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Di Girolamo, C., Nusselder, W. J., Bopp, M., Brønnum-Hansen, H., Costa, G., Kovács, K., . . . Mackenbach, J. P. (2020). Progress in reducing inequalities in cardiovascular disease mortality in Europe. Heart, 106, 40-49
Open this publication in new window or tab >>Progress in reducing inequalities in cardiovascular disease mortality in Europe
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2020 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 106, p. 40-49Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To assess whether recent declines in cardiovascular mortality have benefited all socioeconomic groups equally and whether these declines have narrowed or widened inequalities in cardiovascular mortality in Europe.

METHODS: In this prospective registry-based study, we determined changes in cardiovascular mortality between the 1990s and the early 2010s in 12 European populations by gender, educational level and occupational class. In order to quantify changes in the magnitude of differences in mortality, we calculated both ratio measures of relative inequalities and difference measures of absolute inequalities.

RESULTS: Cardiovascular mortality has declined rapidly among lower and higher socioeconomic groups. Relative declines (%) were faster among higher socioeconomic groups; absolute declines (deaths per 100 000 person-years) were almost uniformly larger among lower socioeconomic groups. Therefore, although relative inequalities increased over time, absolute inequalities often declined substantially on all measures used. Similar trends were seen for ischaemic heart disease and cerebrovascular disease mortality separately. Best performer was England and Wales, which combined large declines in cardiovascular mortality with large reductions in absolute inequalities and stability in relative inequalities in both genders. In the early 2010s, inequalities in cardiovascular mortality were smallest in Southern Europe, of intermediate magnitude in Northern and Western Europe and largest in Central-Eastern European and Baltic countries.

CONCLUSIONS: Lower socioeconomic groups have experienced remarkable declines in cardiovascular mortality rates over the last 25 years, and trends in inequalities can be qualified as favourable overall. Nevertheless, further reducing inequalities remains an important challenge for European health systems and policies.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2020
Keywords
cardiovascular diseases, europe, inequalities, mortality, socioeconomic position
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:sh:diva-38826 (URN)10.1136/heartjnl-2019-315129 (DOI)31439656 (PubMedID)
Available from: 2019-08-30 Created: 2019-08-30 Last updated: 2019-12-17Bibliographically approved
Stickley, A., Leinsalu, M., Ruchkin, V., Oh, H., Narita, Z. & Koyanagi, A. (2019). Attention-deficit/hyperactivity disorder symptoms and perceived mental health discrimination in adults in the general population. European psychiatry, 56, 91-96
Open this publication in new window or tab >>Attention-deficit/hyperactivity disorder symptoms and perceived mental health discrimination in adults in the general population
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2019 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 56, p. 91-96Article in journal (Refereed) Published
Abstract [en]

Background: The experience of discrimination is common in individuals with mental health problems and has been associated with a range of negative outcomes. As yet, however, there has been an absence of research on this phenomenon in adults with attention-deficit/hyperactivity disorder (ADHD). The current study examined the association between ADHD symptoms and mental health discrimination in the general adult population. Methods: The analytic sample comprised 7274 individuals aged 18 and above residing in private households in England that were drawn from the Adult Psychiatric Morbidity Survey, 2007. Information on ADHD was obtained with the Adult ADHD Self-Report Scale (ASRS) Screener. A single-item question was used to assess mental health discrimination experienced in the previous 12 months. Logistic regression analysis was used to examine associations. Results: The prevalence of discrimination increased as ADHD symptoms increased but was especially elevated in those with the most severe ADHD symptoms (ASRS score 18–24). In a multivariable logistic regression analysis that was adjusted for a variety of covariates including common mental disorders, ADHD symptoms (ASRS ≥ 14) were associated with almost 3 times higher odds for experiencing mental health discrimination (odds ratio: 2.81, 95% confidence interval: 1.49–5.31). Conclusion: ADHD symptoms are associated with higher odds for experiencing mental health discrimination and this association is especially elevated in those with the most severe ADHD symptoms. Interventions to inform the general public about ADHD may be important for reducing the stigma and discrimination associated with this disorder in adults. 

