| 1. |
- Alinaghizadeh, Hassan, Statistiker, 1961-
(author)
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Radioactive fall-out from the Chernobyl nuclear power plant accident in 1986 and cancer rates in Sweden, a 25-year follow up
- 2019
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Licentiate thesis (other academic/artistic)abstract
- Aim: The current research aimed to study the association between exposure to low-dose radiation fallout after the Chernobyl accident in 1986 and the incidence of cancer in Sweden.Methods: A nationwide study population, selecting information from nine counties out of 21 in Sweden for the period from 1980 – 2010.In the first study, an ecological design was defined for two closed cohorts from 1980 and 1986. A possible exposure response pattern between the exposure to 137Cs on the ground and the cancer incidence after the Chernobyl nuclear power plant accident was investigated in the nine northernmost counties of Sweden (n=2.2 million). The activity of 137Cs at the county, municipality and parish level in 1986 was retrieved from the Swedish Radiation Safety Authority (SSI) and used as a proxy for received dose of ionizing radiation. Information about diagnoses of cancer (ICD-7 code 140-209) from 1958 – 2009 were received from the Swedish Cancer Registry, National Board of Health and Welfare (368,244 cases were reported for the period 1958 to 2009). The incidence rate ratios were calculated by using Poisson Regression for pre-Chernobyl (1980 – 1986) and post-Chernobyl (1986 – 2009) using average deposition of 137Cs at three geographical levels: county (n=9), municipality (n=95), and parish level (n=612). Also, a time trend analysis with age standardized cancer incidence in the study population and in the general Swedish population was drawn from 1980 – 2009.In the second study, a closed cohort was defined as all individuals living in the three most contaminated counties in mid-Sweden in 1986. Fallout of 137Cs was retrieved as a digital map from the Geological Survey of Sweden, demographic data from Statistics Sweden, and cancer diagnosis from the Swedish Cancer Registry, National Board of Health and Welfare. Individuals were assigned an annual 137Cs exposure based on their place of residence (1986 through 1990), from which 5-year cumulative 137Cs exposures were calculated, accounting for the physical decay of 137Cs and changing residencies. Hazard ratios for having cancer during the follow-up period, adjusted for age, sex, rural/non-rural residence, and pre-Chernobyl total cancer incidence, were calculated.Results: No obvious exposure-response pattern in the age-standardized total cancer incidence rate ratios could be seen in the first study. However, a spurious association between the fallout and cancer incidence was present, where areas with the lowest incidence of cancer before the accident coincidentally had the lowest fallout of cesium-137. Increasing the geographical resolution of exposure from the average values of nine counties to the average values of 612 parishes resulted in two to three times higher degree of variance explanation by regression model. There was a secular trend, with an increase in age standardized incidence of cancer from 1980 – 2009. This trend was stronger in the general Swedish population compared to the nine counties of the present study.In the second study, 734,537 people identified were divided into three exposure categories: the first quartile was low exposure (0.0 to 45.4 kBq/m2), the second and third quartiles were intermediate exposure (45.41 to 118.8 kBq/m2), and the fourth quartile was highest exposure (118.81 to 564.71 kBq/m2). Between 1991 and 2010, 82,495 cancer cases were registered in the three counties. Adjusted HRs (95% CI) were 1.03 (1.01 to 1.05) for intermediate exposure, and 1.05 (1.03 to 1.07) for the highest exposure, when comparing to the reference exposure.Conclusion: Using the ecological data, there was no exposure response trend; however, after refining the data to the individual level of exposure, there was an overall exposure response pattern. Nonetheless, due to the time dependency, these results were restricted to the age group of 25 – 49 among males. Using register-based data only, for determining the association between low-dose exposure to radiation and the risk of developing cancer, is difficult since we cannot control for other significant factors that are associated with cancer.
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| 2. |
- Aronsson, Gunnar, et al.
(author)
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Associations Between Being 'locked-In' and Health - An Epidemiological Study
- 2019
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In: Nordic Journal of Working Life Studies. - : Det Kgl. Bibliotek/Royal Danish Library. - 2245-0157. ; 9:3, s. 71-85
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Journal article (peer-reviewed)abstract
- Objective. The aim of this study was to investigate associations between an individual's level of perceived control over labor market position (locked-in and not locked-in) and self-rated health and psychological well-being. Methods. A representative sample (n = 11,675) of the working population in southern Sweden responded to a questionnaire. Results. Sixty-seven percent of the respondents worked in their preferred workplace and occupation. Nineteen percent reported being in a nonpreferred workplace and nonpreferred occupation (double locked-in). Twenty-three percent reported suboptimal health compared with 31% among the double locked-in. The risk of suboptimal health was elevated in all locked-in groups also after adjustment for background variables and job strain. In the double locked-in group, the fully adjusted odds ratio for suboptimal health was 1.72 (95% confidence interval 1.49-1.99) and for suboptimal psychological well-being 2.17 (95% confidence interval 1.84-2.56). Odds ratio for the other locked-in groups was lower but still statistically significant. Conclusions. Being at a nonpreferred work-place or occupation was associated with impaired health.
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| 3. |
- Conte, Helen, et al.
(author)
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Facilitating interprofessional learning: experiences of using a digital activity for training handover of critically ill patients between a primary health care centre and ambulance services : A qualitative study
- 2024
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In: BMJ Open. - 2044-6055. ; 14:6
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To explore students' and facilitators' experiences of using a developed digital activity for interprofessional learning (IPL) focusing on critically ill patient handovers from a primary healthcare (PHC) centre to the ambulance service.DESIGN: A qualitative study design was employed, and the reporting of this study adheres to the Consolidated criteria for Reporting Qualitative research guidelines for qualitative studies.SETTING: A PHC centre and the ambulance service in Stockholm, Sweden.PARTICIPANTS: A total of 31 participants were included in the study: 22 students from five different healthcare professions, seven facilitators and two observers.INTERVENTION: A digital IPL activity was developed to overcome geographical distances, and the scenario included the handover of a critically ill patient from personnel within the PHC centre to the ambulance service personnel for transport to an emergency department. Four digital IPL activities were conducted in 2021.RESULTS: The digital IPL activity eliminated the issue of geographical distance for students and facilitators, and it enabled the students to find an interprofessional model for collaboration through reasoning, by communicating and sharing knowledge with the support of a common structure. Participants perceived the digital IPL activity and scenario as authentic, feasible and facilitated IPL. Using a case with an acute and life-threatening condition was a success factor for students to experience high realism in their IPL on patient safety, handover, care and treatment.CONCLUSION: The developed digital IPL activity facilitated the students' IPL and demonstrated potential sustainability as the digital approach supported overcoming geographical distances for both students and facilitators. By using a scenario involving an authentic case focusing on handovers of a critically ill patient, IPL, feasibility and acceptability were supported. However, it is crucial to emphasise that a comprehensive evaluation, both quantitative and qualitative, over an extended period of clinical rotations and involving a larger group of students is still warranted to ensure continuous improvement and development.
