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  • 1.
    Bäckström, Caroline A.
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Carlén, Kristina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Larsson, Viveca
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Mårtensson, Lena Birgitta
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Nursing, Midwifery and Social Work, Faculty of Health and Rehabilitation Sciences, The University of Queensland, Australia.
    Thorstensson, Stina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Berglund, Marina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Larsson, Therese
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Bouwmeester, Björn
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health Sciences, University of Skövde, Sweden.
    Wilhsson, Marie
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health Sciences, University of Skövde, Sweden.
    Larsson, Margaretha
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Expecting parents’ use of digital sources in preparation for parenthood in a digitalised society – a systematic review2022In: Digital Health, E-ISSN 2055-2076, Vol. 8, article id 20552076221090335Article, review/survey (Refereed)
    Abstract [en]

    Background

    In today's society, people are experiencing the rapid development of digitalisation. Expecting parents may have difficulties evaluating the information online; they are not always sure which sources of information are trustworthy, and this exacerbates their feelings of anxiety. More research is needed to broaden the knowledge about how their use of digital sources may influence their health.

    Question

    The focus of this study was to explore expecting parents’ use of digital sources and how this influences their health during pregnancy.

    Methods

    A systematic review covered the thematic analysis of 39 articles.

    Findings

    The analysis resulted in the following theme: The digitalised society involves both opportunities and challenges, and expecting parents express a need for a variety of digital sources to improve their health, and sub-themes: Digital sources could promote parents’ health and well-being in a digitalised society; Consuming digital health information facilitates understanding, different feelings and social connections; and A variety of digital sources may facilitate parental identification and adaption to parenthood.

    Conclusion

    Different digital sources in our digitalised society mean access to information and opportunities to extend social connections for expecting parents. This can promote their ability to understand and adapt to parenthood, as well as to improve their health and well-being and make the parental transition. However, professional support during face-to-face consultations cannot always be exchanged to digital sources. It is important to base digital sources devoted to expecting parents and digitalisation overall on multi-sectorial collaborations and coordination between different organisations and the digital sources they provide.

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  • 2.
    Carlén, Kristina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). The Research School of Health and Welfare, School of Health and Welfare, Jönköping University.
    Predictors of mental health in adolescents - with a salutogenic perspective2022Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Mental health in adolescence is an increasing public health concern. Over half of all mental disorders debut by 14 years of age and remain largely untreated up to adulthood, which underlines the importance of early detection. Mental health is a complex concept that consists of both mental well-being and mental ill-health (including mental health problems and mental disorders). However, the development of mental health during the transition period from childhood to adulthood is dependent on the coping strategies used to meet everyday stressors. Therefore, the framework is salutogenic, looking at the world from a resource perspective to promote mental well-being. However, finding predictors also include identifying risk factors of mental ill-health.

    The overall aim of the thesis was to investigate predictors of mental health in adolescents from a longitudinal perspective. The Finnish Family Competence (FFC) study was used with adolescents at 15 years of age and their parents, with a follow-up at 18 years of age. Also, Swedish data material was used, The Longitudinal Research on Development In Adolescence (LoRDIA) with adolescents at 12-13 years and a follow-up at 17 years. In sub-studies I, II, and III the outcome was a probable mental health diagnosis determined by a standardised Development and Well-being Assessment (DAWBA) interview. In sub-study IV the outcome was perceived mental health status (MHS).

    The results showed that a strong sense of coherence was associated with a decreased risk for subsequent mental disorders (sub-study I) and that self-esteem was negatively associated with future mental well-being (sub[1]study IV). Further, low levels of mental health problems reported by the adolescents (sub-study II) or by their parents (sub-study III) were related to a decreased risk for subsequent mental disorders. There was a gender aspect that affected the results and which showed girls as having more internal mental health problems or mental disorders. Other factors indicating an increased risk of mental ill-health were parental low age at childbirth and socioeconomic factors such as the mother’s low educational level, father’s blue-collar profession, and a poor economic situation in the family.

