Mental health problems among adolescents during the COVID-19 pandemic: a repeated cross-sectional study from Sweden.

OBJECTIVE: Most international studies have concluded that exposure to the COVID-19 pandemic was associated with worse mental health. Sweden implemented lighter restrictions than many other countries. We evaluated the association between changes in exposure of COVID-19 restrictions and changes in mental health problems among Swedish adolescents. METHOD: Repeated cross-sectional data were derived from the Stockholm school survey, mandatory for all students in municipal schools and voluntary for students in private schools. Unexposed students were assessed in the year 2020 and exposed were assessed in 2022. Mental health was assessed using items similar to the psychosomatic problem scale. All variables were dichotomised, and a non-parametric logistic regression was used to evaluate associations. RESULTS: A significant positive association was found between exposure of COVID-19 restrictions and self-reports of five to seven mental health problems a week for girls (odds ratio (OR) 1.29, 95% confidence interval (CI) 1.18-1.41), but a non-significant association was found for boys (also after controlling for relevant covariates). Among boys and girls (shown), changes in mental health during the pandemic were moderated by social support from parents (OR 2.23, 95% CI 1.98-2.51), bullying victimisation (OR 2.24, 95% CI 2.06-2.66), a sensation-seeking temperament (OR 1.40, 95% CI 1.24-1.58) and school achievement (OR 1.34, 95% CI 1.18-1.51). CONCLUSIONS: Compared with boys, adolescent girls self-reported worse mental health following COVID-19 exposure. Girls may have been more affected by social distancing regulations in Sweden during the pandemic than boys and may require additional psychosocial support post-pandemic. Social support from parents may play an important role.

Enhancing compliance with waste sorting regulations through inspections and motivational interviewing.

This field experiment investigates the effect of first-time inspections of restaurants' waste sorting and explores whether motivational interviewing (MI) training of inspectors in this specific setting enhances the propensity of restaurants to be compliant with regulations. Our results show strong positive effects of first inspections with an average improvement of 55%. Also, the MI training of inspectors seems to affect compliance. However, this may also be a combined effect of the first inspection, MI training and more days between inspections. Further research is needed.

Periodontal microorganisms and diagnosis of malignancy: A cross-sectional study.

BACKGROUND: Oral infections associate statistically with cancer. OBJECTIVE: We hypothesized that certain periodontal microorganisms might specifically link to malignancies in general and set out to investigate this in our ongoing cohort study. METHODS: A sample of 99 clinically examined patients from our cohort of 1676 subjects was used to statistically investigate the associations between harboring periodontal microorganisms Aggregatibacter actinomycetemcomitans (A.a), Porphyromonas gingivalis (P.g), Prevotella intermedia (P.i), Tannerella forsythia (T.f) and Treponema denticola (T.d). We used oral infection indexes and the incidence figures of malignancies as registered in 2008-2016 in the Swedish National Cancer Register. RESULTS: The pathogen A.a showed strong association with malignancy in 32 out of the 99 patients while P.g and P.i were more prevalent among patients without malignancy. In principal component analyses, A.a appeared in the strongest component while the second strongest component consisted of a combination of T.f and T.d. The third component consisted of a combination of P.g and P.i, respectively. Of basic and oral health variables, gingival index appeared to be the strongest expression of inflammation (Eigen value 4.11 and Explained Variance 68.44 percent). CONCLUSIONS: The results partly confirmed our hypothesis by showing that harboring certain periodontal bacteria might link to malignancy. However, the associations are statistical and no conclusions can be drawn about causality.

Psychometric properties of the short version of the children of alcoholics screening test (CAST-6) among Swedish adolescents.

