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Rämgård, MargaretaORCID iD iconorcid.org/0000-0003-1235-620X
Publications (10 of 67) Show all publications
Al Musawi, A., Hellström, L., Axelsson, M., Midlöv, P., Rämgård, M., Cheng, Y. & Eriksson, T. (2024). Intervention for a correct medication list and medication use in older adults: a non-randomised feasibility study among inpatients and residents during care transitions. International Journal of Clinical Pharmacy
Open this publication in new window or tab >>Intervention for a correct medication list and medication use in older adults: a non-randomised feasibility study among inpatients and residents during care transitions
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2024 (English)In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background Medication discrepancies in care transitions and medication non-adherence are problematic. Few interventions consider the entire process, from the hospital to the patient’s medication use at home.

Aim In preparation for randomised controlled trials (RCTs), this study aimed (1) to investigate the feasibility of recruitment and retention of patients and data collection to reduce medication discrepancies at discharge and improve medication adherence and (2) to explore the outcomes of the interventions.

Method Participants were recruited from a hospital and a residential area. Hospital patients participated in a pharmacist-led intervention to establish a correct medication list upon discharge and a follow-up interview two weeks post-discharge. All participants received a person-centred adherence intervention for three to six months. Discrepancies in the medication lists, the Beliefs about Medicines Questionnaire (BMQ-S), and the Medication Adherence Report Scale (MARS-5) were assessed.

Results Of 87 asked to participate, 35 were included, and 12 completed the study. Identifying discrepancies, discussing discrepancies with physicians, and performing follow-up interviews were possible. Conducting the adherence intervention was also possible using individual health plans for medication use. Among the seven hospital patients, 24 discrepancies were found. Discharging physicians agreed that all discrepancies were errors, but only ten were corrected in the discharge information. Ten participants decreased their total BMQ-S concern scores, and seven increased their total MARS-5 scores.

Conclusion Based on this study, conducting the two RCTs separately may increase the inclusion rate. Data collection was feasible. Both interventions were feasible in many aspects but need to be optimised in upcoming RCTs.

Place, publisher, year, edition, pages
Springer Nature, 2024
National Category
Social and Clinical Pharmacy
Research subject
Health and society
Identifiers
urn:nbn:se:mau:diva-66018 (URN)10.1007/s11096-024-01702-4 (DOI)001159736600001 ()2-s2.0-85184470244 (Scopus ID)
Funder
Malmö University
Available from: 2024-02-16 Created: 2024-02-16 Last updated: 2024-02-26Bibliographically approved
Ramji, R., Rämgård, M., Carlson, E., Shleev, S., Awad, E., Cirovic, S. & Kottorp, A. (2023). Health and quality of life among women after participation in a CBPR-informed physical activity intervention: with a pandemic perspective.. Scientific Reports, 13(1), Article ID 17972.
Open this publication in new window or tab >>Health and quality of life among women after participation in a CBPR-informed physical activity intervention: with a pandemic perspective.
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2023 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 13, no 1, article id 17972Article in journal (Refereed) Published
Abstract [en]

The lack of culturally and contextually oriented interventions promoting physical activity (PA) has led to increased physical inactivity among women living in disadvantaged neighbourhoods in Sweden. In this study one such intervention informed by community-based participatory research (CBPR) has been evaluated among 34 women from a disadvantaged neighbourhood before and during COVID-19. Health-related quality of life (HRQOL), behavioural and biomedical outcomes were assessed directly prior and post-intervention, followed by evaluations at 6-months and 18-months follow-up during COVID-19. The results revealed that HRQOL, particularly psychological, social, and environmental health significantly increased post-intervention compared to prior to intervention but reversed back at 6-months follow-up. Perceived health satisfaction and environmental health increased at 18-months follow-up during COVID-19. Participation in PA improved post-intervention and at 6-months follow-up. Everyday activities and fruit and vegetable intake continued to increase through all timepoints. Systolic blood pressure significantly decreased post-intervention and 6-months follow-up; blood flow rate increased significantly at all timepoints. Overall, the findings underscores the potential effectiveness of CBPR approaches in promoting and sustaining healthy lifestyles, even during acute situations such as the COVID-19. It may even serve as a future model for promoting health and addressing health disparities in similar groups.

