Master's Programme in Public Health Science

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A QUALITATIVE STUDY OF YOUNG PEOPLE'S EXPERIENCES WITH THE STREET GAMES ACADEMY PROGRAM
(2021-08-16) Shomoroo, Megdelawit Ayele; University of Gothenburg/Department of Medicine; Göteborgs universitet/Institutionen för medicin
Disparities in educational attainment and performance by income, race, ethnicity, and immigrant status are prevalent in all countries including high-income countries like Sweden. Despite the available research on the potential of physical activity (PA) and tutoring interventions for improving educational performance among low-income students, it is countered by other research findings that suggest otherwise. This study aims to explore young people's experiences with the “Street Games Academy'': a program promoting physical activity and academic learning in disadvantaged neighbourhoods of the Western Götaland region, Sweden. Convenience sampling was used to recruit 29 participants to three focus group discussions. The discussions focused on the participants’ experiences with the program and how physical activity and tutoring contribute to their study motivation. Thematic analysis was used as it allows to organize and describe the data in a rich manner. The NVivo qualitative data analysis software; QSR International Pty Ltd. Version 12, 2018 was used to process the data and generate themes. Based on the findings, “Street Games Academy” plays an important role in improving the students’ study motivation and their educational aspirations through physical activity promotion and homework help. The study found that physical activities result in better self-reported sleep and improved focus on studies. The tutoring provided by the program has resulted in improved self-reported educational performance. The findings indicate physical activities and tutoring can be used as strategies for improving educational performance among minority students from low socio-economic contexts in Västra Götaland Region of Sweden.
Association of birch pollen and air pollution with asthma-control questionnaire scores among individuals with allergic asthma in Sweden
(University of Gothenburg, 2021-10-15) Amankwaah, Francis; Krage Carlsen, Hanne; Univeristy of Gothenburg, Department of Public Health and Community Medicine Sahlgrenska Academy, Institute of Medicine
Introduction: Asthma is a chronic respiratory disease that affect both adult and children. The disease is as part of the most reported emergency cases to the hospital globally. Over the years asthma prevalence has increased in many countries. In 2016, the disease affected 339 million people globally. To fight asthma, we need to understand the risk factors and triggers that lead to asthma attack and symptoms exacerbation. Investigating the interplay between the risk factors and triggers of asthma is one of the ways to ensure effective asthma management and control. Aim: This study investigated the association between birch pollen and air pollution with Asthma Control Questionnaire score (aggregate score of reported symptoms) among people with allergic asthma. The study also investigated the association of pollen and ACQ, air pollutants and ACQ and the effect of pollen and air pollutant on ACQ score of participants. Methods: Mixed effect linear regression analyses were performed with independent variables to establish which variables showed an association with the ACQ score. Asthma Control Questionnaires (ACQ) was used as a composite measure, an instrument that aggregate the reported asthmatic symptoms after exposure to pollen and air pollution to investigate this association. The study is panel study that collected data in three waves. Both the outcome and explanatory variable were log transformed for statistical analysis. Results: In an unadjusted mixed linear model regression with ACQ as the dependent variable and 24 hours of pollen exposure as the explanatory variable, pollen was statistically significantly (P=0.03). When other variables like temperature, relative humidity and air pollutants were added to the model air pollutants were not significant. Though air pollutants did not have a directly association on patients ACQ score, when air pollutant meets pollen, pollen become a strong agent to induce symptoms of asthma. In addition, average ACQ was 0.59(SD=0.40) which signifies that, generally most of the participants had well controlled or managed asthma. Conclusion: Birch pollen is investigated to have some impact on asthma, even though this association was moderate. Association of air pollutant and ACQ score was insignificant, this notwithstanding pollutant like PM10 could influenced the association between asthma and ACQ (reported symptoms).
Availability, Accessibility, Acceptability, and Quality of SRHR related health care for unaccompanied minor girls in VGR: A qualitative study based on the perceptions of health care professionals.