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| 4. |
- Muli, Irene, et al.
(author)
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Patients' Experiences of Initiating Video Consultations.
- 2023
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In: Studies in Health Technology and Informatics. - 0926-9630 .- 1879-8365. ; 309, s. 204-209
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Journal article (peer-reviewed)abstract
- Implementation and adoption of video consultations (VCs) in healthcare are not straightforward. Experiences of initiating a VC could increase our understanding of adoption by patients. This study aims to report patients' experiences of installing and booking a VC in primary care. Most people found it easy to find and install the VC application. Those with a higher self-reported ability and habit of using digital services and the internet found it easier than those reporting lower ability and habit. About half of our respondents had booked their recent VC themselves, most of whom had done so through a telephone call or the application "Alltid Öppet". The booking process was perceived to be easy by most but more difficult compared to installation. The easy installation process might have led to higher adoption by older people. Nevertheless, during implementation more support should be provided to people with lower digital service and internet use abilities and habits as they might find VC set-up more difficult. More attention should be given to the booking process as it may be a barrier potentially influencing adoption.
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| 5. |
- Muli, Irene, et al.
(author)
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Patients' Introduction to Online Video Consultations in Primary Healthcare
- 2023
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In: Caring is Sharing. - : IOS Press. - 9781643683881 - 9781643683898 ; , s. 1011-1012
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Conference paper (peer-reviewed)abstract
- This study aimed to illustrate ways primary healthcare patients were introduced to video consultations via the public online care application Alltid öppet in Region Stockholm, Sweden. The majority of patients were introduced to this by their providers or other healthcare professionals.
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| 6. |
- Muli, Irene, et al.
(author)
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To connect or not connect : long-term adoption of video consultations, and reasons for discontinuing use
- 2023
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In: Journal of Telemedicine and Telecare. - : SAGE Publications. - 1357-633X .- 1758-1109.
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Journal article (peer-reviewed)abstract
- IntroductionThis study investigates factors related to long-term and short-term adoption of video consultations (VCs) and reasons for discontinuing use among primary care patients.MethodsA sample of primary care patients using VCs with healthcare providers were invited to take a survey in a cross-sectional study. Participants were asked about their intention to continue to have video consultations in the future, and those indicating no intention to use VCs in the future (short-term adopters) were asked about their reasons for this. Prevalence and statistical differences between long-term and short-term adopters were investigated.ResultsThere were several statistically significant differences between long-term and short-term adopters (76% vs. 24%). Long-term adopters consisted of more middle-aged individuals (35?54 years) and the majority worked full-time (56%). They had more positive opinions of VCs and used VCs and video meetings for other purposes to a larger extent. They chose VCs because of the lack of time to go to the healthcare centre and because their provider offered them. The most common reason for discontinuing use was a preference for face-to-face consultations, with the youngest age group (16?34 years) reporting this to a larger extent.DiscussionYounger and older age groups may be less likely to continue the use of VCs, potentially preserving the digital divide. Additionally, disparities in using similar technologies might contribute to the digital divide. Moreover, convenience, positive opinions of VCs, and experience with VCs were related to long-term adoption. Further studies are needed to explore non-use, age?s influence, and address usability issues.
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| 7. |
- Papachristou, Panagiotis, et al.
(author)
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Evaluation of an artificial intelligence-based decision support for the detection of cutaneous melanoma in primary care: a prospective real-life clinical trial
- 2024
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In: British Journal of Dermatology. - : OXFORD UNIV PRESS. - 0007-0963 .- 1365-2133.
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Journal article (peer-reviewed)abstract
- Background Use of artificial intelligence (AI), or machine learning, to assess dermoscopic images of skin lesions to detect melanoma has, in several retrospective studies, shown high levels of diagnostic accuracy on par with - or even outperforming - experienced dermatologists. However, the enthusiasm around these algorithms has not yet been matched by prospective clinical trials performed in authentic clinical settings. In several European countries, including Sweden, the initial clinical assessment of suspected skin cancer is principally conducted in the primary healthcare setting by primary care physicians, with or without access to teledermoscopic support from dermatology clinics.Objectives To determine the diagnostic performance of an AI-based clinical decision support tool for cutaneous melanoma detection, operated by a smartphone application (app), when used prospectively by primary care physicians to assess skin lesions of concern due to some degree of melanoma suspicion.Methods This prospective multicentre clinical trial was conducted at 36 primary care centres in Sweden. Physicians used the smartphone app on skin lesions of concern by photographing them dermoscopically, which resulted in a dichotomous decision support text regarding evidence for melanoma. Regardless of the app outcome, all lesions underwent standard diagnostic procedures (surgical excision or referral to a dermatologist). After investigations were complete, lesion diagnoses were collected from the patients' medical records and compared with the app's outcome and other lesion data.Results In total, 253 lesions of concern in 228 patients were included, of which 21 proved to be melanomas, with 11 thin invasive melanomas and 10 melanomas in situ. The app's accuracy in identifying melanomas was reflected in an area under the receiver operating characteristic (AUROC) curve of 0.960 [95% confidence interval (CI) 0.928-0.980], corresponding to a maximum sensitivity and specificity of 95.2% and 84.5%, respectively. For invasive melanomas alone, the AUROC was 0.988 (95% CI 0.965-0.997), corresponding to a maximum sensitivity and specificity of 100% and 92.6%, respectively.Conclusions The clinical decision support tool evaluated in this investigation showed high diagnostic accuracy when used prospectively in primary care patients, which could add significant clinical value for primary care physicians assessing skin lesions for melanoma. We investigated the diagnostic performance of an AI-based decision support in the form of a mobile app to detect melanoma when used by primary care physicians. The app proved to have high levels of diagnostic accuracy in distinguishing melanomas from other skin lesions. We conclude that it appears to be a potentially valuable diagnostic aid for the primary care physician in the assessment of skin lesions of concern.
