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Christianson, Monica
Publications (10 of 38) Show all publications
Richter Sundberg, L., Gotfredsen, A., Christianson, M., Wiklund, M., Hurtig, A.-K. & Goicolea, I. (2024). Exploring cross-boundary collaborationfor youth mental health in Sweden: a qualitative study using the integrativeframework for collaborative governance. BMC Health Services Research, 24, Article ID 322.
Open this publication in new window or tab >>Exploring cross-boundary collaborationfor youth mental health in Sweden: a qualitative study using the integrativeframework for collaborative governance
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2024 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, article id 322Article in journal (Refereed) Published
Abstract [en]

Background: Youth mental health is a major health concern in almost every country. Mental health accounts for about 13% of the global burden of disease in the 10-to-19-year age group. Still there are significant gaps between the mental health needs of young people and the quality and accessibility of available services. Collaboration between health and social service actors is a recognized way of reducing gaps in quality and access. Yet there is little scientific evidence on how these collaborations are applied, or on the challenges of cross-boundary collaboration in the youth mental health space. This study aims to explore how collaboration is understood and practiced by professionals working in the Swedish youth mental health system.

Methods: We conducted 42 interviews (November 2020 to March 2022) with health and social care professionalsand managers in the youth mental health system in Sweden. Interviews explored participants’ experience andunderstanding of the purpose, realization, and challenges of collaboration. Data were analysed under an emergentstudy design using reflexive thematic analysis.

Results: The analysis produced three themes. The first shows that collaboration is considered as essential andimportant, and that it serves diverse purposes and holds multiple meanings in relation to professionals’ roles andresponsibilities. The second addresses the different layers of collaboration, in relation to activities, relationships, andtarget levels, and the third captures the challenges and criticisms in collaborating across the youth mental healthlandscape, but also in growing possibilities for future development.

Conclusion: We conclude that collaboration serves multiple purposes and takes many shapes in the Swedish youth mental health system. Despite the many challenges, participants saw potential in further building collaboration. Interestingly our participants also raised concerns about too much collaboration. There was scepticism about collaboration directing attention away from young people to the professionals, thereby risking the trust and confidentiality of their young clients. Collaboration is not a panacea and will not compensate for an under-resourced youth mental health system.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Youth mental health, Youth mental health services, Mental health system, Collaboratio, Governance
National Category
Medical and Health Sciences Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Public health; Public health
Identifiers
urn:nbn:se:umu:diva-221945 (URN)10.1186/s12913-024-10757-y (DOI)38468279 (PubMedID)2-s2.0-85187412932 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00364
Available from: 2024-03-11 Created: 2024-03-11 Last updated: 2024-04-22Bibliographically approved
Goicolea, I., Richter Sundberg, L., Wiklund, M., Gotfredsen, A. & Christianson, M. (2024). Widening the scope of mental health with a 'youth centred' approach: a qualitative study involving health care professionals in Sweden’s youth clinics. International Journal of Qualitative Studies on Health and Well-being, 19(1), Article ID 2348879.
Open this publication in new window or tab >>Widening the scope of mental health with a 'youth centred' approach: a qualitative study involving health care professionals in Sweden’s youth clinics
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2024 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 19, no 1, article id 2348879Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to explore how health care providers at youth clinics (YCs) in Sweden engage with, focus on, and navigate across the mental health youth space, while upholding the core bedrock principle of "youth-centeredness".

Methods: Qualitative interviews were conducted with 21 health care professionals working in three YCs located in three different regions of Sweden. Data were analysed using reflexive thematic analysis informed by the work of Braun and Clarke.

Results: The three themes were: 1) "youth mission-at the core of the YCs" work and challenged by a stronger involvement in mental ill health'; 2) "YCs" unique and complementary role in the youth mental health system: a holistic perspective, team work, and a focus on normalization', and 3) "Caught between a rock and a hard place: to treat at a care level that is not optimal for the young users" needs or to refer within an unreliable system'.