AIMS: The Children of Alcoholics Screening Test (CAST-6) is a brief screening instrument developed to identify children with parents having problematic alcohol use. The aim of this study was to evaluate the psychometric properties of the CAST-6 among adolescents aged 15-18 years, and also to identify an optimal cut-off score for this age group. METHODS: A total of 3000 15 to18 year-olds were randomly selected from a register of postal addresses in Sweden. An invitation letter, including access information to the electronic questionnaire, was sent out by regular mail and 1450 adolescents responded with baseline data. Test-retest reliability within a 2-3-week period was calculated based on the 111 respondents who answered the same questionnaire twice. To determine an optimal cut-off score, a small treatment-seeking sample (n = 22) was recruited from a support group agency to be used as a reference group. RESULTS: The six items of the CAST-6 screening test loaded onto one latent factor with good internal consistency (alpha = 0.88), and excellent test-retest reliability (ICC = 0.93, 95% CI 0.90-0.95). The optimal cut-off score among adolescents was 2 points with a sensitivity of 55% and specificity of 79% (AUROC = 0.71, 95% CI 0.58-0.83). CONCLUSIONS: The CAST-6 has good to excellent psychometric properties among adolescents. The identified optimal cut-off score of 2 points should be treated with caution due to study limitations. The CAST-6 can be used in various settings to identify a vulnerable at-risk group of children and adolescents that may be in need of support.

Do professionals ask about children when establishing a collaborative individual plan for clients? A cross-sectional study.

Aim: To examine the extent to which structured action plans, i.e. collaborative individual plans (CIPs), used by professionals within the psychiatric care, substance use treatment services and social services, evaluate if clients have children, and if professionals take actions if clients do have children. According to Swedish law, a CIP should be established when a client is in need of care from more than one branch of the care network. Professionals who meet adult clients have the opportunity to identify children at risk. Including a question in the CIP on whether a client has a child is a good approach to identify children in need of support.Methods: Cross-sectional data from professionals were collected prior to attending a three-day CIP course. A total of 705 individuals (n = 797 invited) responded to the questionnaire.Results: More than 90% reported that they meet clients for whom a CIP should be established, and 52.6% of these (n = 346) were aware of an existing CIP template within their organization. Approximately 30% (n = 203) reported that this template included an item on whether the client has one or more children. Of these, a majority reported ensuring that the children receive adequate care (83.3%, n = 169), and that they follow up on the receipt of such care (62.6%, n = 125).Conclusions: The care network needs to implement CIPs to a higher degree, and CIP templates need to include items about the clients' children to ensure that children at risk are identified and thereby can receive adequate support.

Homeless Adults' Recovery Experiences in Housing First and Traditional Services Programs in Seven European Countries.

Across Europe, as governments turn to housing-led strategies in attempts to reverse rising rates of homelessness, increasing numbers of Housing First (HF) programs are being implemented. As HF programs become more widespread, it is important to understand how service users experience them compared to the more prevalent traditional treatment-first approach to addressing long-term homelessness. Although there is a large body of research on service users' experiences of Housing First compared to treatment-first in North American contexts, comparatively less is known about how these two categories of homeless services are experienced in the European context. In a correlational and cross-sectional study, part of a larger examination of homelessness in Europe, participants (n = 520) engaged with either HF (n = 245) or traditional services (TS; n = 275) programs in seven countries completed measures of their experiences of services (consumer choice, housing quality, and service satisfaction) and recovery (time in independent housing, psychiatric symptoms, and community integration). Across the seven countries, participants engaged with HF programs reported experiencing more consumer choice, better perceived housing quality, and more satisfaction with services than participants engaged in TS programs. Participants in HF programs also reported a greater proportion of time in independent accommodation, fewer psychiatric symptoms, and more community integration. Varying patterns of association between experiences of services and recovery outcomes were observed. Findings indicate HF consistently predicts greater recovery than TS across diverse sociopolitical and economic contexts. Implications of findings for configurations of homeless services and homeless services policy are discussed.

Psychometric Properties of the AUDIT, AUDIT-C, CRAFFT and ASSIST-Y among Swedish Adolescents.