(2021-06-23) Lodeiro, Carolina; University of Gothenburg/Department of Medicine; Göteborgs universitet/Institutionen för medicin
Sexual and reproductive health and rights (SRHR) are fundamental to both the individual’s health as well as to public health. Despite that, SRHR are still only a desire and an ambition for millions of women and girls around the world, and the suffering due to SRHR related issues continues to be a large part of the global ill health. This study aims to examine what SRHR related needs, health care professionals perceive unaccompanied minor girls in Region Västra Götaland, Sweden, to have and, how existing health care services address these needs. Furthermore, the aim is to identify areas for improvement regarding the availability, accessibility, acceptability, and quality of these health services, in accordance with the AAAQ framework. The data for this study was collected through six semi-structured interviews with professionals working at SRHR related health care services and analysed in accordance with established standards for thematic analysis and the theoretical framework AAAQ. Through the process of analysing the data, twelve sub themes were identified as barriers and needs, to reach the enjoyment of the right to health. The findings of the study are in line with previous research which conclude that unaccompanied minor girls have different health needs than the general public and that their right to health and specifically their SRHR is not being fulfilled. The findings of this study do also reveal inadequacies and constraints in the provision of an accessible SRHR related care for these girls and provide directions for recommendations to address these inadequacies.
Beyond Punishment: Police Officers’ Experiences of the Interplay Between Law Enforcement and Harm Reduction
(2025) Zorina, Elena
Drug-related harm reduction services in Sweden have developed slowly, shaped by political resistance and regional disparities. This study focuses on three harm reduction interventions currently implemented in Sweden: needle exchange programs, opioid substitution treatment, and Naloxone distribution. The aim of this study is to examine the interplay between Sweden’s restrictive drug policy and harm reduction services in the Western Region through the lived experiences of police officers. Luhmann’s Systems Theory and a social constructivist approach inform the study’s exploration of police officers’ experiences. Ten semi-structured interviews were conducted with patrol officers, and thematic analysis identified key patterns in perceptions and practices. Findings reveal that while police officers occasionally engage in harm-reducing behaviors, these actions are shaped by discretion and individual judgment rather than institutional policy. Participants expressed both support and skepticism toward harm reduction services, with attitudes shaped more by occupational relevance and lived experience than by public health ideology. Police officers also highlighted challenges related to inter-system collaboration, describing fragmented structures and a lack of formal coordination with healthcare and social services. By applying Luhmann’s Systems Theory, the study shows how the legal and healthcare systems operate under distinct logics, leading to limited structural coupling. For harm reduction efforts to become more consistent and sustainable, cross-system coordination must be strengthened. Reframing harm reduction in terms of public safety and occupational utility may enhance integration and better support both police officers and PWUD in practice.
Determinants of Out-of-Pocket Payments for Healthcare in Sri Lanka
(2025) P. T Fernando, Kurukulasooriya Nilupuli
Introduction: Sri Lanka’s healthcare system, though providing free public services, remains heavily reliant on out-of-pocket payments (OOPP), which accounted for about 40% of current health expenditure in 2022. The 2019 economic crisis worsened poverty and strained public services. Therefore, this study re-examines the determinants of OOPP using 2019 HIES data to understand changes in spending patterns. AIM: This study aims to identify the determinants of out-of-pocket healthcare payments in Sri Lanka using 2019 HIES data, while also analysing the distribution of OOPP across healthcare categories and income quintiles. Method: This study used a quantitative design with secondary data from the 2019 HIES in Sri Lanka, covering 19,911 households. A two-part model was applied: logistic regression to assess the likelihood of incurring OOPP and a Tweedie model to estimate its magnitude. Household-level variables were selected based on Andersen’s behavioural model. Results: Of the 19,911 households, 52% reported out-of-pocket healthcare payments, mainly for private medical services, medicines, and hospital charges. The relative burden of OOPP is similar across the first four quintiles. Higher income reduced both the likelihood and burden of OOPP, while members with chronic illness, economic engagement, and household expenditure were key drivers of higher likelihood and spending of OOPP. Conclusion: The study found that higher income reduces both the likelihood and burden of out-of-pocket healthcare payments. The presence of members with chronic illness and limited access to public care increases costs, highlighting the need for policies that enhance financial protection for vulnerable households.