Conclusion: This study reflects the individuality and key features of YCs, their widening roles within the mental health sphere, and the challenges faced in maintaining and expanding the characteristic "youth-centred" approach while expanding their work with mental health

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
KEYWORDS Youth mental health, youthcentredness, qualitative, reflexive thematic analysis, interviews, youth clinic
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-223982 (URN)10.1080/17482631.2024.2348879 (DOI)38700475 (PubMedID)2-s2.0-85192036204 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00364Public Health Agency of Sweden
Available from: 2024-05-04 Created: 2024-05-04 Last updated: 2024-05-14Bibliographically approved
Thomson, A., Christensen, E., Wiklund, M. & Christianson, M. (2022). A safe place – adolescents' and young adults' perceptions of youth clinics in northern Sweden. Sexual & Reproductive HealthCare, 33, Article ID 100752.
Open this publication in new window or tab >>A safe place – adolescents' and young adults' perceptions of youth clinics in northern Sweden
2022 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 33, article id 100752Article in journal (Refereed) Published
Abstract [en]

Background/objective: Adolescents and young adults are a diverse group with varied health needs. In Sweden, youth clinics are critical for improving their sexual, reproductive, mental, and general health. The aim of this qualitative study was to gain a deeper understanding of key conditions needed for youth friendliness, and to better understand youth-friendly health services from the perspective of adolescents and young adults in northern Sweden.

Methods: Information was collected through focus group discussions and interviews with 23 adolescents and young adults (aged 16 to 25) at youth clinics in each of the four northernmost regions of Sweden. Interviews were analysed inductively using Braun and Clarke's thematic analysis.

Results: Three themes and six sub-themes emerged. A safe, empowering and holistic space, outlines how youth-friendly physical spaces and staff contributed to a sense of safety in contrast to other healthcare facilities. The theme Youth clinics are accessible – but reaching out is challenging, refers to low thresholds for visiting youth clinics and perceived barriers to access. The third theme “You feel a bit vulnerable” – the importance of privacy, highlights privacy dimensions and young people's vulnerability when their privacy is compromised.

Conclusion: Adolescents and young adults perceived youth clinics as being youth-friendly. Key conditions for youth friendliness were safety, respect, a holistic and empowering approach, accessibility, and privacy. Youth-friendly opening hours and outreach to specifically target groups with access barriers are needed. Young people should be involved in the development of equitable youth-friendly health services.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Adolescent health, Qualitative method, Sexual and reproductive health, Swedish youth clinics, Young people, Youth-friendly health services
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nursing
Identifiers
urn:nbn:se:umu:diva-199265 (URN)10.1016/j.srhc.2022.100752 (DOI)000828119700002 ()35803180 (PubMedID)2-s2.0-85133665697 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0235Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00364
Available from: 2022-09-09 Created: 2022-09-09 Last updated: 2024-08-23Bibliographically approved
Christianson, M., Lehn, S. & Velandia, M. (2022). The advancement of a gender ethics protocol to uncover gender ethical dilemmas in midwifery: a preliminary theory model. Reproductive Health, 19(1), Article ID 211.
Open this publication in new window or tab >>The advancement of a gender ethics protocol to uncover gender ethical dilemmas in midwifery: a preliminary theory model
2022 (English)In: Reproductive Health, E-ISSN 1742-4755, Vol. 19, no 1, article id 211Article in journal (Refereed) Published
Abstract [en]

Objectives: Ethical dilemmas at both the individual and structural level are part of the daily work of midwives and gender inequality and injustice can affect women’s sexual and reproductive health. Mainstream bioethical theory has been criticized for neglecting women’s issues. To ensure women’s experiences are addressed, a gender lens on ethics is crucial.

Aim: This study develops a theory model by exploring ethical dilemmas related to gender in the context of maternity care from the perspective of midwifery science and feminist ethics.

Methods: The research strategy followed a coherent stepwise approach: literature search, thematic analysis, elabora- tion of a gender ethics protocol, and the integration of various components into a preliminary gender ethics model for midwifery.

Findings:  A literature search was performed using Scopus and Web of Science to identify ethical dilemmas in mater- nity care linked to gender and power. The search of articles published between 1996 and 2019 returned 61 abstracts. These abstracts were screened and assigned one of the following themes: The Midwifery Profession, The Rights of the Woman, Fetal Rights Dominate, and Medicalization of Pregnancy and Childbirth. A tentative gender ethics frame was developed and tested on two articles on abortion, one from Denmark and one from Japan. The protocol facilitated the gender analysis of ethical dilemmas related to abortion, which were related to the imbalance of power relations  in health care. In the final step, we synthesized the dimensions of gender and power in a gender ethics model for midwifery.

Discussion: The gender ethics protocol developed revealed gendered dimensions of ethical dilemmas in midwifery. This gender analysis adds to the understanding of the “do no harm” principle by revealing assumptions and stereo- types that promote unequal power relations. The gender ethics model is an innovative approach that envisions and exposes powerimbalance at the micro, meso, and macro levels.