BACKGROUND/AIMS: Not enough is known about the psychometric properties of screening instruments for problematic alcohol consumption among adolescents. The aim of the current study was to evaluate and compare the performance of the screening instruments: Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, CRAFFT, and the alcohol domain of Alcohol, Smoking and Substance Involvement Screening Test-Youth (ASSIST-Y) among adolescents and to suggest optimal cut-offs indicating problematic use. METHODS: Data was collected from a general population sample (n = 1,421) and a treatment-seeking sample (n = 59) using electronic versions of the instruments. RESULTS: The internal consistencies for the instruments were fair (alpha's AUDIT 0.74, AUDIT-C 0.75, CRAFFT 0.67, ASSIST-Y 0.62), and test-retest reliabilities were good to excellent (intraclass correlation coefficients AUDIT 0.86, AUDIT-C 0.93, CRAFFT 0.77, ASSIST-Y 0.63). The CRAFFT and ASSIST-Y demonstrated reasonable construct validities while factor solutions for AUDIT and AUDIT-C could not be determined. The optimal cut-off score was 2 for both CRAFFT and ASSIST-Y (61 and 73% sensitivities and 79 and 65% specificities, respectively), while sensitivity scores were poor for AUDIT and AUDIT-C. CONCLUSION: Based on the current sample, ASSIST-Y and the CRAFFT performed better than AUDIT and AUDIT-C. Health-care clinics working with adolescents should carefully consider their choice of screening instruments.

Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) in relation to Alcohol Use Disorder (AUD) severity levels according to the brief DSM-5 AUD diagnostic assessment screener.

Aims: The Alcohol Use Disorders Identification Test (AUDIT) is a well-established and widely used screening instrument. It has been shown that AUDIT has good criterion validity in relation to alcohol abuse and dependence according to DSM-IV, but it has not yet been validated following the introduction of the DSM-5 diagnostic system. The aim of this study was to evaluate concurrent validity for the AUDIT in relation to self-reported DSM-5 severity levels for Alcohol Use Disorder (AUD) in a Swedish general population sample. Methods: A postal questionnaire, containing the AUDIT and the 13-item brief DSM-5 AUD diagnostic assessment screener, was sent to a random sample of 1,500 persons drawn from the Swedish population, aged between 17 and 80 years and having a public residence address in Sweden. To evaluate the concurrent validity of AUDIT in relation to DSM-5 severity criteria for AUD, a Receiver Operating Characteristics (ROC) curve analysis was conducted. Results: Area under the curve (AUROC) showed excellent differentiation between AUD or not, mild (.93), moderate (.92) and severe (.99). Higher individual AUDIT scores were associated with more severe levels of AUD according to the DSM-5 screener. The optimal cutoff scores approximate earlier research on the DSM-IV and were identified as 5, 7 and 13 points, respectively, for mild, moderate and severe AUD. Conclusions: Our findings indicate that AUDIT is a valid screener for detecting concurrent AUD at three severity levels in the Swedish general population.

Alcohol habits in Sweden during 1997-2018: a repeated cross-sectional study.

Aims: This study describes changes in alcohol habits in age and gender strata among the Swedish general population during the 21-year period following the Swedish EU membership in 1995. Methods: The Alcohol Use Disorders Identification Test (AUDIT) was distributed as a postal questionnaire to randomly selected cross-sectional samples every fourth year, starting in 1997. Results: Six samples were included in this study. A comparison between 2014 and 2018 showed a tendency to decreasing average total AUDIT scores, particularly among men and in the youngest age group (Cohen's d = 0.28). Conclusion: The results should be understood in the context of declining response rates in this type of survey.

Changes in alcohol consumption between 2009 and 2014 assessed with the AUDIT.