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| 8. |
- Papachristou, Panagiotis, et al.
(author)
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Evaluation of an artificial intelligence-based decision support for the detection of cutaneous melanoma in primary care: a prospective real-life clinical trial
- 2024
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In: BRITISH JOURNAL OF DERMATOLOGY. - : OXFORD UNIV PRESS. - 0007-0963 .- 1365-2133.
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Journal article (peer-reviewed)abstract
- Background Use of artificial intelligence (AI), or machine learning, to assess dermoscopic images of skin lesions to detect melanoma has, in several retrospective studies, shown high levels of diagnostic accuracy on par with - or even outperforming - experienced dermatologists. However, the enthusiasm around these algorithms has not yet been matched by prospective clinical trials performed in authentic clinical settings. In several European countries, including Sweden, the initial clinical assessment of suspected skin cancer is principally conducted in the primary healthcare setting by primary care physicians, with or without access to teledermoscopic support from dermatology clinics.Objectives To determine the diagnostic performance of an AI-based clinical decision support tool for cutaneous melanoma detection, operated by a smartphone application (app), when used prospectively by primary care physicians to assess skin lesions of concern due to some degree of melanoma suspicion.Methods This prospective multicentre clinical trial was conducted at 36 primary care centres in Sweden. Physicians used the smartphone app on skin lesions of concern by photographing them dermoscopically, which resulted in a dichotomous decision support text regarding evidence for melanoma. Regardless of the app outcome, all lesions underwent standard diagnostic procedures (surgical excision or referral to a dermatologist). After investigations were complete, lesion diagnoses were collected from the patients' medical records and compared with the app's outcome and other lesion data.Results In total, 253 lesions of concern in 228 patients were included, of which 21 proved to be melanomas, with 11 thin invasive melanomas and 10 melanomas in situ. The app's accuracy in identifying melanomas was reflected in an area under the receiver operating characteristic (AUROC) curve of 0.960 [95% confidence interval (CI) 0.928-0.980], corresponding to a maximum sensitivity and specificity of 95.2% and 84.5%, respectively. For invasive melanomas alone, the AUROC was 0.988 (95% CI 0.965-0.997), corresponding to a maximum sensitivity and specificity of 100% and 92.6%, respectively.Conclusions The clinical decision support tool evaluated in this investigation showed high diagnostic accuracy when used prospectively in primary care patients, which could add significant clinical value for primary care physicians assessing skin lesions for melanoma. We investigated the diagnostic performance of an AI-based decision support in the form of a mobile app to detect melanoma when used by primary care physicians. The app proved to have high levels of diagnostic accuracy in distinguishing melanomas from other skin lesions. We conclude that it appears to be a potentially valuable diagnostic aid for the primary care physician in the assessment of skin lesions of concern.
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| 9. |
- Söderberg, Daniel, et al.
(author)
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Individual Patient Factors Associated with the Use of Physical or Digital Primary Care in Sweden
- 2024
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In: Telemedicine journal and e-health. - : Mary Ann Liebert, Inc., publishers. - 1530-5627 .- 1556-3669.
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Journal article (peer-reviewed)abstract
- Introduction: Little is known about factors that influence patients' choice to use physical or digital primary care. This study aimed to compare self-rated health, internet habits, and what patients deem important when choosing health care between users of physical and digital primary health care. Methods: We recruited 2,716 adults visiting one of six physical or four digital primary health care providers in Stockholm, Sweden, October 2020 to May 2021. Participants answered a questionnaire with questions about sociodemography, self-rated health, internet habits, and what they considered important when seeking care. We used logistic regression and estimated odds ratios (ORs) for choosing digital care. Results: Digital users considered themselves healthier and used the internet more, compared with physical users (p < 0.001). Competence of health care staff was the most important factor when seeking care to both physical and digital users (90% and 78%, respectively). Patients considering it important to avoid leaving home were more likely to seek digital care (OR 29.55, 95% confidence interval [CI] 12.65?69.06), while patients valuing continuity were more likely to seek physical care (OR 0.25, 95% CI 0.19?0.32). These factors were significant also when adjusting for self-rated health and sociodemographic characteristics. Conclusion: What patients considered important when seeking health care was associated with what type of care they sought. Patient preferences should be considered when planning health care to optimize resource allocation.
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| 10. |
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| 11. |
- Taloyan, Marina, et al.
(author)
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Cardiovascular risk factors in Assyrians/Syrians and native Swedes with type 2 diabetes: a population-based epidemiological study.
- 2009
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In: Cardiovascular Diabetology. - : Springer Science and Business Media LLC. - 1475-2840. ; 8:Nov 12
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Journal article (peer-reviewed)abstract
- BACKGROUND: A large number of people throughout the world have diabetes and the prevalence is increasing. Persons with diabetes have a twice higher risk of cardiovascular disease than those without diabetes. There is a lack of studies focusing on cardiovascular risk factors in Assyrians/Syrians with type 2 diabetes. The aim of this study is to estimate the prevalence of some cardiovascular risk factors among Assyrians/Syrians and native Swedes with type 2 diabetes and to study whether the association between ethnicity and cardio-vascular risk factors remains after adjustment for age, gender, employment status and housing tenure. METHODS: In the Swedish town of Södertälje 173 Assyrians/Syrians and 181 ethnic Swedes with type 2 diabetes participated in a study evaluating cardiovascular risk factors such as increased haemoglobin A1c (HbA1c), high blood lipids (total serum cholesterol and triglycerides), hypertension and high urinary albumin. The associations between the outcome variables and sociodemographic characteristics were estimated using unconditional logistic regression. RESULTS: The prevalence of increased triglycerides in Swedish-born subjects and Assyrian-Syrians was 61.5% and 39.7% respectively. Swedes had a prevalence of hypertension 76.8% compared to 57.8% in Assyrians/Syrians. In the final logistic models adjusted for gender, age, housing and employment the odds ratio (OR) for Swedish-born subjects for increased triglycerides was 2.80 (95% CI1.61-4.87) and for hypertension 2.32 (95% CI 1.35-4.00) compared to Assyrians-Syrians. CONCLUSION: Ethnic Swedes had higher prevalence of increased triglycerides and hypertension than Assyrians/Syrians. Total cholesterol, HbA1c and urinary albumin did not differ between the two ethnic groups.