Conclusions: The protocol could improve gender competence among researchers, midwives/professionals, and midwifery students throughout the world.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022
Keywords
Ethics, Femenist approach, Gender, Midwifery, Method develpment, Theory model
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-201134 (URN)10.1186/s12978-022-01515-6 (DOI)000885430500001 ()36403070 (PubMedID)2-s2.0-85142249145 (Scopus ID)
Available from: 2022-11-21 Created: 2022-11-21 Last updated: 2024-07-04Bibliographically approved
Christianson, M., Teiler, Å. & Eriksson, C. (2021). A woman’s honor tumbles down on all of us in the family, but a man’s honor is only his”: young women’s experiences of patriarchal chastity norms. International Journal of Qualitative Studies on Health and Well-being, 16, Article ID 1862480.
Open this publication in new window or tab >>A woman’s honor tumbles down on all of us in the family, but a man’s honor is only his”: young women’s experiences of patriarchal chastity norms
2021 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 16, article id 1862480Article in journal (Refereed) Published
Abstract [en]

Purpose: In this qualitative study we explored how young women living in Sweden with ethnic and cultural roots in the Middle East and East Africa comply with or resist so-called honour norms and how they perceive that these norms affect their living conditions.

Method: In depth interviews were performed with 14 young women. The majority were between 21 and 32 years of age with a mean age of 24. All interviews were transcribed verbatim and a grounded theory approach was used. To reflect the diversity in women’s experiences, the grounded theory approach was conducted from a feminist perspective to transform women’s personal narratives to a larger social context.

Results: We analysed the core category “Honorable women in becoming” as the central emerging phenomenon related to categories about structural and individual control of women, the women’s adjustment and resistance, and the continuum of severe consequences and violence that they experienced in their struggle for autonomy.

Conclusion: Simone de Beauvoir’s feminist theory about women as “the other” was an inspiration and gave us valuable input to highlight women’s experiences and situations from a perspective of gender, power, and oppression.

Place, publisher, year, edition, pages
Taylor & Francis, 2021
Keywords
Gender, grounded their study, honour, womwns health, violence against women
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-178290 (URN)10.1080/17482631.2020.1862480 (DOI)000600438400001 ()2-s2.0-85097937356 (Scopus ID)
Funder
Region Västerbotten
Available from: 2021-01-08 Created: 2021-01-08 Last updated: 2023-03-24Bibliographically approved
Jonsson, F., Christianson, M., Wiklund, M., Hurtig, A.-K. & Goicolea, I. (2021). Collective imaginaries of caring landscapes for rural youth: a concept mapping study in northern Sweden. BMC Public Health, 21, Article ID 2191.
Open this publication in new window or tab >>Collective imaginaries of caring landscapes for rural youth: a concept mapping study in northern Sweden
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2021 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, article id 2191Article in journal (Refereed) Published
Abstract [en]

Background: In the current study, the approach of ‘utopia as method’ was combined with the concept ‘landscapes of care’ to explore collective imaginaries of caring landscapes in relation to young people living in rural northern Sweden, while focusing specifically on what such landscapes should ideally look like, and how various strategies could help to realise the visions.

Methods: The research was conducted using a modified concept mapping methodology comprising three phases of data collection and analysis. This facilitated the integration of tacit knowledge and utopian visions of young people, professionals and policymakers living and working in various parts of northern Sweden.

Results: The results indicated that caring landscapes should: ‘provide services responsive to young people’s wishes and needs’, ‘be organised around values of safety, equity and youth participation’, and ‘rework metro-centredness’ in order to care for, with and about rural youth.

Conclusions: The findings can be viewed as an imaginary reconstitution of communities in rural northern Sweden, but also as hypothetical building blocks to be used for developing caring landscapes and a ‘good countryside’ where young people have the possibility to live a good life in decent health.

Place, publisher, year, edition, pages
BioMed Central, 2021
Keywords
Public Health, Environmental and Occupational Health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-190024 (URN)10.1186/s12889-021-12223-4 (DOI)000723996700001 ()34847916 (PubMedID)2-s2.0-85120562536 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-00434
Available from: 2021-12-01 Created: 2021-12-01 Last updated: 2023-08-28Bibliographically approved
Westergren, A., Edin, K., Lindkvist, M. & Christianson, M. (2021). Exploring the medicalisation of childbirth through women's preferences for and use of pain relief. Women and Birth, e118-e127
Open this publication in new window or tab >>Exploring the medicalisation of childbirth through women's preferences for and use of pain relief
2021 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, p. e118-e127Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Sweden, along with other countries, is facing rising intrapartum intervention rates.