    The results from this thesis underline the importance of having a salutogenic approach when dealing with mental health in adolescence to identify coping resources for stressors in Antonovsky’s ‘River of Life’. The school might be an arena for creating interventions with a resource perspective for strengthening a sense of coherence and self-esteem, and for alleviating perceived mental health problems.

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    Paper I
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    Paper IV manuscript abstract
  • 3.
    Carlén, Kristina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Kylberg, Elisabeth
    University of Skövde, Digital Health Research (DHEAR). University of Skövde, School of Health Sciences.
    An intervention of sustainable weight change: Influence of self-help group and expectations2021In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 24, no 4, p. 1498-1503Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Obesity is one of the most challenging public health problems in Western societies. Group activities are a way to empower individuals to make sustainable lifestyle changes. Self-help groups enable individuals to share expectations and experiences on an equal basis.

    OBJECTIVE: The aim was to find a model for sustainable weight reduction for people with obesity and to evaluate the importance of expectations before entering the weight reduction programme.

    METHODS: Persons with a BMI >30 and aged over 30 years were recruited. Weekly seminars for 6 months with discussions concerning physical activity, eating habits and how to change one's lifestyle occurred. After the seminars, a self-help group was initiated. The participants were encouraged to express their expectations before each step in the study.

    RESULTS: Our findings showed that those who had joined a self-help group had reduced their weight significantly (-6.0 kg) compared with those who had not (-1.4 kg). Further, those who expressed a more mature expectation of the coming change in behaviour towards a healthy lifestyle showed slightly larger weight reduction (-6.1 kg) than those who expressed low expectations (-3.7 kg).

    PATIENT OR PUBLIC CONTRIBUTION: Participants expressed their thoughts and views, which were considered and included in the programme.

    CONCLUSIONS: Our findings indicate that the self-help group can be an essential part of a weight reduction programme. The self-help group is a novel strategy to strengthen sustainability in reducing weight. The study also highlights the importance of identifying behaviour change expectations before participating in a programme.

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  • 4.
    Carlén, Kristina
    et al.
    University of Skövde, School of Life Sciences.
    Nilsson, Kerstin
    University of Skövde, School of Life Sciences.
    Andlighet i vården: en intervjustudie bland vårdpersonal2008In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 28, no 1, p. 13-17Article in journal (Refereed)
    Abstract [en]

    Previous research found that spirituality seems difficult to give meaning and to work with in caring. The aim of this interview study was to explore how the nursing staff experienced the spiritual dimension within caring. Data was obtained from ten nursing staff at a Swedish infection department and analyzed with content analyze. The result shows that conditions to discover and to meet spirituality depend on the staff’s ripeness, that self-knowledge affect consciousness about spirituality and in the relationship of care spirituality is visible. The meaning of spirituality is to relate to God and other people, seeking the meaning of life and attitude at fateful occasions. This study shows there is a lot of knowledge released about patients’ spiritual needs only by asking: what do you believe in? The knowledge from this study is usable booth in nursing and in educational settings.