Place, publisher, year, edition, pages
Springer Nature, 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mau:diva-63606 (URN)10.1038/s41598-023-45239-4 (DOI)001087596300084 ()37863947 (PubMedID)2-s2.0-85174618667 (Scopus ID)
Available from: 2023-11-10 Created: 2023-11-10 Last updated: 2024-04-19Bibliographically approved
Lindsjö, C., Sjögren Forss, K., Kumlien, C., Kottorp, A. & Rämgård, M. (2023). Migrant women's engagement in health-promotive activities through a women's health collaboration. Frontiers In Public Health, 11, Article ID 1106972.
Open this publication in new window or tab >>Migrant women's engagement in health-promotive activities through a women's health collaboration
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2023 (English)In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 1106972Article in journal (Refereed) Published
Abstract [en]

Introduction: Social determinants of health impact health, and migrants are exposed to an inequitable distribution of resources that may impact their health negatively, leading to health inequality and social injustice. Migrant women are difficult to engage in health-promotional activities because of language barriers, socioeconomic circumstances, and other social determinants. Based on the framework of Paulo Freire, a community health promotion program was established in a community-academic partnership with a community-based participatory research approach.

Aim: The aim of this study was to describe how a collaborative women's health initiative contributed to migrant women's engagement in health promotion activities.

Materials and methods: This study was part of a larger program, carried out in a disadvantaged city area in Sweden. It had a qualitative design with a participatory approach, following up on actions taken to promote health. Health-promotional activities were developed in collaboration with a women's health group, facilitated by a lay health promoter. The study population was formed by 17 mainly Middle Eastern migrant women. Data was collected using the story-dialog method and the material was analyzed using thematic analysis.

Result: Three important contributors to engagement in health promotion were identified at an early stage of the analysis process, namely, the group forming a social network, the local facilitator from the community, and the use of social places close to home. Later in the analysis process, a connection was made between these contributors and the rationale behind their importance, that is, how they motivated and supported the women and how the dialog was conducted. This therefore became the designated themes and were connected to all contributors, forming three main themes and nine sub-themes.

Conclusion: The key implication was that the women made use of their health knowledge and put it into practice. Thus, a progression from functional health literacy to a level of critical health literacy may be said to have occurred.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
health equality, community-based participatory research, health literacy, health promotion, migrant women, social support, story-dialog method, lay health promoter
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mau:diva-61929 (URN)10.3389/fpubh.2023.1106972 (DOI)001016086800001 ()37397757 (PubMedID)2-s2.0-85164209706 (Scopus ID)
Available from: 2023-08-16 Created: 2023-08-16 Last updated: 2023-08-21Bibliographically approved
Rämgård, M., Ramji, R., Kottorp, A. & Sjögren Forss, K. (2023). 'No one size fits all' - community trust-building as a strategy to reduce COVID-19-related health disparities. BMC Public Health, 23(1), Article ID 18.
Open this publication in new window or tab >>'No one size fits all' - community trust-building as a strategy to reduce COVID-19-related health disparities
2023 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 18Article in journal (Refereed) Published
Abstract [en]