Dietary habits in Swedish children, adolescents and their parents and corresponding greenhouse gas emissions
(2020) Hagby, Josefine
Economic Evaluation of vaccination program against covid-19 among children and elderly population in European Countries : A Systematic Literature Review
(2023-06-02) Pandey, Rohan
Background – The COVID-19 pandemic caused by the novel coronavirus, SARS-CoV-2, has had a significant global impact, with severe implications for public health and economies worldwide. As the virus spreads and new variants emerge, effective vaccination strategies are crucial in controlling the pandemic and mitigating its burden on healthcare systems. Understanding the cost-effectiveness of different vaccination approaches is essential for decision-makers to allocate limited resources efficiently and prioritize interventions for which a systematic literature review was used. Objectives- In this systematic literature review, we aim to report and synthesize health economic evaluations of vaccination programs against Covid-19 in European countries among children compared with an elderly population. Methods- According to Mandrik et al. (2021), a Systematic Literature Review consists of six stages, (i) planning and development, (ii) evidence search, (iii) study selection, (iv) quality assessment, (v) data extraction, and synthesis, (vi) presenting results. This SLR used CINAHL, MEDLINE, PsychInfo, and EMBASE databases. Use of health-economic databases and grey literature were also used. Results- Through search identification, 6053 articles were found, of which 333 were removed because of duplication. Then after the title and abstract screening, 162 articles were selected for the full-text screening, and the rest were excluded for multiple reasons. No potentially relevant study was included in the final inclusion. Conclusion- We did not find any relevant articles that reported an economic evaluation of covid-19 vaccination program among the children population compared to the elderly population in European countries. More evidence is required for the children population to evaluate the vaccination program economically.
eHealth Literacy and its relationship with Perceived Health Status and Psychological Distress during COVID-19 A cross-sectional study of older adults in Blekinge, Sweden
(2023-01-09) Nauman Ghazi, Sarah; University of Gothenburg/Department of Medicine; Göteborgs universitet/Institutionen för medicin
Exploring Key Themes of Patient and Public Involvement (PPI) in Swedish Health Research Documents
(2025) Bruto Winberg, Elin
Introduction: Patient and Public Involvement (PPI) has become an important part of health research, but the existence of many different frameworks and guidelines for the process and the lack of consensus has led to fragmented procedures and terminology. There are currently no national guidelines for PPI in Sweden, and an overview of current PPI related documents could aid in the development of a common framework. Aim: The aim of this study was to explore the key themes in PPI related documents created by Swedish health research actors as well as explore any similarities and differences between them. Methods: A thematic analysis of PPI related documents created by Swedish health research actors was conducted. Results: The result of this study includes five themes constructed from the data: the entanglement of culture and structure within PPI, the importance of flexible systematic procedures, laying the foundation for collaboration in PPI, the appraisal of knowledge and education and ethical aspects of PPI. The similarities found are illustrated by the themes as they were constructed based on similarities and patterns found between the documents. The main differences found include terminology used for collaboration and PPI itself, differences in emphasis put on ethical considerations depending on actors involved and different guidelines for financial compensation. Conclusions: The key themes highlight the many similarities that exist between the documents, and considering these along with the differences can aid in constructing a common framework for PPI in Swedish health research.
Frontline Professional’s Experiences of Supporting Women Exposed to Psychological Violence in Intimate Relationships A qualitative study in southern Sweden involving women’s shelters and municipal services
(2025) Wahlberg Björk, Caroline
Introduction Psychological violence is a prevalent but often invisible form of intimate partner violence (IPV) that profoundly affects women’s mental health and autonomy. Globally, one in three women has experienced physical or sexual IPV or non-partner violence, highlighting the need to address all forms of abuse, including psychological violence. Despite its well-documented consequences, a lack of consensus on what constitutes psychological violence hinders clear identification and intervention. Aim This study explores how professionals in women’s shelters and municipal services in southern Sweden experience supporting women exposed to psychological violence in intimate relationships. Methods A qualitative, phenomenological approach was applied. Five semi-structured interviews were conducted with professionals from both women’s shelters and municipal services. Data were analyzed using thematic analysis according to Braun and Clarke. A feminist theoretical framework informed the interpretation. Results Three central themes were identified: (1)”Bringing it to light” – how professionals support women in recognizing and naming psychological violence; (2) The emotional impact on professionals – highlighting emotional strain and the personal meaning of this work and (3) “We see what’s missing” - pointing to systemic barriers such as fragmented institutional responsibility, unstable resources, legal shortcomings and lack of knowledge. Conclusions/Implications Professionals play a vital role in helping women recognize psychological abuse, which is often normalized or internalized. At the same time, emotional strain and systemic barriers limit their capacity to provide adequate support. These findings underscore the need for improved collaboration, stable resources, stronger legal frameworks and increased societal awareness—particularly in the Swedish context.
