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Lillqvist, J., Nilsson Sommar, J., Gustafsson, P. E., Glader, E.-L., Hamberg, K. & Rolandsson, O. (2023). Are doctors using more preventive medication for cardiovascular disease?: A Swedish cross-sectional study. Scandinavian Journal of Primary Health Care, 41(3), 297-305
Open this publication in new window or tab >>Are doctors using more preventive medication for cardiovascular disease?: A Swedish cross-sectional study
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2023 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 41, no 3, p. 297-305Article in journal (Refereed) Published
Abstract [en]

Background: Despite decreasing mortality from cardiovascular disease (CVD), there are persistent inequities in mortality between socioeconomic groups. Primary preventative medications reduce mortality in CVD; thus, inequitable treatments will contribute to unequal outcomes. Physicians might contribute to inequality by prescribing preventative medication for CVD to themselves in a biased manner.

Aim: To determine whether primary medications for preventing CVD were prescribed inequitably between physicians and non-physicians.

Design and setting: This retrospective study retrieved registry data on prescribed medications for all physicians in Sweden aged 45–74 years, during 2013, and for reference non-physician individuals, matched by sex, age, residence, and level of education. The outcome was any medication for preventing CVD, received at least once during 2013.

Method: Age and the sex-specific prevalence of myocardial infarction (MI) among physicians and non-physicians were used as a proxy for the need for medication. Thereafter, to limit the analysis to preventative medication, we excluded individuals that were diagnosed with CVD or diabetes. To analyse differences in medication usage between physicians and matched non-physicians, we estimated odds ratios (ORs) with conditional logistic regression and adjusted for need and household income.

Results: MI prevalences were 5.7% for men and 2.3% for women, among physicians, and 5.4% for men and 1.8% for women, among non-physicians. We included 25,105 physicians and 44,366 non-physicians. The OR for physicians receiving any CVD preventative medication, compared to non-physicians, was 1.65 (95% confidence interval 1.59–1.72).

Conclusion: We found an inequity in prescribed preventative CVD medications, which favoured physicians over non-physicians.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
cardiovascular disease, epidemiology, Healthcare inequities, pharmacoepidemiology, prevention
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-212491 (URN)10.1080/02813432.2023.2234439 (DOI)001029892800001 ()37467115 (PubMedID)2-s2.0-85165481697 (Scopus ID)
Funder
Västerbotten County Council
Available from: 2023-08-01 Created: 2023-08-01 Last updated: 2023-09-27Bibliographically approved
Kristoffersson, E. & Hamberg, K. (2022). "I have to do twice as well" – managing everyday racism in a Swedish medical school. BMC Medical Education, 22(1), Article ID 235.
Open this publication in new window or tab >>"I have to do twice as well" – managing everyday racism in a Swedish medical school
2022 (English)In: BMC Medical Education, E-ISSN 1472-6920, Vol. 22, no 1, article id 235Article in journal (Refereed) Published
Abstract [en]

Background: Mounting evidence suggests that medical students from cultural/ethnic minority backgrounds face recurring and more or less subtle racist oppression, i.e., everyday racism. Insights into how they handle these inequalities, though, are scarce – especially in a Swedish context. In this interview study we therefore explored and analyzed the strategies used by racialized minority medical students to manage episodes of everyday racism – and their underlying motives and considerations.

Methods: Individual interviews were carried out with 15 medical students (8 women, 7 men) who self-identified as having ethnic- or cultural minority backgrounds. Inspired by constructivist grounded theory, data were collected and analyzed simultaneously.

Results: Participants strove to retain their sense of self as active students and professional future physicians – as opposed to passive and problematic ‘Others’. Based on this endeavor, they tried to manage the threat of constraining stereotypes and exclusion. Due to the power relations in medical education and clinical placement settings as well as racialized students’ experience of lacking both credibility and support from bystanders, few dared to speak up or report negative treatment. Instead, they sought to avoid racism by withdrawing socially and seeking safe spaces. Or, they attempted to adopt a professional persona that was resistant to racial slights. Lastly, they tried to demonstrate their capability or conform to the majority culture, in attempts to refute stereotypes.