  • 5.
    Carlén, Kristina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). The Research School of Health and Welfare, Jönköping University, Sweden.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku and Turku University Hospital, Finland.
    Augustine, Lilly
    CHILD, School of Learning and Communication, Jönköping University, Sweden.
    Saarinen, Maiju M.
    Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Finland.
    Aromaa, Minn
    Department of Public Health, University of Turku and Turku University Hospital, Finland ; City of Turku Welfare Division, Finland.
    Rautava, Päivi
    Department of Public Health, University of Turku and Turku University Hospital, Finland ; Clinical Research Centre, Turku University Hospital, Finland.
    Sourander, André
    Department of Child Psychiatry, University of Turku, Finland ; Department of Child Psychiatry, Turku University Hospital, Finland.
    Sillanpää, Matti
    Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Finland.
    Teenagers’ mental health problems predict probable mental diagnosis 3 years later among girls, but what about the boys?2022In: Child and Adolescent Psychiatry and Mental Health, E-ISSN 1753-2000, Vol. 16, no 1, p. 1-10, article id 41Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of mental disorders is increasing, and there seems to be a gender difference in prevalence, with girls reporting more mental health problems than boys, especially regarding internalizing problems. Most mental disorders debut early but often remain untreated into adulthood. Early detection of mental disorders is essential for successful treatment, which is not always happening. The study aimed to estimate to what extent teenagers’ self-reports predict probable mental diagnosis as they enter adulthood, particularly regarding gender differences. Methods: Self-reported mental health problems, Youth Self-Report (YSR) at 15 years (range 3–110, n = 504) from the ongoing Finnish family competence study (FFC) using modified multivariable Poisson regression analysis for prediction of DAWBA (Development and Wellbeing Assessment) interview outcomes 3 years later. Results: One unit’s increase in YSR was estimated to correspond to an increase in the relative risk of a probable DAWBA-based diagnosis by 3.3% [RR (95% CI) 1.03 (1.03–1.04), p < 0.001]. In gender-specific analysis, the findings applied, particularly to girls. Conclusions: Youth Self-Report (YSR) scores at pubertal age predicted the risk of a probable mental diagnosis at the onset of adulthood, particularly in girls. Further research is needed to explain the lower sensitivity of YSR among boys.

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  • 6.
    Carlén, Kristina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). The Research School of Health and Welfare, Jönköping University, Sweden.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland.
    Augustine, Lilly
    CHILD, School of Learning and Communication, Jönköping University, Sweden.
    Saarinen, Maiju M.
    Department of Child Neurology and General Practice, University of Turku and Turku University Hospital, Finland.
    Aromaa, Minna
    Department of Public Health, University of Turku, Finland ; City of Turku Welfare Division, Finland.
    Rautava, Päivi
    Department of Public Health, University of Turku, Finland ; Turku University Hospital, Clinical Research Centre, Turku, Finland.
    Sourander, André
    Department of Child Psychiatry, University of Turku, Finland ; Department of Child Psychiatry, Turku University Hospital, Finland.
    Sillanpää, Matti
    Department of Child Neurology and General Practice, University of Turku and Turku University Hospital, Finland.
    Parental distress rating at the child’s age of 15 years predicts probable mental diagnosis: a three‑year follow‑up2022In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 22, no 1, article id 177Article in journal (Refereed)
    Abstract [en]

    Background: Mental health in adolescence is an increasing global public health concern. Over half of all mental disorders debut by 14 years of age and remain largely untreated up to adulthood, underlining the significance of early detection. The study aimed to investigate whether parental distress rating at the child's age of 15 predicts a probable mental diagnosis in a three-year follow-up.

    Methods: All data was derived from the Finnish Family Competence (FFC) Study. The analysis focused on whether parental CBCL (Child Behavior Checklist) rating (n = 441) at the child's age of 15 years predicted the outcome of the child's standardised DAWBA (Development and Well-Being Assessment) interview at offspring's 18 years.

    Results: Multivariable analysis showed that a one-unit increase in the total CBCL scores increased the relative risk of a DAWBA-based diagnosis by 3% (RR [95% CI] 1.03 [1.02-1.04], p < 0.001).

    Conclusions: Parental CBCL rating in a community sample at the adolescent's age of 15 contributes to early identification of adolescents potentially at risk and thus benefitting from early interventions.

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  • 7.
    Carlén, Kristina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland.
    Augustine, Llilly
    Department of Communication and Behavioral Sciences, School of Education and Communication, Jönköping University, Sweden.
    The association between adolescents’ self-esteem and perceived mental well-being in Sweden in four years of follow-up2023In: BMC Psychology, E-ISSN 2050-7283, Vol. 11, article id 413Article in journal (Refereed)
    Abstract [en]

    Background The situation concerning adolescent mental health is a global public health concern, and the concept includes the ability to cope with problems of everyday life. A person’s approach and attitude towards themselves, i.e., their self-esteem, affects mental health. The study aimed to appraise and deepen the scientific understanding of adolescents’ self-reported self-esteem at age 12−13 from a resource perspective and test its ability to predict subsequent perceived mental well-being at age 17.

