Profiles

Mats Thorslund

Professor med inriktn mot äldre människor

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Works at Department of Social Work
Email mats.thorslund@ki.se
Visiting address Sveavägen 160, Sveaplan
Postal address Institutionen för socialt arbete 106 91 Stockholm

Publications

A selection from Stockholm University publication database
  • Pär Schön, Marti G. Parker, Mats Thorslund.

    Objectives. To analyze gender differences in care utilization and correlates to utilization among very old people for visits to physicians and dentists.

    Methods. Based on non-institutionalized respondents in SWEOLD, a nationally represen­tative interview survey of persons aged 77+ (n=529).

    Results: There were no gender differences in physician visits but men were more likely to have visited the dentist than women. Marriage was positively associated with visits to the physician and the dentist for men. Higher education was positively associated with physician visits for men and with dentist visits for women. Men with impaired mobility were less likely to report physician visits than men without mobility problems.

    Discussion: Unmarried men may be at a disadvantage for both dental and physician care. Given women’s poorer physical and dental health status, they may be disadvantaged both regarding visits to physician and dentist.

  • Pär Schön (et al.).

    Background. Life expectancy (LE) has increased. Health expectancy studies divide LE into life spent in different health conditions.

    Objective. To describe the number of years spent with musculoskeletal pain in relation to total LE at age 65 in 1991/1992 and 2000/2002 and to examine the change in the proportion of LE spent free from musculoskeletal pain (pain-free life expectancy, PFLE) among men and women. Do the years added to life consist of years with or without musculoskeletal pain?

    Methods. PFLE was calculated using Sullivan’s method by combining prevalence rates of musculoskeletal pain from two nationally representative population-based studies in Sweden (LNU and SWEOLD) from 1991/1992 and 2000/2002 and life tables from Statistics Sweden.

    Results. In 1991/1992, both men and women aged 65 could expect to live 12 years free from musculoskeletal pain. However, the proportion of PFLE among men (75%) and women (60%) differed significantly (p = 0.000). Ten years later, both men and women could expect significantly more years with pain. PFLE among women had decreased to 51% (p = 0.059; 10.6 pain-free years, 10.0 years with pain); among men it had decreased to 68% (p = 0.152; 11.7 pain-free years, 5.5 years with pain). 

    Conclusions. The estimated proportion of pain-free LE at age 65 decreased between 1991/1992 and 2000/2002. For men, the number of pain-free years remained unchanged, but years with pain increased. For women, there was both a decrease in pain-free years and an increase in years with pain.  Results suggest an expansion of morbidity in the older population.

  • 2015. Stefan Fors, Mats Thorslund. International Journal of Public Health 60 (1), 91-98

    OBJECTIVES: Although the past two decades have involved changes in the living conditions of the oldest old in Sweden, little is known about how health inequalities have developed in this group during the period. This study explores the educational disparities in a wide range of health outcomes among the oldest old in Sweden between 1992 and 2011.

    METHODS: The study uses the repeated cross-sectional design of the SWEOLD survey, a nationally representative survey of the oldest old in Sweden with comparable data from 1992, 2002, and 2011. The development of educational disparities in health was tracked across the three waves.

    RESULTS: The results show that although the prevalence of most health problems increased during the period, the prevalence of disability in activities of daily living decreased. Despite these changes, educational disparities in health remained largely unaffected.

    CONCLUSIONS: The results of the study suggest that the association between education and health is remarkably robust. It prevailed into the oldest age groups, was consistently found for a wide range of health problems, and tended to be stable over extended periods of time.

  • 2014. Kristina Larsson, Ingemar Kåreholt, Mats Thorslund. European Journal of Ageing 11 (4), 349-359

    The effects of gender and marital status on care utilisation in the last years of life are highly correlated. This study analysed whether gender differences in use of eldercare (home help services or institutional care) or hospital care in the last 5 years of life, and the place of death, could be attributed to differences in marital status and thereby to potential access to informal care. A longitudinal Swedish study provided register data on 567 participants (aged 83 +) who died between 1995 and 2004. A higher proportion of unmarried than married people used home help services; this was true of both men and women. The likelihood of receiving home help was lower for those living with their spouse (OR = 0.38) and for those with children (OR = 0.60). In the 2 years preceding death, the proportion receiving home help services decreased and the proportion in institutional care increased. Women were significantly more likely to die in institutional care (OR = 1.88) than men. Although men were less likely to live in institutional care than women and more likely to be inpatients in the 3 months preceding death, after controlling for residence in institutional care, neither gender nor marital status was statistically significant when included in the same model. In summary, the determining factor for home help utilisation seemed to be access to informal care, whereas gender differences in health status could explain women’s higher probability of dying in institutional care.

