 participants (age mean = 43.46, SD = 13.31) diagnosed with different types of mental illness answered to the Swedish version of the Satisfaction with Life Scale (five items, 7-point scale: 1 = strongly disagree, 7 = strongly agree). Results: We found positive and significant relationships between the five items of the scale (r ranging from 0.37 to 0.75), good reliability (Cronbach’s alpha = 0.86), and that the one-factor solution had best goodness of fit (loadings between 0.52–0.88, p < 0.001). Additionally, there were no significant differences in comparative fit indexes regarding gender and occupation status. All items had high discrimination values (between 1.95–3.81), but item 5 (“If I could live my life over, I would change almost nothing”); which had a moderate discrimination value (1.17) and the highest estimated difficulty on response 7 (3.06). Moreover, item 2 (“The conditions of my life are excellent”) had less discrimination and redundant difficulty with both item 1 (“In most ways my life is close to my ideal”; 2.03) on response 7 and with item 3 (“I am satisfied with my life”; –1.21) on response 1. The five items together provided good information, with especial good reliability and small standard error within −1.00 up to about 2.00 and the highest amount of test information at 0.00 of the level of life satisfaction within this population. Conclusions: Consistent with previous research, the scale had good reliability and provided good information across most of the latent trait range. In addition, within this population, sociodemographic factors such as gender and occupation status do not influence how individuals respond to the items in the scale. However, the items couldn’t measure extreme levels of low/high life satisfaction. We suggest replication of these findings, the test of additional items, and the modification of items 2 and 5 in order to use the scale among individuals with mental illness.
49.	Garcia, Danilo, 1973, et al. (författare) Quantitative Semantics Test Theory: Validation of two Short Personality Inventories 2020 Ingår i: 32nd Association for Psychological Science Annual Convention. Chicago, Illinois, USA.. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract We quantified individuals’ self-descriptive words (i.e., identity) in order to validate two short personality inventories (i.e., Quantitative Semantic Test Theory). Despite being short, both inventories captured individuals’ identity as expected. Nevertheless, our method also pointed out some shortcomings and overlaps between the personality traits measured within these inventories.
50.	Garcia, Danilo, 1973, et al. (författare) Questions of Self-regulation and Affect: Affectivity, Locomotion, Assessment, and Psychological Well-Being 2018 Ingår i: Biquarterly Iranian Journal of Health Psychology. - 2588-4204. ; 1:1, s. 37-50 Tidskriftsartikel (refereegranskat)abstract Objective: The affectivity system is a complex dynamic system, thus, it needs to be seen as a whole-system unit that is best studied by analyzing four profiles: self-destructive (low positive affect, high negative affect), low affective (low positive affect, low negative affect), high affective (high positive affect, high negative affect), and self-fulfilling (high positive affect, low negative affect). Our purpose was to examine individual differences in psychological well-being and self-regulatory strategies (assessment/locomotion). Additionally, we investigated if the effect of psychological well-being on self-regulatory strategies was moderated by the individual’s type of profile. Method: Participants (N = 567) answered the Positive Affect Negative Affect Schedule, Ryff’s Scales of Psychological Well-being, and the Regulatory Mode Questionnaire. We conducted a Multivariate Analysis of Variance using age as covariate and Structural Equation Modeling in a multi-group for moderation analysis. Result: Individuals with a self-fulfilling profile scored highest in all psychological well-being constructs and locomotion and lowest in assessment. Nevertheless, matched comparisons showed that increases in certain psychological resources might lead to profile changes. Moreover, while some psychological well-being constructs (e.g., self-acceptance) had an effect of self-regulatory mode independently of the individual’s profile, other constructs’ (e.g., personal growth) effect on self-regulation was moderated by the person’s unique type of profile. Conclusions: Although only theoretical, these results give an idea of how leaps/changes might be extreme (i.e., from one profile at the extreme of the model to the other extreme), while other might be serial (i.e., from one profile to another depending on matching affective dimensions).

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