Martin Lindström

Lund University, Lund, Skåne, Sweden

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Publications (110)259.38 Total impact

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    ABSTRACT: Studies have suggested poorer health in the homosexual and bisexual groups compared to heterosexuals. Tobacco smoking, which is a health-related behavior associated with psychosocial stress, may be one explanation behind such health differences. Social capital, i.e. the generalized trust in other people and social participation/social networks which decreases the costs of social interaction, has been suggested to affect health through psychosocial pathways and through norms connected with health related behaviours, The aim of this study is to investigate the association between sexual orientation and daily tobacco smoking, taking social capital into account and analyzing the attenuation of the logit after the introduction of social participation, trust and their combination in the models.
    BMC Public Health 06/2014; 14(1):565. · 2.08 Impact Factor
  • Maria Fridh, Martin Lindström, Maria Rosvall
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    ABSTRACT: In Sweden mental ill-health has increased among the young, especially among young women. Our aim was to investigate the association between experience of physical violence during the past year and self rated psychological health among young men and women. The study population consisted of men (n = 2,624) and women (n = 3,569) aged 18-34 years who participated in the 2008 public health survey study in Skane. The survey was a cross-sectional stratified random sample postal questionnaire study with a 54.1% participation rate. Associations were investigated by logistic regression models. The prevalence of poor psychological health was 18.9% among men and 27.7% among women. One in ten men and one in twenty women had experienced physical violence during the past year. Most men were violated in public places, while women were most often violated at home. Women who had experienced violence during the past year showed more than doubled odds of poor psychological health, odds ratio (OR): 2.66 (95% confidence interval (CI): 2.00, 3.53). Such an association could not be seen in men OR: 1.12 (95% CI: 0.85, 1.47). Adjustment for covariates (i.e. age, country of birth, socioeconomic status, economic stress, alcohol risk consumption, emotional support, instrumental support and generalized trust in other people) did not change the association found among women. Violated women, but not men, showed nearly doubled odds of poor psychological health after multiple adjustments. There was also a gender difference regarding location of violence. Awareness of gender differences regarding context and mental impact of violence may assist public health workers in reducing the consequences of violence and to design preventive strategies.
    BMC Public Health 01/2014; 14(1):29. · 2.08 Impact Factor
  • Martin Lindström, Maria Fridh, Maria Rosvall
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    ABSTRACT: Investigations of mental health in a life course perspective are scarce. The aim is to investigate associations between economic stress in childhood and adulthood, and poor psychological health in adulthood with reference to the accumulation, critical period and social mobility hypotheses in life course epidemiology. The 2008 public health survey in Skåne is a cross-sectional postal questionnaire study. A random sample was invited which yielded 28,198 respondents aged 18-80 (55% participation). Psychological health was assessed with the GHQ12 instrument. Logistic regression models were used to investigate the associations adjusting for age, country of birth, socioeconomic status, emotional support, instrumental support and trust, and stratifying by sex. The accumulation hypothesis was confirmed because combined childhood and adulthood exposures to economic stress were associated with poor psychological health in a graded manner. The social mobility hypothesis was also confirmed. The critical period hypothesis was not confirmed because both childhood and adulthood economic stress remained significantly associated with poor psychological health in adulthood. Economic stress in childhood is associated with mental health in adulthood.
    Psychiatry research. 11/2013;
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    Martin Lindström
    Addiction 09/2013; · 4.58 Impact Factor
  • Martin Lindström, Maria Rosvall
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    ABSTRACT: To investigate associations between economic stress in childhood and adulthood, and lack of internal health locus of control (HLC), testing the accumulation and critical period life course hypotheses. Methods: A cross-sectional public health (postal) survey was conducted in Skåne in 2008, based on a random sample with 28,198 participants in the age interval 18-80 years, with 55% participation. Logistic regressions analyzed associations between childhood and current economic stress, and lack of internal HLC. Results: A 33.7% prevalence of men and 31.8% of women lack internal HLC, which was significantly associated with the covariates included. The accumulation hypothesis was partly supported because combined childhood and adulthood economic stress exposures were significantly associated with lack of internal HLC in a graded manner. The critical period hypothesis was not supported since the association between economic stress in childhood and lack of internal HLC was partly significant in the final model, and the association with adult (current) economic stress was also significant. Conclusions: The accumulation hypothesis was partly supported. The critical period hypothesis was not supported since both childhood and current economic stress experience were significantly associated with lack of internal HLC. Economic conditions in childhood as well as adulthood are plausibly of relevance for HLC.