Keywords
ADHD, Adult, Discrimination, Epidemiology
National Category
Psychiatry
Identifiers
urn:nbn:se:sh:diva-37426 (URN)10.1016/j.eurpsy.2018.12.004 (DOI)000458502900011 ()30654318 (PubMedID)2-s2.0-85059847384 (Scopus ID)
Available from: 2019-02-08 Created: 2019-02-08 Last updated: 2019-11-06Bibliographically approved
Mackenbach, J. P., Valverde, J. R., Bopp, M., Bronnum-Hansen, H., Deboosere, P., Kalediene, R., . . . Nusselder, W. J. (2019). Determinants of inequalities in life expectancy: an international comparative study of eight risk factors. The Lancet Public Health, 4(10), E529-E537
Open this publication in new window or tab >>Determinants of inequalities in life expectancy: an international comparative study of eight risk factors
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2019 (English)In: The Lancet Public Health, ISSN 2468-2667, Vol. 4, no 10, p. E529-E537Article in journal (Refereed) Published
Abstract [en]

Background Socioeconomic inequalities in longevity have been found in all European countries. We aimed to assess which determinants make the largest contribution to these inequalities. Methods We did an international comparative study of inequalities in risk factors for shorter life expectancy in Europe. We collected register-based mortality data and survey-based risk factor data from 15 European countries. We calculated partial life expectancies between the ages of 35 years and 80 years by education and gender and determined the effect on mortality of changing the prevalence of eight risk factors-father with a manual occupation, low income, few social contacts, smoking, high alcohol consumption, high bodyweight, low physical exercise, and low fruit and vegetable consumption-among people with a low level of education to that among people with a high level of education (upward levelling scenario), using population attributable fractions. Findings In all countries, a substantial gap existed in partial life expectancy between people with low and high levels of education, of 2.3-8.2 years among men and 0.6-4.5 years among women. The risk factors contributing most to the gap in life expectancy were smoking (19.8% among men and 18.9% among women), low income (9.7% and 13.4%), and high bodyweight (7.7% and 11.7%), but large differences existed between countries in the contribution of risk factors. Sensitivity analyses using the prevalence of risk factors in the most favourable country (best practice scenario) showed that the potential for reducing the gap might be considerably smaller. The results were also sensitive to varying assumptions about the mortality risks associated with each risk factor. Interpretation Smoking, low income, and high bodyweight are quantitatively important entry points for policies to reduce educational inequalities in life expectancy in most European countries, but priorities differ between countries. A substantial reduction of inequalities in life expectancy requires policy actions on a broad range of health determinants.

Place, publisher, year, edition, pages
The Lancet Publishing Group, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:sh:diva-39269 (URN)10.1016/S2468-2667(19)30147-1 (DOI)000488875200016 ()31578987 (PubMedID)2-s2.0-85072716131 (Scopus ID)
Available from: 2019-10-31 Created: 2019-10-31 Last updated: 2019-11-06Bibliographically approved
Leinsalu, M., Reile, R. & Stickley, A. (2019). Economic fluctuations and long-term trends in depression: a repeated cross-sectional study in Estonia 2004-2016. Journal of Epidemiology and Community Health, 73(11), 1026-1032
Open this publication in new window or tab >>Economic fluctuations and long-term trends in depression: a repeated cross-sectional study in Estonia 2004-2016
2019 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 11, p. 1026-1032Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In the 2000s, the Baltic countries experienced unprecedented credit-driven economic growth that was followed by a deep recession. This study examined the impact of profound macroeconomic changes on population mental health in Estonia in 2004-2016.

METHODS: Data on 17 794 individuals in the 20-64 age group were obtained from seven nationally representative cross-sectional surveys. The prevalence of past 30-day depression was calculated for men and women further stratified by sociodemographic characteristics. Multivariable regression analysis was used to assess whether these characteristics were associated with the yearly variation in depression.

RESULTS: In 2006, the adjusted prevalence ratio for depression was 0.77 (95% CI 0.64 to 0.93) for men and 0.85 (95% CI 0.74 to 0.97) for women as compared with 2004; in 2010, the prevalence ratio as compared with 2008 for both men and women was 1.22 (95% CIs 1.04 to 1.43 and 1.09 to 1.37, respectively). Among men, the increase in the prevalence of depression in 2008-2010 was statistically significant for 35-64 year olds, ethnic Estonians, those who were married, mid-educated or were employed, whereas among women, a significant increase was observed in 50-64 year olds, Estonians and non-Estonians, those who were not-married, were highly educated or mid-educated, in the mid-income group or were employed.