Background Citizens with low levels of social capital and social status, and relative poverty, seem to have been disproportionally exposed to COVID-19 and are at greater risk of experiencing poor health. Notably, the incidence of COVID-19 was nearly three times higher among citizens living in socially vulnerable areas. Experiences from the African Ebola epidemic show that in an environment based on trust, community partners can help to improve understanding of disease control without compromising safety. Such an approach is often driven by the civil society and local lay health promoters. However, little is known about the role of lay health promoters during a pandemic with communicable diseases in the European Union. This study had its point of departure in an already established Community Based Participatory Research health promotion programme in a socially disadvantaged area in southern Sweden. The aim of this study was to explore how citizens and local lay health promoters living in vulnerable neighbourhoods responded to the COVID-19 pandemic a year from the start of the pandemic.Method In-depth interviews with the 5 lay health promoters and focus group discussions with 34 citizens from the neighbourhood who were involved in the activities within the programme were conducted in autumn 2020. The interviews and focus group discussions were transcribed verbatim and analysed using qualitative content analysis following an inductive approach.Results Four themes emerged including, 'balancing between different kinds of information', 'balancing between place-based activities and activities on social media', 'bridging between local authorities and the communities and community members', and 'balancing ambivalence through participatory dialogues'.Conclusion The study highlights that a Community Based Participatory Research programme with lay health promoters as community trust builders had a potential to work with communicable diseases during the pandemic. The lay health promoters played a key role in promoting health during the pandemic by deepening the knowledge and understanding of the role that marginalised citizens have in building resilience and sustainability in their community in preparation for future crises. Public health authorities need to take the local context into consideration within their pandemic strategies to reach out to vulnerable groups.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Health promotion, Culture brokers, Pandemic, Resilience, Vulnerable neighbourhood
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mau:diva-58376 (URN)10.1186/s12889-022-14936-6 (DOI)000907148500001 ()36597039 (PubMedID)2-s2.0-85145429653 (Scopus ID)
Available from: 2023-02-27 Created: 2023-02-27 Last updated: 2024-02-05Bibliographically approved
Isma, G. E., Rämgård, M. & Enskär, K. (2023). Perceptions of health among school-aged children living in socially vulnerable areas in Sweden. Frontiers In Public Health, 11, Article ID 1136832.
Open this publication in new window or tab >>Perceptions of health among school-aged children living in socially vulnerable areas in Sweden
2023 (English)In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 1136832Article in journal (Refereed) Published
Abstract [en]

Introduction: According to the Convention on the Rights of the Child, all children have the right to health. Since good health is a decisive factor for children's future, investing in children's health is important, especially children from vulnerable areas. The purpose of this study was to investigate the perceptions of health among school-aged children from socially vulnerable areas.

Methods: The study has an explorative mixed-method design with a participatory and inductive approach based on focus group interviews with children and youth leaders, respectively, at Multi-activity Centers in three of the vulnerable areas in Malmö Municipality, as well as results from the Multi-activity Centers' own questionnaire. The data has been analyzed with inductive and deductive content analysis.

Results: The children and the youth leaders described health in terms of well-being, participation, and activity. Well-being included feeling good and safe, having a healthy body, and having fun by doing things together with friends and leaders. Participating in activities was described as having a feeling of involvement, being able to have an influence on the organization of the activities and participating on one's own terms.

Discussion: The result of this study shows that participating in activities increases the child's sense of well-being.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
multi-activity center, health, well-being, participatory design, schoolchildren, socially vulnerable area
National Category
Nursing
Identifiers
urn:nbn:se:mau:diva-61905 (URN)10.3389/fpubh.2023.1136832 (DOI)001030170900001 ()37483930 (PubMedID)2-s2.0-85165276154 (Scopus ID)
Available from: 2023-08-16 Created: 2023-08-16 Last updated: 2023-08-21Bibliographically approved
Ramji, R., Rämgård, M. & Kottorp, A. (2023). Psychometric properties of the WHOQOL-BREF in citizens from a disadvantaged neighborhood in Southern Sweden. Frontiers in Psychology, 14
Open this publication in new window or tab >>Psychometric properties of the WHOQOL-BREF in citizens from a disadvantaged neighborhood in Southern Sweden
2023 (English)In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 14Article in journal (Refereed) Published
Abstract [en]