AIM: To explore the medicalisation of childbirth through women's preferences for and use of pain relief, and to investigate whether the presence of a birth plan had any impact on use of pain relief, rate of intervention, and satisfaction with the birth experience.

METHODS: The study was cross-sectional, and included 129 women with birth plans and 110 without, all of whom gave birth in one hospital in Sweden between March and June 2016. Data from birth plans and medical records was analysed through descriptive statistics and logistic regression.

FINDINGS: Parity rather than birth plan was a greater determinant for use of pain relief, frequency of interventions, and level of satisfaction; primiparas used more pain relief, had more interventions, and were less satisfied with their birth experiences than multiparas. Epidural analgesia was associated with a two to threefold increase in interventions, but 79.5% of all women had some form of intervention during birth, regardless of having an epidural or not. Women were generally highly satisfied with their birth experiences, women without epidural analgesia and interventions slightly more so.

CONCLUSION: Contrary to their initial plans, especially primiparas used more pharmacological pain relief than intended, and nearly all (94.6%) had some form of intervention during labour and birth. More interventions were associated with lower levels of satisfaction. The high rate of intervention in a healthy population of birthing women is disquieting and requires further attention.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Birth plans, Cross-Sectional study, Epidural analgesia, Intrapartum interventions, Medicalisation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-169189 (URN)10.1016/j.wombi.2020.02.009 (DOI)000619175200004 ()32094035 (PubMedID)2-s2.0-85079881222 (Scopus ID)
Funder
Region Västerbotten
Available from: 2020-03-25 Created: 2020-03-25 Last updated: 2024-07-23Bibliographically approved
Richter Sundberg, L., Christianson, M., Wiklund, M., Hurtig, A.-K. & Goicolea, I. (2021). How can we strengthen mental health services in Swedish youth clinics? A health policy and systems study protocol. BMJ Open, 11(10), e048922-e048922
Open this publication in new window or tab >>How can we strengthen mental health services in Swedish youth clinics? A health policy and systems study protocol
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2021 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 10, p. e048922-e048922Article in journal (Refereed) Published
Abstract [en]

Introduction: Strengthening first-line mental healthcare services for youth remains a priority for the Swedish government. The government is currently investigating how different sectors involved can be strengthened, butevidence is scarce. Youth clinics play a key role in these discussions, being one of the most trusted services for youth. However, analysis of organisational functions andcoordination with other services is important to strengthen youth clinics’ role in first-line mental healthcare. This study investigates these challenges and aims to analysethe integration of mental healthcare within youth clinics to identify strategies to strengthen first-line mental healthcare for youth in Sweden.

Methods and analysis: This study adopts a health policyand systems approach. In the first phase, a formative realist evaluation is conducted to ascertain what works in terms of integrating mental healthcare services within youth clinics, for what type of youth subpopulations and under what circumstances. National-level stakeholders will be interviewed to elicit the programme theory that explains how the intervention is supposed to work. The programme theory will then be tested in three–five cases. The cases will be comprised of youth clinics and their stakeholders. Quantitative and qualitative information will be gathered,including via visual methodologies and questionnaires. The second phase includes a concept mapping study, engaging stakeholders and young people to build consensuson strategies to strengthen the integration of menta lhealthcare into youth clinics.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2021
Keywords
Public Health, Youth Mental Health
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nursing
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-188842 (URN)10.1136/bmjopen-2021-048922 (DOI)000711080000021 ()34686550 (PubMedID)2-s2.0-85118465320 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00364
Available from: 2021-10-24 Created: 2021-10-24 Last updated: 2023-08-28Bibliographically approved
Westergren, A., Edin, K. & Christianson, M. (2021). Reproducing normative femininity: Women's evaluations of their birth experiences analysed by means of word frequency and thematic analysis. BMC Pregnancy and Childbirth, 21(1), Article ID 300.
Open this publication in new window or tab >>Reproducing normative femininity: Women's evaluations of their birth experiences analysed by means of word frequency and thematic analysis
2021 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 21, no 1, article id 300Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Given the significance of the birth experience on women's and babies' well-being, assessing and understanding maternal satisfaction is important for providing optimal care. While previous research has thoroughly reviewed women's levels of satisfaction with the childbirth experience from a multitude of different angles, there is a dearth of papers that use a gender lens in this area. The aim of this study is to explore through a gender perspective the circumstances attributed to both women's assessment of a positive birth experience and those which contribute to a lack of satisfaction with their birth experience.