CONCLUSIONS: Population mental health is responsive to macroeconomic changes. In less wealthy high-income countries, the greater impact of recession on depression among advantaged groups may relate to a higher debt burden coupled with job insecurity.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
depression, economic fluctuations, socioeconomic differences
National Category
Sociology
Identifiers
urn:nbn:se:sh:diva-38732 (URN)10.1136/jech-2018-211939 (DOI)000497280000008 ()31406016 (PubMedID)2-s2.0-85070606279 (Scopus ID)
Funder
Riksbankens Jubileumsfond, P15-0520:1
Available from: 2019-08-15 Created: 2019-08-15 Last updated: 2019-12-09Bibliographically approved
Reile, R. & Leinsalu, M. (2019). Factors associated with improving diet and physical activity among persons with excess body weight. European Journal of Public Health, 29(6), 1166-1171
Open this publication in new window or tab >>Factors associated with improving diet and physical activity among persons with excess body weight
2019 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 6, p. 1166-1171Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: As overweight and obesity are highly prevalent in Eastern Europe, the study examined the trends and factors associated with self-reported weight reducing behaviours among individuals with excess body weight in Estonia.

METHODS: Study used nationally representative cross-sectional data from 2006 to 2016 including 4302 men and 3627 women aged 20-64 years with excess body weight (BMI ≥ 25). Trends in the prevalence of changing eating habits and physical activity and their sociodemographic and health-related correlates were studied using descriptive statistics and multivariable logistic regression.

RESULTS: Among overweight or obese respondents, 41% of men and 48% of women reported improvements in dietary habits and 19% of men and women reported increase in physical activity during the past 12 months in 2016. Positive trend for 2006-2016 regarding both outcomes was observed for men whereas no statistically significant differences were found for women. Women and those with lower than tertiary education had higher odds for reporting change in eating habits whereas older age and smoking or excessive alcohol consumption reduced the odds. Improvement in physical activity was more likely among younger respondents, women, ethnic Estonians and those with tertiary education, whereas poorer health and smoking reduced the odds. Weight-related advice from health professionals or family had strong effect on both outcomes.

CONCLUSION: Socio-demographic and health profiles differentiate the self-reported behavioural change among persons with excess body weight. Advice from either health professionals or family may have a potential to facilitate positive changes in eating habits and physical activity among those individuals.

Place, publisher, year, edition, pages
European Public Health Association, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:sh:diva-39172 (URN)10.1093/eurpub/ckz170 (DOI)31544930 (PubMedID)
Available from: 2019-10-31 Created: 2019-10-31 Last updated: 2019-12-17Bibliographically approved
Baars, A. E., Rubio-Valverde, J. R., Hu, Y., Bopp, M., Brønnum-Hansen, H., Kalediene, R., . . . Nusselder, W. J. (2019). Fruit and vegetable consumption and its contribution to inequalities in life expectancy and disability-free life expectancy in ten European countries. International Journal of Public Health, 64(6), 861-872
Open this publication in new window or tab >>Fruit and vegetable consumption and its contribution to inequalities in life expectancy and disability-free life expectancy in ten European countries
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2019 (English)In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 64, no 6, p. 861-872Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To assess to what extent educational differences in total life expectancy (TLE) and disability-free life expectancy (DFLE) could be reduced by improving fruit and vegetable consumption in ten European countries.

METHODS: Data from national census or registries with mortality follow-up, EU-SILC, and ESS were used in two scenarios to calculate the impact: the upward levelling scenario (exposure in low educated equals exposure in high educated) and the elimination scenario (no exposure in both groups). Results are estimated for men and women between ages 35 and 79 years.

RESULTS: Varying by country, upward levelling reduced inequalities in DFLE by 0.1-1.1 years (1-10%) in males, and by 0.0-1.3 years (0-18%) in females. Eliminating exposure reduced inequalities in DFLE between 0.6 and 1.7 years for males (6-15%), and between 0.1 years and 1.8 years for females (3-20%).