Background: Citizens living in disadvantaged neighborhoods experience poorer health than the majority, and this inequality is a public health problem even in a welfare state such as Sweden. Numerous initiatives aimed at improving health and quality of life in these populations are being implemented and evaluated. Given that these populations are predominantly multicultural and multilingual, an instrument such as the WHOQOL-BREF, which is cross-culturally validated and available in multiple languages, may be appropriate. However, this cannot be ascertained since the psychometric properties of WHOQOL-BREF have never been assessed in the Swedish context. Thus, the current study aimed at assessing the psychometric properties of the WHOQOL-BREF questionnaire in citizens from a disadvantaged neighborhood in Southern Sweden.

Methods: The respondents in this study were 103 citizens who participated in the health promotional activities of a Health promotional program and also responded to the 26-item, WHOQOL-BREF questionnaire as a part of an evaluation to assess the impact of the activities on the health-related quality of life of citizens. A Rasch model using WINSTEP 4.5.1 was used to assess the psychometric properties in this study.

Results: Five of the 26 items, including pain and discomfort, dependence on medical substances, physical environment, social support, and negative feelings did not display acceptable goodness-of-fit to the Rasch model. On removing these items, the 21-item WHOQOL-BREF scale had an improved internal scale validity and person-separation reliability than the original 26-item version for this group of citizens from the neighborhood. When assessing the individual domains, three of the five items that were misfits on analyzing the full model also showed misfits in relation to two respective domains. When these items were removed, the internal scale validity of the domains also improved.

Conclusion: WHOQOL-BREF seemed to be psychometrically inadequate when used in the original form due to internal scale validity problems, while the modified 21-item scale seemed better at measuring the health-related quality of life of citizens living in socially disadvantaged neighborhoods in Sweden. Omission of items shall be done but with caution. Alternatively, future studies may also consider rephrasing the items with misfits and further testing the instrument with larger samples exploring the associations between subsamples and specific item misfit responses.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Care science
Identifiers
urn:nbn:se:mau:diva-60289 (URN)10.3389/fpsyg.2023.1118575 (DOI)000975343200001 ()37113124 (PubMedID)2-s2.0-85153473969 (Scopus ID)
Funder
Vinnova, DNR 2016-00421, 2017-01272
Available from: 2023-06-09 Created: 2023-06-09 Last updated: 2023-06-20Bibliographically approved
Yin, J., Rämgård, M. & Wangel, A.-M. (2023). Sexual health in diabetes care is a 'hot topic'-A qualitative study with Diabetes Specialist Nurses. Journal of Clinical Nursing, 32(19-20), 7568-7577
Open this publication in new window or tab >>Sexual health in diabetes care is a 'hot topic'-A qualitative study with Diabetes Specialist Nurses
2023 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 32, no 19-20, p. 7568-7577Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study is to illuminate Diabetes Specialist Nurses' experiences of having a conversation about sexual health with adults with diabetes.

Background: It is well known that diabetes mellitus may affect a person's sexual function. Interview studies with men and women living with diabetes show that conversations about sexual health are important. However, research on Diabetes Specialist Nurses' experiences of having such conversations is limited.

Design: A qualitative approach, with individual interviews, was used.

Method: Purposive sampling was used to recruit 12 informants from adult diabetes care, within primary health care and within hospital settings in southern Sweden, between September and November 2021. A qualitative latent content analysis was used for data analysis. The COREQ guidelines were followed to ensure rigour for this study.

Results: One theme, 'Sexual health is a hot topic', could be understood in light of three categories: 'Obstructive factors that complicate the conversation', 'Promoting factors that facilitate the conversation' and 'Improvements that may facilitate the conversation'. The findings embrace the Diabetes Specialist Nurses' experiences of having a conversation about sexual health with persons with diabetes.