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| 12. |
- Taloyan, Marina, et al.
(author)
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Depression and gender differences among younger immigrant patients on sick leave due to chronic back pain : a primary care study
- 2014
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In: Primary Health Care Research and Development. - 1463-4236 .- 1477-1128. ; 15:1, s. 5-14
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Journal article (peer-reviewed)abstract
- Background: Mental ill-health and pain are major causes for disability compensation in female adults in Sweden. Aims: The aims of this study were to (1) analyse gender differences in the prevalence of depression among immigrant patients with chronic back pain and (2) explore whether factors such as age, marital status, educational level, religious faith, number of children and number of diagnosed pain sites could explain these differences. Methods: The study sample consisted of 245 sick-listed primary care patients in consecutive order aged 18 through 45 years with a median duration of sick leave of 10 months for back pain and participating in a rehabilitation programme. Explanatory variables included physicians' diagnosed pain sites, age, marital status, education, number of children and religious affiliation. Predictive factors for depression were analysed using logistic regression. Findings: The women differed significantly from the men in three aspects: they were less educated, had more children and had more multiple pain sites, that is, 68% versus 45%. In the age-adjusted model, women were twice as likely to have depression (odds ratio (OR) 2.1). Regardless the gender, those with intermediate education of 9-11 years had the lowest odds of outcome compared with those with,0-8 years and >= 12 years education. Finally, after adjusting for all explanatory variables, the ORs of depression for women decreased to a non-significant level (OR 1.8; 95% confidence interval (CI) 0.94-3.43). Furthermore, regardless of the gender, those with multiple pain sites had twice higher odds (OR 2.04; 95% CI 1.11-3.74) of depression than those with fewer pain sites. Conclusion: Gender differences in odds of depression in our study could be explained by a higher prevalence of diagnosed multiple pain sites in women. This calls for tailor-made treatments that focus on the pain relief needs of immigrant women with low education and chronic back pain.
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| 13. |
- Taloyan, Marina, et al.
(author)
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Does Labor Market Position Explain the Differences in Self-Rated Health between Employed Immigrants and Native Swedes : a Population-Based Study from Southern Sweden
- 2019
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In: Journal of International Migration and Integration. - : Springer Science and Business Media LLC. - 1488-3473 .- 1874-6365. ; 20:3, s. 703-715
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Journal article (peer-reviewed)abstract
- Many groups of immigrants have worse health than the native population in the host countries. One possible explanation for this is that immigrants are disadvantaged in the labor market, since it has been shown that both precarious and locked-in labor market position can be associated with health problems. However, no published study to date has analyzed the prevalence or consequences of locked-in labor market position among immigrants. The aim of the current study is to analyze the labor market using a population-based survey. More concretely to investigate to what extent immigrants are over-represented in locked-in labor market positions and to what extent this can explain the health disadvantage among immigrants. The study is based on a dataset of the 20,449 individuals, who in the year 2000 were aged 18-64, from a survey of a representative sample of the population in the Scania region with citizen or resident status of southern Sweden, the Public Health in Scania Study conducted by the Unit of Social Medicine at Lund University, Malmo University Hospital (MAS). Respondents born abroad with Swedish parents had the highest employment rate (81.5%), with 73.7% of the employed on permanent contracts followed by participants born in Western Europe excluding the Nordic countries (81.4%), with 66.4% permanently employed, followed by native Swedes (79.1%), with 76.9% permanently employed. The lowest employment rate was observed among those born in the Middle East and North Africa, 49.4%, with 36.8% permanently employed and 19.1% self-employed. Employed participants born in the Middle East or North Africa had an excess risk of poor self-rated health if they were in a double locked-in as well as not locked-in situation, compared with native Swedes in the same labor market situations (OR = 2.18 and 2.04, respectively). In conclusion, it appears that selection into less preferred occupations or workplaces cannot explain the excess risk of poor health among immigrants from outside of Western world. Further studies, including qualitative ones, should provide detailed information from immigrants about their labor market position and the reason behind it.
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| 14. |
- Taloyan, Marina, et al.
(author)
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Ethnic differences in dissatisfaction with sexual life in patients with type 2 diabetes in a Swedish town.
- 2010
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In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 10
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Journal article (peer-reviewed)abstract
- BACKGROUND: The first aim of this study was to analyze whether self-reported satisfaction with one's sexual life was associated with ethnicity (Swedish and Assyrian/Syrian) in patients with type 2 diabetes. The second was to study whether the association between satisfaction with one's sexual life and ethnicity remained after controlling for possible confounders such as marital status, HbA1c, medication, and presence of other diseases. METHODS: This cross-sectional, questionnaire-based study was conducted at four primary health care centers in the Swedish town of Södertälje. A total of 354 persons (173 ethnic Assyrians/Syrians and 181 ethnic Swedes) participated. RESULTS: The total prevalence of self-reported dissatisfaction with one's sexual life in both groups was 49%. No significant ethnic differences were found in the outcome. In the final model, regardless of ethnicity, the odds ratio (OR) for self-reported dissatisfaction with one's sexual life in those ≥ 70 years old was 2.52 (95% CI 1.33-4.80). Among those living alone or with children, the OR was more than three times higher than for married or cohabiting individuals (OR = 3.10, 95% CI 1.60-6.00). Those with other diseases had an OR 1.89 times (95% CI 1.10-3.40) higher than those without other diseases. CONCLUSIONS: The findings demonstrate that almost half of participants were dissatisfied with their sexual life and highlight the importance of sexual life to people with type 2 diabetes. This factor should not be ignored in clinical evaluations. Moreover, the findings demonstrate that it is possible to include questions on sexual life in investigations of patients with type 2 diabetes and even in other health-related, questionnaire studies, despite the sensitivity of the issue of sexuality.
