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  • 1.
    Annersten Gershater, Magdalena
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Holmberg, C. Nagorny
    Novo Nordisk Scandinavia AB, Malmö, Sweden..
    Grahn, M.
    Malmö City, Malmö.
    Andersson, M.
    Hlth & Med Care Management, Grp Off, Reg Skane, Malmö, Sweden..
    Diabetes prevalence is rising among young residents in Malmö, Sweden2021In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 64, no SUPPL 1, p. 161-161Article in journal (Other academic)
  • 2.
    Bragason, K.
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Zdravkovic, Slobodan
    Malmö högskola, Faculty of Health and Society (HS).
    Tyden, P.
    Skåne University Hospital, Dept of Cardiology, Malmö, Sweden.
    Leosdottir, M.
    Skåne University Hospital, Dept of Cardiology, Malmö, Sweden.
    Secondary prevention after myocardial infarction widens health disparities between Swedish and immigrant patients2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no Suppl 1, article id 2936Article in journal (Other academic)
    Abstract [en]

    Background and introduction: Immigrants bear a disproportionate burden of poor cardiovascular health. Secondary prevention programs are essential for patients who have suffered from myocardial infarction (MI) as modification of risk factors favorably impacts their health. However, little is known about whether disparities in cardiovascular health are influenced by secondary prevention. Purpose: The purpose of this study was to determine if secondary prevention influences disparities in cardiovascular health between Swedish and immigrant MI patients. Methods: A cohort of 400 MI patients (58.6±8 years) was followed for two years, 292 Swedish and 108 immigrants (71% men). During the first year after MI patients participated in a secondary prevention program. The average number of six selected risk factors, before and two years post MI was evaluated and the mean change in risk burden from baseline calculated. The risk factors were current smoking, BMI >30 kg/m2, total cholesterol >4,5 or LDL >2,5 mmol/l (in accordance with reference values at the time of the study), HDL >1.0/1.2 (men/women) mmol/l, blood pressure >140/90 mmHg and HbA1c >45 mmol/mol (>52 mmol/mol for diabetic patients). Results: There were significant differences in risk factor exposure between Swedes and immigrants among men (p=0.045) and women (p=0.003) two years after MI. After adjustments for age, marital status and socio-economic status significance was lost among men. Swedish women reduced their exposure by 1.51 risk factors, while immigrant women only reduced theirs by 0.74 (p=0.007). No significant differences were observed for males, with Swedish men reducing their risk factors by 1.25 compared to 1.17 for immigrant men (p=0.593). Conclusion(s): The results indicate that while benefitting patients in general, secondary prevention did not benefit all groups equally. Immigrant women were less likely to reduce their risk than Swedish women, which could not be explained by age, marital status and socioeconomic status. No differences were found between immigrant and Swedish men.

  • 3. Carlzén, Katarina
    et al.
    Witmer, Hope
    Malmö University, Faculty of Culture and Society (KS), Department of Urban Studies (US).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Partnership Skåne: establishing a model for health diplomacy at subnational level2019In: Health diplomacy: spotlight on refugees and migrants / [ed] Santino Severoni, Monika Kosinska, Palmira Immordino, Michaela Told, Mihály Kökény, WHO regional office for europe , 2019, p. 172-183Chapter in book (Other academic)
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  • 4. Carlzén, Katarina
    et al.
    Zdravkovic, Slobodan
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö högskola, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    PROMOTING REFUGEES’ RIGHT TO HEALTH AND SOCIAL INCLUSION: A SYSTEMATIC APPROACH2016In: Public health panorama, ISSN 2412-544X, Vol. 2, no 4, p. 442-448Article in journal (Refereed)
    Abstract [en]

    The societal effects of forced migration are a burning topic of current political debate in Europe. There is an obvious absence of sustainable approaches to deal with this issue. We describe a collaborative and systemic regional effort, involving some 50 partners, towards a health-promoting and inclusive integration process designed to reach all refugees who settle in the southern region of Sweden. The main components of this process are now being disseminated to other regions in Sweden, which is contributing to national capacity-building. In addition, a national educational programme is being developed for those engaged in conveying civic and health information to asylum seekers and refugees. This work involves stakeholders in collaboration with six universities from different geographical areas of Sweden. The effort we describe in this report is expected to greatly contribute to providing better opportunities for all refugees in Sweden, and to empower them to control their own adaptation to a new life, thus reducing the risk of health deterioration often seen among them.

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  • 5.
    Dalingwater, Louise
    et al.
    Sorbonne Univ, British Polit, Paris, France..
    Mangrio, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Strange, Michael
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Policies on marginalized migrant communities during Covid-19: migration management prioritized over population health2023In: Critical Policy Studies, ISSN 1946-0171, E-ISSN 1946-018X, Vol. 17, no 2, p. 316-336Article in journal (Refereed)
    Abstract [en]

    Migration management policies in many states have marginalized significant numbers of individuals on the basis of their precarious residency status, negatively impacting their health. This article looks at how three European states with high levels of contagion - France, Sweden, and the United Kingdom - adapted their migration management policies to the changed circumstances during the Covid 19 pandemic in which there was new pressure for prioritizing population health over other concerns. The analysis compares globally-recognized 'best practices' for migrant health during the pandemic with policies adopted by France, Sweden, and the UK - selected as prominent migrant-hosting states and that experienced high rates of Covid-19. The article draws on supplementary evidence through interviews with civil society organizations working directly with migrants living on the margins of society - what are termed here 'marginalized migrants' (MMs). As the article concludes, the national policies often fell below international 'best practices' such that migration management was often prioritized over population health despite the crisis. The perspective developed in this paper is important for understanding where migration control policies have been prioritized over public health.

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  • 6.
    Dalingwater, Louise
    et al.
    Sorbonne University.
    Mangrio, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Strange, Michael
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    The well-being of marginalized migrants in Europe duing the Covid-19 epidemic: evidence from France, Sweden, and the UK2022In: The Unequal Costs of Covid-19 on Well-being in Europe / [ed] Louise Dalingwater,Vanessa Boullett, Iside Costantini & Paul Gibbs, Springer Nature, 2022, p. 177-202Chapter in book (Refereed)
    Abstract [en]

    International guidance set forth recommendations to protect marginalized migrant populations during Covid-19 given the significant inequalities in terms of social and economic well-being reported in the literature. However, a cross-country study of three European countries with high rates of Covid-19 infections and deaths has shown that migrant well-being has significantly decreased since the outbreak of Covid-19 in Europe from March 2020 and that policy measures to help those marginalized populations have been insufficient. The conclusions on migrant well-being during Covid-19 draw on interviews with prominent civil society organizations in all three countries that work specifically on migrant health and welfare. All interviews were semi-structured and conducted between October and November 2020. The analysis mainly focuses on objective/material measures of well-being related to access to health care, information on prevention of infection, housing and exclusion by host population.

  • 7.
    Hansen, Michael Ulrich
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Vejzovic, Vedrana
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Ambulance nurses' experiences of using prehospital guidelines for patients with acute chest pain - A qualitative study.2022In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 63, p. 1-7, article id 101195Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ambulance nurses have an important role in early recognition and treatment often being the first medical contact for patients with acute chest pain. However, there is sparse knowledge on the experiences of ambulance nurses with regard to use of Prehospital Guidelines for patients with Acute Chest Pain.

    AIM: To explore ambulance nurses' experiences of using prehospital guidelines for patients with acute coronary syndrome.

    METHOD: A qualitative descriptive study design. Semi-structured interviews with 22 ambulance nurses recruited through purposive sampling strategy. The material was transcribed and analysed using content analysis.

    RESULTS: Two main categories emerged from the results. The first category Sense of professional obligation included experiences of having an important role in caring for patients with acute chest pain. Understanding this role and the collaboration in the chain of care prompted ambulance nurses to adhere to the guidelines. However, not receiving enough feedback on the provided care made them uncertain whether to use guidelines. The second category Clinical difficulties using guidelines consisted of experiences of being surrounded by practical challenges while using guidelines. Ambulance nurses meet these challenges by relying on their clinical experience, which sometimes led to them deviating from the guidelines.

    CONCLUSIONS: The ambulance nurses experienced a mixture of feeling secure and insecure when using the guidelines. Foremost, when encountering patients with unspecific chest pain, they felt a lack of feedback and an insufficient collaboration within the chain of care, which made them deviate from guidelines. To increase adherence in guidelines, post-registration education to update the knowledge and skills about guidelines for acute chest pain is needed followed by formal inter-disciplinary feedback on the care provided.