Impact of COVID-19 on the management of autoimmune disease in Sweden
(2021-08) Staaf (previously Atkins), Emily; Hunsberger, Monica; Univeristy of Gothenburg, School of Public Health and Community Medicine, Sahlgrenska Academy, Institute of Medicine
Objective: To determine the extent and nature of changes in healthcare resource use and deaths during the COVID-19 pandemic of patients with multiple sclerosis (MS) or rheumatoid arthritis (RA) in Sweden, with a focus on digital events and planned visits. Methods: Patients had a main diagnosis of MS or RA between 2014-2020 (“incident”) or 1987-2020 (“prevalent”). Retrospective aggregate data were obtained from the National Patient Register on patient characteristics, number of in- and outpatient events in specialised healthcare, planned visits, digital events, inpatient admissions, and length of stay for overnight admissions in each study period. From the Cause of Death Register, the number and top causes of death were obtained for patients in each study period, as well as the number with COVID-19 as an underlying cause of death. Healthcare use during the COVID-19 pandemic was observed for 7 months in 2020, and equivalent annual study periods between 2014-2019 were used to determine normal variation. Results: Compared to normal annual variation, specialised healthcare use by MS and RA incident patients did not change during 2020. However, the number of planned inpatient visits decreased, and number of digital outpatient visits significantly increased (P>0.005) for both diseases. The number of deaths was not notably different in the COVID-19 study period, although COVID-19 was found to be one of the most common causes of death in RA patients in 2020. Conclusions: This study provides evidence of MS and RA patients’ healthcare resource use in Sweden during the COVID-19 pandemic, and the results suggest that whilst the use of specialised healthcare has remained fairly unchanged, patients appear to have avoided physical visits and instead migrated towards digital visits. Further research is needed to explore the long-term effects of the pandemic on healthcare resource use in order to strengthen these conclusions.
Integrating preventive lifestyle advice into cancer screening programs: A scoping review
(2024) Hainarosie, Mona
Introduction: Cancer is predicted to be the leading cause of death by 2035, resulting in millions of deaths and significant economic losses globally. To address this, integrating cancer preventive lifestyle advice with cancer screening may be a powerful strategy to reduce the risk for cancer by leveraging the heightened attention the cancer screening participants have on their cancer risk at this moment. Aim: To map the existing knowledge on providing cancer preventive lifestyle advice alongside cancer screening, explore types of interventions delivered, their acceptability and impact, highlighting the preferences and views of screening participants. Method: A scoping review was conducted using the Population-Concept-Context framework. Searches in three databases and gray literature identified relevant studies. Review selection and characterization were performed by one independent reviewer using eligibility criteria: Population (participants to cancer screening), Concept (cancer preventive lifestyle advice), and Context (cancer screening for breast, colorectal, cervical and lung cancer). Results: The search strategy returned 112 papers of which 18 papers were retained for analysis. The most researched cancer preventive lifestyle advice was about diet and physical activity, figuring in 13 and 15 studies, respectively. Delivery formats ranged from leaflets to counselling. Over 50% of screening participants accepted receiving this advice. The impact of providing it was mainly positive for diet and conflicting for physical activity. Conclusion: Extensive literature supports the integration of cancer preventive lifestyle advice alongside cancer screening, as screening participants generally find it acceptable. However, research gaps remain, particularly in broadening lifestyle advice and underexplored screening contexts, notably for cervical and lung cancer.