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| 15. |
- Taloyan, Marina
(author)
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Health, migration and quality of life among Kurdish immigrants in Sweden
- 2008
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Doctoral thesis (other academic/artistic)abstract
- Background: Although immigrants generally have poorer health and higher psychological distress than the native population, information on health, migration and quality of life among Kurdish immigrants is limited. Aims: Study I, to explore the association between (i) ethnicity and self-reported health (SRH) and (ii) complaints of psychological distress. Study II, to determine whether there was an association between (i) sex and poor SRH and (ii) psychological distress in Kurdish immigrants. Study III, to examine the association between (i) ethnicity and poor psycholo-gical well-being (PW) and (ii) to assess the relationship between sociodemographic characteristics, SRH, somatic pain, GIC and poor PW. Study IV, to describe mental health among 14 Kurdish men based on their own individual stories with regard to migration. Study V, to explore the coping patterns reported by 10 Kurdish men through their individual life stories during the whole migration process. Methods: Study I was based on responses from a total of 111 Kurdish men originating from Turkey and Iran from Inv-ULF (the first Swedish National Survey of Immigrants) and 1412 Swedish men from SALLS (Swedish Level-of-Living Surveys-SALLS) data collected in 1996 by Statistics Sweden. Study II was based on a whole Kurdish sample (n=197) from Inv-ULF. Study III, Kurdish sample from Inv-ULF and 1407 Swedes from SALLS were studied. The odds ratios with 95% Confidence intervals were calculated using unconditional logistic regression in all three quantitative studies (studies I-III). Studies IV and V, 10 men were interviewed face-to-face and one focus group of 4 participants was used. The analyses were done using Grounded Theory in study IV and Narrative analysis in study V. Results: Study I showed that the age-adjusted odds for poor SRH and sleeping difficulties among Kurdish men were about 3.5 times higher than among Swedish men. The odds decreased to 2.1 and 2.7 respectively in a model adjusted for age and the other explanatory variables. Study II showed that Kurdish men and women had a high prevalence of poor SRH and psychological distress. Sex differences in anxiety remained also when all explanatory variables were taken into account. Study III showed that the odds ratios for Kurdish individuals for having poor PW were twice as high as for Swedish individuals after adjustment for age, sex, employment and SRH. Men with poor SRH had more than threefold higher odds ratios for having poor PW compared to those with good SRH. Futhermore, being female, having somatic pain and recurrent GIC regardless of ethnicity increased the odds for poor PW. Study IVdescribed emerged model with two major themes and interlinked categories. The themes were: 1) protective factors for good mental health (self-satisfaction, sense of freedom, sense of belonging, creation and re-creation of Kurdish identity) and 2) risk factors for poor mental health (dissatisfaction with Swedish society, lack of sense of freedom, yearning, worrying about the current political situation in the home country). Study V identified the coping strategies such as: contributing to the Kurdish culture and the home country; getting an education; creating one´s own society / building a family; achieving inner security and balance; being active and occupied and finally, coping with ongoing political instability in the country of origin. Conclusions: In the present thesis we found that Kurdish men and women reported a high prevalence of poor SRH and psychological distress. Negative experiences of pre-migration as well as postmigration were associated with the outcomes. Protective factors for good mental health and risk factors for poor mental health were emerged in this study. In order to cope with the Swedish society itwas important for Kurdish men to be included in it and acknowledged as individuals and to be able to contribute to the Kurdish culture and the home country. Findings in this thesis may be helpful inenabling the primary health services to take the impact of the migration experiences of Kurdish men into account.
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| 16. |
- Taloyan, Marina, et al.
(author)
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Hypertriglyceridemic waist may explain ethnic differences in hypertension among patients with type 2 diabetes in Sweden
- 2012
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In: BMC Research Notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 5
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Journal article (peer-reviewed)abstract
- BackgroundHypertension is common among persons with type 2 diabetes. The aim of this study was to analyze the association between ethnicity and hypertension prevalence after adjusting for age, sex, Hba1c, total cholesterol, elevated triglycerides and hypertriglyceridemic waist. The study population consisted of 354 primary health care patients diagnosed with type 2 diabetes (173 Assyrians/Syrians and 181 Swedes) residing in Södertälje, Sweden. Unconditional logistic regression was used to analyze the data.ResultsHypertension prevalence was higher among Swedes than Assyrians/Syrians, (77% versus 58%; p = 0.001). In the unadjusted logistic regression model, the odds ratio for hypertension in Swedes was twice as high than that in Assyrians/Syrians (OR = 2.44; 95% CI =1.54-3.86). In the age- and sex-adjusted model, odds ratio of hypertension was 2.25 (95% CI 1.41-3.60). After adjustments for total cholesterol was made, the odds ratio of hypertension decreased slightly to 1.73. When elevated triglycerides and hypertriglyceridemic waist were separately introduced, the odds ratio of hypertension was no longer significant between the ethnic groups (1.60 and 1.43 for triglycerides and hypertriglyceridemic waist respectively). In addition, advanced age – 60–69 years old (OR = 1.80, CI 95% 1.00-3.20) and ≥ 70 years old (OR = 2.88, CI 95% 1.40-5.93), elevated total cholesterol (OR = 1.48, CI 95% 1.12-1.95) and presents of hypertriglyceridemic waist (those with high WC and high TG) were significant confounding factors for the increased risk of hypertension independent of ethnicity.ConclusionsThe crude differences in prevalence of hypertension between the Swedes and Assyrians/Syrians in our study population with type 2 diabetes were no longer significant when adjusting for high triglycerides levels or the presence of hypertriglyceridemic waist.
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| 17. |
- Taloyan, Marina, et al.