Conclusions: Racism is not caused by the exposed individuals’ own ways of being or acting. Therefore, behavioral changes on the part of minority students will not relieve them from discrimination. Rather, strategies such as adaptation and avoidance run the risk of re-inscribing the white majority as the norm for a medical student. However, as long as racialized minority students stand alone it is difficult for them to act in any other way. To dismantle racism in medical education, this study indicates that anti-racist policies and routines for handling discrimination are insufficient. School management should also acknowledge racially minoritized students’ experiences and insights about racist practices, provide students and supervisors with a structural account of racism, as well as organize training in possible ways to act as a bystander to support victims of racism, and create a safer working environment for all.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Everyday racism, Grounded theory, Interviews, Medical education, Racial microaggressions
National Category
Pedagogy International Migration and Ethnic Relations
Identifiers
urn:nbn:se:umu:diva-193798 (URN)10.1186/s12909-022-03262-5 (DOI)000777233400010 ()35365131 (PubMedID)2-s2.0-85127530216 (Scopus ID)
Available from: 2022-05-06 Created: 2022-05-06 Last updated: 2022-05-06Bibliographically approved
Kristoffersson, E., Rönnqvist, H., Andersson, J., Bengs, C. & Hamberg, K. (2021). "It was as if I wasn't there": experiences of everyday racism in a Swedish medical school. Social Science and Medicine, 270, Article ID 113678.
Open this publication in new window or tab >>"It was as if I wasn't there": experiences of everyday racism in a Swedish medical school
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2021 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 270, article id 113678Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore and analyze how cultural/ethnic minority students at a Swedish medical school perceive and make sense of educational experiences they viewed as related to their minority position. We interviewed 18 medical students (10 women, and 8 men), who self-identified as coming from minority backgrounds. Data were collected and analyzed simultaneously, inspired by constructivist grounded theory methodology. The concepts 'everyday racism' and 'racial microaggressions' served as a theoretical framework for understanding how inequities were experienced and understood. Participants described regularly encountering subtle adverse treatment from supervisors, peers, staff, and patients. Lack of support from bystanders was a common dimension of their stories. These experiences marked interviewees' status as 'Other' and made them feel less worthy as medical students. Interviewees struggled to make sense of being downgraded, excluded, and discerned as different, but seldom used terms like being a victim of discrimination or racism. Instead, they found other explanations by individualizing, renaming, and relativizing their experiences. Our results indicate that racialized minority medical students encounter repeated practices that, either intentionally or inadvertently, convey disregard and sometimes contempt based on ideas about racial and/or cultural 'Otherness'. However, most hesitated to name the behaviors and comments experienced as "discriminatory" or "racist", likely because of prevailing ideas about Sweden and, in particular, medical school as exempt from racism, and beliefs that racial discrimination can only be intentional. To counteract this educational climate of exclusion medical school leadership should provide supervisors, students, and staff with theoretical concepts for understanding discrimination and racism, encourage them to engage in critical self-reflection on their roles in racist power relations, and offer training for bystanders to become allies to victims of racism.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Everyday racism, Interviews, Medical education, Minority students, Racial microaggressions, Sweden
National Category
Gender Studies General Practice
Research subject
family medicine
Identifiers
urn:nbn:se:umu:diva-179399 (URN)10.1016/j.socscimed.2021.113678 (DOI)000621367100002 ()33434719 (PubMedID)2-s2.0-85099220516 (Scopus ID)
Available from: 2021-02-01 Created: 2021-02-01 Last updated: 2023-09-05Bibliographically approved
Sperens, M., Georgiev, D., Eriksson Domellöf, M., Forsgren, L., Hamberg, K. & Hariz, G.-M. (2020). Activities of daily living in Parkinson's disease: Time/gender perspective. Acta Neurologica Scandinavica, 141(2), 168-176
Open this publication in new window or tab >>Activities of daily living in Parkinson's disease: Time/gender perspective
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2020 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 141, no 2, p. 168-176Article in journal (Refereed) Published
Abstract [en]

Objective: The objectives of this study were to explore the changes in the activities of daily living (ADL) in persons with Parkinson's disease (pwPD) over time and to investigate possible differences in ADL performance between men and women with PD.

Materials & Methods: One hundred twenty‐nine persons (76 men) with a clinically established PD self‐assessed their ADL performance from the time of diagnosis up to 8 years follow‐up using the ADL taxonomy. Other demographic and clinical data (motor state, cognition, depression) were also collected and subjected to further analysis.

Results: Nine of 12 domains in the ADL taxonomy showed a change over time (Eating and Drinking [P = .009], Mobility [P < .001], Toilet activities [P = .031], Dressing [P < .001], Personal hygiene [P < .001], Communication [P < .001], Cooking [P = .001], Shopping [P < .001] and Cleaning [P < .001]). In addition to time, two domains, (Shopping [P = .007] and Cleaning [P = .027]) also showed an effect of gender with worse scores in women. The nine ADL domains showing effect of time, showed temporary improvement at 12 months follow‐up, most probably due to dopaminergic medication. All nine domains deteriorated at later follow‐up.

