A survey targeting ASPHER members was launched in 2010/11, being a first initiative in improving ethics education in European Schools of Public Health. An 8-items questionnaire collected information on teaching of ethics in public health. A 52% response rate (43/82) revealed that almost all of the schools (95% out of 40 respondents with valid data) included the teaching of ethics in at least one of its programmes. They also expressed the need of support, (e.g.: a model curriculum (n=25), case studies (n=24)), which indicates further work to be met by the ASPHER Working Group on Ethics and Values in Public Health.

BACKGROUND: While a large body of research has focused on the challenges experienced by healthcare staff when providing sexual and reproductive health services, little attention has been paid to the ways healthcare providers navigate these challenges. This study examined healthcare providers' accounts of encounters when providing sexual and reproductive health (SRH) services to migrants in Southern Sweden. It sought to examine challenges and dilemmas experienced by healthcare providers, strategies used to navigate these challenges and dilemmas, and assumptions underlying participants' accounts.

METHODS: The data collection was conducted between September 2020 and March 2021. Qualitative thematic analysis was used to analyze thirty-one interviews with healthcare providers working in youth clinics and women healthcare clinics. The analysis was guided by a conceptual framework combining person-centered care approach, Foucault's concepts on power/knowledge, and theories to navigate diversity in healthcare setting: cultural competency and cultural humility.

RESULTS: Three themes were identified in the analysis: 1) Between person centeredness and cultural considerations; 2) Knowledge positions and patient involvement; and 3) beyond the dyadic interaction healthcare provider-patient. Some participants understood person-centered care as individualized care where the influence of culture on the encounter should be de-emphasized, whereas others tended to highlight this influence. Many participants viewed the influence of culture as primarily driven by migrants' cultural backgrounds, and as a source of challenges and dilemmas. Participants' strategies to navigate these perceived challenges and dilemmas included practicing cultural humility and seeking cultural competency. Knowledge positions also emerged as an important aspect of participants' accounts of encounters with migrants. Many participants experienced that migrant patients were lacking knowledge about the body and sexuality. This disadvantaged knowledge position affected migrant involvement in care. Additionally, the study shows how participants placed their experiences in a broader organizational and social context. Participants highlighted several organizational challenges to encountering migrants and discussed dilemmas stemming from the interplay between migrants' structural and individual disadvantages.

CONCLUSIONS: The study findings illuminate the complex links between person-centered care and two important dimensions of the encounters with migrants: culture and knowledge positions. They also shed the light on the organizational and structural challenges surrounding these encounters. These findings suggest that multilevel strategies are needed to improve the quality of encounters when providing SRH services to migrants. These strategies could include ensuring universal access to SRH services to migrants, adjusting the encounter duration when interpretation is needed, and providing necessary resources to healthcare providers to build their structural competency.

Background

Previous research has shown that migrants in Sweden are disadvantaged in terms of sexual and reproductive health and rights (SRHR). SRHR policies might play a crucial role in shaping migrants’ SRHR outcomes. The purpose of the study was to critically examine: a) how migrants were represented in the discourses embedded within Swedish SRHR-related policies, and b) how migrants’ SRHR-related issues were framed and addressed within these discourses.

Methods

Critical discourse analysis (CDA) was used to analyze a total of 54 policy documents. Following Jäger’s approach to CDA, discourse strands and entanglements between different discourse strands were examined.

Results

Our findings consisted of three discourse strands: 1) “Emphasizing vulnerability”, 2) “Constructing otherness”, and 3) “Prioritizing the structural level or the individual level?”.

Migrants’ representation in Swedish SRHR-related policies is often associated with the concept of vulnerability, a concept that can hold negative connotations such as reinforcing social control, stigma, and disempowerment. Alongside the discourse of vulnerability, the discourse of otherness appears when framing migrants’ SRHR in relation to what is defined as honor-related violence and oppression. Furthermore, migrant SRHR issues are occasionally conceptualized as structural issues, as suggested by the human rights-based approach embraced by Swedish SRHR-related policies. Relevant structural factors, namely migration laws and regulations, are omitted when addressing, for example, human trafficking and HIV/AIDS.

Conclusions

We conclude that the dominant discourses favor depictions of migrants as vulnerable and as the Other. Moreover, despite the prevailing human rights-based discourse, structural factors are not always considered when framing and addressing migrants’ SRHR issues. This paper calls for a critical analysis of the concept of vulnerability in relation to migrants’ SRHR. It also highlights the importance of avoiding othering and paying attention to the structural factors when addressing migrants’ SRHR.

Background: Problematic alcohol use in Sweden occurs among 16 % of the adult population. Digital interventions of varying intensity have shown positive effects in contributing to reductions in problematic use, and the TeleCoach app has shown positive effects in non-treatment-seeking university students with excessive drinking (Gajecki et al., 2017). This pilot study evaluates the app among adult internet help-seekers. This pilot study evaluated the app among adult internet help-seekers, and motivated continued data collection in the current target group Methods: Adult internet-help seekers, recruited via advertisement, were included if they scored ³6 (women) or ³8 (men) on the Alcohol Use Disorders Identification Test (AUDIT). Those with depression scores of ³31 on the Montgomery Åsberg Depression Rating Scale (MADRS-S) or problematic drug use scores of ³8 on the Drug Use Disorders Identification Test (DUDIT) were contacted for a telephone interview and included following clinical assessment; if not reached they were excluded. Participants randomized at a 1:1 ratio to the TeleCoach™ web-based app or to a web-based app with information texts from primary care-based self-help material for changing problematic alcohol use. At six-week follow-up, the primary outcome was the number of standard drinks per past week (Timeline-Followback). Results: Of 147 persons assessed for eligibility, 89 were assigned to the intervention group (n=42) or control group (n=47). Average AUDIT levels at baseline were ³18.The baseline number of standard drinks per week was 32.73 (SD 21.16) for the intervention group, and 26 (4.08) for the control group; at 6-week follow-up it was 12.73 (10.52) and 13.48 (11.13) for the intervention and control groups, respectively. No significant between-groups effects occurred, but withingroup changes over time were significant (F(1, 55)=43.98; p< 0.000), with an effect size of 1.37 for the intervention group and 0.92 for the control group. Conclusions: The results suggest that web-based apps can be of help to internet help-seekers motivated to reduce problematic alcohol use. We have proceeded with the planned larger randomized, controlled study and will present 6-week follow-up data for the entire study sample (n=∼1000) in this presentation.

Objectives This study evaluates whether initiation rates, completion rates, response patterns and prevalence of psychiatric conditions differ by level of personal integrity information given to prospective participants in an online mental health self-report survey. Methods A three-arm, parallel-group, single-blind experiment was conducted among students from two Swedish universities. Consenting participants following e-mail invitation answered the World Health Organization (WHO) World Mental Health-International College Student (WMH-ICS) mental health self-report survey, screening for eight psychiatric conditions. Random allocation meant consenting to respond (1) anonymously; (2) confidentially, or (3) confidentially, where the respondent also gave consent for collection of register data. Results No evidence was found for overall between-group differences with respect to (1) pressing a hyperlink to the survey in the invitation email; and (2) abandoning the questionnaire before completion. However, participation consent and self-reported depression were in the direction of higher levels for the anonymous group compared to the two confidential groups. Conclusions Consent to participate is marginally affected by different levels of personal integrity information. Current standard participant information procedures may not engage participants to read the information thoroughly, and online self-report mental health surveys may reduce stigma and thus be less subject to social desirability bias.