Conclusions: Diabetes Specialist Nurses often experience difficulty having a conversation about sexual health with their patients. The findings provide a deeper understanding of their experiences of obstructive as well as promoting factors related to conversations about what is considered a 'hot topic'.

Relevance to Clinical Practice: To increase knowledge on how to have a conversation about sexual health within diabetes care, support is needed from the organisation; the organisation could, for instance, support the diabetes care staff in gaining education and training regarding sexual health.

Patient or Public Contribution: Not applicable due to the current method.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
diabetes mellitus, diabetes specialist nurse, fundamentals of care, nursing research, person-centred care, qualitative content analysis, sexual health
National Category
Nursing
Identifiers
urn:nbn:se:mau:diva-61881 (URN)10.1111/jocn.16832 (DOI)001032706700001 ()37475608 (PubMedID)2-s2.0-85165468506 (Scopus ID)
Available from: 2023-08-16 Created: 2023-08-16 Last updated: 2023-10-18Bibliographically approved
Avery, H., Sjögren Forss, K. & Rämgård, M. (2022). Empowering communities with health promotion labs: result from a CBPR programme in Malmö, Sweden. Health Promotion International (1), 1-15, Article ID daab069.
Open this publication in new window or tab >>Empowering communities with health promotion labs: result from a CBPR programme in Malmö, Sweden
2022 (English)In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, no 1, p. 1-15, article id daab069Article in journal (Refereed) Published
Abstract [en]

Health promotion is thus not only a participatory practice, but a practice forempowerment and social justice. The study describes findings from a community-basedparticipatory and challenge-driven research program. that aimed to improve health through healthpromotion platform in an ethnically diverse low-income neighbourhood of Malmö, Sweden. Localresidents together with lay health promoters living in the area were actively involved in theplanning phase and decided on the structure and content of the program. Academic, public sectorand commercial actors were involved, as well as NGOs and residents. Empowerment was usedas a lens to analyse focus group interviews with participants (n=322) in six co-creative healthpromotinglabs on three occasions in the period 2017-2019. The CBP R interview guide focusedon the dimensions of participation, collaboration and experience of the activities. The CBP Rapproach driven by community member contributed to empowerment processes within the healthpromotion labs: Health promotors building trust in social places for integration, Participantsmotivate each other by social support and Participants acting for community health in widercircle. CBP R Health promotion program should be followed up longitudielly with communityparticipants to be able to see the processes of change and empowerment on the community level.

Place, publisher, year, edition, pages
Oxford University Press, 2022
Keywords
CBPR, Sweden, empowerment, health promotion, immigrant background, inequity, urban neighbourhoods
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mau:diva-45017 (URN)10.1093/heapro/daab069 (DOI)000756384500001 ()34263320 (PubMedID)2-s2.0-85124804866 (Scopus ID)
Available from: 2021-08-20 Created: 2021-08-20 Last updated: 2024-02-05Bibliographically approved
Ramji, R., Carlson, E., Kottorp, A. & Rämgård, M. (2022). Impact of a CBPR-informed physical activity intervention before and during COVID-19 among women from a disadvantaged neighborhood in Sweden.. Frontiers In Public Health, 10, Article ID 997329.
Open this publication in new window or tab >>Impact of a CBPR-informed physical activity intervention before and during COVID-19 among women from a disadvantaged neighborhood in Sweden.
2022 (English)In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, article id 997329Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Public health practitioners have been striving to reduce the social gradient and promote physical activity among citizens living in disadvantaged neighborhoods. The emergence of the COVID-19 pandemic, which has affected these citizens extensively, has posed a significant challenge to efforts to maintain a physically active lifestyle. Thus, the aim of this study was to explore the impact of a CBPR-informed physical activity intervention before and during the COVID-19 pandemic from the perspective of women from a socially disadvantaged neighborhood.