(author)
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Physical-mental multimorbidity in a large primary health care population in Stockholm County, Sweden
- 2023
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In: Asian Journal of Psychiatry. - : Elsevier. - 1876-2018 .- 1876-2026. ; 79
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Journal article (peer-reviewed)abstract
- Background: Multimorbidity of mental and physical disorders may be common. Our objectives were to estimate the prevalence of mental disorders and determine physical-mental multimorbidity relationships adjusted for sex and age within a primary care population in Region Stockholm, Sweden.Methods: From 2.4 million Region Stockholm inhabitants, we included adult patients with >= 1 primary care consultation from 2013 through 2017. We clustered 40 physical diagnoses into 9 categories and grouped mental disorders into mild-moderate (i.e., depression, anxiety, stress disorder, sleep disturbance) or severe (i.e., bipolar disorder, schizophrenia).Results: Of 1 105 065 patients, mean age was 49 years, 56% were females, and nearly one-third had a mental disorder (97% mild-moderate). Adjusted odds ratios (AOR) for mild-moderate and severe mental disorders were highest in patients with alcohol abuse (AOR=3.7, 95% CI 3.6-3.8; AOR=7.2, 95% CI 6.7-7.6, respectively) vs. those with no abuse. Higher odds for either level of mental comorbidity occurred in patients with chronic heart failure (CHF), cerebrovascular disease, Transient ischemic attack (TIA), Chronic obstructive pulmonary disease (COPD), Gastroesophageal reflux disease-irritable bowel syndrome (GERD-IBS), chronic pain, dementia, nicotine dependence, and Parkinson's disease. For mild-moderate mental disorders, AOR in males was highest (1.45) at age 28 and was below 1.0 after age 46; AOR in females was highest (1.30) at age 38 and was below 1.0 after age 38. For severe mental disorders, AOR was below 1.0 after age 58 in males and after age 62 in females.Conclusion: Physical-mental multimorbidity was common in primary care patients in Sweden, with the highest odds occurring in those who were female, younger, and/or had an alcohol abuse disorder.
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| 18. |
- Taloyan, Marina, et al.
(author)
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Poor physical function, relationship problems and alcohol use are predictors of increased overall mortality in Swedish cancer patients : 27-years follow-up study in Stockholm County
- 2018
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In: JOURNAL OF CANCER POLICY. - : Elsevier BV. - 2213-5383. ; 16, s. 52-56
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Journal article (peer-reviewed)abstract
- Background: To study the mortality rates among cancer patients and whether these differences are associated with history of poor physical health and socio-economic situation.Method: The relation between overall mortality and 30 questions of life-style and health was investigated in all subjects (n = 3197) who received a diagnosis of cancer (ICD-7 140-209) between 1969 and 1996 from the Rebus-cohort created in 1969 (n = 32186).Results: The overall mortality was increased in both men and women who received a cancer diagnose if they had reported problems with physical function at the beginning of the study. Men who received a cancer diagnose also had higher mortality due to cancer if they had relationship problems (HR = 1.23, 1.02-1.48), and alcohol use problem (HR = 1.35, 1.04-1.74) at baseline. Women who received cancer also had higher risk to die in cardiovascular diseases if they had reported physical function problem (HR = 1.97, 1.25-3.12) at the beginning of the study.Conclusions: Poor physical function is a predictor of increased mortality among subjects with diagnosis of cancer.
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| 19. |
- Taloyan, Marina, et al.
(author)
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Poor self-rated health in adult patients with type 2 diabetes in the town of Södertälje: A cross-sectional study.
- 2010
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In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 28, s. 216-220
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Journal article (peer-reviewed)abstract
- Abstract Objective. Several studies indicate that ethnicity may be a strong predictor of poor self-rated health (SRH). The aims of the present study were to investigate whether there was an association between ethnicity and poor SRH in subjects with type 2 diabetes and to determine if the association remained after adjusting for possible confounders such as age, gender employment, marital status, and education. Design. A cross-sectional study based on a patient population in the town of Södertälje. An unconditional logistic regression was performed to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs). Setting. Four primary health care centers. Subjects. A total of 354 individuals were included: Assyrian/Syrian-born (n = 173) and Swedish-born (n = 181). Results. The odds ratio for rating poor SRH for Assyrian/Syrian subjects with type 2 diabetes was 4.5 times higher (95% CI = 2.7-7.5) than for Swedish patients in a crude model. After adjusting for possible confounders, unemployed/retired people had 5.4 times higher odds for reporting poor SRH than employees (OR = 5.4; 95% CI = 2.3-12.5). Women had 1.8 times higher odds (95% CI = 1.0-3.0) for reporting poor SRH than men. In the final model poor SRH among Assyrians/Syrians decreased but still remained significant (OR=3.7; 95% CI = 2.5-6.6). Conclusions. The findings in this study are important for planning primary health care services. They highlight the crucial importance of being aware of the subjective health status of immigrants fleeing from war in the Middle East and resettling in Sweden.
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| 20. |
- Taloyan, Marina, et al.
(author)
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Remote digital monitoring for selected chronic diseases in primary health care
- 2023
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In: The Cochrane Library. - : John Wiley & Sons. - 1465-1858. ; :3
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Journal article (peer-reviewed)abstract
- Abstract - Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of remote digital monitoring for adults with selected chronic diseases (hypertension, type 2 diabetes, chronic obstructive pulmonary disease, congestive heart failure, and asthma) in primary healthcare settings.
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| 21. |
- Taloyan, Marina, et al.
(author)
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Self-rated health amongst male and female employees in Sweden : a nationally representative study
- 2015
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In: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 88:7, s. 849-859
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Journal article (peer-reviewed)abstract
- Purpose Self-rated health (SRH) is a well-established measure within social epidemiology. However, most studies on SRH tend to be amongst the general population, where SRH has been found to be lower in women than in men. Few studies have specifically investigated patterns of SRH just within an employed population. The purpose of this study was to (1) investigate whether there are gender differences in reporting suboptimal SRH in an employed Swedish population and (2) study whether these differences could be explained by socio-economic, work-, health- and/or lifestyle-related factors. Methods This study is cross-sectional analysis of data from the 2008 wave of Swedish Longitudinal Occupational Survey of Health, a nationally representative cohort of the Swedish working population. This study includes the responses of 9,756 employed individuals. Logistic regression analyses were performed. Results After adjusting for age, income and working hours (full vs. part time), men had significantly higher odds of suboptimal SRH than women OR 1.38 (95 % CI 1.22-1.55). With stepwise inclusion of health factors such as long-standing disease, sleep quality and fatigue, the OR for men increased to 1.65 (95 % CI 1.44-1.89). Gender differences in reporting suboptimal SRH were attenuated to 1.29 (95 % CI 1.11-1.51) with the inclusion of lifestyle factors. However, they remained significant after inclusion of all explanatory variables. Conclusions In contrast to findings in general population studies, our results show that men in employment have higher odds of suboptimal SRH than their female counterparts. As SRH is an important indicator of health with a strong association with mortality, an excess risk of suboptimal SRH amongst employed men shows that more attention should be paid to men's health in the workplace.