Objective: During the COVID pandemic, government authorities worldwide have tried to limit the spread of the virus. Sweden's distinctive feature was the use of voluntary public health recommendations. Few studies have evaluated the effectiveness of this strategy. Based on data collected in the spring of 2020, this study explored associations between compliance with recommendations and observed symptoms of contagion in others, using self-report data from university students.

Results: Compliance with recommendations ranged between 69.7 and 95.7 percent. Observations of moderate symptoms of contagion in "Someone else I have had contact with" and "Another person" were markedly associated with reported self-quarantine, which is the most restrictive recommendation, complied with by 81.2% of participants. Uncertainty regarding the incidence and severity of contagion in cohabitants was markedly associated with the recommendation to avoid public transportation, a recommendation being followed by 69.7%. It is concluded that students largely followed the voluntary recommendations implemented in Sweden, suggesting that coercive measures were not necessary. Compliance with recommendations were associated with the symptoms students saw in others, and with the perceived risk of contagion in the student's immediate vicinity. It is recommended that voluntary recommendations should stress personal relevance, and that close relatives are at risk.

OBJECTIVE: The present study investigates if symptoms of COVID-19 contagion in different social contexts (cohabitants, family, acquaintances, and others) are associated with university students' own self-reported symptoms of COVID-19 contagion, mental health, and study capacity. This was investigated by a cross-sectional survey administrated in Sweden during the first wave of the COVID-19 pandemic, at the time when universities were locked down to limit viral spread and contagion.

RESULTS: Mild to moderate symptoms of COVID-19 in cohabitants and family members were associated with student's self-reported symptoms of contagion, while no associations could be seen in relation to mental health and study capacity. Symptoms of COVID-19 contagion in acquaintances and others were not associated with students' self-reported symptoms, nor with their mental health and study capacity. To conclude, during the initial lockdown of universities students' self-reported symptoms of contagion were mainly associated with cohabitants and family members, while symptoms of contagion in different social contexts were not associated with mental health and study capacity. Findings suggest that lockdown of universities may have contributed to limiting infection pathways, while still allowing students to focus on their studies despite significant contagion among others known to the student.

Objective: To investigate perceived changes in academic self-efficacy associated with self-reported symptoms of COVID-19, changes in mental health, and trust in universities’ management of the pandemic and transition to remote education during lockdown of Swedish universities in the spring of 2020. Methods: 4495 participated and 3638 responded to self-efficacy questions. Associations were investigated using multinomial regression. Results: Most students reported self-experienced effects on self-efficacy. Lowered self-efficacy was associated with symptoms of contagion, perceived worsening of mental health and low trust in universities’ capacity to successfully manage the lockdown and transition to emergency remote education. Increased self-efficacy was associated with better perceived mental health and high trust in universities. Conclusion: The initial phase of the pandemic was associated with a larger proportion of students reporting self-experienced negative effects on academic self-efficacy. Since self-efficacy is a predictor of academic performance, it is likely that students’ academic performance will be adversely affected. 

OBJECTIVE: This study used causal inference to estimate the longitudinal effects of contagion in cohabitants and family members on university students' mental health and academic self-efficacy during the COVID-19 pandemic.

DESIGN: A prospective longitudinal study including a baseline online measurement in May 2020, and online follow-ups after 5 months and 10 months. Participants were recruited through open-access online advertising.

SETTING: Public universities and university colleges in Sweden.

PARTICIPANTS: The analytical sample included 2796 students.

OUTCOME MEASURES: Contagion in cohabitants and in family members was assessed at baseline and at the 5-month follow-up. Mental health and academic self-efficacy were assessed at the 5-month and 10-month follow-ups.

RESULTS: Mild symptoms reported in cohabitants at baseline resulted in negative mental health effects at follow-up 5 months later, and mild baseline symptoms in family members resulted in negative effects on academic self-efficacy at follow-ups both 5 and 10 months later.

CONCLUSIONS: Notwithstanding the lack of precision in estimated effects, the findings emphasise the importance of social relationships and the challenges of providing students with sufficient support in times of crisis.

In higher education, students' trust in the university management may affect both mental health and academic self-efficacy. This longitudinal study, conducted during the most challenging course of the COVID-19 pandemic, uses multinomial regression and causal inference to estimate the effects of students' trust in their universities' strategies for managing the pandemic, on students' self-reported changes in mental health and academic self-efficacy. The analyzed sample (N = 2796) was recruited through online advertising and responded to a baseline online survey in the late spring of 2020, with two follow-up surveys five and ten months later. Results show that positive trust in university management of the pandemic protected against experiencing one's mental health and academic self-efficacy as worse rather than unchanged, both five and ten months after the baseline assessment. The findings emphasize the importance of developing and maintaining trust-building measures between academia and students to support students' mental health and academic self-efficacy in times of uncertainty.

Introduction: Risk factors of traditional substance use related problems in young adults are more well-known than for behavioral addictions such as gambling and gaming problems. The present study aims to provide knowledge about the longitudinal patters of substance use related and behavioral addictions in early adulthood. Methods: Using self-report surveys, substance-related, psychiatric, and demographic predictors were assessed in Swedish high school seniors and re-assessed six years later along with gambling and gaming problems, n = 800. Associations (Risk Ratios) between risk factors in late adolescence and problem behaviors in young adulthood were analyzed. Results: Tobacco use, illicit drug use, and hazardous drinking in young adulthood were associated with tobacco use, illicit drug use, alcohol use, conduct problems, and impaired impulse control in late adolescence. Gambling problems in young adulthood were only associated with heredity of alcohol problems, while gaming was not associated to any problem behavior in late adolescence. Conclusion: It is concluded that predictors for traditional substance-related addictions differ from predictors for behavioral addictions, and that this difference is more pronounced for gaming problems than for gambling problems.

Research question and purpose: Les Mills is a New Zealand-based fitness distributor with a community consisting of approximately 140.000 instructors worldwide who teach standardized work- out routines. This paper aims to explore how the COVID-19 pandemic and related measurements, such as social distancing affect the everyday lives and professions of Les Mills International (LMI) group fitness instructors. The aim was met with the following research questions: RQ1: How are social distancing and social connectedness understood, and how do they condition LMI instructors’ understanding of their profession? RQ2: What do LMI instructors think about the #LesMillsUnited campaign to maintain a strong trainer community in the midst of the pandemic? RQ3: How do LMI instructors think that group fitness will change long term due to social distancing? Research methods: Using qualitative measures and a case-study-based approach, data were gathered through interviews with LMI-certified group fitness instructors. Seven semi-structured focused group dis- cussions with fifteen group fitness instructors from different countries were conducted and audio recorded. The first round of virtual discussions took place in April 2020, and the follow-up talks in September 2020. A thematic analysis was employed to analyze the material. Results and findings: According to the participants, online classes as a means of upholding group fitness in times of social distancing is an insufficient substitute to face-to-face instructing, lacking social connectedness that is normally maintained through successful rituals or social scripts. Navigating “instructorhood” during the pandemic includes emotional labor where not only relationships to clients are challenged, but instructors also experience societal pressure to reinvent themselves as instructors. Implications: With no way of telling how long social distancing needs to be practiced, the group fitness industry is facing unprecedented challenges. Making sense of the group fitness profession currently preoccupies instructors who may now have to redefine to themselves how they can teach, and who for.