    Scandinavian Journal of Public Health 09/2013; · 1.97 Impact Factor
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    ABSTRACT: The past decade has seen a vast increase in empirical research investigating associations between social capital and health outcomes. Literature reviews reveal 'generalized trust' and 'social participation' to be the most robust of the commonly used social capital proxies, both showing positive association with health outcomes. However, this association could be confounded by unmeasured factors, such as the shared environment. Currently, there is a distinct lack of social capital research that takes into account such residual confounding. Using data from the United Kingdom's British Household Panel Survey (BHPS) (waves thirteen to eighteen, N = 6982), this longitudinal, multilevel study investigates the validity of the association between trust, social participation and self-rated health using a family-based design. As the BHPS samples on entire households, we employed 'mean' and 'difference from the mean' aggregate measures of social capital, the latter of which is considered a social capital measurement that is not biased by the shared environment of the household. We employed Generalized Estimating Equations for all analyses, our two-level model controlling for correlation at the household level. Results show that after adjusting for the shared environment of the household over a six year period, the association between social participation and self-rated health was fully attenuated (OR = 0.97 (95% confidence interval 0.89-1.06)), while the association with trust remained significant (OR = 1.11 (1.02-1.20)). Other health determinants, such as being a smoker, having no formal qualifications and being unemployed maintain their associations with poor self-rated health. The association between social capital (specifically trust and social participation) and self-rated health appear to be confounded by shared environmental factors not previously considered by researchers. However, the association with trust remains, adding to existing empirical evidence that generalised trust may be an independent predictor of health.
    BMC Public Health 07/2013; 13(1):665. · 2.08 Impact Factor
  • Martin Lindström, Birgit Modén, Maria Rosvall
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    ABSTRACT: AIMS: To investigate the associations between economic stress in childhood and adulthood, and tobacco smoking, with reference to the accumulation, critical period and social mobility hypotheses from life-course epidemiology. DESIGN/SETTING/PARTICIPANTS/MEASUREMENTS: The 2008 public health survey in Skåne, Sweden is a cross-sectional postal questionnaire study based on a random sample which yielded 28,198 participants aged 18-80 (55% participation). Logistic regression models were used to investigate associations between economic stress in childhood and adulthood, and tobacco smoking. FINDINGS: A 17.4% prevalence of men and 19.1% of women reported tobacco smoking. Tobacco smoking was more prevalent among middle-aged men and young women, among those born outside Sweden, with low occupational status, low social support, low trust, economic stress in childhood and adulthood. The accumulation hypothesis was confirmed because combined childhood and adulthood exposures to economic stress were associated (p<0.001) with tobacco smoking in a graded manner. The critical period hypothesis was not supported because the associations between economic stress in childhood as well as adulthood, respectively, and tobacco smoking were significant (p=0.004 and p<0.001) throughout the analyses. The social mobility hypothesis was confirmed because upward social mobility was significantly associated (p<0.001) with lower odds of smoking, while downward social mobility was significantly associated (p<0.001) with higher odds of smoking. CONCLUSIONS: Downward social mobility and economic stress in both childhood and adulthood should be considered as risk factors for tobacco smoking over the life course.