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  • 8.
    Håkansson, Peter Gladoic
    et al.
    Malmö University, Faculty of Education and Society (LS), Department of Society, Culture and Identity (SKI). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Kvantitativa studier bland nyanlända ungdomar och ensamkommande: Tillvägagångssätt och utmaningar2019Report (Other academic)
    Abstract [sv]

    Det finns ett flertal tillfällen då det är svårt att hitta respondenter via traditionella register eller insamlingsmetoder. Att undersöka nyanlända ungdomars hälsa är ett sådant tillfälle. Projektet MILSA 2.0 är en forskningsbaserad stöd- och utvecklingsplattform och ett av projektets mål har varit att utveckla metoder för att samla in kunskap om nyanländas hälsa. I delprojektet MILSA 2.3 undersöks barn och ungdomars hälsosituation framförallt med fokus på social kapital, riskbeteenden och framtidstro. Den metod som utvecklades i projektet byggde på att samla in enkätsvar via skolorna i Skånes kommuner. Metoden förutsatte ett nära samarbete med kontaktpersoner i kommunerna. Enkäterna var översatta av MILSA-projektet till arabiska, dari och pashto, men även en version på svenska erbjöds respondenterna. Trots vissa brister utifrån ett traditionellt obundet slumpmässigt urval (OSU), menar vi att urvalet kan svara på frågor som vi inte annars hade kunnat få svar på. Vi bör naturligtvis vara medvetna om de brister som finns i urvalet, men samtidigt kan det bidra till ny kunskap om en grupp där det finns väldigt begränsat med data. För framtida studier av liknande grupper bör mer resurser avsättas för ett närmare samarbete med kommunerna och studien måste tydligare förankras med skolor och kommuner utifrån den metod som ska användas.

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  • 9. Kisch, Annika
    et al.
    Lenhoff, Stig
    Zdravkovic, Slobodan
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Bolmsjö, Ingrid
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
    Factors associated with changes in quality of life in patients undergoing allogeneic haematopoietic stem cell transplantation2012In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 21, no 6, p. 735-746Article in journal (Refereed)
    Abstract [en]

    Factors associated with changes in quality of life in patients undergoing allogeneic haematopoietic stem cell transplantation It is well known that patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) experience changes in quality of life. We investigated factors associated with quality of life changes in adult HSCT patients. The Functional Assessment of Cancer Therapy - Bone Marrow Transplantation (FACT-BMT) scale, supplemented with the Functional Assessment of Chronic Illness Therapy - Spiritual Well-being (FACIT-Sp) subscale, was administered on three occasions, immediately before transplantation, 100 days and 12 months after transplantation. Analyses of nine selected factors were made where changes in quality of life were found. Seventy-five patients were included and 40 of these completed the study. Emotional well-being was found to improve between the baseline and 100 days, while all other dimensions deteriorated, including overall quality of life. Physical and social/family well-being deteriorated between the baseline and the 12-month follow-up, while emotional well-being improved. The main factors associated with deteriorating quality of life over time were found to be significant infections, female gender and transplantation with stem cells from a sibling donor. In our further studies we aim to focus on the relationships between patients and sibling donors in order to improve the care. Careful attention must be paid to continuous adequate information during the transplantation procedure.

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  • 10.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Newly arrived refugee parents in sweden and their experience of the resettlement process: A qualitative study2020In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 48, no 7, p. 699-706Article in journal (Refereed)
    Abstract [en]

    Aims: The Swedish public support system for integration and establishment of newly arrived refugees includes an individualized introduction plan, containing language, civic and health information classes. As the plan requires active involvement, the simultaneous establishment of childcare and school start for children risks creating additional challenges and frustrations. The aim of the study was to explore the experience of adjustment among newly arrived refuge parents in the resettlement process, so as to understand how this risk may be mitigated. Methods: A qualitative study conducted with 24 Syrian refugee parents participating in the resettlement process and having received asylum status. Results: Parents experienced stress due to long waiting times for residence permits and the struggle to find stable housing. The parents established themselves by enrolling in language studies and looking for employment. They also faced challenges adjusting socially since they were mainly meeting people from their own country and therefore felt excluded from the Swedish society. Conclusions: The parents describe the experiences of having escaped from a war-torn country and arrived in new surroundings as mainly challenging for their current situation. Feelings of uncertainty arise as families struggle with daily life while waiting for residence permits, finding stable housing, learning a language and adjusting to new social circumstances. Having this in mind, we conclude that this group of refugees is exposed to health risks in the near future and as such is in need of additional support.

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  • 11.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Nyanlända flyktingars upplevelse av hälsa under etableringen i Sverige: Delrapport från MILSA 2.02020Report (Other (popular science, discussion, etc.))
    Abstract [en]

    BackgroundMigration in general is a factor that could lead to increased stress-levels among migrants, which is often caused by different circumstances that have occurred before the migration. After their arrival in a host country, a period of uncertainty occurs for asylum seekers. This results from waiting for their asylum claim to be assessed. Prolonged waiting for permission to stay correlate negatively in relation with mental health. In Sweden, all newly arrived migrants are invited to participate in an establishment process, which means individually developed support for the newly arrived persons to settle and begin to integrate. However, a foundation for being able to actively participate in the establishment process is a good health as well as stable and safe housing. A special vulnerable group among the newly arrived are families with children. This results from challenges that this group face with health and secure and stable housing in contrast to other newly arrived persons that are without a partner and children. Further on, newly arrived women are also a vulnerable group to consider. Therefore, there is a great need to illuminate the newly arrived families and especially women, and how they consider their health as well as their situation during their establishment process.

    Aim

    The aim was to shed light on the newly arrived families experience of health, with a focus on female newly arrived migrants health during their establishment.

    Material and methods

    The present report consists of two qualitative research studies that employed interviews. The interviews were carried out using semi-structured guides and consisted of several questions and themes. 26 interviews were carried out in total. 15 of these focused on families and 11 focused on the situation for newly arrived women. In the first study the data was analyzed by the method by Attride-Stirling and thematic network and in the second study with Burnard`s method for content analysis. Authorized translators were used. All interviews were conducted within the county of Scania.

    Conclusion

    Newly arrived families within the establishment process are fighting the asylum application as well as being challenged to find stable housing for their families. The children enjoyed school and the parents were driven by a determination to learn the Swedish language as well as being able to enter the Swedish labor market, although the later was considered to be a challenge for them. Some of the parents were suffering from stress due to having family12members left in home countries. Further to this the participants highlighted challenges with regard to integration in to Swedish society. When we do consider the situation of the newly arrived women, they were also seeing that family reunification is of importance and crucial for their mental well-being. The women in the present study, were eager to learn the language and to enter the labor market.In conclusion, it is of great importance to be sensitive to determinants of health such as unemployment, participation, the social life in Sweden as well as safe housing conditions with looking at certain vulnerable groups experiences of the establishment process in Sweden.

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  • 12.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Recently arrived refugee families and the experience of having an introduction plan and being in the resettlement process in Sweden: a qualitative study2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 142-142Article in journal (Other academic)
  • 13.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Understanding experiences of the Swedish health care system from the perspective of newly arrived refugees2018In: BMC Research Notes, E-ISSN 1756-0500, no 11Article in journal (Refereed)
    Abstract [en]

    Objective Refugees seek medical advice for a variety of reasons. Previous research suggests that understanding the refugees´ experiences of and access to healthcare are important factors for improving their health as access to healthcare has been found to be a leading health indicator. Therefore, the aim of this study was to illuminate experiences of the Swedish health care system from the perspective of newly arrived refugees. Results More than 70 % of newly arrived refugees in the county of Scania were in need of health care during the last 3 months of 2015-2016. They did not seek care to the same extent as the general population. The main reasons were explained as too high costs, long waiting times and language difficulties. Some disclosed being denied access to health care for reasons, such as being denied care when seeking emergency room for stomach problems and being denied follow-up care for diabetes.

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  • 14.
    Mangrio, Elisabeth
    et al.
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlzén, Katarina
    Länsstyrelsen Skåne.
    Grahn, Mathias
    Malmö Stad.
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Kartläggning av nyligen nyanländas hälsa, levnadsvanor, sociala relationer, arbetsmarknad och boendemiljö efter etableringen.: Delrapport från MILSA 2.02020Report (Other (popular science, discussion, etc.))
    Abstract [en]

    Background

    It is often a long and time-consuming process for migrants i.e. refugees to establish themselves into a new society. This includes adapting to the new society within which they find themselves, learning the local language as well as trying to access the labour market. To facilitate this, in 2010 Sweden adopted a mandatory 24 months structured and individually based public support system for to facilitate migrants establishment in the country (once a residence permit has been granted). This research questions how well the group of newly arrived migrants i.e. refugees from Syria and Iraq is equipped to take on the challenges that await them after the mandatory period of establishment has ended. For example, has their situation improved? How is their physical and mental health status? How do they consider the establishment period? Are they employed or what are their thoughts on the possibility of becoming so? This understanding is crucial in order to ensure that there is a solid empirical foundation upon which to base an assessment of, and were necessary adapt, the establishment procedure in Sweden.

    Aim

    The aim of the survey has been to map health and health related factors among adult newly arrived migrants from Iraq and Syria in Skåne that received the public support for their establishment. In addition to this the research sought to determine if this support has contributed to increased participation in society as well as increased access to the labour market.