The COVID-19 pandemic and its related measurements have challenged physical activity in various ways, ranging from closed fitness facilities to virtual curfews. Correspondingly, there is currently a rising scholarly interest in investigating how people have navigated their physical activity during the pandemic, and, especially, if physical activity has decreased or not. Accordingly, surveys and studies are rapidly accumulating. Therefore, the purpose of this literature review is to summarize, categorize, and map literature published before May 2021 on physical activity amid COVID-19.This study consists of a mixed methods explanatory sequential design, based on an outcome-oriented pragmatism of the middle. Firstly, a systematic literature review on Scopus was conducted, followed by a VOS-viewer bibliometric analysis. Subsequently, a focused literature review was written. The point of integration of methods was embedded. The systematic review resulted in 1,335 articles, which were used for two separate VOS-viewer visualizations. The illustrations reveal where research comes from, which journals have published most on physical activity during COVID-19, and how the research is globally cited. Furthermore, based on the review, three clear topical trends of research emerge; spatial transitions, frequencies of physical activity, and motivations to exercise during COVID-19. The bibliometric data demonstrates that research from only a few countries seem to be impactful, whereas the review portrays that conclusions in regard to whether physical activity has decreased or not lack agreement, possibly as a result of disclosing different definitions of physical activity.

The COVID-19 pandemic precipitated numerous changes in daily life, including the cancellation and restriction of sports globally. Because sports participation contributes positively to the development of student-athletes, restricting these activities may have led to long-term mental health changes in this population. Using a repeated cross-sectional study design, we measured rates of depression using the Patient Health Questionnaire-2 and anxiety using the Generalized Anxiety Disorder-2 scale in student-athletes attending elite sport high schools in Sweden during the second wave of the pandemic (February 2021; n = 7021) and after all restrictions were lifted (February 2022; n = 6228). Depression among student-athletes decreased from 19.8% in 2021 to 17.8% in 2022 (p = .008, V = .026), while anxiety screening did not change significantly (17.4% to 18.4%, p > .05). Comparisons between classes across years revealed older students exhibited decreases in depressive symptoms, while younger cohorts experienced increases in symptoms of anxiety from 2021 to 2022. Logistic regressions revealed that being female, reporting poorer mental health due to COVID-19, and excessive worry over one's career in sports were significant predictors of both depression and anxiety screenings in 2022. Compared to times when sports participation was limited, the lifting of restrictions was associated with overall reduced levels of depression, but not anxiety.

BACKGROUND: Experiences from the COVID-19 pandemic may help to better understand resilience, competences and skills for healthcare providers and the healthcare system. Within sexual and reproductive health inequalities for migrants exist and it is an area where promoting both cultural competency and healthcare equity in the clinical encounter is expected of healthcare providers yet can create tension. The aim is to explore healthcare providers experiences of encounters with migrants in the context of the pandemic and the subsequent changes in routines and norms.

METHODS: A qualitative study based on semi-structured interviews with 31 healthcare providers working in sexual and reproductive healthcare in southern Sweden. Interviews were conducted during the COVID-19 pandemic influencing how healthcare providers reflected on their experiences. Analysis was done using reflexive thematic data analysis.

FINDINGS: Healthcare providers reflected on how changes in routines increased the understanding of challenges and enablers in the intercultural encounter including the impact on communication and role of relatives and male partners. They emphasized the dynamics of culture in the clinical encounter and healthcare system through highlighting the importance of structural awareness, self-reflection and the flexibility of conducts and norms, often given a cultural connotation.

CONCLUSION: The COVID-19 pandemic resulted in changes of previously established routines directly affecting clinical encounters, which provided a unique opportunity for healthcare providers to reflect, with communication and self-reflection being discussed as central in complex encounters. It highlighted the dynamics of presumed deeply rooted cultural norms and the interplay with social factors affecting healthcare providers and patients alike.

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.

BackgroundMental healthcare is an important component in societies' response to mental health problems. Although the World Health Organization highlights availability, accessibility, acceptability and quality of healthcare as important cornerstones, many Europeans lack access to mental healthcare of high quality. Qualitative studies exploring mental healthcare from the perspective of people with lived experiences would add to previous research and knowledge by enabling in-depth understanding of mental healthcare users, which may be of significance for the development of mental healthcare. Therefore, the aim of the current study was to describe experiences of mental healthcare among adult Europeans with mental health problems.MethodIn total, 50 participants with experiences of various mental health problems were recruited for separate focus group interviews in each country. They had experiences from both the private and public sectors, and with in- and outpatient mental healthcare. The focus group interviews (N=7) were audio recorded, transcribed verbatim and analysed through thematic analysis. The analysis yielded five themes and 13 subthemes.ResultsThe theme Seeking and trying to find help contained three subthemes describing personal thresholds for seeking professional help, not knowing where to get help, and the importance of receiving help promptly. The theme Awaiting assessment and treatment contained two subthemes including feelings of being prioritized or not and feelings of being abandoned during the often-lengthy referral process. The theme Treatment: a plan with individual parts contained three subthemes consisting of demands for tailored treatment plans in combination with medications and human resources and agreement on treatment. The theme Continuous and respectful care relationship contained two subthemes describing the importance of continuous care relationships characterised by empathy and respect. The theme Suggestions for improvements contained three subthemes highlighting an urge to facilitate care contacts and to increase awareness of mental health problems and a wish to be seen as an individual with potential.ConclusionFacilitating contacts with mental healthcare, a steady contact during the referral process, tailored treatment and empathy and respect are important aspects in efforts to improve mental healthcare. Recommendations included development of collaborative practices between stakeholders in order to increase general societal awareness of mental health problems.

The COVID-19 pandemic has brought about several restrictions throughout society which has limited people's outdoor activities and forced individuals to stay home. These circumstances have possibly had an impact on the prevalence of domestic violence and other types of assault. This paper uses police crime data from the first six months of 2020 to analyse if any changes in domestic violence can be attributed to the implementation of COVID-19 restrictions in Sweden. Using the LUPP method, developed by The Swedish Council for Crime Prevention (BRÅ), this paper investigates weekly changes in crime compared to the same period in 2019 while additionally studying the prevalence of different types of relationships between the victim and offender. Results indicate that partner violence for men has doubled in relation to all assault crimes, and that partner violence for women has also increased substantially, accounting for 46 % of total assault crimes in the observed period. Abuse by family members, other acquaintances, and unknown persons have seemingly gone down in 2020, compared to the same period in 2019. A concluding regression analysis reveals weak to moderate correlations between changes in domestic violence- and non-domestic violence crimes and COVID-19 restrictions, even when changes in seasonality is accounted for. While the increase in domestic violence crimes does not directly coincide with the emergence of COVID-19, results indicate that the implemented restrictions have played an important role in maintaining heightened levels throughout the observed period. Future research is advised to continue testing for correlations to COVID-19 restrictions, while also considering other variables which could be related to domestic violence, such as increased alcohol consumption at home, family isolation, and economic stress. 

Background: Recent research indicates that understanding how children and youth perceive mental health, how it is manifests, and where the line between mental health issues and everyday challenges should be drawn, is complex and varied. Consequently, it is important to investigate how children and youth perceive and communicate about mental health. With this in mind, our goal is to synthesize the literature on how children and youth (ages 10-25) perceive and conceptualize mental health.

Methods: We conducted a preliminary search to identify the keywords, employing a search strategy across electronic databases including Medline, Scopus, CINAHL, PsychInfo, Sociological abstracts and Google Scholar. The search encompassed the period from September 20, 2021, to September 30, 2021. This effort yielded 11 eligible studies. Our scoping review was conducted in accordance with the PRISMA-ScR Checklist.