    Addiction 02/2013; · 4.58 Impact Factor
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    ABSTRACT: Objective: To study the association between sexual orientation and self-rated health, including trust, offence, threat of violence, and violence. Design/setting/participants/measurement: The 2008 Public Health Survey in Skåne is a cross-sectional postal questionnaire study. A total of 28,198 persons aged 18-80 years responded (55%). Logistic regressions analysed the association between sexual orientation and self-rated health. Results: 27.4% of all men and 30.0% of all women rated their health as poor. Poor self-rated health was significantly more prevalent in higher age, among immigrants, people with lower education, low social support, low trust, experience of being offended, experience of threat of violence and violence, and bisexual and other orientation. Homosexual and bisexual men and women had higher age-adjusted odds ratios of having felt offended compared to heterosexual respondents. The odds ratios of low trust, threat of violence (men), and experience of violence (women) were significant for respondents with bisexual orientation but not for respondents with homosexual orientation. In the age-adjusted model, no significant association was observed between homosexual orientation and poor self-rated health among women. All other associations between sexual orientation and health were significant in the age-adjusted model but non-significant in the multiple models. Conclusions: Associations between sexual orientation and health disappear after multiple adjustments including trust and experience of offence, threat of violence, and violence. The study suggests that the group with bisexual orientation seems to be more exposed to low social capital (trust), threat of violence, and violence than the group with homosexual orientation.
    Scandinavian Journal of Public Health 02/2013; · 1.97 Impact Factor
  • Martin Lindström, Jakob Axelsson, Maria Rosvall
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    ABSTRACT: Objective: The objective was to investigate the association between experience of violation during the past 3 months and self-rated health, taking trust (social capital), economic stress, and country of birth and parents' country of birth into account. Design/setting/participants/measurements: The 2008 public health survey in Skåne is a cross-sectional study with 55% response rate. A random sample was approached using a postal questionnaire, and 28,198 persons aged 18-80 responded. Logistic regression models investigated associations between experience of violation during the past 3 months and self-rated health. Results: A 27.4% proportion of the men and 30.0% of the women reported less than good health. Less than good health was significantly higher in older age groups, among persons born outside Sweden, with low education, economic stress, low trust in other people, and experience of violation during the past 3 months. The group with experience of violation at one occasion during the past 3 months had odds ratio 1.76 (95% CI 1.57-1.97) of less than good health among men and odds ratio 1.78 (95% CI 1.62-1.96) among women, while the group with experience of violation two or more times during the past 3 months had odds ratio 4.28 (95% CI 3.36-5.44) among men and 3.54 (95% CI 2.89-4.35) among women in the final multiple analyses. Conclusions: Experience of violation during the past 3 months is significantly associated with less than good health, which is a finding with important policy implications.
    Scandinavian Journal of Public Health 10/2012; · 1.97 Impact Factor
  • Martin Lindström, Maria Rosvall
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    ABSTRACT: The associations between marital status and poor mental health are investigated, and whether social capital, trust, and economic stress attenuate the associations between marital status and poor mental health. The public health survey in Skåne (southern Sweden) 2008 is a cross-sectional study including 28,198 persons aged 18–80. Logistic regression models investigate associations between marital status and mental health, adjusting for age, country of birth, education, emotional support, instrumental support, trust in others, and economic stress. A 13.8% prevalence of the men and 18.2% of the women had poor mental health. Significantly higher odds ratios of poor mental health for the unmarried, divorced and widows/widowers compared to married/cohabitating remained throughout the analyses. Trust and economic stress only moderately attenuated these associations.
    The Social Science Journal. 09/2012; 49(3):339–342.
  • M Lindström, M Rosvall
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    ABSTRACT: To investigate the association between marital status and lack of internal health locus of control (HLC), taking economic stress and trust into account. Cross-sectional study. The public health survey Skåne 2008 is a postal questionnaire study (55% participation rate). A random sample was invited to participate, and 28,198 individuals aged 18-80 years agreed. Logistic regression models were used to discern associations between marital status and lack of internal HLC. The multiple regression analyses included age, country of birth, education, economic stress and 'horizontal' trust. In total, 33.7% of the men and 31.8% of the women lacked internal HLC. After age-adjustments, the unmarried and divorced men and the widowed women displayed significantly higher odds ratios of lack of internal HLC. The significantly higher odds ratios only remained for unmarried men throughout the multiple analyses. In contrast, divorced women had significantly lower odds ratios of lack of internal HLC than married women after adjustments for economic stress. Health promotion regarding HLC and related behaviours should consider men and women who are not cohabiting. Health promotion should particularly consider unmarried men due to their higher propensity to lack internal HLC. The economic conditions and exposure to economic stress among widowed and divorced women should also be highlighted.