METHODS: Through the use of a local birth evaluation form at a Swedish labour ward, 190 women gave written evaluations of their birth experiences. The evaluations were divided into groups of positive, ambiguous, and negative evaluations. By means of a latent and constructionist thematic analysis based on word count, women's evaluations are discussed as reflections of the underlying sociocultural ideas, assumptions, and ideologies that shape women's realities.

RESULTS: Three themes were identified: Grateful women and nurturing midwives doing gender together demonstrates how a gender-normative behaviour may influence a positive birth experience when based on a reciprocal relationship. Managing ambiguous feelings by sympathising with the midwife shows how women's internalised sense of gender can make women belittle their negative experiences and refrain from delivering criticism. The midwifery model of relational care impeded by the labour care organisation describes how the care women receive during labour and birth is regulated by an organisation not always adapted to the benefit of birthing women.

CONCLUSIONS: Most women were very satisfied, predominantly with emotional support they received from the midwives. The latent constructionist thematic analysis also elicited women's mixed feelings towards the birth experience, with the majority of negative experiences directed towards the labour care organisation. Recognising the impact of institutional and medical discourses on childbirth, women's birth evaluations demonstrate the benefits and challenges of gender-normative behaviour, where women's internalised sense of gender was found to affect their experiences. A gender perspective may provide a useful tool in unveiling gender-normative complexities surrounding the childbirth experience.

Place, publisher, year, edition, pages
BioMed Central, 2021
Keywords
Birth experience, Childbirth, Femininity, Gender identity, Midwifery, Parturition, Patient satisfaction, Qualitative data analysis
National Category
Nursing Gynaecology, Obstetrics and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-182328 (URN)10.1186/s12884-021-03758-w (DOI)000640506400001 ()33853542 (PubMedID)2-s2.0-85104424850 (Scopus ID)
Funder
Region Västerbotten
Available from: 2021-04-19 Created: 2021-04-19 Last updated: 2025-02-11Bibliographically approved
Waenerlund, A.-K., San Sebastian, M., Hurtig, A.-K., Wiklund, M., Christianson, M. & Goicolea, I. (2020). Assessing the youth-friendliness of youth clinics in northern Sweden: a survey analyzing the perspective of the youth. BMC Health Services Research, 20(1), Article ID 346.
Open this publication in new window or tab >>Assessing the youth-friendliness of youth clinics in northern Sweden: a survey analyzing the perspective of the youth
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2020 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 20, no 1, article id 346Article in journal (Refereed) Published
Abstract [en]

Background: Sweden has nearly 300 youth clinics that have been offering services since the 1970s. However, no evaluation has been done to assess their youth-friendliness. This study aims to assess: i) to what extent youth clinics are perceived as youth-friendly by the young people using them; and ii) if the level of youth friendliness is equally perceived across different sociodemographic groups of users.

Methods: The four northernmost counties of Sweden were included in the study. Of the total identified 22 youth clinics, 20 participated by giving out questionnaires to the youth after their visits to the respective youth clinics. In total 1110 youth participated in the study and answered questions according to the World Health Organization’s criteria of accessibility, equity, respect, privacy and confidentiality, no judgement, and quality. Means and frequencies were calculated, and t-test and ANOVA were used to compare means by sociodemographic variables.

Results: Participants perceived the youth clinics as very youth friendly across the measured domains, with scores as high as 4.8 and 4.9 (of a maximum of 5). Youth clinics were perceived in a similar way regardless of gender, but other sociodemographic factors influenced some of the domains, especially ethnic background.

Conclusions: The perception of youth friendliness in youth clinics was very high. Nonetheless, younger users; users who did not categorize themselves as either heterosexual, homosexual, or bisexual; users with trans-experiences; and users with non-Swedish backgrounds gave youth clinics lower scores for certain domains.

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Youth clinic, Sweden, Youth friendly, Health services, Health service accessibility, Youth, Questionnaire
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nursing
Identifiers
urn:nbn:se:umu:diva-170792 (URN)10.1186/s12913-020-05188-4 (DOI)000530101600001 ()32326967 (PubMedID)2-s2.0-85084030444 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0235
Available from: 2020-05-27 Created: 2020-05-27 Last updated: 2023-03-23Bibliographically approved
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