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| 22. |
- Taloyan, Marina, et al.
(author)
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Sexual dysfunction in Assyrian/Syrian immigrants and Swedish-born persons with type 2 diabetes
- 2012
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In: BMC Research Notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 5
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Journal article (peer-reviewed)abstract
- BACKGROUND: Few studies have investigated sexual dysfunction in immigrant patients with type 2 diabetes in Sweden. The aim of this study was to examine the association between ethnicity and sexual dysfunction and to analyze if this association remains after adjusting for explanatory variables including age, marital status, HbA1c, triglycerides, and hypertension. This cross-sectional study was conducted at four primary health care centers in the Swedish town of Sodertalje. A total of 354 persons with type 2 diabetes (173 Assyrians/Syrians and 181 Swedish-born patients) participated in the survey. The main outcome measure was the self-reported presence of sexual dysfunction based on two questions, one regarding loss of ability to have sexual intercourse and the other loss of sexual desire. Response rates were 78% and 86%, respectively. FINDINGS: The total prevalence of loss of ability to have intercourse was 29.5%. In the multivariate models, the odds of loss of ability to have intercourse was significantly higher in the oldest age group (OR = 5.80; 95% CI, 2.33--14.40), in men (OR = 3.33; 95% CI, 1.33--8.30), and in unmarried individuals (OR = 2.40; 95% CI, 1.02--5.70). The odds of reporting loss of sexual desire was higher in Assyrians/Syrians than in Swedish-born patients and increased from 2.00 in the age- and gender-adjusted model to 2.70 in the fully adjusted model when all confounders were taken into account. CONCLUSIONS: Sexual dysfunction appears to be more common in Assyrians/Syrians than in Swedish-born patients. Health care workers should actively ask about sexual function in their patients with type 2 diabetes.
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| 23. |
- Taloyan, Marina, et al.
(author)
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Short-term cognitive-behavioral treatment in multicultural primary care of patients with longstanding backache
- 2013
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In: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 54:5, s. 371-375
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Journal article (peer-reviewed)abstract
- The efficacy of cognitive-behavioral therapy in multi-cultural primary care patients with longstanding backache is not evaluated. The purpose of this study was to investigate the outcome of a four weekly-treatment given by primary care physicians regarding pain-related worry, depression and severe pain and to determine which social, clinical or gender factors were associated with outcome.The study group consisted of 245 patients in consecutive order from 19 countries, 18 to 45years, entering rehabilitation program because of longstanding backache. Prevalences of pain-related worry and depression and severe pain was counted and compared before and after. Logistic regression was used to calculate the odds (OR; 95% CI) for persistent pain-related worry and/or persistent depression and severe pain (VAS 50). The prevalences of pain-related worry and depression were both significantly lower after treatment (pain-related worry 83% before vs. 38% after; depression 43% before vs. 31% after). Also the number of patients scoring 50 VAS was a little, but significantly, fewer (68% vs. 61%). Use of interpreter doubled the risk of having persistent pain-related worry (OR 2.1; 95% CI 1.1-4.1) but the risk was not significant regarding persistent depression (OR 1.8; 0.6-5.4). The rating of VAS rating 50 after treatment was twice as high, OR 2.3 (95% CI 1.1-4.6) in the 38-45year old age group. To conclude, a focus on pain ideas reduced pain-related worry and depression in these patients with various sociocultural backgrounds and longstanding backache.
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| 24. |
- Taloyan, Marina, et al.
(author)
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Sickness presence in the Swedish Police in 2007 and in 2010 : Associations with demographic factors, job characteristics, and health
- 2016
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In: Work. - 1051-9815 .- 1875-9270. ; 54:2, s. 379-387
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Journal article (peer-reviewed)abstract
- BACKGROUND: Sickness presence (SP) is a complex phenomenon that has been shown to predict sickness absence, poor work performance, and suboptimal self-rated health. However, more research is needed to increase the understanding of how SP relates to occupational factors, demographic variables, and self-rated health.OBJECTIVE: The aims of this study were to investigate (1) the prevalence of SP among the Police employees in Sweden in 2007 and in 2010; (2) the association between demographics, seniority, occupational group (police officer vs civil servant), and self-reported health on the one hand and SP on the other hand for both years separately.METHODS: Survey data from Swedish Police employees from 2007 (n = 17,512) and 2010 (n = 18,415) were analyzed using logistic regression to assess odds ratios (OR) and 95% confidence intervals (CI).RESULTS: The prevalence of SP was stable between the years, but the proportion who stated that they had not been ill at all decreased from 2007 to 2010 (28.0% vs. 23.6%), while the proportion stating always having stayed at home when ill did not differ; 45.0% in 2007 to 45.8% in 2010. The ORs of SP were higher among those with suboptimal self-rated health compared to those with optimal self-rated health (4.38 (95% CI 4.02- 4.78) and 4.31 (3.96- 4.70) in 2007 and 2010, respectively) and among police officers compared with civilians (1.26 (1.17-1.36) and 1.19 (1.10-1.28)), whereas no clear patterns were found for age, gender, and seniority.CONCLUSIONS: The prevalences of SP were about the same in 2007 and 2010 and were slightly lower compared to in previous studies. The strong association between SP and suboptimal self-rated health suggests that high levels of SP may be an early marker of future illness and sickness absence. In future studies of SP it is important to account for having been ill, that is, at risk of SP.
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| 25. |
- Taloyan, Marina, et al.