    Public health 08/2012; 126(9):790-5. · 1.26 Impact Factor
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    ABSTRACT: Despite the vast amount of research over the past fifteen years, there is still lively debate surrounding the role of social capital on individual health outcomes. This seems to stem from a lack of consistency regarding the definition, measurement and plausible theories linking this contextual phenomenon to health. We have further identified a knowledge gap within this field - a distinct lack of research investigating temporal relationships between social capital and health outcomes. To remedy this shortfall, we use four waves of the British Household Panel Survey to follow the same individuals (N = 8114) between years 2000 and 2007. We investigate temporal relationships and association between our outcome variable self-rated health (SRH) and time-lagged explanatory variables, including three individual-level social capital proxies and other well-known health determinants. Our results suggest that levels of the social capital proxy 'generalised trust' at time point (t - 1) are positively associated with SRH at subsequent time point (t), even after taking into consideration levels of other well-known health determinants (such as smoking status) at time point (t - 1). That we investigate temporal relationships at four separate occasions over the seven-year period lends considerable weight to our results and the argument that generalised trust is an independent predictor of individual health. However, lack of consensus across a variety of disciplines as to what generalised trust is believed to measure creates ambiguity when attempting to identify possible pathways from higher trust to better health.
    Social Science [?] Medicine 04/2012; 75(2):340-8. · 2.73 Impact Factor
  • Martin Lindström
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    ABSTRACT: The association between marital status and generalized trust in other people was investigated. The public health survey in Skåne 2008 is a cross-sectional study including 28,198 persons (55% participation rate) aged 18–80 in southern Sweden. Logistic regression models investigated associations between marital status and trust, adjusting for age, country of birth, education, emotional support, instrumental support and economic stress. 33.9% of the men and 35.7% of the women had low trust. The significantly higher odds ratios of low trust for unmarried men and women and divorced men remained throughout the analyses, while the significant association disappeared for divorced women in the final model. In contrast, the odds ratios of low trust for widows/widowers remained not significant compared to the married/cohabitating category throughout the analyses.
    Fuel and Energy Abstracts 03/2012;
  • Martin Lindström, Sadiq M Ali, Maria Rosvall
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    ABSTRACT: To investigate the association between socioeconomic status, unemployment and self-rated psychological health, taking economic stress and horizontal trust into account. The 2008 public health survey in Skåne is a cross-sectional postal questionnaire study with a 55% participation rate. A random sample was invited and 28,198 persons aged 18-80 participated. Logistic regression models were used to investigate associations between socioeconomic status by occupation (SES), labour market connection and self-rated psychological health (GHQ12). The multiple regression analyses included age, country of birth, education, economic stress and generalized (horizontal) trust. 13.8% of the men and 18.2% of the women had poor psychological health. Poor psychological health was more common among the young, among those born abroad, among those with lower education, with economic stress, and low horizontal trust. There were no significant differences between the employed and self-employed groups. However, the people who had retired early, the unemployed and those on long-term sick leave had significantly higher odds ratios of poor psychological health than higher non-manual employees throughout the analyses. There were no differences in psychological health between non-manual employees in higher positions and other employed and self-employed SES groups among men or women. In contrast, the early retired, the unemployed and the category on long-term sick leave had significantly higher odds ratios of poor psychological health among both men and women throughout the multiple analyses. Both economic stress and trust affected this association (i.e., lowered the odds ratios of poor psychological health), but affected by economic stress to a somewhat higher extent.