Results: As various aspects of uncertainty in understanding of mental health have emerged, the results indicate the importance of establishing a shared language concerning mental health. This is essential for clarifying the distinctions between everyday challenges and issues that require treatment.

Conclusion: We require a language that can direct children, parents, school personnel and professionals toward appropriate support and aid in formulating health interventions. Additionally, it holds significance to promote an understanding of the positive aspects of mental health. This emphasis should extend to the competence development of school personnel, enabling them to integrate insights about mental well-being into routine interactions with young individuals. This approach could empower children and youth to acquire the understanding that mental health is not a static condition but rather something that can be enhanced or, at the very least, maintained.

Children and young adults with neurodevelopmental disorders (ND) are at increased risk of bullying compared to typically developing peers. It is still unclear to what extent they are involved in cyber bullying. This systematic review aimed at studying the prevalence of cyber bullying as perpetrators, victims, or both ("bully-victims") among students with ND in a school setting and in need of special education. The Web of Science, Scopus, ERIC, PsycINFO, PubMED, and Cochrane databases were searched including a manual search of reference lists, until February 24, 2018. Eight studies conducted in Europe, North America, the Middle East, and Australia were included reporting a prevalence of cyber-victimization among students with ND of 0%-41%, a prevalence of cyber-perpetration of 0%-16.7%, and a prevalence of bully-victims of 6.7%. Three out of five studies using control groups showed that students with ND might be more involved in cyber bullying overall compared to typically developing students. Students in segregated school settings report slightly higher prevalence rates of cyber bullying compared to students with ND in inclusive school settings, especially among girls. When comparing prevalence rates among studies using the same definition, we found similar prevalence rates. There was a tendency towards students with ND being more involved in cyber bullying compared to typically developing students, but this needs to be confirmed in future studies that should include control groups with typically developing students as well as validated and standardized measurements of cyber bullying and ND diagnoses.

Background and objectives: Internet gaming disorder (IGD) is associated with health, social, and academic problems but whether these are consequences of the disorder rather than precursors or correlates is unclear. We aimed to evaluate whether IGD in the 1st year of university predicts health, academic and social problems 1 year later, controlling for baseline health, academic and social problems, demographics, and mental health symptoms.

Methods: In a prospective cohort study, 1741 university students completed both a baseline online survey in their 1st year and a follow-up survey 1 year later. Log-binomial models examined the strength of prospective associations between baseline predictor variables (IGD, baseline health, academic and social problems, sex, age, and mental health symptoms) and occurrence of health, academic and social problems at follow-up.

Results: When extensively adjusted by the corresponding outcome at baseline, any mental disorder symptoms, sex, and age, baseline IGD was associated only with severe school impairment and poor social life (risk ratio [RR] = 1.77; 95% confidence interval [CI] = 1.14-2.75, p = .011; RR = 1.22; 95% CI = 1.07-1.38, p = .002, respectively).

Conclusions and scientific significance: University authorities and counselors should consider that incoming 1st-year students that meet criteria for IGD are likely to have increased academic and social impairments during their 1st year for which they may want to intervene. This study adds to the existing literature by longitudinally examining a greater array of negative outcomes of IGD than previously documented.

Aim: The aim in this survey was to study the clinical characteristics of infections caused by Borrelia genospecies in patients with erythema migrans where Borrelial origin was confirmed by polymerase chain reaction. The aim was also to study factors influencing the clinical appearance of erythema migrans. Methods: The study was conducted in southern Sweden from May 2001 to December 2003 on patients 18 years and older attending with erythema migrans at outpatient clinics. All erythema migrans were verified by polymerase chain reaction, photographed and categorized into “annular” or “non-annular” lesions. A logistic regression model was used to analyze relations between the appearance of the erythema migrans (i.e., annular or non-annular) and factors that influenced its clinical appearances. Results: A total of 118 patients, 54 women (45.8%) and 64 men (54.2%), fulfilled the inclusion criteria. Of these patients, 74% were infected by B. afzelii, 26% by B. garinii ( p < 0.001). A total of 45% (38/85) of the erythema migrans were annular, 46% (39/85) were non-annular and 9.4% (8/85) were atypical. For men infected by B. afzelii the odds ratio of developing non-annular erythema migrans was 0.09 (95% CI: 0.03 - 0.33) in comparison with women with the same infection. Conclusions: In this prospective study of a large series of erythema migrans, where infecting genospecies were confirmed by polymerase chain reaction, the sex of patients infected with B. afzelii had a strong influence on the appearance of the rash. Patients infected by B. garinii more often had non-annular erythema migrans and a more virulent infection with more individuals presenting with fever, raised levels of C-reactive protein and seroreactivity in the convalescence sera.

Background: The aim of this study was to describe and categorize the different predominant patterns of PCR confirmed erythema migrans (EM) and to study possible correlations according to the clinical pictures and Borrelia substrains. Methods: Patients over 18 years old, seeking care with tick exposure and an EM were consecutively included during a study period of three years. We evaluated clinical and laboratory findings with regard to Borrelia burgdorferi s.l. spirochetes detected with nested Osp A PCR in skin biopsy specimens. Laboratory and serology testing were done acute, after 6 weeks and after 6 months. The patients were clinically evaluated at the initial visit and repeatedly after 14 days unitl recovery. Results: 118 patients (women=54, men=64) with a positive B. Burgdorferi s.l. PCR analysis were included. In this area totally 73.7% of the EM were caused by B. afzelii and 26.3% by B. garinii (p=0.0001). Leisons caused by B. garinii had a shorter duration from tick bite to the initial visit (p= 0.001) but there were no differences between the sizes of the EM, indicating a faster development of lesions caused by B. garinii. Patients with lesions caused by B. garinii to a greater extent had presented with fever at the initial visit (p=0.02). Also patients with B. garinii lesions to a greater extent had elevated levels of CRP at the initial visit (p=0.006). 45% of the EM were categorized as “annular”, 27% as “homogeneous”, 19% as “central erythemas” and 9% as “atypical”. The lesions caused by B. afzelii were predominately “annular” and the lesions caused by B. gaarinii were predominately “homogeneous”. Conclusions: In this study most EM were caused by B. afzelii. Leisons caused by B. garinii developed faster and the patients to a greater extent presented with fever and elevated levels of CRP at the initial visit. Leisons caused by B. garinii were mostly homogenous and by B. afzelii were mostly annular.

The aim is to highlight the influence of patients’ gender on Lyme borreliosis and especially erythema migrans (EM), focusing on exposure to tick bites, epidemiology, and the clinical picture. All studies were conducted in the county of Blekinge, located in southeastern Sweden. A prospective study was conducted in 235 individuals (women, n=110; men, n=125) engaged in recreational or occupational activities focusing on exposure to tick bites. A retrospective epidemiological study evaluating 123,495 electronic patients´ records (women, n=61,712; men, n=61,783) and a prospective clinical study including 118 patients (women, n=54; men, n=64) 18 years or older seeking care for EM > 5 cm in diameter with genospecies verified by polymerase chain reaction were conducted. Results: Women 40 years or older had a 48% higher risk than men 40 years or older and 42% higher risk than women younger than 40 years of attracting tick bites (0.0188 versus 0.0127 and 0.0188 versus 0.0132 tick bites respectively per hour). Additionally they had a 96% higher risk than men younger than 40 years of attracting tick bites (0.0188 versus 0.0096). The annual incidence rate of EM in women was 506 and in men 423 cases per 100,000 inhabitants (p<0.001). Significant differences in incidence rates occurred in those 40 years or older. Odds ratios for males infected with Borrelia afzelii developing nonannular EM were 0.09 (95% confidence interval [CI] 0.03 to 0.33) in comparison with females infected by Borrelia afzelii. Conclusions: Significant gender differences in the risk of contracting tick bites, incidence rates, and clinical picture of EM have been observed. Exposure to tick bites alone may not explain these observations and further studies need to be done to clarify the biologic, immunologic, and sociological mechanisms causing these differences.