BACKGROUND: Alcohol habits in Sweden, assessed as sales and estimates of unrecorded consumption, have changed since joining the EU. Earlier studies using the Alcohol Use Disorders Identification Test (AUDIT) showed that reported consumption is consistent with sales data, which makes it possible to assess consumption according to sex and age. AIMS: This study reports the changes in alcohol habits between 2009 and 2014, a period starting a couple of years after Sweden joined the EU. METHOD: The AUDIT was sent to a random sample of the Swedish population aged between 17 and 80 years old. RESULTS: No statistically significant changes were shown in six age and sex groups. CONCLUSIONS: Alcohol habits have stabilised in Sweden but on a higher consumption level than before.

Adults with mild to moderate depression exhibit more alcohol related problems compared to the general adult population: a cross sectional study.

BACKGROUND: Alcohol use has been shown to interfere with treatment for depression, but consumption habits are not routinely screened in primary care. To date, few studies have compared the alcohol consumption habits of patients with depression to the general population. The purpose of this study was to compare alcohol habits in adults diagnosed with depression in primary care to the general adult population in Sweden. METHODS: Nine hundred fourty six patients diagnosed with mild to moderate depression, without a primary substance use disorder, in primary care settings located across Sweden completed the Alcohol Use Disorders Identification Test (AUDIT). Consumptions habits and alcohol related problems in the depressed sample were compared to those in the general adult population (n = 663). Analyses were stratified by gender and age. RESULTS: Ratings of alcohol problems and measures of hazardous drinking and binge drinking were significantly higher among patients seeking treatment for depression in primary care compared to the general population. Male patients scored higher on the AUDIT total and AUDIT-C (consumption) subscale than men in the general population. Compared to younger adults (aged 17-27) older depressed adults (aged 28-50 and 51-71) exhibited higher rates of consumption and problems related to alcohol. CONCLUSIONS: Compared to the general adult population, consumption and problems related to alcohol use were substantially higher among patients with mild to moderate depression in primary care. Routine screening of alcohol use in primary care is recommended for patients presenting with depression.

Anti-Social Behaviors Associated with Anabolic-Androgenic Steroid Use among Male Adolescents.

Anabolic-androgenic steroids (AAS) have been linked to a range of problematic behaviors, but AAS use is still sometimes portrayed as more benign than other forms of classical drug abuse. To address this issue, we compared the prevalence of anti-social behaviors among adolescent AAS users, non-AAS illicit drug users, and drug non-users. We examined 3 waves (2004, 2008, and 2012) of self-reported cross-sectional data from a secondary school survey conducted in Stockholm, Sweden (total n = 19,773; response percentage, 79.6%). Across all survey years, the risk ratios for virtually all measured anti-social behaviors were significantly higher among AAS users compared to non-AAS illicit drug users and to drug non-users.

The psychometric properties of the AUDIT: a survey from a random sample of elderly Swedish adults.

BACKGROUND: Increasing alcohol consumption and related harms have been reported among the elderly population of Europe. Consequently, it is important to monitor patterns of alcohol use, and to use a valid and reliable tool when screening for risky consumption in this age group. The aim was to evaluate the internal consistency reliability and construct validity of the Alcohol Use Disorders Identification Test (AUDIT) in elderly Swedish adults, and to compare the results with the general Swedish population. Another aim was to calculate the level of alcohol consumption (AUDIT-C) to be used for comparison in future studies. METHODS: The questionnaire was sent to 1459 Swedish adults aged 79-80 years with a response rate of 73.3%. Internal consistency reliability, were assessed using Cronbach alpha, and confirmatory factor analysis assessed construct validity of the Alcohol Use Disorders Identification Test (AUDIT) in elderly population as compared to a Swedish general population sample. RESULTS: The results showed that AUDIT was more reliable and valid among the Swedish general population sample than among the elderly and that Item 1 and 4 in AUDIT was less reliable and valid among the elderly. CONCLUSIONS: While the AUDIT showed acceptable psychometric properties in the general population sample, it's performance was of less quality among the elderly respondents. Further psychometric assessments of the AUDIT in elderly populations are required before it is implemented more widely.

Periodontitis may predict the use of prescription medicines later in life, a database study.