Investigating relationships between sickness absence rate, level of education and immigrant status
(2021-11-04) Culcear, Adelina Roxana; Hunsberger, Monica; Univeristy of Gothenburg, Department of Public Health and Community Medicine Sahlgrenska Academy, Institute of Medicine
Introduction: The rate of sickness absence is one of the greatest concerns in the developed countries especially because long-term sickness absence was associated with negative impacts on individual health, increased risk for permanent disability, and exclusion from the labor market. According to previous literature, long-term sickness absence, permanent work disability, and disability pension were found to be higher among immigrants compared to natives. Aim: To investigate if the proportion of immigrants in the municipalities from Västra Götland’s Region has a relationship with the level of sickness absence and if this relation remains unchanged if immigrants’ level of education is considered. Methods: An ecological study design was adopted, using data of 2019 from Statistics Sweden (SCB) and the Swedish Social Insurance Agency (Försäkringskassan). The study is based on the Region Västra Götland from Sweden, and it includes 49 municipalities. The main group of interest is the immigrants’ group who are persons born outside Sweden and have non-Swedish parents. Simple and multiple regression models were utilized to investigate if the proportion of immigrants influences the level of sickness absence and if changes occur when considering immigrants’ level of education. Within the analyses, we controlled for some confounding factors such as sex (proportion of females), age, household size, average income, population density and proportion of divorced persons. Results: There was a statistically significant relationship between sickness absence rate and immigrant status, but there was not found a significant relationship between sickness absence and education. Thus 1 unit increase in proportion immigrants reduces by 1.4% sickness absence while education level is not considered. However, the estimated effect increased to 1.6% when we accounted for education level. Conclusion: Surprisingly, in Region Västra Götland, the high number of immigrants contributes to the decrease of the sickness absence rate. This result could be due to the sickness presenteeism or to the healthy immigrant effect. The statistically insignificant relation of the level of education on the sickness absence rate may indicate a mismatch between education and job of the immigrants, but also a lack of adjustment to the labor market and society.
Maternal mental health and birth trauma - Women´s perceptions of birth trauma and adequacy of healthcare practices in labour-ward care: A narrative review
(2024) Holloway, Emma
Background: It is thought that up to 45% of women globally report being mistreated by healthcare providers during childbirth. Research further suggests that an estimated 3-4% will go on to experience postpartum post-traumatic stress disorder. The negative effects of poor maternal mental health are many, for both mother and child. While there is an adequate amount of research on birth trauma, women’s own perceptions of their traumatic birth experience are missing. There is therefore a need to better understand how women, as told by themselves, perceive healthcare practices, specifically the actions of healthcare providers, in relation to birth trauma. Not only would this promote more positive and fulfilling labour-ward experiences, but also better mental and physical health outcomes, making it a clinically significant area worth looking more at. Aims: The aims of this study are to explore and synthesize existing raw qualitative data on women’s (1) experiences of a traumatic birth and (2) perceptions of the adequacy of healthcare practices in addressing their needs. Method: A narrative review was undertaken on two databases, PubMed and PsycInfo. 31 peer-reviewed qualitative studies met the eligibility criteria and were included in the review. The raw data from these were then analyzed using Braun & Clarke’s thematic analysis. Results: Three higher-level main themes were identified: (1) Over-medicalized, (2) Made to be a passive participant, and (3) Undermining the dignity of one’s experience. These were then further organized into seven subthemes. Conclusion: During pregnancy, childbirth, and postpartum, women are especially vulnerable and need to have healthcare providers that will both guide and support them. For the provision of truly woman-centered care, a means to protect against birth trauma, dedicated space has to be given to hear from women about how they themselves want to be cared for. Mothers deserve much more than the mistreatment and abuse many are currently faced with, and it is our responsibility as public health professionals to advocate for meaningful change.
Priority setting for acute surgery procedures
(2022-06-21) Glantz, Hillevi; Hunsberger, Monica; Univeristy of Gothenburg, School of Public Health & Community Medicine
Accessibility as well as providing care on equal terms to all inhabitants are the main objectives stated in the Swedish law SFS 2017: 30. As Sweden is facing demographic imbalances with more patients in need of care, prioritization decisions have become more common. Health care professionals daily face various forms of prioritization decisions on how to use available resources to provide care on equal terms. However, a literature review scoping relevant existing research shows that guidelines on how to prioritize care in daily practices are few. Further, no studies give an in-depth process description on how priority decisions might be evaluated or improved in practice. The study's extensive empirical material was obtained by observations and interviews from a four-month long improvement process at Skaraborgs Hospital Group (SkaS) that sought to improve local priority guidelines for acute surgery within as well as between specialties. The case description gives an overall narrative of a long volatile process with perspectives from both involved and non-involved staff capturing the work to improve prioritization routines at SkaS. The research questions focus on how priorities for acute surgery are currently performed at SkaS and what factors affect priority setting? Further, is the current priority setting perceived to be fair and work towards the targeted statutory objectives in practice? Finally, has the priority process affected SkaS and what benefits and shortcomings can be identified to improve priority setting in daily practice? A thematic qualitative content analysis was used to identify key themes that were related to the research questions. The identified themes were also validated by participants in the improvement project. The study´s result found homogeneous perceptions among co-workers regarding routines and justice in the case process concerning priorities, but certain scenarios imply that some priorities were not solely based on patient's needs assessment. However, patient safety and medical treatment quality were found to not be at risk despite delayed acute surgeries. Transparent dialogues with an understanding of each specialty department's patients were found to be a key factor to improve current routines. The main benefit was insights of learning in the process. In addition, routines for priorities between specialties were argued to be beneficial to continuously work with. The organization's process confirms that SkaS succeeded to decide on a value-creating change to prioritize elective surgeries according to eight principles stated in the Swedish law. The study’s findings support previous research that there remain conflicts of priority setting in healthcare, especially regarding horizontal practical priorities. The study also provides an insight into processes from everyday care illuminating how priorities are complied with in practice. The findings could be relevant for other health care organizations working with improvements project in similar contexts.