    Methods Data from the Longitudinal Research on Development in Adolescence (LoRDIA) prospective follow-up study of adolescents aged 12−13, and 17 (n=654) were analysed using ANCOVA. The outcome variable, perceived mental well-being (MWB), covers the aspects of mental well-being inspired by the “Mental Health Continuum,” representing positive mental health. Covariates were self-esteem (SE) and reported initially perceived MWB at age 12−13. Other independent explanatory variables were gender, the family’s economy, and the mother’s educational level.

    Results Self-esteem appeared relatively stable from 12−13 to 17 years (M=20.7 SD=5.8 vs. M=20.5 SD=1.7). There was a significant but inverted U – shaped association between SE at age 12–13 and perceived MWB at age 17 [F (1, 646)=19.02, β-0.057; CI -0.08−-0.03, Eta=0.03, p=.000]. Intermediate but not strong SE predicted significantly good MWB. When conducting the ANCOVA for boys and girls separately, only the mother’s educational level was significantly positively associated with perceived MWB of girls.

    Conclusions Good self-esteem in early adolescence increases the likelihood of an unchanged favourable development of self-esteem and the probability of good perceived mental well-being. SE explained 18 per cent of the variation of MWB, and even more among girls. However, normal SE rather than high SE at 12 and 13 years is predictive of later mental well-being. Girls reported low self-esteem more often. Therefore, supporting self-esteem early in life can promote mental well-being in adolescence.

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  • 8.
    Carlén, Kristina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). The Research School of Health and Welfare, Jönköping University, Sweden.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). University of Turku, Department of Public Health, Finland.
    Lindmark, Ulrika
    School of Health and Welfare, Department of Natural Sciences and Biomedicine, Centre for Oral Health, Jönköping University, Sweden / Department of Health Sciences, Karlstad University, Sweden.
    Saarinen, Maiju M.
    Department of General Practice, University of Turku and Turku University Hospital, Finland.
    Aromaa, Minna
    University of Turku, Department of Public Health, Finland / City of Turku Welfare Division, Finland.
    Rautava, Päivi
    University of Turku, Department of Public Health, Finland / Turku University Hospital, Finland.
    Sillanpää, Matti
    Department of General Practice, University of Turku and Turku University Hospital, Finland.
    Sense of coherence predicts adolescent mental health2020In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 274, p. 1206-1210Article in journal (Refereed)
    Abstract [en]

    Background: Strong sense of coherence (SOC) has been shown to predict good mental health among adults whereas its predictive value in adolescence is unclear. This life-course oriented prospective study explores whether SOC predicts mental health in a three-year follow-up. Methods: The data is part of the ongoing ‘Finnish Family Competence Study’ launched in 1986 in southwestern Finland (baseline n = 1287). The outcome variable was adolescent's mental health at 18 years of age, measured on the Development and Well-Being Assessment (DAWBA) scale. The main predictor was Antonovsky's SOC score (1987) measured at the age of 15. A total of 498 adolescents were included in the present analyses. Poisson regression was used by univariate and multivariable models using the parents’ age and socioeconomic status and adolescents’ gender as covariates. Results: Multivariable analysis showed that a one-unit increase in SOC decreased the relative risk of a DAWBA-based diagnosis by 4 % (RR [95% CI] 0.96 [0.94–0.98], p < 0.001). Limitations: Typical of very long follow-up, as in our study of nearly two decades, a substantial proportion of the original population-based cohort was lost to follow-up weakening the representability of our cohort. Conclusions: Sense of coherence is a useful and clinically sensitive tool to predict mental health in adolescence. The easily administered, coping-oriented SOC questionnaire is an appropriate instrument in screening for adolescents who would benefit from supportive measures to strengthen their mental well-being. 