    Material and methods

    The survey was conducted using a broad questionnaire in Arabic which focused on different health related questions, care needs, living conditions, social relations, violence , migration specific questions, employment, participation in society as well as questions related to sexual health. The selection of respondents is based on a random sample containing 10 000 individuals living in Skåne who were born in Iraq and Syria. The research looked at those who had received a residence permit between 01.09.2012 and 31.08.2016. The age of the respondents was between 20 and 64 years when receiving the residence permit. The survey was conducted during the autumn of 2018. The questionnaire was sent out to the respondents as a paper questionnaire with the possibility to answer the13questionnaire online. In total, 3208 questionnaires were received resulting in a response rate of 33%.

    Conclusion

    The survey found the following. The time period for receiving residence permit was usually within one year of arrival. A good level of Swedish language proficiently was only reported by a few respondents. The self-reported health status is in line with the rest of the population in the region. In addition, the participants recognised that the maintenance of their health was largely their responsibility, and was important. There were also some reports of unmet health needs as well as unmet dental care needs. Health related living conditions, such as smoking and physical inactivity, is more common amongst this group than the rest of the population. Lack of trust for different institutions is a challenge as it is more prevalent amongst this group than the general population. However, in contrast to this, there were high level of trust reported with regard to child health care centres. Almost all participants reported that they participated in the public support for establishment, including civic and health communication. The majority reported that the activities included in the establishment programme as being relevant. However, the observed challenges were not being sensitive to the various situations of the participants, quality as well as that, the activities overlap. Loss of social network as well as language barriers are considered by many as an obstacle for entering the labour market. Access to the Swedish labour market was reportedly a significant ongoing challenge for the participants.

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  • 15.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Enskär, Karin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Uppsala Universitet.
    Ramji, Rathi
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Tengland, Per-Anders
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Theodoridis, Kyriakos
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    The Need for Parental Support for Migrant Parents in Transition Into Sweden: A Perspective2022In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, article id 680767Article in journal (Refereed)
    Abstract [en]

    Migration is a stressful experience and research shows that newly arrived migrants in Sweden suffer from different challenges and struggle to relate to parenting in a new culture that is different from their own. The Swedish Child Health Services (CHS) focuses on promoting health among children, as well as supporting parents in parenting. Although this is a goal, migrant parents participate at lower rates in parental support groups. This paper aims to discuss how the Swedish CHS can support these families and address the need for improvement in the parental support offered to migrant parents during transition into their host country. In addition, this paper also aims to review and discuss the advantages of using a community-based participatory research approach together with the Swedish CHS to identify and apply culturally appropriate support programs to increase health literacy among migrant parents.  

    The Swedish government decided to place greater emphasis and resources on supporting parents and promoting equal health among families in Sweden, with special emphasis on migrants and other vulnerable groups. This report from the Swedish government indicates the importance of creating knowledge about new ways, methods, and actions that may be needed to increase this support. One suggestion of this paper is to provide culturally appropriate healthcare work using a community-based participatory research approach, where migrant parents themselves are actively involved in the development of support programs. This approach will not only provide migrant families knowledge and support, it will also build on their needs and the challenges they can share, and receive support to overcome.

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  • 16.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Grahn, M.
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Mental health and family composition after migration to Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 35-36Article in journal (Other academic)
  • 17.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Grahn, Mathias
    Malmö Stad.
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Cuadra, Carin
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Social relations and mental ill-health among newly arrived refugees in Sweden: a cross-sectional study2022In: PLOS Global Public Health, E-ISSN 2767-3375, Vol. 2, no 7, article id e0000362Article in journal (Refereed)
    Abstract [en]

    Background: Previous research indicates that social relations have an impact on the well-being of refugees and that well-being is important for effective integration into the host country. Few studies in Sweden have, to the best of our knowledge, looked at the association between social relations and mental ill-health among newly arrived refugees. The aim is to investigate what effect social relations have on the mental health of newly arrived refugees in the south of Sweden. Methods: A cross-sectional study was conducted in Scania, the southernmost county of Sweden, between February 2015 and February 2016. The study population consisted of newly arrived adult refugees speaking Dari or Arabic, who received the civic and health information that is part of an introduction course for all newly arrived refugees. Results: Individuals who rarely met with friends had higher odds of experiencing mental ill-health (OR=1.70, 95% CI, 1.03-2.82) than individuals who frequently spent time with friends. Furthermore, individuals who seldom attended social/community meetings or activities in an organisation or group, such as a sports association or another kind of association, a church, a mosque, or women’s or men’s meetings, had higher odds of mental ill-health (OR=1.58, 1.1-2.28), compared to those who frequently did so. Conclusions: The study suggests a link between spending time with friends, as well as engaging in social/community activities, and the mental health of newly arrived refugees in the southernmost county of Sweden, which is one of the counties in Sweden that received the highest number of refugees. The results are in line with a previous study on the same subject in Sweden.

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  • 18.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Maneesh, Paul-Satyaseela
    Acharya Inst Technol, R&D Directorate, Bengaluru, India..
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Strange, Michael
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Antimicrobial Resistance & Migrants in Sweden: Poor Living Conditions Enforced by Migration Control Policies as a Risk Factor for Optimal Public Health Management2021In: Frontiers In Public Health, ISSN 2296-2565, Vol. 9, article id 642983Article in journal (Refereed)
    Abstract [en]

    Infectious diseases exacerbated by Antimicrobial Resistance (AMR) are of increasing concern in Sweden, with multi-drug resistant strains associated with new resistance mechanisms that are emerging and spreading worldwide. Existing research has identified that sub-optimal living conditions and poor access to healthcare are significant factors in the spread and incubation of AMR strains. The article considers this linkage and the effort to control the spread of AMR in relation to migrants, highlighting deficiencies in public policy where such individuals are often increasingly exposed to those conditions that exacerbate AMR. In many of the richest countries, those conditions are not accidental, but often direct goals of policies designed with the goal of deterring migrants from staying within host countries. Without engaging with the politics around migration control, the article points to urgent need for more holistic assessment of all public policies that may, however unintentionally, undermine AMR control through worsening living conditions for vulnerable groups. The consequences of prioritizing policies meant to deliberately worsen the living conditions of migrants over avoiding those conditions that accelerate AMR spread, are today made ever apparent where new AMR strains have the potential to dwarf the societal effects of the current Covid-19 pandemic.

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  • 19.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Nieuwenhuijsen, Kyra
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS).
    Wahel Sebhatu, Rahel
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS).
    Strange, Michael
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Rapport #2 PHED-kommissionen för framtiden för hälso-och sjukvård efter Covid-19: allmän hälso- och sjukvård för en gemensam framtid. Baserad på offentliga seminarier som hållits mars - juni 20212022Report (Other academic)
    Abstract [sv]

    Den här rapporten ger en sammanfattning av de seminarier som organiserades under våren 2021 av PHEDKommissionen för framtiden för hälso- och sjukvården efter covid-19, som bjöd in till vittnesmål från hälso- och sjukvårdspersonal, tjänstemän, tankesmedjor, forskare, civilsamhället och andra intresserade parter baserat på de erfarenheter de fått och lärt sig av under pandemin. De vittnesmål som framfördes kom från många olika geografska platser och många olika nivåer, vilket gjorde dem relevanta både för Sverige och globalt. De fastställer fera centrala rekommendationer för att skydda och förbättra folkhälsan. Dessa rekommendationer både kompletterar och i hög grad utökar de rekommendationer som togs fram i den första rapporten, som var mer fokuserad på Sverige (”Ojämlikhet i samhället gör oss sårbara för pandemier”) och baserad på vittnesmål från hösten 2020, och som kan nås via: https://phed.uni.mau.se/. Den stora mängd erfarenheter som sammanfattas här går långt utöver pandemiperioden och tillhandahåller idéer och praktisk vägledning för att skydda och stärka människors hälsa så att den blir mer motståndskraftig inför framtida kriser. 

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  • 20.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Nieuwenhuijsen, Kyra
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS).
    Wahel Sebhatu, Rahel
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS).
    Strange, Michael
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Report #2 PHED commission on the future of healthcare post covid-19: universal health coverage for a real future. Based on sessions conducted from March until June 20212022Report (Other academic)
    Abstract [en]

    This report summarises the Spring 2021 sessions of the PHED Commission on the Future of Healthcare Post Covid-19, which invited testimony from healthcare practitioners, civil servants, thinktanks, researchers, civil society, and other interested parties based on their experiences learnt during the pandemic. The evidence presented came from multiple geographies and levels, making it relevant both to Sweden and globally. It identifes several key recommendations for protecting and improving public health. These recommendations supplement and greatly expand upon those identifed in the report (‘Societal inequity makes us vulnerable to pandemics’) based on testimony from Fall/Autumn 2020, which can be accessed via: https://phed.uni.mau.se/. The wealth of experience summarized here goes well beyond the pandemic period, providing ideas and practical guidance for protecting and strengthening human health to be more resilient in the face of future crises.