Quasi experimental study of SMS text messages as a nudging strategy for Covid-19 vaccination in Sweden
(2023-06-02) Hmon, Wut
Introduction In the roll-out of the COVID-19 vaccination program, a variety of policy tools were used to increase vaccination rates in Sweden. A SMS nudge intervention was implemented to increase vaccine adoption in Värmland and Västra Götaland among residents aged 16–39, 12 weeks after those aged >18 became eligible for vaccination in those counties. Aim The purpose of this paper is to assess the effect of SMS nudge interventions on COVID-19 vaccination uptake in Sweden. Method To analyze the adoption of the COVID-19 vaccine, quasi-experimental evidence and differences-in difference methodologies were utilized. The period of interest is from week 26 to week 44 of 2021 (6 weeks after the SMS reminder). The targeted age group was divided into three strata for in-depth evaluation. The robustness of the model was examined by incorporating county-specific covariates and analyzing multiple timeframes. Results The estimated effect of the SMS nudge on COVID-19 vaccination uptake was a 0.0083 percentage point decrease in vaccination rates, with very wide confidence interval (95% CI -0.06; +0.05) 30-39- year-olds demonstrate a small positive impact in the treated group with a value of 0.005, while 16-17 and 18-29-year-olds are estimated at -0.04 and -0.01 units, respectively. Conclusion This thesis finds no evidence that SMS nudging has increased vaccination rates for COVID-19 in Sweden. Thus, instead of SMS, policy makers could consider utilizing other nudges. This result contradicts with previous studies, most likely because of the time lapse between the eligibility contact and SMS nudge implementation.
Selling Sexual Content on OnlyFans: A Focus on Self-Portrayal, Stigma & Attitudes
(2024-05-31) llieva, Paulina; llieva, Paulina
In 2021, there was a decrease in street prostitution but an increase in digital prostitution. One example where digital prostitution is occurring is the social media platform OnlyFans. Selling sexual content on OnlyFans increased especially during the pandemic and lockdown. Prostitution is interrelated to several public health issues and sexual exploitation online has been found to be equally as harmful as sexual exploitation offline. The motivation for prostitution is hard to distinguish, theories suggest that self-objectification and self-portrayal is affected by individuals lived experiences and identity construction. Since OnlyFans became popular only recently, there is a lack of studies on OnlyFans. This study aimed to investigate how Swedish YouTubers portray themselves and experience stigma in relation to selling sexual content on OnlyFans, as well as viewers attitudes towards them and OnlyFans, as reflected in YouTube-comments. The method of analysis was qualitative content analysis. The recruitment strategy was purposive sampling since YouTube-videos were found and chosen with clearly specified search words and selection criterion. The findings showed that the participants portrayed themselves as unconcerned and confident when it comes to selling sexual content on OnlyFans, and viewers tend to be very supportive towards them, while some had a hard time respecting them. They do experience stigma but at the same time, they all explain how they love being photographed naked and sexually, which corresponds with theories about objectification among women. This study can be used in interventions aiming to increase knowledge about digital prostitution, but it would be beneficial to do the same study in a much larger scale.