    Scandinavian Journal of Public Health 02/2012; 40(1):51-60. · 1.97 Impact Factor
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    ABSTRACT: The social environment in which children grow up is closely associated with their health. The aim of this study was to investigate the relationship between maternal educational level, parental preventive behavior, parental risk behavior, social support, and use of medical care in small children in Malmö, Sweden. We also wanted to investigate whether potential differences in child medical care consumption could be explained by differences in parental behavior and social support. This study was population-based and cross-sectional. The study population was 8 month-old children in Malmö, visiting the Child Health Care centers during 2003-2007 for their 8-months check-up, and whose parents answered a self-administered questionnaire (n = 9,289 children). Exclusive breast feeding ≥4 months was more common among mothers with higher educational level. Smoking during pregnancy was five times more common among less-educated mothers. Presence of secondhand tobacco smoke during the first four weeks of life was also much more common among children with less-educated mothers. Less-educated mothers more often experienced low emotional support and low practical support than mothers with higher levels of education (>12 years of education). Increased exposure to unfavorable parental behavioral factors (maternal smoking during pregnancy, secondhand tobacco smoke and exclusive breastfeeding <4 months) was associated with increased odds of in-hospital care and having sought care from a doctor during the last 8 months. The odds were doubled when exposed to all three risk factors. Furthermore, children of less-educated mothers had increased odds of in-hospital care (OR = 1.34 (95% CI: 1.08, 1.66)) and having sought care from a doctor during the last 8 months (OR = 1.28 (95% CI: 1.09, 1.50)), which were reduced and turned statistically non-significant after adjustment for unfavorable parental behavioral factors. Children of less-educated mothers were exposed to more health risks, fewer health-promoting factors, worse social support, and had higher medical care consumption than children with higher educated mothers. After adjustment for parental behavioral factors the excess odds of doctor's visits and in-hospital care among children with less-educated mothers were reduced. Improving children's health calls for policies targeting parents' health-related behaviors and social support.
    BMC Public Health 11/2011; 11:891. · 2.08 Impact Factor
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    ABSTRACT: Debate still surrounds which level of analysis (individual vs. contextual) is most appropriate to investigate the effects of social capital on health. Applying multilevel ecometric analyses to British Household Panel Survey data, we estimated fixed and random effects between five individual-, household- and small area-level social capital indicators and general health. We further compared the variance in health attributable to each level using intraclass correlations. Our results demonstrate that association between social capital and health depends on indicator type and level investigated, with one quarter of total individual-level health variance found at the household level. However, individual-level social capital variables and other health determinants appear to influence contextual-level variance the most.
    Health & Place 07/2011; 17(4):946-53. · 2.42 Impact Factor
  • M Lindström
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    ABSTRACT: To investigate the associations between social capital (trust) and leisure-time physical activity. The 2004 Public Health Survey in Skåne is a cross-sectional study. In total, 27,757 individuals aged 18-80 years answered a postal questionnaire (59% participation). Logistic regression models were used to investigate the associations between trust, desire to increase physical activity and leisure-time physical activity. The prevalence of low leisure-time physical activity was 15.3% among men and 13.2% among women. Middle-aged men and older women, respondents born abroad, those with medium/low education, those with the desire to increase physical activity but needing support, and those reporting low trust had significantly higher odds ratios of low leisure-time physical activity than their respective reference groups. The associations between low trust and desire to increase physical activity and between low trust and low leisure-time physical activity remained in the multiple models. The positive association between low trust and low leisure-time physical activity remained after multiple adjustments. There is a concentration of men and women with low leisure-time physical activity who report the desire to increase their physical activity but think that they need support to do so. This group also has a significantly higher prevalence of low trust.
    Public health 07/2011; 125(7):442-7. · 1.26 Impact Factor
  • Giuseppe N Giordano, Martin Lindström
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    ABSTRACT: Smoking prevalence across high-income countries such as the United Kingdom has significantly decreased over the past few decades; this decrease, however, has not occurred uniformly across social strata. The highest concentrations of smokers are currently found in lower-income groups. Lack of access to material resources and differing social norms have been cited as possible causes of this imbalance in smoking behaviour. Social capital, measured by trust and levels of community participation, has also been postulated to influence health behaviour. Data from the British Household Panel Survey were used to identify smoking and non-smoking cohorts at baseline (N = 10,512); from these, individuals whose smoking behaviour had changed (the dependent variable) were identified. Measures of social capital, income, employment and marital status, and considered confounders were tested for associations with changes in smoking behaviour over a 2-year period. Both bivariate and multivariate models were utilized to elicit associations. Only marital and employment status, along with social capital measures, remained significantly associated with changes in smoking behaviour. Individual/household income, baseline social class and general/psychological health failed to demonstrate any significant association with changes in smoking status. Support mechanisms (via marriage and employment) and elements social capital (measured by 'trust' and 'social participation') are independently and positively associated with smoking cessation; continual lack of active social participation and remaining single are associated with smoking initiation. Smoking interventions should consider increased participation as an intrinsic part of their design.