The objective of this follow-up study was to determine the long-term outcome of strictly classified cases of neuroborreliosis treated with antibiotics. A one-year prospective population-based survey of Lyme borreliosis was conducted in southern Sweden, between 1992 and 1993. A total of 349 identified cases with suspected neuroborreliosis were followed up 5 years later. Medical records were reviewed and all participants filled in a questionnaire. Of those classified with definite neuroborreliosis 114/130 completed the follow-up, of whom 111 had completed the initial antibiotic treatment. Of the 114 patients followed up, 86 (75%) had recovered completely and 70 (61%) had recovered within 6 months. Residual neurological symptoms such as facial palsy, concentration disorder, paresthesia and/or neuropathy were reported by 28/114. No significant differences between different antibiotic treatments were observed in terms of occurrence of sequelae. To conclude, we found that 25% (95% confidence interval 17-33%) of the patients suffered from residual neurological symptoms 5 years post-treatment. However, the clinical outcome of treated neuroborreliosis is favourable as only 14/114 (12%) of the patients had sequelae that influenced their daily activity post-treatment. Early diagnosis and treatment would seem to be of great importance in order to avoid such sequelae.

The objective of this follow-up study was to determine the long-term outcome in patients treated with antibiotics for strictly classified cases of neuroborreliosis. A one-year prospective population-based survey of Lyme borreliosis was conducted in southern Sweden, 1992-1993. Totally 349 identified cases with suspected neuroborreliosis were registered. Of those, 130 were classified as definitively neuroborreliosis and followed up five years later. Medical records were reviewed and all participants filled in a questionnaire. Totally, 114/130 (88%) completed the follow-up of whom 111/114 (97%) had fulfilled the initial antibiotic treatment. Of these, 86/114 (75%) had recovered completely and 70 (61%) recovered within six months. However 28/114 (25%) suffered from remaining neurological symptoms such as facial palsy, concentration disorder, paresthesia and/or neuropathy. The longer the duration from the neurological symptoms onset to antibiotic treatment the higher was the rate of sequelae. Of those who were treated within 30 days 5/32 (16%) and of those who were treated after 30 days 16/41 (39%) respectively, reported sequelae. Women suffered significantly more from sequelae compared to men, this difference was not seen among the children. No significant differences between the different antibiotic treatments given and experience of sequelae were seen. To conclude, we found that 25% (95% CI 17% to 33%) of the patients suffered from remaining neurological symptoms five years post treatment. However, the clinical outcome of treated neuroborreliosis is favourable as only 14/114 (12%) of the patients had sequelae that influenced their daily activity post treatment and early diagnosis and treatment seems to be of great importance to possibly avoid also these cases.

The present study includes baseline data from 2867 students (77.8% from Sweden, 22.2% from US) and evaluates the relationships among self-reported disabilities, alcohol use, other substance use, and psychosocial adjustment. There were 114 (4.6%) ‘‘hard-of-hearing’’ (HH) students, 129 (5.2%) reported visual disabilities, 33 (1.3%) reported motor disabilities, 223 (9.0%) reported a reading/writing disability, and 97 (3.6%) reported they had ‘‘other’’ disabilities. Of these, 70 (14.1%) reported more than one disability. Presence of a disability was significantly higher among Sweden students (2 (1)=19.93, p< 0.001), with 19.1% of Sweden students and 11.5% of US students reporting at least one disability. Reporting any type of disability was associated with significantly greater alcohol use frequency, intensity, and related problems (all p < 0.02), significantly more mental health symptoms and conduct problems (p < 0.005), and significantly greater likelihood of illicit and prescription drug use (all p < 0.001). With respect to specific disabilities, individuals with motor disabilities reported the highest levels of alcohol use and mental health symptoms, whereas individuals who reported ‘‘other’’ disabilities had higher rates of illicit drug use and conduct problems. Further, there was a significantly positive correlation between the number of disabilities and intensity of alcohol use, mental health symptoms, conduct problems, illicit and prescription drug use, and alcohol related problems (all p < 0.001). The association between conduct problems and disability (any disability and number of disabilities) was moderated by country of origin, gender, and drinking for coping reasons on the Drinking Motives Questionnaire. Participants in Sweden, males, and those who drank for coping reasons were more likely to report a relationship between disability and conduct problems (p < 0.001). Participants who drank for coping reasons were also more likely to report a relationship between disability and alcohol related problems (p=0.001). These findings indicate students with disabilities are an important risk group for preventive interventions for alcohol, substance, and mental health problems, and may benefit from interventions which target healthy coping skills. This research was supported by NIAAA # 5R01AA018276 awarded to Drs. Larimer & Berglund

Objective Previous literature has suggested that identifying putative differences in health care seeking patterns before death by suicide depending on age and gender may facilitate more targeted suicide preventive approaches. The aim of this study is to map health care utilisation among individuals in the two years prior to suicide in Sweden in 2015 and to examine possible age and gender differences. Methods Design: A retrospective explorative study with a medical record review covering the two years preceding suicide. Setting: All health care units located in 20 of Sweden's 21 regions. Participants: All individuals residing in participating regions who died by suicide during 2015 (n = 949). Results Almost 74% were in contact with a health care provider during the 3 months prior to suicide, and 60% within 4 weeks. Overall health care utilisation during the last month of life did not differ between age groups. However, a higher proportion of younger individuals (< 65 years) were in contact with psychiatric services, and a higher proportion of older individuals (>= 65 years) were in contact with primary and specialised somatic health care. The proportion of women with any type of health care contact during the observation period was larger than the corresponding proportion of men, although no gender difference was found among primary and specialised somatic health care users within four weeks and three months respectively prior to suicide. Conclusion Care utilisation before suicide varied by gender and age. Female suicide decedents seem to utilise health care to a larger extent than male decedents in the two years preceding death, except for the non-psychiatric services in closer proximity to death. Older adults seem to predominantly use non-psychiatric services, while younger individuals seek psychiatric services to a larger extent.

AIMS: The COVID-19 containment strategy in Sweden uses public health recommendations relying on personal responsibility for compliance. Universities were one of few public institutions subject to strict closure, meaning that students had to adapt overnight to online teaching. This study investigates the prevalence of self-reported recommendation compliance and associations with self-reported symptoms of contagion, self-experienced effects on mental health and academic self-efficacy among university students in Sweden in May-June 2020.

METHODS: This was a cross-sectional 23 question online survey in which data were analysed by multinomial regression, taking a Bayesian analysis approach complemented by null hypothesis testing.

RESULTS: A total of 4495 students consented to respond. Recommendation compliance ranged between 70% and 96%. Women and older students reported higher compliance than did men and younger students. Mild to moderate COVID-19 symptoms were reported by 30%, severe symptoms by fewer than 2%; 15% reported being uncertain and half of the participants reported no symptoms. Mental health effects were reported by over 80%, and changes in academic self-efficacy were reported by over 85%; in both these areas negative effects predominated. Self-reported symptoms and uncertainty about contagion were associated with non-compliance, negative mental health effects, and impaired academic self-efficacy.