Medications used for the treatment of diseases also affect oral health. We investigated how having/not having periodontitis at baseline in 1985 was associated with purchases of medicines in the long term. The study paradigm is in the oral health-systemic health connections. We hypothesized that periodontitis links to purchases of medicines later in life. The study cohort consisted of 3,276 individuals from the greater Stockholm area, Sweden. Of them, 1,655 were clinically examined at baseline. Patients were followed-up for >35 years, using the national population and patient registers. The burden of systemic diseases and purchases of medicines were statistically analyzed comparing patients with (n = 285) and without (n = 1,370) periodontitis. The results showed that patients with periodontitis had purchased more of certain medications than non-periodontitis patients. Periodontitis patients purchased significantly more drugs used in diabetes (p = 0.035), calcium channel blockers (p = 0.016), drugs acting on the renin-angiotensin system (p = 0.024), and nervous system drugs (p = 0.001). Hence, patients with periodontitis indeed had purchased specific medications statistically significantly more than the periodontally healthy ones. This indicates that periodontitis, over time, might increase the risk for systemic diseases with the subsequent need for medication.

Factors that affect levels of alexithymia, empathy and communication skills of nursing students in northern Iran.

AIM: The inability of nurses to express their own emotions, understand others' emotions and show empathy could result in communication gaps that could affect patient care outcomes. This study investigates the factors associated with the levels of alexithymia, empathy and communication skills among nursing students. DESIGN: A survey was conducted among 365 nursing students, and data were collected using an online questionnaire. METHODS: Data analyses were done using SPSS software version 22. RESULTS: There was a significant positive association between age and empathy and a negative association between the number of times a nurse took the entrance exam. The level of education and interest in nursing correlate with communication skills. All the predictor variables of alexithymia in this current study were not significant. Emphasis should be placed on improving nursing students' empathy and communication skills. Student nurses should be taught how to recognize and express their emotions. To assess their mental health, they must be screened regularly.

Attitudes of Emergency Nurses and Patients' Family Members Towards the Presence of Family Members During Cardiopulmonary Resuscitation; a Cross-sectional Study.

Introduction: Family presence during cardiopulmonary resuscitation (CPR) is one of the elements where family-centered care is practiced. This study aimed to investigate the attitudes of Iranian emergency nurses and patients' family members regarding the presence of family during CPR. Methods: In a cross-sectional study, 350 emergency nurses and 254 family members of patients admitted to the emergency department of an educational hospital in Iran were enrolled. Data were collected from May to November 2020 using convenience sampling and using a 27-item questionnaire of participants' attitudes towards family presence during CPR. Results: The mean attitude scores of nurses and family members of patients regarding family presence during CPR were 86.79 ± 7.50 and 92.48 ± 6.77, respectively (p < 0.001). The highest and lowest mean scores of nurses' attitude towards family presence during CPR were related to "CPR performance will be negatively influenced" and "Family members have the right to be present during CPR of their relatives/ Allows relatives to stay with the patient until the end/ Makes the patient less worried ", respectively. The highest and lowest mean scores of family members' attitude towards family presence during CPR were related to "Family members may interfere with CPR" and " May be beneficial to the relatives' grieving process ", respectively. Conclusion: Overall, the results of this study showed that the attitude of emergency nurses and patients' family members towards family presence during CPR was positive. Of course, the mean attitude score of nurses in this regard was significantly lower.

Prevalence of cancer in relation to signs of periodontal inflammation.

We investigated the associations between periodontal inflammation (gingivitis and periodontitis) and all-kind malignancies, specifically breast and prostate cancer, in a cohort followed-up for 30 years. The study hypothesis was based on the oral inflammation vs. systemic health paradigm. A sample of 2,168 subjects from an original cohort of 105,718 individuals from the greater Stockholm area in Sweden that had been followed since 1985 was investigated. Swedish national health registers were used in the study. Chi-square tests and logistic multiple regression analyses were conducted. The results showed that periodontitis was significantly associated with any cancer after adjusting for gender, age, income, and education (p = 0.015). The probability of getting cancer increased on average by 38% if the patient had periodontitis vs. had not; the odds ratio was 1.380 (95% confidence interval l.066-1.786). No significant association was observed between periodontitis and breast cancer (p = 0.608), while the association between periodontitis and prostate cancer tended towards significance (p = 0.082). However, no statistically significant difference was found between the observed and the calculated distribution of any cancer in gingivitis groups (p = 0.079). Thus, the study hypothesis was partly confirmed by showing a statistically significant association between periodontitis and any cancer.