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  • 21.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Sjöström, Karin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Grahn, Mathias
    Malmö Stad.
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Risk for mental illness and family composition after migration to Sweden2021In: PLOS ONE, E-ISSN 1932-6203, Vol. 16, no 5, article id e0251254Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of the present study is to determine how marital status and certain post-migration family structures are associated with the risk of mental illness among recently arrived Arabic- speaking refugees in Sweden. 

    Methods: A cross-sectional study was conducted during 2015 and 2016. The study population was recruited by inviting all adult refugees who participated in the mandatory public integration support programme. All refugees that participated had received refugee status. A total of 681 of the invited participants returned the GHQ-12 questionnaires, through which the risk for mental illness was measured and only Arabic- speaking refugees (N=638) were included in the analyses. 

    Results: Marital status per se was not associated with a risk for mental illness. However, for the whole study sample there was a statistical significant odds ratio of 1.72 (95% CI 1.03–2.86). For male Arabic-speaking refugees with a spouse or child left behind in the home country there was a borderline significant increased risk for mental illness, odds ratio = 1. 87 (95% CI 0.99–3.56). The risk for female Arabic-speaking refugees was non-significant, odds ratio = 1.35 (95% CI 0.55–3.33). 

    Conclusions: Arabic- speaking refugees who were separated from family members reported an increased risk for mental illness after arriving in the host country. Actions to facilitate family reunion after arriving as a refugee (in Sweden) seems to be an important factor to promote mental health among refugees. 

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  • 22.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Slobodan, Zdravkovic
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    A qualitative study of refugee families’ experiences of the escape and travel from Syria to Sweden2018In: BMC Research Notes, E-ISSN 1756-0500, Vol. 11, no 594Article in journal (Refereed)
    Abstract [en]

    Objective: Research shows that, depending on the route of travel during the escape, the journey presents the refugees with different health risks. Traumatic events during flight may have long-lasting physical and psychological effects on the refugee children. Therefore, it is important to illuminate the experiences that refugee families arriving in Sweden have endured during their flight. A qualitative study was conducted through interviews with fifteen recently arrived Syrian refugee families. Results: The parents described different reasons as to why they as families had to escape the war. Some families had lost jobs and loved ones in the war and did not want their children to die as well. They mentioned that the journeys varied between 10 and 40 days and were usually filled with struggles and threats. The escape to Sweden was expressed as an emotionally trying journey. Many parents talked about the fear and terror the children felt. Traumatic events during the escape, such as separation from family, death of family members, sexual violence, kidnapping or extortion may have long-lasting physical and psychological effects on the refugee children and their families. Therefore, health care workers meeting and caring for these families after arrival must pay close attention to that.

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  • 23.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Crowded living and its association with mental ill-health among recently-arrived migrants in Sweden: a quantitative study2018In: BMC Research Notes, E-ISSN 1756-0500, Vol. 11Article in journal (Refereed)
    Abstract [en]

    Objective Housing and neighbourhood conditions are widely acknowledged important social determinants of health and health inequalities that persist in developed countries despite general improvements in health outcomes across populations. Previous research has investigated what effect crowded living conditions have on mental health and concluded that women living in crowded conditions were more likely to suffer from depression. In contrast, men living in the same conditions responded with withdrawal or aggression. To the best of our knowledge, only a few studies have examined the association between recently-arrived migrants living in crowded conditions and poor mental health. The aim of this study was to investigate the association between crowded living conditions among recently-arrived migrants in Sweden and mental ill-health. The result is based on 681 migrants who completed and returned questionnaires in 2015-2016. Results The analyses, independent of gender, resulted in a significant unadjusted odds ratio of 1.46 (95% CI 1.05-2.03); even after adjustments were made, the association remained significant OR 1.47 (1.05-2.07). When adding stability in housing into the adjustment-model, the OR did not remain significant OR 1.40 (0.99-1.99), p-value 0.061.

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  • 24.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlson, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Refugee women's experience of the resettlement process: a qualitative study.2019In: BMC Women's Health, E-ISSN 1472-6874, Vol. 19, no 1, article id 147Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Resettlement can be particularly challenging for women as having a lower socioeconomic status and language barriers, may impede women's access to education, employment opportunities, health-care services, as well as the cultural, social, material and resilience factors that facilitate adjustment and adaption. Thus, the aim of this study is to further explore the perception of refugee women in Sweden concerning their situation during active participation in the resettlement process in the country. METHODS: Qualitative interview study with 11 recently arrived refugee women who had received their residence permits and were enrolled in the resettlement process. The interviews were conducted in Swedish with the support of an authorized Arabic translator present by telephone. RESULTS: Refugee women suffered from being separated from their loved ones and felt compelled to achieve something of value in the host country. All experienced both physical and mental anguish. CONCLUSIONS: Stakeholders in societies that receive refugee women should stress the importance of finding opportunities for and fast entrance into employment in the host countries. This would be beneficial for the integration and well-being of refugee women after migration.

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  • 25.
    Mangrio, Elisabeth
    et al.
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Ivert, Anna-Karin
    Malmö University, Faculty of Health and Society (HS), Department of Criminology (KR).
    Risk for mental illness following exposure to violence and threats among newly arrived refugees2022In: BMC Research Notes, E-ISSN 1756-0500, Vol. 15, no 1, article id 361Article in journal (Refereed)
    Abstract [en]

    Objective: There is an association between pre-migration exposure to threats and violence, and the risk for mental illness among newly arrived refugees (NAR). The aim of this study is therefore to investigate the effect of pre-migration violent and threatening experiences on the mental health of NAR in Sweden. The participants were recruited between February 2015 and February 2016, undergoing the naturalisation process in Sweden. In total, 681 questionnaires were returned (response rate of 39.5%).

    Results: The results showed that almost 50% of the sample were at risk for mental illness. Analysis of pre-migration exposure to violence or threats, and risk for mental illness, showed a significant odds ratio for violence as well as for threats. Analysing men and women separately resulted in a significant odds ratio for women for pre-migration threats. For men, pre-migration violence and threats were significantly associated with the risk for mental illness. The host society receiving NAR must screen for mental illness and be prepared to provide support and care for refugees who were exposed to violence or threats, and who are subsequently at risk for mental illness. This must be considered in order to improve health and subsequently the social integration of refugees.

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  • 26.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Sjögren Forss, Katarina
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    The Association Between Self-perceived Health and Sleep-Quality and Anxiety Among Newly Arrived Refugees in Sweden: A Quantitative Study.2020In: Journal of Immigrant and Minority Health, ISSN 1557-1912, E-ISSN 1557-1920, Vol. 22, p. 82-86Article in journal (Refereed)
    Abstract [en]

    Previous research findings suggest that insomnia could be related to decreased health status and that it could also be affected by traumatic life experiences, such as war. Good health is important for newly arrived refugees for an effective integration process. The aim of the present study is, therefore, to investigate the association between self-perceived health and sleep quality among newly arrived refugees in Sweden. The results are based on 681 migrants who participated in a survey between 2015 and 2016. There was a significant odds ratio (OR) after adjustment for confounders for newly arrived refugees that were experiencing bad self-perceived health to also experience bad sleep: OR 8.07 (4.34-15.00). Furthermore, the OR remained significant but lower after adjustments for confounders for newly arrived refugees that had bad self-perceived health to be suffering from anxiety during sleep, with OR 3.83 (2.11-6.94).

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  • 27.
    Mangrio, Elisabeth
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Strange, Michael
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Working With Refugees' Health During COVID-19: The Experience of Health- and Social Care Workers in Sweden2022In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, article id 811974Article in journal (Refereed)
    Abstract [en]

    Introduction

    In Sweden, often seen as one of the most egalitarian countries, the COVID-19 pandemic exposed high levels of health inequality, especially harming people with a refugee background. This is also despite Sweden’s image as a refugee-friendly country. In this context, the aim of this paper is to better understand how Swedish health- and social workers have reacted to the health- and social needs of refugees during the pandemic. The Swedish case is particularly interesting because, as seen in the paper, health- and social workers had the task of communicating health guidance to refugees who were sometimes more reliant on information from abroad where the consensus on COVID-19 restrictions ran contrary to the approach recommended by the Swedish public health authority.

    Method

    The study utilizes a qualitative content analysis of 13 in-depth interviews with health- and social workers in Sweden, active in the care of refugees within different kinds of health- and social care settings. 

    Results

    The analysis showed that healthcare services have remained open during the pandemic but with new precautions at reception areas impacting how refugees access healthcare. As discussed in the article, the shift to digital tools has particularly impacted refugees, worsening already existing barriers to healthcare services faced by those with refugee status. Public health recommendations were poorly designed to the needs of refugees whose living conditions often prevented them from self-isolation and social distancing. Furthermore, Sweden’s initially non-restrictive approach to the pandemic instructed health- and social-workers to encourage refugees to take far fewer precautions (e.g. self-isolation, home-schooling, pregnant women to avoid virus hotspots) compared both with European neighbours and the international media typically used by refugees. When Sweden shifted towards a more restrictive approach, health- and social-workers had to revise their guidance in relation to the new recommendations around precautions.