CONCLUSIONS: Students generally followed public health recommendations during strict closure of universities, but many reported considerable negative consequences related to mental health and academic self-efficacy. Digital interventions should be developed and evaluated to boost coping skills, build resilience and alleviate student suffering during the pandemic and future similar crises.

Two years ago, a Special Issue on E-health Interventions for Addictive Behaviors was published in the International Journal of Behavioral Medicine. The issue included 16 articles, addressing topics like methodologies for developing e-health interventions, how to engage intervention users and establish a working alliance, and empirical findings from randomized controlled trials and a naturalistic study. The issue began with two articles offering a wide perspective on the field, with a systematic review of reviews on digital interventions for problematic alcohol use, as well as a too for describing e-health interventions as a step towards standardized reporting in order to facilitate communication about the interventions and comparisons between them. This symposium will follow up on the Special Issue by bringing together some of the contributors for presentations of their current work and a discussion on the current state-of-the-art in digital interventions for addictive behaviors. This symposium is sponsored by SBM’s Scientific and Professional Liaison Council (SPLC), in partnership with the International Society of Behavioral Medicine (ISBM).

Background: Problematic alcohol use in Sweden occurs among 16 % of the adult population. Digital interventions of varying intensity have shown positive effects in contributing to reductions in problematic use, and the TeleCoach app has shown positive effects in non-treatment-seeking university students with excessive drinking (Gajecki et al., 2017). This pilot study evaluated the app among adult internet help-seekers, and motivated continued data collection in the current target group. Methods: Adult internet-help seekers, recruited via advertisement, were included if they scored ³6 (women) or ³8 (men) on the Alcohol Use Disorders Identification Test (AUDIT). Those with depression scores of ³31 on the Montgomery Åsberg Depression Rating Scale (MADRS-S) or problematic drug use scores of ³8 on the Drug Use Disorders Identification Test (DUDIT) were contacted for a telephone interview and included following clinical assessment; if not reached they were excluded. Participants randomized at a 1:1 ratio to the TeleCoach™ web-based app or to a web-based app with information texts from primary care-based self-help material for changing problematic alcohol use. At six-week follow-up, the primary outcome was the number of standard drinks per past week (Timeline-Followback). Results: Of 147 persons assessed for eligibility, 89 were assigned to the intervention group (n=42) or control group (n=47). Average AUDIT levels at baseline were ³18.The baseline number of standard drinks per week was 32.73 (SD 21.16) for the intervention group, and 26 (4.08) for the control group; at 6-week follow-up it was 12.73 (10.52) and 13.48 (11.13) for the intervention and control groups, respectively. No significant between-groups effects occurred, but withingroup changes over time were significant (F(1, 55)=43.98; p< 0.000), with an effect size of 1.37 for the intervention group and 0.92 for the control group. Conclusions: The results suggest that web-based apps can be of help to internet help-seekers motivated to reduce problematic alcohol use. We have proceeded with the planned larger randomized, controlled study and will present 6-week follow-up data for the entire study sample (n=∼1000) in this presentation.

Objective: Mental wellbeing is a fundamental aspect of the broader notion of quality of life. Little is known about the mental wellbeing of university students in general and Swedish university students in particular. As emerging adults, university students typically experience substantial changes to their living conditions, relationships, and academic stress, and depression and anxiety are prospectively associated with lower academic achievement at the end of the first year.

Methods: Data from five cross-sectional cohorts (n = 7423), collected between spring 2020 and spring 2022, were compared descriptively, regarding sociodemographic factors, lifetime and past 30-day symptoms of mental health problems, experiences of bullying, feeling loved and measures of well-being. Linear regression identified protective factors for wellbeing according to the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS), and risk factors for lower wellbeing.

Results: Participants were > 70% women, 24–27 years old, 75–83% born in Sweden. About one-third had experienced physical bullying at school and about 70% felt loved and cared for. About two-thirds had medium levels of wellbeing, with one-third having low levels and about 5% having high levels. Protective factors for wellbeing included older age, male gender, feeling loved most of the time, and the grit construct. Risk factors included being an international student, non-heterosexual sexual orientation, having symptoms of depression or anxiety most of the time, and experiencing effort/reward imbalance.

Conclusions: A large proportion of students experience less than optimal wellbeing. Interventions to enhance positive, nurturing relationships and reinforce grit-related factors could support students in this challenging period of life.

BACKGROUND: Emerging adulthood is often associated with mental health problems. About one in three university students report symptoms of depression and anxiety that can negatively affect their developmental trajectory concerning work, intimate relationships, and health. This can interfere with academic performance, as mood and anxiety disorders are key predictors of dropout from higher education. A treatment gap exists, where a considerable proportion of students do not seek help for mood and anxiety symptoms. Offering internet interventions to students with mental health problems could reduce the treatment gap, increase mental health, and improve academic performance. A meta-analysis on internet interventions for university students showed small effects for depression and none for anxiety. Larger trials are recommended to further explore effects of guidance, transdiagnostic approaches, and individual treatment components.

METHODS: This study will offer 1200 university students in Sweden participation in a three-armed randomized controlled trial (RCT) evaluating a guided or unguided transdiagnostic internet intervention for mild to moderate depression and anxiety, where the waitlist control group accesses the intervention at 6-month follow-up. Students reporting suicidal ideation/behaviors will be excluded and referred to treatment within the existing healthcare system. An embedded study within the trial (SWAT) will assess at week 3 of 8 whether participants in the guided and unguided groups are at higher risk of failing to benefit from treatment. Those at risk will be randomized to an adaptive treatment strategy, or to continue the treatment as originally randomized. Primary outcomes are symptoms of depression and anxiety. Follow-ups will occur at post-treatment and at 6-, 12-, and 24-month post-randomization. Between-group outcome analyses will be reported, and qualitative interviews about treatment experiences are planned.

DISCUSSION: This study investigates the effects of a transdiagnostic internet intervention among university students in Sweden, with an adaptive treatment strategy employed during the course of treatment to minimize the risk of treatment failure. The study will contribute knowledge about longitudinal trajectories of mental health and well-being following treatment, taking into account possible gender differences in responsiveness to treatment. With time, effective internet interventions could make treatment for mental health issues more widely accessible to the student group.

OBJECTIVES: The aim of this study was to evaluate staff-assessed care quality as an indicator of register-based measures of care quality at dental clinics, more specifically register-based measures of survival of dental fillings and initiation of preventive treatments for caries patients.

METHODS: This prospective study includes data from cross-sectional workplace psychosocial risk assessment surveys at dental clinics and register data on survival of dental fillings, and initiation of preventive treatment for caries patients obtained from the Swedish Quality Registry for Caries and Periodontal Disease (SKaPa) Demographic background data on the age, gender, income level and place of birth of patients was obtained from Statistics Sweden (SCB). The data were analysed using discrete-time multilevel survival analysis and multiple linear regression analysis.

RESULTS: The results showed that staff-assessed care quality rated by the total staff or by dental nurses at the clinic predicted the risk of replacement of dental fillings made due to a caries diagnosis during the 3-year follow-up period, controlling for potential confounding due to patient demographic characteristics (age, sex, income and country of birth). In contrast, the better the staff-assessed care quality at the clinic, the smaller the proportion of the patients received preventive care in addition to operative caries therapy when controlling for potential confounding due to patient demographics. Care quality assessed by dentists at the clinic did not predict either of these outcome measures.