    The European Journal of Public Health 06/2011; 21(3):347-54. · 2.52 Impact Factor
  • Giuseppe Nicola Giordano, Martin Lindström
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    ABSTRACT: The positive association between social capital and general health outcomes has been extensively researched over the past decade; however, studies investigating social capital and psychological health show less consistent results. Despite this, policy-makers worldwide still employ elements of social capital to promote and improve psychological health. This United Kingdom study investigates the association between changes in psychological health over time and three different individual-level proxies of social capital, measures of socio-economic status, social support and the confounders age and gender. All data are derived from the British Household Panel Survey data, with the same individuals (N = 7994) providing responses from 2000-2007. The data were split according to baseline psychological health status ('Good' or 'Poor' psychological health - the dependent variable). Using Generalised Estimating Equations, two separate models were built to investigate the association between changes from baseline psychological health over time and considered variables. An autoregressive working correlation structure was employed to derive the true influence of explanatory variables on psychological health outcomes over time. We found that generalised trust was the only social capital variable to maintain a positive and highly significant association with psychological health in multivariable models. All measures of socioeconomic status and social support were rendered insignificant, bar one. We therefore argue that the breakdown of the traditional family unit (and subsequent reduction in family capital investment), along with psychosocial pathways, demonstrate plausible mechanisms by which a decrease in generalised trust could lead to an increasing trend of worse psychological health in youth over successive birth cohorts. Policy makers, while providing welfare solutions in response to breakdown in traditional family structure, must also consider perverse incentives they provide. If perceived as a viable lifestyle choice, welfare provision could inadvertently promote further decline of trust, at even greater cost to society.
    Social Science [?] Medicine 03/2011; 72(8):1219-27. · 2.73 Impact Factor
  • Martin Lindström
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    ABSTRACT: To investigate the association between political trust in the Riksdag and lack of belief in the possibility to influence one's own health (external locus of control), taking horizontal trust into account. The 2008 public health survey in Skåne is a cross-sectional postal questionnaire study with a 55% participation rate. A random sample of 28,198 persons aged 18-80 years participated. Logistic regression models were used to investigate the associations between political trust in the Riksdag (an aspect of vertical trust) and lack of belief in the possibility to influence one's own health (external locus of control). The multiple regression analyses included age, country of birth, education, and horizontal trust in other people. A 33.7% of all men and 31.8% of all women lack internal locus of control. Low (external) health locus of control is more common in higher age groups, among people born outside Sweden, with lower education, low horizontal trust, low political trust, and no opinion concerning political trust. Respondents with not particularly strong political trust, no political trust at all and no opinion have significantly higher odds ratios of external locus of control throughout the multiple regression analyses. Low political trust in the Riksdag seems to be independently associated with external health locus of control.
    Scandinavian Journal of Public Health 02/2011; 39(1):3-9. · 1.97 Impact Factor

Publication Stats

2k Citations
259.38 Total Impact Points

Institutions

  • 1996–2013
    • Lund University
      • • Department of Clinical Sciences
      • • Department of Health Sciences
      • • Department of Community Health Sciences
      Lund, Skåne, Sweden
  • 2002–2012
    • Malmö University
      • Faculty of Health and Society (HS)
      Malmö, Skåne, Sweden
    • Umeå University
      • Department of Statistics
      Umeå, Vaesterbotten, Sweden
  • 2006–2010
    • Karolinska Institutet
      • • Institutionen för folkhälsovetenskap
      • • Allmänmedicin - CeFAM
      Solna, Stockholm, Sweden
    • Akademiska Sjukhuset
      Uppsala, Uppsala, Sweden