Conclusions: As expected, there was deterioration in self‐assessed performance in the majority od ADL domains over time. Women assessed their ADLs worse in two domains (Shopping and Cleaning) probably reflecting a general gender‐related activity pattern rather than being a PD‐specific finding.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
activities of daily living, gender differences, longitudinal study, Parkinson's disease
National Category
Neurology
Research subject
Neurology
Identifiers
urn:nbn:se:umu:diva-166577 (URN)10.1111/ane.13189 (DOI)000497350700001 ()31693751 (PubMedID)2-s2.0-85075258125 (Scopus ID)
Available from: 2019-12-19 Created: 2019-12-19 Last updated: 2023-03-24Bibliographically approved
Asklund, I., Samuelsson, E., Hamberg, K., Umefjord, G. & Sjöström, M. (2019). User Experience of an App-Based Treatment for Stress Urinary Incontinence: Qualitative Interview Study. Journal of Medical Internet Research, 21(3), Article ID e11296.
Open this publication in new window or tab >>User Experience of an App-Based Treatment for Stress Urinary Incontinence: Qualitative Interview Study
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2019 (English)In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 21, no 3, article id e11296Article in journal (Refereed) Published
Abstract [en]

Background: Stress urinary incontinence (SUI) affects 10%-39% of women. Its first-line treatment consists of lifestyle interventions and pelvic floor muscle training (PFMT), which can be performed supervised or unsupervised. Health apps are increasing in number and can be used to improve adherence to treatments. We developed the Tät app, which provides a 3-month treatment program with a focus on PFMT for women with SUI. The app treatment was evaluated in a randomized controlled trial, which demonstrated efficacy for improving incontinence symptoms and quality of life. In this qualitative interview study, we investigated participant experiences of the app-based treatment.

Objective: This study aimed to explore women’s experiences of using an app-based treatment program for SUI.

Methods: This qualitative study is based on telephone interviews with 15 selected women, with a mean age of 47 years, who had used the app in the previous randomized controlled trial. A semistructured interview guide with open-ended questions was used, and the interviews were transcribed verbatim. Data were analyzed according to the grounded theory.

Results: The results were grouped into three categories: “Something new!” “Keeping motivation up!” and “Good enough?” A core category, “Enabling my independence,” was identified. The participants appreciated having a new and modern way to access a treatment program for SUI. The use of new technology seemed to make incontinence treatment feel more prioritized and less embarrassing for the subjects. The closeness to their mobile phone and app features like reminders and visual graphs helped support and motivate the women to carry through the PFMT. The participants felt confident that they could perform the treatment program on their own, even though they expressed some uncertainty about whether they were doing the pelvic floor muscle contractions correctly. They felt that the app-based treatment increased their self-confidence and enabled them to take responsibility for their treatment.

Conclusions: Use of the app-based treatment program for SUI empowered the women in this study and helped them self-manage their incontinence treatment. They appreciated the app as a new tool for supporting their motivation to carry through a slightly challenging PFMT program.

Trial Registration: ClinicalTrials.gov NCT01848938; https://clinicaltrials.gov/ct2/show/NCT01848938 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT01848938)

Keywords
mobile applications, urinary incontinence, stress, pelvic floor muscle training, self-management, qualitative research, grounded theory, women’s health
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-157751 (URN)10.2196/11296 (DOI)000461286800001 ()30869644 (PubMedID)2-s2.0-85062859247 (Scopus ID)
Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2024-01-17Bibliographically approved
Sperens, M., Hamberg, K. & Hariz, G.-M. (2018). Challenges and strategies among women and men with Parkinson's disease: striving toward joie de vivre in daily life. British Journal of Occupational Therapy, 81(12), 700-708
Open this publication in new window or tab >>Challenges and strategies among women and men with Parkinson's disease: striving toward joie de vivre in daily life
2018 (English)In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 81, no 12, p. 700-708Article in journal (Refereed) Published
Abstract [en]

Introduction: To offer people with Parkinson's disease optimal occupational therapy, it is important to have a detailed understanding of how they manage everyday life. The aims of this study were to explore how people with Parkinson's disease manage the effect of the disease on everyday life and to investigate gender similarities and differences concerning this issue.

Method: We interviewed 24 people with Parkinson's disease (14 men), at a mean of 8 years after diagnosis. The interviews were analysed according to Grounded Theory.