A systematic review of the economic evaluation for Covid-19 vaccination for age groups elderly and adult in European countries
(2023-06-02) Untung, Tanto
Aim: This systematic review aimed to identify empirical evidence of the cost-effectiveness of Covid-19 vaccination programs within European countries among elderly and adult age groups. The result further acted as a parameter to assess the cost-effectiveness of a similar program in Sweden. Method: A literature search was conducted in the Medline, Embase, PscyInfo, CINAHL and Tuft CEA, Cochrane and INAHTA databases in February 2023 with PICO as inclusion criteria. The inclusion criteria are economic evaluation articles with age-group separation, age-group based vaccinated European residents as population, Covid-19 vaccination as intervention and non vaccinated European residents as control. The search was conducted by two reviewers with SBU search strategy. Handsearch was done on relevant websites and reference lists of selected articles. It was continued with title/abstract screening, full-text screening, and quality and risk of bias assessment with SBU checklist. The reporting follows guidelines from the Mastrigt articles. Results: The screening resulted in 5,720 reports, title/abstract screening yielded 160 reports and after full text screening, four articles remained. Two articles with moderate quality were selected for further analysis. The economic evidence indicated that Covid-19 vaccination is cost-effective in the elderly age group. Transferability to Sweden was hindered by the contrast difference in the data source. Conclusion: According to reviewed studies, the Covid-19 vaccination policy in the elderly population is cost-effective. The inclusion of the adult age group in the program depends on the vaccines' prices for it to be cost-effective. In house health economic research is needed to assess the cost-effectiveness of the Swedish Covid-19 vaccination program.
The impact of traditional bullying and cyberbullying victimization on self-perceived stress in Swedish adolescents. The longitudinal STARS study.
(2025) Panteli, Sofia
Introduction: Traditional bullying and cyberbullying victimization have been associated with various mental health issues. Adolescents with increased perceived stress may be at a greater risk of developing a mental health disorder. Aim: The study investigated whether bullying victimization and cyberbullying victimization from early to mid-adolescence is associated with increased self-perceived stress and examined gender differences in these associations. Methods: Data from the baseline(age 13) and two-year follow-up(age 15) measurements of the Study of Resilience and Stress (STARS) in Sweden were used. The sample consisted of 2099 participants (44% male and 56% female). Perceived stress was measured by Cohen’s Perceived Stress Scale. Traditional and cyberbullying bullying victimization were assessed using one item from the Bully/Victim Questionnaire and a global question, respectively. Statistical analyses included independent t-tests, chi square tests, one-way ANOVAs and General Linear Models for repeated measures. Results: Compared to males, females reported higher stress levels and were more exposed to cyberbullying victimization at both time points. In both males and females, exposure to bullying or cyberbullying victimization at the age of 13, 15 or at both time points was associated with increased stress levels over the two-year period. The impact of bullying and cyberbullying victimization on stress persisted over time, even in the absence of continued exposure. Conclusions: Being bullied or cyberbullied either at age 13, 15 or at both time points, has a negative impact on perceived stress in both males and females, highlighting the need for measures that address and prevent these sources of stress during adolescence.
The infected question of sterile needles: A qualitative study of policy change regarding the needle exchange program of Gothenburg, Sweden
(2019-06-03) Sundin Andersson, Charlotta
The first needle exchange programs in Sweden started up in Lund in 1986 and Malmoe in 1987. It would take 27 years before Stockholm’s first official needle exchange opened in 2013 and another five years before Gothenburg followed their example in 2018. How can this delay of over three decades be understood and what were the events leading to this policy change? I have been analyzing political documents concerning the question of needle exchange in Gothenburg as well as interviewing relevant decisionmakers, civil servants and health care staff about the process. I have made a thematic analysis of the data and interpreted the result through the framework of Walts and Gilson’s policy analysis triangle. The findings suggest that the needle exchange of Gothenburg was delayed due to a strong opposition from a majority of the local decision makers, against harm reduction of all kinds. The opposition is based in the idea that harm reduction is incompatible with Swedish drug politics and the vision of a drug free society. The policy change was made possible because a change in the law on needle exchange that removed the municipal veto in the question and shifted the responsibility to the politicians in charge of health care issues. The changing of the law was proceeded by a number of changes in the Swedish government in combination with international critique concerning the lack of needle exchanges among other harm reducing efforts. With the example of the Gothenburg needle exchange, this thesis attempts to describe a potentially radical change in the Swedish approach to harm reduction.

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