Alcohol habits in Sweden during 1997-2009 with particular focus on 2005 and 2009, assessed with the AUDIT: a repeated cross-sectional study.

AIM: This study aimed to survey the changes in alcohol habits during a period with the European Union legal practices. METHODS: Alcohol habits in Sweden were surveyed in the general Swedish population at four timepoints, in 1997, 2001, 2005 and 2009, using the 10-item AUDIT questionnaire. DESIGN: Four separate randomly drawn cross-sectional samples of 1,250 individuals were surveyed at each timepoint. RESULTS: An average of 70% of the sampled individuals responded to the AUDIT questionnaire. Men had higher total AUDIT scores than women in 2005 and 2009, but scores increased among women 61-71 years old and decreased among men 61-71 years old. Younger men and women 17-27 years old decreased their AUDIT-C consumption scores by almost 20% between 2005 and 2009. An analysis of problem drinkers (+8 for men/+6 for women) indicated that a larger proportion of elderly women drank moderately in 2009 compared with 2005, but fewer elderly women drank hazardously. CONCLUSIONS: Earlier increases in drinking levels between 1997 and 2001 may reflect a latent high demand that was restricted by low availability. When availability due to European Union harmonization increased, alcohol consumption followed suit. After a period of adaptation, alcohol consumption appears to have stabilized.

Psychometric properties and norm data of the Swedish version of the NEO-PI-R.

BACKGROUND: Internationally, the NEO Personality Inventory-Revised (NEO-PI-R) is a well established questionnaire for assessment of personality in accordance with the Five Factor Model. The instrument has been translated into many languages including Swedish. AIM: The aim of this study was to make a psychometric evaluation of the Swedish version of NEO-PI-R based on a sample from the general population. METHODS: Postal questionnaires were sent to a random sample of 1250 persons (n = 766 responders). RESULTS AND CONCLUSIONS: The test showed satisfactory internal consistency in the broad factors as well as the facets. A factor analysis indicated that the factors were similar but not identical to those obtained in American studies. In sum, The Swedish version of the NEO-PI-R shows satisfactory psychometric properties and the instrument will continue to be a valuable tool in psychological research and in clinical practice.

Bullying at school and mental health problems among adolescents: a repeated cross-sectional study.

OBJECTIVE: To examine recent trends in bullying and mental health problems among adolescents and the association between them. METHOD: A questionnaire measuring mental health problems, bullying at school, socio-economic status, and the school environment was distributed to all secondary school students aged 15 (school-year 9) and 18 (school-year 11) in Stockholm during 2014, 2018, and 2020 (n = 32,722). Associations between bullying and mental health problems were assessed using logistic regression analyses adjusting for relevant demographic, socio-economic, and school-related factors. RESULTS: The prevalence of bullying remained stable and was highest among girls in year 9; range = 4.9% to 16.9%. Mental health problems increased; range = + 1.2% (year 9 boys) to + 4.6% (year 11 girls) and were consistently higher among girls (17.2% in year 11, 2020). In adjusted models, having been bullied was detrimentally associated with mental health (OR = 2.57 [2.24-2.96]). Reports of mental health problems were four times higher among boys who had been bullied compared to those not bullied. The corresponding figure for girls was 2.4 times higher. CONCLUSIONS: Exposure to bullying at school was associated with higher odds of mental health problems. Boys appear to be more vulnerable to the deleterious effects of bullying than girls.