METHODS: A total of 34 women participated in a CBPR-informed physical activity intervention previously developed in collaboration with lay health promoters and other citizens from the same neighborhood. Focus group discussions were conducted at four time points, namely, at baseline prior to the intervention, post-intervention, 6 months after the intervention ended, and during the COVID-19 pandemic. The data were analyzed using qualitative content analysis following an inductive approach.

RESULTS: In total, four themes emerged from the discussions: "Wavering between frustration and action," "Shifting from prioritizing family needs to taking control of self," "Between isolation and social support," and "Restricted access to health-related knowledge vs. utilizing internalized knowledge".

CONCLUSION: The results of this study reveal that building on CBPR-informed health promotion initiatives has the potential to foster individual empowerment and assist during acute situations like the COVID-19 pandemic through mobilizing communities and their resources, which leads to increased community resilience and health. This study is regarded as unique in that it involves evaluation of a CBPR intervention that was initiated ahead of the pandemic and followed even during the pandemic.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
community empowerment, community resilience, community-based participatory research, pandemic (COVID-19), social support
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mau:diva-56697 (URN)10.3389/fpubh.2022.997329 (DOI)000893344500001 ()36478727 (PubMedID)2-s2.0-85143333962 (Scopus ID)
Available from: 2022-12-14 Created: 2022-12-14 Last updated: 2023-07-05Bibliographically approved
Rämgård, M. & Avery, H. (2022). Lay Health Promoters Empower Neighbourhoods-Results From a Community-Based Research Programme in Southern Sweden. Frontiers In Public Health, 10, 1-13, Article ID 703423.
Open this publication in new window or tab >>Lay Health Promoters Empower Neighbourhoods-Results From a Community-Based Research Programme in Southern Sweden
2022 (English)In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, p. 1-13, article id 703423Article in journal (Refereed) Published
Abstract [en]

This article focuses on the role of lay health promoters in the Lindangen initiative, a community-based participatory research (CBPR) programme for health promotion that started 2016 in a low-income neighbourhood in the outskirts of Malmo, southern Sweden. The programme aimed to support equitable health and develop an innovative model for community health promotion. The purpose of this article is to describe the role of the lay health promoters in the initiative and discuss the challenges of their position mediating between residents of the neighbourhood and the established institutions, using interviews, meeting notes and focus groups sessions with the health promoters and local stakeholders. Lay health promoters' role and function developed in a collaborative process of networking with local stakeholders and citizens in local meeting places. Their work was based on their credibility in their role, in combination with the use of a CBPR model that was open to innovation, with a strong focus on actively engaging members of the community. This allowed the lay health promoters to take political and social stances towards various issues, and to start to concretely address the social determinants of health in the community, as well as express recommendations to policymakers. Based on these experiences, the lay health promoters gained clearer insights into the institutional and structural conditions that impact their community. The position they had in the process of the programme resulted in empowerment and a new local association for health promotion; LindangenKraft (LindangenPower) driven by the health promotors and community members.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
empowerment, community-based participatory research (CBPR), health equity, health promoters, community health work
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mau:diva-53943 (URN)10.3389/fpubh.2022.703423 (DOI)000798120600001 ()35602126 (PubMedID)2-s2.0-85130769118 (Scopus ID)
Available from: 2022-08-01 Created: 2022-08-01 Last updated: 2023-10-23Bibliographically approved
Projects
Health promotion in collaboration MITRA Open road; Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV)Existentiell loneliness – a challenge in care for older person; Malmö UniversityHealth promotion in Collaboration; Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV); Publications
Ramji, R. (2022). Health promotional interventions informed by community-based participatory research in a socially disadvantaged neighbourhood: development, exploration and evaluation. (Doctoral dissertation). Malmö universitet
Existential loneliness from the perspective of older migrantsCitizens building local resilience by health promotion during the COVID-19 pandemic; Malmö UniversitymHealth in pandemic situations: Smartphone based portable and wearable sensors for COVID-19 diagnostic; Malmö University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1235-620X

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