Findings: 'Striving to maintain a good everyday life' was established as a core category. To overcome obstacles caused by the disease, the interviewees struggled with perpetual adaptation to the medication regime and ongoing changes in their abilities. To achieve best possible everyday life, it was essential to keep their own spirit up; for example, by prioritising valued occupations. Women and men contributed to all categories and used the same strategies.

Conclusion: Men and women with Parkinson's disease used the same strategies to manage daily life challenges. Our findings support the relevance of disease-specific occupational therapy interventions focusing on the individual fit between person, environment and occupation, and highlight the need for joyful occupations to attain a satisfactory daily life.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Parkinson's disease, occupational therapy, activity of daily living, coping strategies, quality of life, gender
National Category
Occupational Therapy
Research subject
Occupational therapy
Identifiers
urn:nbn:se:umu:diva-154900 (URN)10.1177/0308022618770142 (DOI)000452512500004 ()2-s2.0-85047441648 (Scopus ID)
Funder
Swedish Research Council, 2009-5833Swedish Research Council, 2012-5210
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2023-03-23Bibliographically approved
Kristoffersson, E., Diderichsen, S., Verdonk, P., Lagro-Janssen, T., Hamberg, K. & Andersson, J. (2018). To select or be selected - gendered experiences in clinical training affect medical students' specialty preferences. BMC Medical Education, 18, Article ID 268.
Open this publication in new window or tab >>To select or be selected - gendered experiences in clinical training affect medical students' specialty preferences
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2018 (English)In: BMC Medical Education, E-ISSN 1472-6920, Vol. 18, article id 268Article in journal (Refereed) Published
Abstract [en]

Background: The literature investigating female and male medical students' differing career intentions is extensive. However, medical school experiences and their implications for professional identity formation and specialty choice have attracted less attention. In this study we explore the impact of medical school experiences on students' specialty preferences, investigate gender similarities and differences, and discuss how both might be related to gender segregation in specialty preference.

Methods: In a questionnaire, 250 Swedish final-year medical students described experiences that made them interested and uninterested in a specialty. Utilizing a sequential mixed methods design, their responses were analyzed qualitatively to create categories that were compared quantitatively.

Results: Similar proportions of women and men became interested in a specialty based on its knowledge area, patient characteristics, and potential for work-life balance. These aspects, however, often became secondary to whether they felt included or excluded in clinical settings. More women than men had been deterred by specialties with excluding, hostile, or sexist workplace climates (W = 44%, M = 16%). In contrast, more men had been discouraged by specialties' knowledge areas (W = 27%, M = 47%).

Conclusions: Male and female undergraduates have similar incentives and concerns regarding their career. However, the prevalence of hostility and sexism in the learning environment discourages especially women from some specialties. To reduce gender segregation in specialty choice, energy should be directed towards counteracting hostile workplace climates that explain apparent stereotypical assumptions about career preferences of men and women.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Medical students, Specialty preference, Professional identity formation, Sexism, Mixed methods
National Category
Gender Studies
Identifiers
urn:nbn:se:umu:diva-154055 (URN)10.1186/s12909-018-1361-5 (DOI)000451080300003 ()30453953 (PubMedID)2-s2.0-85056700280 (Scopus ID)
Funder
Swedish Research CouncilVästerbotten County Council
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2023-03-24Bibliographically approved
Sperens, M., Hamberg, K. & Hariz, G.-M. (2017). Are Patients Ready for "EARLYSTIM"?: Attitudes towards Deep Brain Stimulation among Female and Male Patients with Moderately Advanced Parkinson's Disease. Parkinson's Disease, Article ID 1939831.
Open this publication in new window or tab >>Are Patients Ready for "EARLYSTIM"?: Attitudes towards Deep Brain Stimulation among Female and Male Patients with Moderately Advanced Parkinson's Disease
2017 (English)In: Parkinson's Disease, ISSN 2090-8083, E-ISSN 2042-0080, article id 1939831Article in journal (Refereed) Published
Abstract [en]

Objective: To explore, in female and male patients with medically treated, moderately advanced Parkinson's disease (PD), their knowledge and reasoning about Deep Brain Stimulation (DBS).

Methods: 23 patients with PD (10 women), aged 46- 70, were interviewed at a mean of 8 years after diagnosis, with open-ended questions concerning their reflections and considerations about DBS. The interviews were transcribed verbatim and analysed according to the difference and similarity technique in Grounded Theory.