CONCLUSIONS: Upward levelling of fruit and vegetable consumption would have a small, positive effect on both TLE and DFLE, and could potentially reduce inequalities in TLE and DFLE.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Disability-free life expectancy, Fruit and vegetable consumption, Socioeconomic inequalities, Total life expectancy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:sh:diva-38331 (URN)10.1007/s00038-019-01253-w (DOI)000475618000006 ()31183533 (PubMedID)2-s2.0-85067289467 (Scopus ID)
Funder
EU, Horizon 2020, 633666
Available from: 2019-06-13 Created: 2019-06-13 Last updated: 2019-12-11Bibliographically approved
Tanaka, H., Nusselder, W. J., Bopp, M., Brønnum-Hansen, H., Kalediene, R., Lee, J. S., . . . Mackenbach, J. P. (2019). Mortality inequalities by occupational class among men in Japan, South Korea and eight European countries: a national register-based study, 1990–2015. Journal of Epidemiology and Community Health, 73(8), 750-758
Open this publication in new window or tab >>Mortality inequalities by occupational class among men in Japan, South Korea and eight European countries: a national register-based study, 1990–2015
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2019 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 8, p. 750-758Article in journal (Refereed) Published
Abstract [en]

Background: We compared mortality inequalities by occupational class in Japan and South Korea with those in European countries, in order to determine whether patterns are similar.

Methods: National register-based data from Japan, South Korea and eight European countries (Finland, Denmark, England/Wales, France, Switzerland, Italy (Turin), Estonia, Lithuania) covering the period between 1990 and 2015 were collected and harmonised. We calculated age-standardised all-cause and cause-specific mortality among men aged 35–64 by occupational class and measured the magnitude of inequality with rate differences, rate ratios and the average inter-group difference.

Results: Clear gradients in mortality were found in all European countries throughout the study period: manual workers had 1.6–2.5 times higher mortality than upper non-manual workers. However, in the most recent time-period, upper non-manual workers had higher mortality than manual workers in Japan and South Korea. This pattern emerged as a result of a rise in mortality among the upper non-manual group in Japan during the late 1990s, and in South Korea during the late 2000s, due to rising mortality from cancer and external causes (including suicide), in addition to strong mortality declines among lower non-manual and manual workers.

Conclusion: Patterns of mortality by occupational class are remarkably different between European countries and Japan and South Korea. The recently observed patterns in the latter two countries may be related to a larger impact on the higher occupational classes of the economic crisis of the late 1990s and the late 2000s, respectively, and show that a high socioeconomic position does not guarantee better health.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:sh:diva-38341 (URN)10.1136/jech-2018-211715 (DOI)31142611 (PubMedID)
Projects
LIFEPATH project
Funder
EU, Horizon 2020, 633666
Available from: 2019-06-14 Created: 2019-06-14 Last updated: 2019-11-06Bibliographically approved
Stickley, A., Oh, H., Koyanagi, A., Leinsalu, M., Narita, Z., Roberts, B. & McKee, M. (2019). Perceived discrimination and psychological distress in nine countries of the former Soviet Union. International Journal of Social Psychiatry, 55(2), 158-168
Open this publication in new window or tab >>Perceived discrimination and psychological distress in nine countries of the former Soviet Union
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2019 (English)In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 55, no 2, p. 158-168Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:: Perceived discrimination has been linked to worse mental health. However, little is known about this association in the countries of the former Soviet Union (fSU).

AIM:: To address this deficit, this study examined the link between perceived discrimination and psychological distress in nine fSU countries.

METHODS:: Data were analyzed from 18,000 adults aged ⩾18 years obtained during the Health in Times of Transition (HITT) survey undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine in 2010 and 2011. A single-item measure was used to assess discrimination. Psychological distress was measured with a 12-item scale. Logistic regression analysis and meta-analysis were used to examine associations.

RESULTS:: After adjusting for all potential confounders, when using none/little discrimination as the reference category, moderate and strong discrimination were associated with significantly increased odds for psychological distress in the total population and in men and women separately with odds ratios ranging from 1.93 to 2.64. Meta-analysis based on country-wise estimates showed that the level of between-country heterogeneity was negligible.