    Conclusion

    Refugees have faced increased barriers to maintaining their health and well-being during the pandemic that exceed those experienced by the rest of the Swedish population. Refugees have, in general, taken precautions in regard to social distancing and followed recommendations but faced challenges with social distancing due to isolation and crowded living. Public health authorities have often failed to acknowledge that individuals use increasingly diverse sources of knowledge when trying to protect their health, and that not everyone has access to the knowledge needed to access healthcare and social systems. At the same time, there is a need to acknowledge that refugees are sometimes a source of expertise that was ignored by the Swedish health and social system during the pandemic. There is a need for urgent efforts to halt the worsening health conditions for this specific group, but also to counter knock-on societal effects and rising health inequity.

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  • 28. Nayak, Raj
    et al.
    Zdravkovic, Slobodan
    Malmö högskola, Faculty of Health and Society (HS), Department of Health and Welfare Studies (HV).
    Janzon, Ellis
    Malmö högskola, Faculty of Health and Society (HS), Department of Health and Welfare Studies (HV).
    Incidence of myocardial infarction among Swedish and immigrant women: can physical activity modify the risk? An epidemiological study on the Malmo Diet and Cancer Study2013In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 7, p. 672-679Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sweden has shown a decreasing tendency in the incidence of myocardial infarction (MI), except among middle-aged women. The incidence among middle-aged immigrant women is less explored. AIM: To determine if foreign-born women have a higher risk of MI as compared to women born in Sweden. Furthermore, to examine if physical activity (PA) modifies the risk of MI regardless of immigration status and smoking habits. METHODS: The Malmo Diet and Cancer Study was used for analyses. A total of 16,776 women aged 45-73 years participated. The mean follow-up time was 13.8+/-4 years. RESULTS: Mean age was 57.4+/-7.9 years. No difference was found in incidence of MI between Swedish and immigrant women (p=0.72). For current smokers among Swedish women, the relative risk (RR) with no/low PA was 2.93 (95% CI 2.07-4.14) and with moderate/high PA, the RR was 2.21 (95% CI 1.61-3.03) with no/low PA-never smoker as the reference group. Among immigrant smoking women, the RR with no/low PA was 4.56 (95% CI 1.62-12.8) and with moderate/high PA, the RR was 3.27 (95% CI 1.21-8.84) with no/low PA-never smoker as the reference group. CONCLUSIONS: PA reduces the risk of MI in non-smokers as well as in smokers, regardless of immigration status. Furthermore, PA was even more beneficial for women born outside Sweden. Against this background, immigrant women ought to get special consideration and attention from both caregivers and public health workers.

  • 29.
    Pia, Svensson
    et al.
    Lunds universitet.
    Wångdahl, Josefin
    Uppsala universitet.
    Zdravkovic, Slobodan
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Utvärdering av MILSA-utbildningen. En delutvärdering av MILSA utbildningsplattform för samhälls- och hälsokommunikation.2021Report (Other academic)
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  • 30.
    Rämgård, Margareta
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Grahn, M.
    Municipal Malmo, Unit Stat & Anal, Malmo, Sweden..
    Schölin, T.
    Avdelningen Reg Utveckling, Malmo, Sweden..
    Holmberg, C. Nagorny
    Novo Nordisk Scandinavia AB, Med Affairs, Malmo, Sweden..
    Annersten Gershater, Magdalena
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Inequalities in diabetes type 2 prevalence in the multicultural city Malmo, Sweden2021In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, no S3Article in journal (Other academic)
    Abstract [en]

    Background

    Type-2 diabetes is a progressive disease and very much linked to health equity prerequisites and poverty. Its long-term complications include cardiovascular diseases, blindness, amputation and kidney failure. The aim of the study was to explore diabetes type 2 (T2D) prevalence in Malmö, a socioeconomically diverse and multicultural city with a relatively young population.

    Methods

    The study is a part of the Cities Changing Diabetes project related to the 14 geographical developing areas CTC (Community That Care) in Malmö. The whole city has been divided into 14 areas based on socioeconomical homogeneity as well as shared local area affiliation. Results are obtained from the Patient Administrative System (ICD E11 code) in regional health care as well as from Statistics Sweden.

    Results

    The prevalence of T2D was 4.3% in 2018. It has increased since 2011 mostly noticeable for residents between 18 and 64 years of age. There are considerable differences in T2D prevalence by CTC-areas where the highest observed prevalence rate was 6.4% and the lowest was 2.6%. The areas with the lower prevalence rates have a high level of education as well as high average household income. The opposite is observed in the areas with the highest prevalence rates where the residents have lower educational level as well as low average income. Two of the three CTC-areas with the highest T2D prevalence rates consists of a younger population as compared to the city in general whereas the third consists of the oldest population in the city.

    Conclusions

    The prevalence of T2D has increased during the last decade in Malmö. There are significant differences in T2D prevalence within the city related to contextual and socioeconomic factors. The highest T2D prevalence occurs in the area with the lower income and lower level of education.

    Key messages 

    • Promotive actions need to be specifically targeted at younger populations in the city of Malmö to prevent the increase in type-2 diabetes and its complications.
    • Contextual factors need to be taken into consideration in the development of sustainable primary and secondary preventive actions for type-2 diabetes in community care and the health care system.
  • 31.
    Sjögren Forss, Katarina
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Mangrio, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Leijon, M.
    Grahn, M.
    Zdravkovic, Slobodan
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Physical activity in relation to wellbeing among newly arrived refugees in Sweden2020In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, no s5, article id ckaa166.727Article in journal (Other academic)
    Abstract [en]

    BackgroundIn the light of the growing number of refugees that the world has faced during the last years it is reasonable to suggest that the number with both physiological and mental health needs will raise and result in increased public health challenges. Physical activity with its well documented positive impact on both mental and physical health might be one way for refugees to promote health. The importance of investigating participation in physical activity in this group and the impact it might have on their health and wellbeing cannot be underestimated. Few studies exists in the field and therefore, this study aimed to investigate physical activity in relation to mental well-being, vitality, stress and sleep quality among newly arrived refugees in Sweden. 

    MethodsThe study was based on the results from a survey, conducted in 2015 - 2016 among newly arrived adult refugees who spoke Arabic, Pashto, Somali or Dari, participated in a mandatory public integration support programme in the Scania region of Sweden and agreed to participate in the survey. Ultimately 681 participants completed the survey (a response rate of 39,5%). 

    ResultsWe found a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees.

    ConclusionsNewly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, regardless of their external circumstances, and supported in their attempts to do so.

    Key messages There is a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees.Newly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, and supported in their attempts to do so.

  • 32.
    Sjögren Forss, Katarina
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Mangrio, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Leijon, Matti
    Department of Medical and Health Sciences, Linköping University.
    Grahn, Mathias
    Unit for Statistics and Data, Municipality of Malmö.
    Zdravkovic, Slobodan
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Physical Activity in Relation to Wellbeing Among Newly Arrived Refugees in Sweden: A Quantitative Study2021In: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, article id 532883Article in journal (Refereed)
    Abstract [en]

    Background: Little is known about physical activity among newly arrived refugees and what impact physical activity might have on their health, as measured by mental wellbeing, vitality, stress and sleep quality. Thus, this study sought to investigate the relationship between physical activity and wellbeing among refugees who were newly arrived in Sweden. Methods: The present study was based on the results from a survey, conducted in 2015-2016 among newly arrived adult refugees who spoke Arabic, Pashto, Somali or Dari, participated in a mandatory public integration support programme in the Scania region of Sweden and agreed to participate in the survey. Ultimately 681 participants completed the survey (a response rate of 39.5%). Results: We found a significant association between physical activity and mental wellbeing, vitality, stress and sleep quality among newly arrived refugees. Conclusions: Newly arrived refugees need to be informed about the importance of prioritizing physical activity for their health and wellbeing, regardless of their external circumstances, and supported in their attempts to do so.

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  • 33.
    Strange, Michael
    et al.
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Gustafsson, Hilda
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Mangrio, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Rapport #1 PHED-kommissionen för framtiden för hälso-och sjukvård efter Covid-19: Ojämlikhet i samhället gör oss sårbara för pandemier2021Report (Other academic)
    Abstract [sv]

    Under hösten 2020 organiserade PHED-projektet i ett samarbete mellan Malmö och Lunds universitet en kommission och bjöd in till muntliga och skriftliga vittnesmål om framtiden för hälso- och sjukvården efter covid-19. Efter att initialt ha fokuserat på Region Skåne, utvidgades diskussionerna till att omfatta ett bredare nationellt fokus liksom internationella jämförelser med Frankrike och Storbritannien. Undersökningen omfattade vittnesmål från såväl yrkesverksamma inom hälso- och sjukvård som tjänstemän, civilsamhället och forskare. Överlag framställde vittnesmålen covid-19 som både en tragedi och ett lärotillfälle som skulle kunna stärka samhället. Flera centrala rekommendationer för att skydda och förbättra folkhälsan togs fram.