(author)
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Sickness presence in the Swedish Police in 2007 and in 2010 : Associations with demographic factors, job characteristics, and health
- 2016
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In: Work. - : IOS Press. - 1051-9815 .- 1875-9270. ; 54:2, s. 379-387
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Sickness presence (SP) is a complex phenomenon that has been shown to predict sickness absence, poor work performance, and suboptimal self-rated health. However, more research is needed to increase the understanding of how SP relates to occupational factors, demographic variables, and self-rated health.OBJECTIVE: The aims of this study were to investigate (1) the prevalence of SP among the Police employees in Sweden in 2007 and in 2010; (2) the association between demographics, seniority, occupational group (police officer vs civil servant), and self-reported health on the one hand and SP on the other hand for both years separately.METHODS: Survey data from Swedish Police employees from 2007 (n = 17,512) and 2010 (n = 18,415) were analyzed using logistic regression to assess odds ratios (OR) and 95% confidence intervals (CI).RESULTS: The prevalence of SP was stable between the years, but the proportion who stated that they had not been ill at all decreased from 2007 to 2010 (28.0% vs. 23.6%), while the proportion stating always having stayed at home when ill did not differ; 45.0% in 2007 to 45.8% in 2010. The ORs of SP were higher among those with suboptimal self-rated health compared to those with optimal self-rated health (4.38 (95% CI 4.02- 4.78) and 4.31 (3.96- 4.70) in 2007 and 2010, respectively) and among police officers compared with civilians (1.26 (1.17-1.36) and 1.19 (1.10-1.28)), whereas no clear patterns were found for age, gender, and seniority.
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| 26. |
- Taloyan, Marina, et al.
(author)
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Sickness presenteeism predicts suboptimal self-rated health and sickness absence : a nationally representative study of the Swedish working population
- 2012
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 7:9
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Journal article (peer-reviewed)abstract
- BACKGROUND: Earlier studies have suggested that sickness presenteeism (SP) may be a risk factor for future health problems. The purpose of the present study was to test this in a nationally representative prospective study of Swedish workers.METHODS: Prospective cohort with a representative sample of the Swedish working population surveyed in 2008 and 2010. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using logistic regression.RESULTS: Those who reported more than 7 days of SP had higher risk of suboptimal SRH compared to those who reported no SP (OR = 5.95; 95% CI 4.98-7.12), also after adjustment for confounders (OR = 1.64; 95% CI 1.30-2.06). Those who reported 1-7 days of SP also had an increased risk before and after adjustments. Inclusion of self-rated physical and psychological work capacity did not attenuate the associations, whereas of emotional exhaustion attenuated the ORs to non-significance for both outcomes, indicating that the health consequences associated with SP are largely related to mental health.CONCLUSION: The results strengthen earlier findings suggesting that SP can be a risk factor for future suboptimal general health and sickness absence, particularly through mental health problems. This indicates that asking about SP could yield important information for employers, occupational health practitioners and GPs, possibly leading to more timely intervention that could decrease the risk of future sickness absence and more serious health problems, especially in the mental domain. Further studies of the possible causal pathways between SP and future health development are also warranted, especially since going to work is often seen as desirable also for those with poor health.
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| 27. |
- Taloyan, Marina, et al.
(author)
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Web-based support for individuals with type 2 diabetes - a feasibility study
- 2021
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In: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 21:1
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Journal article (peer-reviewed)abstract
- BackgroundSelf-care is one of the cornerstones in the treatment of type 2 diabetes. Patients with type 2 diabetes struggle to maintain acceptable levels of blood sugar, blood pressure and lipids, the fundamental for the prevention of macro- and microvascular as well as neuropathic complications. The primary aim of the study was to evaluate the feasibility and describe patients' and caregivers' experiences of using the web- and smartphone-based system Triabetes. The secondary aim was to investigate if the use of the system could improve patients' clinical outcomes.MethodsFeasibility was assessed with describing recruitment rate and the participants views of using the system. Laboratory and anthropometry data were also collected.ResultsThe study showed that recruitment of patients to participate in the intervention was limited and compliance to the study protocol was low. A majority of the patients stated that the system was easy to get an overview of and that the system motivated them and made it easier and fun to handle lifestyle habits. A secondary finding of the study was that there was a significant lowering of LDL values.Conclusions Feasibility in terms of recruitment rate was low. The participants agreed that the application overall was useful but suggested several improvements. Summarized lessons learned from this study are following: (1) we need more knowledge about what motivates a person to use a digital tool for a longer period of time; (2) the tool must be easy and less time consuming to use; (3) the technical structure needs to be improved and automatic recording of data must be improved.
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| 28. |
- Terio, Minna, et al.
(author)
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Preventing frailty with the support of a home-monitoring and communication platform among older adults-a study protocol for a randomised-controlled pilot study in Sweden
- 2022
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In: Pilot and Feasibility Studies. - : BMC. - 2055-5784. ; 8:1
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Journal article (peer-reviewed)abstract
- Background: POSITIVE (i.e. maintaining and imPrOving the intrinSIc capaciTy Involving primary care and caregiVErs) is a new intervention program consisting of home-monitoring equipment and a communication platform to support treatment of frailty symptoms initially in primary care and prevent disability in older adults. Methods: The primary objectives are to estimate the potential efficacy of the POSITIVE system on improving frailty in at least one point in Fried's criteria and five points in Frailty Trait Scale. The secondary objectives are to (A) assess the recruitment, retention, drop-out rates, compliance with the intervention and the intervention mechanisms of impact; (B) evaluate the usability and acceptance of the POSITIVE system, and to get estimations on; (C) the potential efficacy of the intervention on improving the participants' physical performance, cognitive functions, mood, independency level in activities in daily living, the impact on quality of life and number of falls during the follow-up period; (D) the impact on the caregiver quality of life and caregiver burden; and (E) on the consumption of health care resources, participants' perception of health and level of care received, and healthcare professionals' workload and satisfaction. A randomised controlled, assessor-blinded pilot study design recruiting from a primary care centre in Stockholm Region will be conducted. Fifty older adults identified as pre-frail or frail will be randomised into a control or an intervention group. Both groups will receive a medical review, nutritional recommendations and Vivifrail physical exercise program. The intervention group will receive the POSITIVE-system including a tablet, the POSITIVE application and portable measurement devices. The participants receiving the POSITIVE program will be monitored remotely by a primary care nurse during a 6-month follow-up. Data will be collected at baseline, 3 and 6 months into the intervention though the platform, standardised assessments and surveys. A process evaluation as per Medical Research Council guidance will be conducted after the 6-month follow-up period. Discussion:The implications of the study are to provide estimations on the potential efficacy of the POSITIVE system in improving frailty among older adults and to provide relevant data to inform powered studies of potential efficacy and effectiveness, as well as to inform about the feasibility of the current study design.
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