Results: From the patients' narratives, the core category "Processing DBS: balancing symptoms, fears and hopes" was established. The patients were knowledgeable about DBS and expressed cautious and well considered attitudes towards its outcome but did not consider themselves ill enough to undergo DBS. They were aware of its potential side-effects. They considered DBS as the last option when oral medication is no longer sufficient. There was no difference between men and women in their reasoning and attitudes towards DBS.

Conclusion: This study suggests that knowledge about the pros and cons of DBS exists among PD patients and that they have a cautious attitude towards DBS. Our patients did not seem to endorse an earlier implementation of DBS, and they considered that it should be the last resort when really needed.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2017
Keywords
Parkinson's disease, DBS, gender
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-134831 (URN)10.1155/2017/1939831 (DOI)000399239900001 ()2-s2.0-85018652181 (Scopus ID)
Funder
Swedish Research Council, 2009-5833Swedish Research Council, 2012-5210
Available from: 2017-05-24 Created: 2017-05-24 Last updated: 2023-03-24Bibliographically approved
Georgiev, D., Hamberg, K., Hariz, M., Forsgren, L. & Hariz, G.-M. (2017). Gender differences in Parkinson's disease: a clinical perspective. Acta Neurologica Scandinavica, 136(6), 570-584
Open this publication in new window or tab >>Gender differences in Parkinson's disease: a clinical perspective
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2017 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 136, no 6, p. 570-584Article in journal (Refereed) Published
Abstract [en]

Available data indicate that there are gender differences in many features of Parkinson's disease (PD). Precise identification of the gender differences is important to tailor treatment, predict outcomes, and meet other individual and social needs in women and men with PD. The aim of this study was to review the available clinical data on gender differences in PD. Original articles and meta-analyses published between 1990 and 2016 systematically exploring gender differences in PD were reviewed. There is slight male preponderance in incidence and prevalence of PD. PD starts earlier in men. Women tend to be more prone to develop tremor-dominant PD but are less rigid than men. Motor improvement after deep brain stimulation is equal in both sexes, but women tend to show better improvement in activities of daily living. Furthermore, women with PD show better results on tests for general cognitive abilities, outperform men in verbal cognitive tasks, show more pain symptoms, and score higher on depression scales. It seems, however, that the differences in cognition, mood, and pain perception are not disease specific as similar gender differences can be found in healthy subjects and in other neurological conditions. Despite PD being the most frequently studied movement disorder, studies investigating gender differences in PD are still scarce with most of the studies being cross-sectional. Good-quality, prospective, longitudinal studies analyzing gender differences in PD and comparing them to matched healthy controls are needed in order to properly address the issues of gender differences in PD.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
activities of daily living, gender differences, motor symptoms, non-motor symptoms, Parkinson's disease, quality of life
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-140684 (URN)10.1111/ane.12796 (DOI)000414488000002 ()28670681 (PubMedID)2-s2.0-85021805793 (Scopus ID)
Available from: 2017-10-16 Created: 2017-10-16 Last updated: 2023-03-24Bibliographically approved
Malterud, K., Hamberg, K. & Reventlow, S. (2017). Qualitative methods in PhD theses from general practice in Scandinavia. Scandinavian Journal of Primary Health Care, 35(4), 309-312
Open this publication in new window or tab >>Qualitative methods in PhD theses from general practice in Scandinavia
2017 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 4, p. 309-312Article in journal (Refereed) Published
Abstract [en]

Qualitative methodology is gaining increasing attention and esteem in medical research, with general practice research taking a lead. With these methods, human and social interaction and meaning can be explored and shared by systematic interpretation of text from talk, observation or video. Qualitative studies are often included in Ph.D. theses from general practice in Scandinavia. Still, the Ph.D. programs across nations and institutions offer only limited training in qualitative methods. In this opinion article, we draw upon our observations and experiences, unpacking and reflecting upon values and challenges at stake when qualitative studies are included in Ph.D. theses. Hypotheses to explain these observations are presented, followed by suggestions for standards of evaluation and improvement of Ph.D. programs. The authors conclude that multimethod Ph.D. theses should be encouraged in general practice research, in order to offer future researchers an appropriate toolbox.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2017
Keywords
PhD, Qualitative research, Scandinavia, general practice, research training
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-142038 (URN)10.1080/02813432.2017.1397257 (DOI)000416735200002 ()29094644 (PubMedID)2-s2.0-85032818387 (Scopus ID)
Available from: 2017-11-17 Created: 2017-11-17 Last updated: 2023-03-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9271-9260

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