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  • 34.
    Strange, Michael
    et al.
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Gustafsson, Hilda
    Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Mangrio, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Report #1 PHED-commission on the future of healthcare post covid-19: social inequity makes us vulnerable to pandemics2021Report (Other academic)
    Abstract [en]

    During Fall/Autumn 2020, the PHED project between Malmö and Lund Universities organised a Commission inviting oral and written testimony on the future of healthcare post Covid-19. Focused initially on the Scania region, the discussions expanded to include a wider Swedish national focus, and international comparison with France and the United Kingdom. The inquiry included testimony from healthcare practitioners, civil servants, civil society, as well as researchers. Overall, the testimony pointed to Covid-19 as both a tragedy and a learning moment by which to strengthen society. It identifies several key recommendations for protecting and improving public health.

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  • 35.
    Strange, Michael
    et al.
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Culture and Society (KS), Department of Global Political Studies (GPS). Malmö University, Faculty of Culture and Society (KS), Rethinking Democracy (REDEM).
    Nilsson, Carol
    Lund university, Department of Experimental Medical Science.
    Zdravkovic, Slobodan
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Mangrio, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    The Precision Health and Everyday Democracy (PHED) Project: Protocol for a Transdisciplinary Collaboration on Health Equity and the Role of Health in Society2020In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 9, no 11, article id e17324Article in journal (Refereed)
    Abstract [en]

    Background: The project “Precision Health and Everyday Democracy” (PHED) is a transdisciplinary partnership that combines a diverse range of perspectives necessary for understanding the increasingly complex societal role played by modern health care and medical research. The term “precision health” is being increasingly used to express the need for greater awareness of environmental and genomic characteristics that may lead to divergent health outcomes between different groups within a population. Enhancing awareness of diversity has parallels with calls for “health democracy” and greater patient-public participation within health care and medical research. Approaching health care in this way goes beyond a narrow focus on the societal determinants of health, since it requires considering health as a deliberative space, which occurs often at the banal or everyday level. As an initial empirical focus, PHED is directed toward the health needs of marginalized migrants (including refugees and asylum seekers, as well as migrants with temporary residency, often involving a legally or economically precarious situation) as vulnerable groups that are often overlooked by health care. Developing new transdisciplinary knowledge on these groups provides the potential to enhance their wellbeing and benefit the wider society through challenging the exclusions of these groups that create pockets of extreme ill-health, which, as we see with COVID-19, should be better understood as “acts of self-harm” for the wider negative impact on humanity.

    Objective: We aim to establish and identify precision health strategies, as well as promote equal access to quality health care, drawing upon knowledge gained from studying the health care of marginalized migrants.

    Methods: The project is based in Sweden at Malmö and Lund Universities. At the outset, the network activities do not require ethical approval where they will not involve data collection, since the purpose of PHED is to strengthen international research contacts, establish new research within precision strategies, and construct educational research activities for junior colleagues within academia. However, whenever new research is funded and started, ethical approval for that specific data collection will be sought.

    Results: The PHED project has been funded from January 1, 2019. Results of the transdisciplinary collaboration will be disseminated via a series of international conferences, workshops, and web-based materials. To ensure the network project advances toward applied research, a major goal of dissemination is to produce tools for applied research, including information to enhance health accessibility for vulnerable communities, such as marginalized migrant populations in Sweden.

    Conclusions: There is a need to identify tools to enable the prevention and treatment of a wide spectrum of health-related outcomes and their link to social as well as environmental issues. There is also a need to identify and investigate barriers to precision health based on democratic principles.

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  • 36.
    Svensson, Pia
    et al.
    Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Agardh, Anette
    Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Zdravkovic, Slobodan
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Asamoah, Benedict Oppong
    Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Investigating pathways for predisposing, enabling and need factors in predicting the use of STI/HIV-testing services among Syrian and Iraqi migrants in Scania, Sweden - a cross-sectional study with directed acyclic graphs for modelling pathways to testing2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, p. 2177-, article id 2177Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Some groups of migrants have increased vulnerability to Sexually Transmitted Infections (STI) and Human Immunodeficiency Virus (HIV) transmission partly due to a lower uptake of disease preventive activities targeting the general population in receiving country. Limited access to economic and social resources and poor language skills may exacerbate exposure to sexual risks and utilization of health services.

    AIM: To explore general and migrant specific predictors for STI/HIV-testing among Syrian and Iraqi migrants in Sweden and to investigate potential pathways that link predisposing, enabling and need- factors to STI/HIV-testing.

    METHOD: Cross-sectional study design based on a migration specific framework for health care utilization. Directed acyclic graphs (DAGs) were used to model assumptions about factors associated with the uptake of STI/HIV-testing services. Bi-variable and multivariable logistic regression analyses assessed individual predictors while adjusting for covariates. The magnitude of the indirect effect of mediating variables were estimated with bootstrap analyses and a method for decomposing the total effect.

    RESULT: The pathways between younger age, unmarried, and self-identifying as bi- or homosexual and testing were mainly indirect, mediated by experiences of sexual coercion and other risk behaviours. One third of the indirect mediating effect of the pathway between higher education and testing could be attributed to Swedish language skills.

    CONCLUSION: Utilization of STI/HIV-testing services among Syrian and Iraqi migrants seemed to be motivated by sexual risk exposure and risk awareness. Interventions should focus on language-adapted information about available screening services and where to go for advice on sexual wellbeing and sexual rights. Such activities should be implemented within an integration promoting framework, addressing structures that increase STI/HIV risk exposure, specifically targeting vulnerable subgroups of migrants.

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  • 37.
    Zdravkovic, Slobodan
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö högskola, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Björngren Cuadra, Carin
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö högskola, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Kartläggning av nyanländas hälsa2015In: Milsa: Stödplattform för migration och hälsa: Grunden läggs, Länsstyrelsen Skåne , 2015, p. 79-87Chapter in book (Other academic)
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  • 38.
    Zdravkovic, Slobodan
    et al.
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Carlzen, K.
    Agardh, A.
    Svensson, P.
    Westerling, R.
    Professional development of civic and health communicators: a national platform in Sweden MILSA 3.02020In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, p. V35-V35, article id ckaa165.081Article in journal (Other academic)
    Abstract [en]

    BackgroundEstablishing oneself in a new country is especially challenging for forced migrants affecting both physical and mental health. The Swedish introduction system includes a mandatory civic orientation program conducted in the refugeés native language, covering different aspects of the Swedish society. MILSA has advocated for including health promotion as a key component in the introduction system, stating that culturally sensitive health communication is a human right for refugees. Through this work, health communication is now included in the program in many parts of Sweden. However, there are challenges due to a lack of professional recognition related to the absence of a recognized training. In order to create a national capacity for a quality based civic and health communication, MILSA has developed a national training program carried out in collaboration with five universities, actors on local, regional, and national levels as well as NGOs and experts in different areas. 

    MethodsA web-based program including six physical workshops is given nationally. The program consists of 22 modules targeting society and public health issues but also pedagogy, leadership and communication. Evaluation studies are included in the program targeting the education itself and as well as investigating effects on the refugees.

    ResultsThe program has been running for three years ending in autumn 2020 including four admission periods. The early evaluation showed very encouraging results where participants reported a deeper knowledge of civics and public health, resulting in being more secure and comfortable in their daily work, including improvements regarding skills in pedagogy, leadership and conflict management.

    ConclusionsThe need for an educational platform is recognized by many stakeholders in Sweden. The program has received a very positive evaluation. Due to this, MILSA has initiated a process of establishing a national commissioned program on permanent basis.

    Key messages The program has been highly regarded by the communicators, due to the gained knowledge in their everyday work.The importance of health communication and professional development and its value for the recipients of civic orientation is recognized by many stakeholders within but also outside the country.

  • 39.
    Zdravkovic, Slobodan
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Carlzén, Katarina
    Länsstyrelsen Skåne.
    Grahn, Mathias
    Malmö Stad.
    Mangrio, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Kartläggning av hälsa, levnadsvanor, sociala relationer, arbetsmarknad och boendemiljö bland arabisktalande nyanlända inom etableringen: Delrapport från MILSA 2.02020Report (Other (popular science, discussion, etc.))
    Abstract [en]

    Background

    Forced migration is a trying and difficult experience to endure. Several supplementary challenges in relation to the establishment process await almost immediately after arrival. The process of establishing into a new society is often a long and challenging process. Both learning the language and understanding the society are the first immediate barriers for entering the Swedish labour market, as well as the authorization of diplomas and qualifications. A common challenge is also finding stable and adequate housing. A prerequisite for being able to take on these challenges is the health capital/status of recently arrived migrants (RAM). Health approached in a wide-ranging manner includes all factors that are in one way or another affecting the life of a human being. In order to enhance the establishment and inclusion of RAM it is important to have the fundamental understanding of the situation that this group are facing in relation to their health, as well as different health related risk factors.

    Aim

    The aim of the survey was to evaluate health and health related factors for RAM adults included in the establishment process in the southern region of Sweden, Skåne.