CONCLUSION:: Perceived discrimination is associated with psychological distress in countries throughout the fSU. Quantitative and qualitative research is now warranted to determine its specific forms and impact on population health in individual fSU countries.

Keywords
Discrimination, Eastern Europe, epidemiology, mental health
National Category
Sociology
Research subject
Baltic and East European studies
Identifiers
urn:nbn:se:sh:diva-37766 (URN)10.1177/0020764019827982 (DOI)000461225700010 ()30755059 (PubMedID)2-s2.0-85061717078 (Scopus ID)
Available from: 2019-02-26 Created: 2019-02-26 Last updated: 2019-11-06Bibliographically approved
Mackenbach, J. P., Rubio Valverde, J., Bopp, M., Brønnum-Hansen, H., Costa, G., Deboosere, P., . . . Nusselder, W. J. (2019). Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015. European Journal of Epidemiology
Open this publication in new window or tab >>Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015
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2019 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284Article in journal (Refereed) Epub ahead of print
Abstract [en]

Socioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e.g., ‘relative’ and ‘absolute’ inequalities, inequalities in ‘attainment’ and ‘shortfall’). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences. © 2019, The Author(s).

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Europe, Mortality, Social inequality, Trends
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:sh:diva-39540 (URN)10.1007/s10654-019-00580-9 (DOI)31729683 (PubMedID)2-s2.0-85075123993 (Scopus ID)
Projects
LIFEPATH project
Funder
EU, Horizon 2020, 633666
Available from: 2019-12-05 Created: 2019-12-05 Last updated: 2019-12-06Bibliographically approved
Stickley, A., Leinsalu, M., DeVylder, J. E., Inoue, Y. & Koyanagi, A. (2019). Sleep problems and depression among 237 023 community-dwelling adults in 46 low- and middle-income countries. Scientific Reports, 9(1), Article ID 12011.
Open this publication in new window or tab >>Sleep problems and depression among 237 023 community-dwelling adults in 46 low- and middle-income countries
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, no 1, article id 12011Article in journal (Refereed) Published
Abstract [en]

Sleep problems are considered a core symptom of depression. However, there is little information about the comorbidity of sleep problems and depression in low- and middle-income countries (LMICs), and whether sleep problems with depression confer additional risk for decrements in health compared to sleep problems alone. This study thus examined the association between sleep problems and depression and whether sleep problems with depression are associated with an increased risk for poorer health in 46 LMICs. Cross-sectional, community-based data from 237 023 adults aged ≥18 years from the World Health Survey (WHS) 2002-2004 were analyzed. Information on sleep problems (severe/extreme) and International Classification of Diseases 10th Revision depression/depression subtypes was collected. Multivariable logistic (binary and multinomial) and linear regression analyses were performed. Sleep problems were associated with subsyndromal depression (odds ratio [OR]: 2.23, 95% confidence interval [CI]: 1.84-2.70), brief depressive episode (OR = 2.48, 95% CI = 2.09-2.95) and depressive episode (OR = 3.61, 95% CI = 3.24-4.03). Sleep problems with depression (vs. sleep problems alone) conferred additional risk for anxiety, perceived stress and decrements in health in the domains of mobility, self-care, pain, cognition, and interpersonal activities. Clinicians should be aware that the co-occurrence of sleep problems and depression is associated with a variety of adverse health outcomes in LMICs. Detecting this co-occurrence may be important for treatment planning.

Place, publisher, year, edition, pages
Springer, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:sh:diva-38779 (URN)10.1038/s41598-019-48334-7 (DOI)000481590200052 ()31427590 (PubMedID)2-s2.0-85071033827 (Scopus ID)
Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-12-27Bibliographically approved
Projects
Health and Population Developments in Eastern Europe in the Conditions of Economic Crisis [A052-2010_OSS]; Södertörn UniversityAdverse childhood experiences, alcohol use in adulthood and mortality: Examining the associations using retrospective survey data and record linkage in Estonia [50/2014_OSS]; Södertörn UniversityLarge-scale macroeconomic changes and their impact on inequalities in mortality: a register-based study of mortality in the countries of the Baltic Sea region 2000-2011. [P15-0520:1_RJ]; Södertörn University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4453-4760

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