CONCLUSIONS: Premature failure of dental fillings is costly for both patients and society, which leads to a need for relevant measures for following dental care quality. Our findings indicate that staff-assessed care quality - a cheap and easy measure to collect and follow continuously in dental practice - can be used to monitor aspects of quality in real time in order to facilitate continuous improvement and quickly amend quality problems. Also, it can be used for integrating quality improvement in systematic work environment risk management.

This study presents the Swedish standard version of the Copenhagen Psychosocial Questionnaire, COPSOQ III, and investigates its reliability and validity at individual and workplace levels with the aim of establishing benchmarks for the psychosocial work environment. Cross-sectional data from (1) a random sample of employees in Sweden aged 25-65 years (N = 2847) and (2) a convenience sample of non-managerial employees at 51 workplaces (N = 1818) were analysed. Internal consistency reliability was evaluated as well as the effects of sex, work sector and blue/white-collar work. Population benchmarks and mean scores for major occupational groups were computed based on weighted data. ICC(1) and ICC(2) estimates were computed to evaluate aggregation to the workplace level and Pearson inter-correlations to evaluate construct validity at individual and aggregated levels. The reliability and scale characteristics were satisfactory, with few exceptions, at both individual and workplace levels. The strength and direction of correlations supported the construct validity of the dimensions and the amount of variance explained by workplace justified aggregation to the workplace level. The present study thus supports the use of COPSOQ III for measurement at the workplace level and presents benchmarks for risk management as well as for research purposes.

Women from high-mortality settings in sub-Saharan Africa can remain at risk for adverse maternal outcomes even after migrating to low-mortality settings. To conceptualise underlying socio-cultural factors, we assume a 'maternal migration effect' as pre-migration influences on pregnant women's post-migration care-seeking and consistent utilisation of available care. We apply the 'three delays' framework, developed for low-income African contexts, to a high-income western scenario, and aim to identify delay-causing influences on the pathway to optimal facility treatment. We also compare factors influencing the expectations of women and maternal health providers during care encounters. In 2005-2006, we interviewed 54 immigrant African women and 62 maternal providers in greater London, United Kingdom. Participants were recruited by snowball and purposive sampling. We used a hermeneutic, naturalistic study design to create a qualitative proxy for medical anthropology. Data were triangulated to the framework and to the national health system maternity care guidelines. This maintained the original three phases of (1) care-seeking, (2) facility accessibility, and (3) receipt of optimal care, but modified the framework for a migration context. Delays to reciprocal care encounters in Phase 3 result from Phase 1 factors of 'broken trust, which can be mutually held between women and providers. An additional factor is women's 'negative responses to future care', which include rationalisations made during non-emergency situations about future late-booking, low-adherence or refusal of treatment. The greatest potential for delay was found during the care encounter, suggesting that perceived Phase 1 factors have stronger influence on Phase 3 than in the original framework. Phase 2 'language discordance' can lead to a 'reliance on interpreter service', which can cause delays in Phase 3, when 'reciprocal incongruent language ability' is worsened by suboptimal interpreter systems. 'Non-reciprocating care conceptualisations', 'limited system-level care guidelines', and 'low staff levels' can additionally delay timely care in Phase 3.

The development of the public health workforce is acornerstone in WHO's Action Plan for Strengthening Public HealthServices and Capacities. Public health education shall combineEssential Public Health Operations – surveillance; monitoring; healthprotection and promotion; disease prevention; service delivery;communication and research – with the competences needed within:public health methods; population health and its social, economicand environmental determinants; and man-made systems andinterventions to improve population health. An authorised publichealth profession founded on graduation from comprehensive publichealth education is needed. The capacity and standards of Schoolsof Public Health should accordingly be continuously developed.

Today schools and departments of public health (SDPHs), as well as public health professionals are searching for interface and synergies between public health science and practice. They are increasingly relying on partnerships in order to achieve common goals. To collect more information on the fragmented institutional landscape the Association of Schools of Public Health in the European Region (ASPHER) organised a survey among its full institutional 81 members with the core objective to assess the exit competences of master of public health graduates according to the new Essential Public Health Operations (EPHO) of WHO-EURO. The survey results indicate that usually European SDPHs are small units, funded from tax money. A total of 130 academic programmes released 3035 graduates per last year All selected competences within each EPHO showed high reliability and high internal consistency (alpha>0.75, p<0.01). SDPH assess their best teaching output to be in the field of health promotion, followed by disease prevention and identification of priority health problems and health hazards in the community, while they see the least success regarding preparedness and planning for public health emergencies. Given the fragmentation of the institutional infrastructure, the harmonization of programme content and thinking is impressive. Even more surprising is the observation that the determination of the desired performance by employers of public health professionals for most EPHOs (6 out of 10) is almost congruent with the estimated output of SDPHs. The main objective of the workshop was to continue with permanent dialogue on innovation and good practice in public health education, continuing training and lifelong learning and to strengthen everlasting collaboration of European schools in efforts to improve public health performance.

Objective The Capitation Contract system (CCS) is a payment model adopted by the Swedish Public Dental Health Service (PDHS). Patients enrolled in the CCS are usually assessed as being at lower risk of dental disease and are more regular dental attenders than those treated by Fee for Service (FFS). With increasing numbers of patients and CCS enrolments, Sweden faces a shortage of dental personnel. Our aim was to analyse dentists ' and dental hygienists ' perceptions and experiences of the capitation contact system. Material and methods Eleven dentists and dental hygienists from three Swedish regions participated in online qualitative interviews conducted according to the Grounded Theory methodology. Results When working with CCS the informants tried hard ' to find a balance between attitudes, compliance with guidelines and clinical resources '. Not all patients were offered CCS, even though they qualified: among other determinants were the informants' interpretations of guidelines and regulations, clinical resources, and patient interest. Conclusions When dental resources are in balance, the informants appreciate the CCS and consider it to be favourable to patient health but are aware of conflicting loyalties of their dual roles of insurance sales agent and care provider. The informants ' individual mindset affects which patients are offered CCS enrolment.

Reproductive decision-making and fertility patterns change with time and place, and are influenced by contemporary societal factors. In this paper, we have studied biosocial aspects of reproductive decision-making over time and generations in a Nordic setting. The aim was to explore intergenerational changes and influences on decision-making, especially regarding preconditions to first birth. Twenty-six focus group interviews were conducted in southern Sweden, including a total of 110 participants aged 17–90 years. The analysis of the interviews resulted in six themes: (i) ‘Providing security – an intergenerational precondition’; (ii) ‘A growing smorgasbord of choices and requirements’; (iii) ‘Parenthood becoming a project’; (iv) ‘Stretched out life stages’; (v) ‘(Im)possibilities to procreate’; and (vi) ‘Intergenerational pronatalism’. Our findings reflect increasing expectations on what it means to be prepared for parenthood. Despite increasing awareness of the precariousness of romantic relationships, people still wish to build new families but try to be as prepared as possible for adverse events. The findings also show how increasing life expectancy and medical advancements have come to influence people’s views on their reproductive timeline.

Studies across countries emphasizes that communication barriers can severely hinder access to health care services by migrants, leading to health inequities. The aim of this explorative research was to gain a deeper understanding of migrants’ perspectives on public health communication in Jönköping, Sweden. Empirical data has been gathered through multicultural focus groups with migrants from countries outside Europe, living in the county of Jönköping. The data has been analyzed using Braun & Clarke’s six step model for thematic analysis and from the theoretical framework of a Culture-Centered Approach to health communication, as presented by Mohan Dutta. 