    Material and methods

    All recently arrived Arabic speaking individuals that currently participated in civic- and health communication through Partnership Scania were invited to participate in the study. The period of data collection was between May 2018 and March 2019. The questionnaire was initially developed in Swedish and translated into Arabic. It contains questions addressing different diseases, care needs, migration specific questions, housing, social relations, violence, living habits and sexual health among other things. The questionnaire was distributed in a paper format in civic and health communication classes through civic and health communicators. In total, 315 questionnaires were received resulting in an approximate response rate of 25,3%.11

    Conclusion

    The study found that a large percentage of RAM reported being either overweight or obese, with many of them considering that they gained weight since their flight to Sweden. Almost one in ten RAM participants reported their health status as bad or very bad. A third of participants reported their health as fairly good. Almost half of the respondents experienced an improvement in self-reported health status after receiving the residence permit, but almost one fifth experienced a change for the worse. Almost half the participants had been in a need for health care during the last three months from the date of answering the questionnaire without seeking care. Furthermore, almost a third of the RAM was at risk for their mental ill-health. A higher proportion of men as compared to women reported being at risk for their mental ill-health. More than half of the respondents were not physically active or were active less than 30 minutes per week. The majority of the respondents reported distrust for humans beings. A considerable proportion were lacking social networks in relation to finding jobs. Half of the respondents were missing any contact with employers and a third experienced difficulties having their qualification validated.

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  • 40.
    Zdravkovic, Slobodan
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Grahn, M.
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Annersten Gershater, Magdalena
    Are recently arrived migrants at higher risk of developing diabetes in Scania, Sweden?2020In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, no s5, article id ckaa166.1107Article in journal (Other academic)
    Abstract [en]

    Background: The world is facing increased migration as well as increased diabetes prevalence including earlier disease debut than ever before. Sedentary lifestyle and obesity constitute risk factors for development of diabetes type 2, the most common diabetes type among adults. It is thus important to increase the awareness of diabetes prevalence and of those being at risk for the disease. The aim was to focus on self-reported diabetes and weight in recently arrived migrants (RAM) in comparison with the rest of the population of Scania.

    Methods: A cross-sectional study was used to collect data through random sampling using a self-administrated questionnaire. 10 000 questionnaires in Arabic were sent to adult RAM in Scania born in Syria or Iraq and 10 000 questionnaires to a random sample of the Scania population as a control group. The overall response rate was 32.8 %, 3461 were male and 3105 were female and the overall mean age was 44.7 (range 22 -70).

    Results: 170 RAM and 147 controls reported diabetes, 741 RAM and 585 controls reported a body mass index (BMI) ≥ 30 kg/m2. A significantly higher prevalence of self-reported diabetes was observed among RAM (6.2% compared to 4.9%, p-value = 0.02). In comparison with age, significantly (p-value < 0.05) higher prevalence was present in RAM as compared to the control group in all age categories except the age category 65-80 where the difference was borderline significant (p-value = 0.056). With regard to BMI no significant difference was observed between the RAM and the control group having diabetes, but independently of diabetes the prevalence of BMI 25-30 kg/m2 and BMI ≥ 30 kg/m2 was significantly higher in RAM (p-value < 0.01).

    Conclusions: Self-reported diabetes is more prevalent in RAM as compared to a control group representing the rest of the population in Scania. Considerably large amount of the respondents in both groups are overweight or obese and are therefore to be considered at risk for developing diabetes type 2.

    Key messages 

    Self-reported diabetes in Scania is more prevalent in RAM from Iraq and Syria than in the rest of the population in Scania.Health care services need to address that a large number of the population in Scania is being overweight or obese, which is even more prominent in RAM from Iraq and Syria.

  • 41.
    Zdravkovic, Slobodan
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö högskola, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Grahn, Mathias
    Björngren Cuadra, Carin
    Malmö högskola, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Kartläggning av nyanländas hälsa2016Report (Other academic)
    Abstract [sv]

    Bakgrund God hälsa är en förutsättning för en inkluderande och effektiv etablering av nyanlända flyktingar i Sverige. En migrationsprocess föranledd av flykt utgör en belastande livserfarenhet. Kännedom om hur tiden innan och efter flykten påverkar hälsan, och det allmänna hälsotillståndet i nära anslutning till flykten, utgör viktig kunskap för beslutsfattare. Denna kunskap utgör en central grund för att kunna behovsanpassa etableringsinsatser för nyanlända flyktingar. Syfte Syftet med kartläggningen är att ge en väl underbyggd bild av hälsoläget bland nyanlända flyktingar som omfattas av etableringslagstiftningen. Material och metod Studien vänder sig till alla vuxna nyanlända flyktingar med modersmålen arabiska, dari, pashto eller somaliska. Ett mätinstrument, i det här fallet en enkät, utvecklades på respektive språk och omfattar bland annat självrapporterad hälsa, förändring i hälsa, sjukdomar, läkemedel, bakgrundsfaktorer, livsstilsfaktorer, sociala bestämningsfaktorer, sömn- och välbefinnande, tandhälsa, smittsamma sexuella sjukdomar och preventivmedel samt hälsolitteracitet. Enkätutdelningen påbörjades den 13 februari 2015 och avslutades den 12 februari 2016. Studien bygger på frivilligt deltagande och anonymitet. Totalt besvarades 681 enkäter (svarsfrekvens 39,5 %) varav 93,7 % på arabiska och 6,3 % på dari. 69,3 % av respondenterna var män. Enkäter på pashto och somaliska har inte delats ut eftersom det 10 vid tiden för datainsamlingsperioden inte funnits grupper på dessa språk inom samhälls- och hälsokommunikationen. Majoriteten av respondenterna var födda i Syrien (75,6 %) följt av Irak (4,1 %) och Afghanistan (3,1 %). Konklusion De flesta nyanlända som besvarat enkäten har långsiktiga planer på att stanna i Sverige och ser ljust eller mycket ljust på framtiden. Det rådande hälsotillståndet bland respondenterna verkar utgöra en god utgångspunkt för en effektiv etablering. Självrapporterad hälsa, hälsobesvär och använda läkemedel är någorlunda i linje med den övriga befolkningen. Oroväckande livsstilsfaktorer för framtida sjukdom är övervikt och fetma samt fysisk inaktivitet och rökning. Bekymmersamma sociala faktorer är trångboddhet, osäker boendesituation, låg tillit och lågt förtroende för samhällsinstitutioner såsom sjukvården och tolkar. Flertalet har varit utsatta för allvarliga hot om våld innan flykten och nästan hälften lider av dålig psykisk hälsa. Var tionde ser mörkt eller mycket mörkt på framtiden. Var femte sover ganska eller mycket dåligt och varannan har dålig eller mycket dålig tandhälsa. Ekonomisk stress verkar inte utgöra en riskfaktor men väldigt få har en kontantmarginal att klara en oförutsedd situation. Var femte har hälsoproblem som hindrar ett aktivt jobbsökande. Otillfredsställda vårdbehov eller bristfällig kunskap om vården är vanligt förekommande. Att läsa och förstå skriftlig hälsoinformation är problematisk och bristande för många nyanlända. Det är viktigt att uppmärksamma att föreliggande resultat främst gäller arabisktalande nyanlända med högre utbildningsnivå. Alla resultat och konklusioner bör också sättas i förhållande till den situation de nyanlända befinner sig i. Upplevelse av en underordnad situation i mötet med myndigheter tillsammans med viljan och behovet till etablering och självförsörjning kan eventuellt i vissa fall ha lett till en överskattning av den egna hälsorelaterade förmågan.

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  • 42.
    Zdravkovic, Slobodan
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Health and Welfare Studies (HV).
    Grahn, Mathias
    Björngren Cuadra, Carin
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Self-reported health and country of origin: Does level of education and length of stay in Sweden make a difference?2014Conference paper (Other academic)
    Abstract [en]

    Background Self-reported health (SRH) is an important indicator for general health status of an individual. The latest measure of SRH in Scania resulted in the majority reporting good or very good health. This encouraging overall finding does not target vulnerable subgroups such as migrants. The aim of this study is to address the effect of country of birth on SRH and explore if level of education and length of stay (LOS) makes a difference. Methods The 2012 public health survey in Scania served as the basis for the study. Data was collected on 28029 adults aged 18-80. The variables of interest were SRH, LOS in Sweden of foreign born and level of education. Results The mean age of people born in Sweden was 51.4 and 48.6 for those born abroad. The odds ratio (OR) of poor SRH was 1.38 (95% CI=1.30-1.47) where people born abroad reported worse SRH overall and across different levels of education. People born in Sweden reported poor SRH more than those born abroad with LOS below 10 years 1.24 (1.10-1.41) independent of education, except for highly educated people born in Sweden 0.72 (0.59-0.89). People born in Sweden reported poor SRH less than those born abroad with LOS above 10 years 0.55 (0.51-0.60) independent of education. Conclusions Inequalities in health persist across educational levels and SRH deteriorates with LOS. Recommended actions: a. Enhance the understanding of health inequalities. b. Improve procedures for including foreign born to the society. c. Initiate future studies in the field. Message 1 Inequalities in health due to country of birth are not due to level of education. Message 2 LOS in the country worsens health in those born abroad as compared to people born in Sweden independently of education.