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  • 9.
    Gånedahl, Hanna
    et al.
    University of Skövde, School of Health and Education.
    Zsaludek Viklund, Pernilla
    University of Skövde, School of Health and Education.
    Carlén, Kristina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Kylberg, Elisabeth
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekberg, Joakim
    Unit for Health Analysis, Centre for Healthcare Development, County Council of Östergötland, Linköping, Sweden / Unit of Community Medicine, Department of Medicine and Health, Linköping University, Sweden.
    Work-site wellness programmes in Sweden: a cross-sectional study of physical activity, self-efficacy, and health2015In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 129, no 5, p. 525-530Article in journal (Refereed)
    Abstract [en]

    In Sweden, a work-site wellness programme implies reimbursing some of the expenses for health-promoting activities. Although work-site wellness programmes are readily available in Sweden, a large number of employees elect not to participate.

    OBJECTIVES: The aim of this study was to investigate the association of physical activity, self-reported general health assessment and self-efficacy with participation in a work-site wellness programme.

    STUDY DESIGN: A cross-sectional study design was used.

    METHODS: An online questionnaire was distributed to employees of a manufacturing company with 2500 employees in southwest Sweden.

    RESULTS: Those who took advantage of the work-site wellness programme assessed their general health as better and had higher assessment of physical activity. The study showed that being enlisted also implies a higher level of physical activity and general health; however, the effect sizes of these correlations were small. Self-efficacy, i.e. perceived behavioural control, was not associated with participation in the work-site wellness programme. However, self-efficacy was correlated with both general health assessment and physical activity. A regression analysis to determine explanatory contributions to the general health assessment score showed no significant contribution from participation in a work-site wellness programme, but was instead explained by perceived behavioural control and physical activity.

    CONCLUSIONS: Given the small effect size of the difference in physical activity between participators and non-participators in the work-site wellness programme, it is probable that only a small proportion of participators changed their health-promoting activities as a result of the work-site wellness programme.

  • 10.
    Shebehe, Jacques
    et al.
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Sweden.
    Ottertun, Emma
    University of Skövde, School of Health Sciences.
    Carlén, Kristina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Gustafson, Deborah R.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, United States.
    Knowledge about infections is associated with antibiotic use: cross-sectional evidence from the health survey Northern Ireland2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 1041Article in journal (Refereed)
    Abstract [en]

    Background: Antibiotic overuse is the main modifiable driver of antibiotic resistance. Factors associated with overuse have been inconsistently reported and vary across populations. Given the burgeoning occurrence of infectious diseases around the world, there remains a great need to identify barriers and solutions to the control of infections. We examined whether knowledge about infections and antibiotic resistance is associated with antibiotic use in a northern European population sample. Methods: The Health Survey Northern Ireland 2014/15 was completed by a cross-sectional sample of 4135 participants aged > 16 years. Participants were asked whether they had taken an antibiotic in the past 12 months; and six questions were asked concerning knowledge about infections and antibiotic resistance. Correct answers to the six knowledge questions defined a knowledge score (score range 0–6 correct answers). We used multivariable logistic regression to estimate odds of self-reported antibiotic use during the last 12 months in association with knowledge score (lowest score, 0/6, as referent), and response to each knowledge question. Covariates included sex, age group, smoking, alcohol drinking, deprivation index, self-rated health, and satisfaction with life. Results were outputted as Odds Ratios (OR) and 95% Confidence Intervals (CI). Results: Antibiotic use in the past 12 months was reported by 39.0% (1614/4135); and 84.2% (3482/4135) scored < 6/6 correct on knowledge statements. Compared to the lowest knowledge score (0/6 correct), the highest knowledge score (6/6 correct) was associated with higher odds of antibiotic use (adjusted OR 2.03, 95% CI [1.46, 2.81], p < 0.001), with a P-value < 0.001 for trend with increasing knowledge score. Female sex, age, high deprivation, and poor general health, were independently associated with higher odds of antibiotic use. Stratified analyses showed sex and age group differences. Conclusion: Knowledge, and other modifiable and non-modifiable risk factors, were positively associated with antibiotic use in the past 12 months. While the causal direction of these associations could not be determined, given the high prevalence of lesser knowledge, as well as independent contributions of other factors including socioeconomic characteristics, health literacy campaigns to raise awareness of antibiotic resistance should take a multi-pronged approach. © 2021, The Author(s).

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