The findings revealed communication barriers that hinder groups of migrants from accessing the public health communication and advice for improvement that could increase access and trust. The Swedish language, low digital use and limited digital skills as well as low trust towards the Swedish system are prominent obstacles that affect the communication processes in different layers. The participants express the need for a more flexible health system to increase access and prefer communication in native language verbally or printed. For those who use digital health communication, they want the Region to search engine-optimize in their native languages to ease the process of finding the right sources. Furthermore, authoritarian doctors as messengers of health communication are preferred.

The health communication participants have received from the Region’s health communicators in their native language is presented to be a tool for increased trust and understanding. Their methods enable a participatory communication flow. To continue the development of participatory communication activities can be one way of combating the barriers faced by some groups of migrants. It is clear that a “one size fits all-communication approach”, with a focus on digital Swedish public health communication does not succeed to reach this target group. The communication barriers need to be understood from an organizational perspective. It is essential that migrants are invited to influence strategies, innovations and systems. In order to reduce the health gap, the Region needs to listen actively to migrants and engage them to co-create solutions that promote access and trust. 

Following the outbreak of COVID-19 in 2020, the majority of European countries imposed lockdowns, whereas Sweden introduced comparatively moderate constraints. The Public Health Agency of Sweden stated that sports and physical activity could continue if conducted ‘safely’ and recommended outdoor activities. This article aims to identify new spatial practices and strategies developed by organised recreational sport providers (i.e. sport clubs, commercial providers) following the outbreak of the pandemic. Further, it identifies obstacles and opportunities for new spatial solutions, as well as possible long-term (lasting) effects of the strategies imposed. Also, it discusses these obstacles and opportunities in relation to contemporary sport facility challenge. The data draws upon 24 semi-structured interviews with sport coaches and leaders. All interviews were transcribed verbatim and analysed using a thematic analysis. The results suggest that most respondents show adaptability by moving their activities outdoors. Generally, for-profit organisations have been more innovative and adaptive. Obstacles for new spatial solutions include localisation, weather, (perceived) need of equipment, leadership, competing interests in public space, and notably the perception of what sport is. Positive examples of spatial adaptability show that there is a potential for sport providers to open up for different spatial solutions and more flexibility in relation to their activities, in order to ease the pressure on formal indoor (and, to some extent, outdoor) sport facilities while amending the perception of sport activities. 

Research methods

The data draws upon 24 semi-structured interviews with sport coaches and leaders. All interviews were transcribed verbatim and analysed using a thematic analysis.

Results and findings

The results suggest that most respondents show adaptability by moving their activities outdoors. Generally, for-profit organisations have been more innovative and adaptive. Obstacles for new spatial solutions include localisation, weather, (perceived) need of equipment, leadership, competing interests in public space, and notably the perception of what sport is.

Implications

Positive examples of spatial adaptability show that there is a potential for sport providers to open up for different spatial solutions and more flexibility in relation to their activities, in order to ease the pressure on formal indoor (and, to some extent, outdoor) sport facilities while amending the perception of sport activities.

OBJECTIVES: The purpose of the present survey is to give an update of European experts' opinion on infection control and prevention in dentistry during second wave of pandemic. The secondary aim was to analyse how experts' opinion changed in the light of the new scientific evidence since the first wave.

MATERIAL & METHODS: An anonymous online 14-item questionnaire was sent to a total of 27 leading academic experts in Oral (and Maxillofacial) Surgery from different European countries, who had completed a previous survey in April-May 2020. The questionnaire covered the topics of dental setting safety, personal protective equipment (PPE), and patient-related measures to minimise transmission risk. Data collection took place in November-February 2020/21.

RESULTS: 26 experts participated in the follow-up survey. The overall transmission risk in dental settings was scored significantly lower compared to the initial survey (P<0.05), though the risk associated with aerosol generating procedures (AGP) was still considered to be high. Maximum PPE was less frequently recommended for non-AGP (P<0.05), whereas the majority of experts still recommended FFP2/FFP3 masks (80.8%), face shields or goggles (88.5%), gowns (61.5%), and caps (57.7%) for AGP. Most of the experts also found mouth rinse relevant (73.1%) and reported to be using it prior to treatment (76.9%). No uniform opinion was found regarding the relevance of COVID-19 testing of staff and patients.

CONCLUSION: With the continuation of dental care provision, transmission risk has been scored lower compared to the first wave of pandemic. However, high risk is still assumed for AGP, and maximum PPE remained advised for the respective treatments.

Testing assumptions of the widely used demand–control (DC) model in occupational psychosocial epidemiology, we investigated (a) interaction, i.e., whether the combined effect of low job control and high psychological demands on depressive symptoms was stronger than the sum of their single effects (i.e., superadditivity) and (b) whether subscales of psychological demands and job control had similar associations with depressive symptoms. Logistic longitudinal regression analyses of the 5-year cohort of the German Study of Mental Health at Work (S-MGA) 2011/12–2017 of 2212 employees were conducted. The observed combined effect of low job control and high psychological demands on depressive symptoms did not indicate interaction (RERI = −0.26, 95% CI = −0.91; 0.40). When dichotomizing subscales at the median, differential effects of subscales were not found. When dividing subscales into categories based on value ranges, differential effects for job control subscales (namely, decision authority and skill discretion) were found (p = 0.04). This study does not support all assumptions of the DC model: (1) it corroborates previous studies not finding an interaction of psychological demands and job control; and (2) signs of differential subscale effects were found regarding job control. Too few prospective studies have been carried out regarding differential subscale effects. 

Since 2015, the Swedish government has invested more money in the post-partum care to make it more accessible. The number of Swedish qualitative studies, which highlight women's experiences of sexological support after childbirth since 2015, is limited. This means that we do not know how adequate the government's investments have been in terms of patients' access to sexological support after childbirth. The purpose of the study is to gain an increased understanding of what sexological support, from healthcare, people feel they need after childbirth. The author has conducted ten qualitative semi-structured interviews with respondents who had a vaginal birth in the last two years. Analyzed through Merleau-Ponty's (1945/2006) and Ahmed's (2014) phenomenological theories the results show that the respondents' sexual health was affected by the interaction of the changes in their physical body and life situation. These aspects were also influenced by their partner and the post-partum care. During the follow-up, several respondents felt that their midwife focused too much on their physical body instead of changes related to their sexual health. Participants expressed a need for more information and confirmation regarding the physical, psychological, and social changes that affected their sexual health. The participants also wished to have more sexological support for their partner. This result indicates that the government's investment in the post-partum care has not been sufficient in terms of sexual health after childbirth, which means that parts of this care remain unavailable.

Key words: childbirth, partner, post-partum, postnatal care, sexual health, sexual function, sexual satisfaction, sexological support.

This paper distinguishes between the uses of empowerment across different contexts in healthcare policy and health promotion, providing a model for the ethical and political scrutiny of those uses. We argue that the controversies currently engendered by empowerment are better understood by means of a historical distinction between two concepts of empowerment, namely, what we call the radical empowerment approach and the new wave of empowerment. Building on this distinction, we present a research agenda for ethicists and policy makers, highlighting three domains of controversy raised by the new wave of empowerment, namely: (1) the relationship between empowerment and paternalistic interferences on the part of professionals; (2) the evaluative commitment of empowerment strategies to the achievement of health-related goals; and (3) the problems arising from the emphasis on responsibility for health in recent uses of empowerment. Finally, we encourage the explicit theorisation of these moral controversies as a necessary step for the development and implementation of ethically legitimate empowerment processes.