  • 43.
    Zdravkovic, Slobodan
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö högskola, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Grahn, Mathias
    Public Health and Social Sustainability Unit Region Skåne, Malmö, Sweden.
    Björngren Cuadra, Carin
    School of Social Work, Lund University, Lund, Sweden.
    Self-reported health issues in recently arrived migrants to Sweden2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no suppl 1, p. 220-220Article in journal (Other academic)
    Abstract [en]

    Background The awareness of health and health related needs in migrants (i.e. refugees) is crucial for effective public support systems. For this and other reasons a regional survey was established to address various health issues in recently arrived migrants to Scania. The questions that the present study is seeking answers for relates health, changes in health as well as self-reported possibility to affect health in general but also in relation to level of education. Methods Data collection occurred between February 13, 2015 and February 12, 2016. The inclusion criteria were recently arrived adult migrants speaking Arabic, Dari, Pashto or Somali participating in the public support system. Questions on selfreported health, self-reported changes in health since the move to Sweden, self-reported possibility to affect own health as well as education was examined among others in an extensive health survey. The survey was funded by the European refugee fund. Results 681 respondents took part in the survey where 94% were Arabic speaking. 69% were men and 51% were 18 to 34 years. 23% graded self-reported health as very well and 46% as well. Highly educated reported very well to a higher degree (30%) than the primary (17%) and the secondary level (12%) (pvalue< 0.01). Change in health was reported by 32% as negative and by 21% as positive. No significant difference was observed in relation to education. 70% reported the possibility of affecting own health as very important and the comparison with education was significant (p-value<0.01). Over 64%, independently of education, reported own contribution as very important. Conclusions The majority of recently arrived migrants’ reports good health and own contribution for health as very important. Negative change in health was reported by almost a third of the migrants. (a) Increase efforts to stop negative changes in health. (b) Enhance health information practice to increase the benefits of own contribution for health. Key messages: - Recently arrived migrants reports a similar level of good health as the inhabitants of Scania observed in the latest regional public health survey - A third of the respondents reports worsening health since the move to Sweden

  • 44.
    Zdravkovic, Slobodan
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö högskola, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Grahn, Mathias
    Department of Public Health and Social Sustainability, Scania Regional Council, Malmö, Sweden.
    Valentin Kvist, Ann
    Strategic Unit, Department Rehabilitation to Work, Swedish Public Employment Service, Stockholm, Sweden.
    Östergren, PO
    Social Medicine and Global Health, Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden.
    Björngren Cuadra, Carin
    School of Social Work, Lund University, Lund, Sweden.
    Recently arrived migrants’ health status in the region of Scania, Sweden2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no Suppl 1, p. 492-492Article in journal (Other academic)
    Abstract [en]

    Background Knowledge of health and health related issues in recently arrived migrants (i.e. refugees) to Sweden is limited, although studies indicate that health status of migrants in general is worse than people born in Sweden and that it deteriorates over time. Regular public health surveys have difficulty reaching new migrants, partly due to language barriers. In order to address health and health related issues a study was initiated in Scania targeting recently arrived migrants. A grant for the study was received by the European refugee fund. Methods Data was collected within the framework of the public system for supporting migrants’ establishment to society and labour market, which ensures coverage. The inclusion criteria were all adult recently arrived migrants to Scania, 18 to 64 years taking part in the public support system between February 13, 2015 and February 12, 2016. Questionnaires in Arabic, Dari, Pashto and Somali were used for data collection. Health issues covered diabetes, asthma, war injuries, dental, mental, and selfreported health among others. Health related issues address health-literacy, smoking, drug use, physical activity, and health system use as well as education and social relations mentioning few. The further aims of the study are to identify evidence for introducing need-specific strategies and to enhance the possibility for evaluating the adequacy of present practices. Results The study reveals necessary knowledge about health and health related needs in this group of new residents of Scania. Results will be available after the summer 2016 also including methodological concerns. Conclusions The study adds knowledge on health and health related needs in recently arrived residents and serves as a complement to the regular public health survey in Scania. It also addresses a number of methodological questions. Key messages: - Unique health and health related knowledge will be revealed in recently arrived immigrants of Scania - The study will reveal evidence for need-specific health strategies and for evaluating the adequacy of present practices

  • 45.
    Zdravkovic, Slobodan
    et al.
    Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM). Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Jonsson, C.
    Digitalisering IT & MT, VO Data & Analys, Lund, Region Skane, Sweden..
    Annersten Gershater, Magdalena
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Ericsson, A.
    Novo Nordisk Scandinavia AB, Natl Market Access, Malmo, Sweden..
    Grahn, M.
    Unit Stat & Anal, Malmo, Sweden..
    Rämgård, Margareta
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Dozet, A.
    Dept Hlth Care Governance, Lund, Region Skane, Sweden..
    Health care costs for residents diagnosed with diabetes type 2 in Malmo, Sweden between 2011 and 20182021In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, no S3Article in journal (Other academic)
    Abstract [en]

    Background

    During the last decade, type 2 diabetes (T2D) prevalence has increased worldwide, especially among children and young adults. Diabetes is a chronic disease that if not diagnosed in time can lead to serious health complications and put pressure on the societal resources. The aim of this study was to evaluate the economic impact of the increased T2D prevalence in Malmö over time on the regional health care organization.

    Methods

    A longitudinal population-based study in Malmö, within the Cities Changing Diabetes project. Data was collected from the Patient Administrative System in Region Skåne, classifying T2D by the ICD E11 code. The health care cost (HCC) has been adjusted by the Consumer Price Index (CPI) to 2020 prices.

    Results

    The prevalence of T2D increased from 2,5% in 2011 to 4,3% in 2018. The increase in T2D prevalence was most noticeable for residents 18 - 64 years. The overall HCC for treating residents with T2D was approximately €47,2 million in 2011 and €90,7 million in 2018. The HCC in 2018 was higher for males than for females (€54,6 million vs €36,2 million). In 2018, the cost was €49,9 million for those 18 - 64 years and €40,5 million for those being 65 years or older. The overall HCC increased during the study period (3,3 times for those 18 - 64 years and 1,4 times for those being 65 years or older). For the age group 18 - 64 the HCC per resident was €5 000 in 2011 and €5 300 in 2018. The HCC per resident for all age groups, has not changed markedly, from €6 200 in 2011 to €6 100 in 2018 as well as the number of health care visits (23 in 2011 and 29 in 2018).

    Conclusions

    The HCC for T2D has increased markedly since 2011. This increase is most noticeable for people under 65 years. The overall HCC for these patients and its change over time puts an increased strain on the health care provider Region Skåne, mainly due to increased prevalence.

    Key messages 

    • The overall HCC during 2011 – 2018 has increased 2 times for residents with T2D and 1.5 times for residents without T2D. This increase is likely to continue if the current trend remains.
    • The main driving force behind the increase in HCC over time is the increase in T2D prevalence and not in HCC per resident.
  • 46.
    Zdravkovic, Slobodan
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Mangrio, Elisabeth
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV). Malmö University, Malmö Institute for Studies of Migration, Diversity and Welfare (MIM).
    Håkansson, Peter
    Malmö University, Faculty of Culture and Society (KS), Department of Urban Studies (US).
    Westerling, Ragnar
    A support platform for migration and health (MILSA 2.0), Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 472-472Article in journal (Other academic)
    Abstract [en]

    Background: Solid health is a prerequisite for successful inclusion and participation in support systems for recently arrived migrants’ (RAM) i.e. refugees. The society support system may vary depending on the age of RAM but is equally important for an effective start of the establishing process. Understanding health needs of RAM in different phases of establishing is essential as such knowledge is central for the supporting system. Methods: MILSA 2.0 consists of five studies targeting various health aspects. The focus is depicted into an early phase of establishment as well as following the period after the mandatory process. The platform addresses health issues of families with children as well as various health aspects of Arabic speaking adult RAM soon after arrival to Sweden. Also, it focuses on RAM adolescents in relation to risk behavior, social capital and confidence as well as on health issues in adult RAM after the formal establishment process. The platform also illuminates an extended support system of civic and health communication both in time as well as lecturing environment primarily targeting social capital, coherence and self-efficacy. Results: MILSA 2.0 addresses different phases of an establishing process in Sweden. Several health and health related factors are addressed such as self-rated health, social capital, trust, physical activity, sexual and reproductive health and living conditions. The extended civic and health communication addresses increased program hours as well as new program environments such as libraries, museums, and workplaces. Conclusions: These five studies reveals health related knowledge in different aspects of the establishing process as well as it develops several questionnaires and reveals methodological aspects. The platform focuses on both adolescent and adult RAM during and after the mandatory public support system including both the recipients of the support as well as the supporting actors. Key messages: - MILSA 2.0 develops questionnaires and determines health related concerns both during and after the mandatory establishing process. - MILSA 2.0 evaluates the effect of a policy change regarding standard procedures of civic and health communication.

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