  • 2013. Josephine Heap, Carin Lennartsson, Mats Thorslund. International Journal of Social Welfare 22 (2), 130-140

    Heap J, Lennartsson C, Thorslund M. Coexisting disadvantages across the adult age span: a comparison of older and younger age groups in the Swedish welfare state To experience coexisting disadvantages the simultaneous lack of several different welfare resources implies a hampered ability to manage one's living conditions. Here, we study coexisting disadvantages in the oldest population compared with younger age groups in Sweden, by drawing on two linked, nationally representative surveys (n = 5,392). The measurement of coexisting disadvantages included physical health, psychological health, frequency of social contact, cash margin and political resources. The highest odds of coexisting disadvantages were found after age 75 age groups that are frequently excluded from studies of coexisting disadvantages. This pattern persisted when controlling for socio-demographic and socio-economic characteristics. The age pattern was partly driven by the high prevalence of physical health problems in the older population. However, even when excluding physical health problems, the odds of coexisting disadvantages were highest among people older than 85 the fastest-growing segment of the population in many Western countries.

  • 2013. Stefan Fors (et al.). Läkartidningen 110, CA33
  • 2013. Susanne Kelfve, Mats Thorslund, Carin Lennartsson. European Journal of Ageing 10 (3), 237-245

    Surveys of the oldest old population are associated with several design issues. Place of residence and possible physical or cognitive impairments make it difficult to maintain a representative study population. Based on a Swedish nationally representative survey among individuals 77+, the present study analyze the potential bias of not using proxy interviews and excluding the institutionalized part of the population in surveys of the oldest old. The results show that compared to directly interviewed people living at home, institutionalized and proxy interviewed individuals were older, less educated and more likely to be female. They had more problems with health, mobility and ADL, and a significantly increased mortality risk. If the study had excluded the institutionalized part of the population and/or failed to use proxy interviews, the result would have been severely biased and resulted in underestimated prevalence rates for ADL, physical mobility and psychologic problems. This could not be compensated for weighting the data by age and sex. The results from this study imply that accurate population estimates require a representative study population, in which all individuals are included regardless of their living conditions, health status, and cognitive ability.

  • 2013. Mats Thorslund (et al.). European Journal of Ageing 10 (4), 271-277

    The female advantage in life expectancy (LE) is found worldwide, despite differences in living conditions, the status of women and other factors. However, this advantage has decreased in recent years in low-mortality countries. Few researchers have looked at the gender gap in LE in old age (age 65) in a longer historical perspective. Have women always had an advantage in LE at old age and do different countries share the same trends? Life expectancy data for 17 countries were assessed from Human Mortality Database from 1751 to 2007. Since most of the changes in LE taking place today are driven by reductions of old age mortality the gender difference in LE was calculated at age 65. Most low-mortality countries show the same historical trend, a rise and fall of women's advantage in LE at age 65. Three phases that all but two countries passed through were discerned. After a long phase with a female advantage in LE at 65 of <1 year, the gender gap increased significantly during the twentieth century. The increase occurred in all countries but at different time points. Some countries such as England and France had an early rise in female advantage (1900-1919), while it occurred 50 years later in Sweden, Norway and in the Netherlands. The rise was followed by a more simultaneous fall in female advantage in the studied countries towards the end of the century, with exceptions of Japan and Spain. The different timing regarding the increase of women's advantage indicates that country-specific factors may have driven the rise in female advantage, while factors shared by all countries may underlie the simultaneous fall. More comprehensive, multi-disciplinary study of the evolution of the gender gap in old age could provide new hypotheses concerning the determinants of gendered differences in mortality.

  • 2012. Mats Thorslund. Jämlik ålderdom?, 137-163
  • 2011. Pär Schön (et al.). Aging Clinical and Experimental Research 23 (2), 91-98

    Background and aims: Research has shown increased prevalence rates over time in several health indicators in the older population. These increases have not been accompanied by corresponding increases in ADL and IADL disability. Given that disability and other health indicators follow different trends, the associations between them may change. Since both health and disability appear to follow different trends for men and women, we can also expect gender differences in the associations. We examined gender differences in how objective tests of function as well as self-reported health and function indicators were associated with ADL/IADL in 1992 and 2002.

    Methods: Data were from the Swedish Panel Study of Living Conditions among the Oldest Old (SWEOLD), a nationally representative interview survey of persons aged 77+.

    Results: Compared to men, women had significantly higher prevalence rates for most health indicators both survey years, but there were no significant gender differences in ADL/IADL limitations. Prevalence rates increased significantly between 1992 and 2002 for all health indicators, but not for ADL/IADL. Most of the associations between ADL/IADL and other health indicators were stronger for men than for women. The overall pattern was that associations have become weaker for women over time; for men, the picture was mixed.

    Conclusions: The changing associations between ADL/IADL and other health indicators may reflect a complex interplay between changes in a range of social and environmental factors, some of which may be modifiable. ADL/IADL appear to reflect different dimensions of health and different kinds of needs for men and women.

  • 2011. S Kelfve, Mats Thorslund, C Lennartsson. 2011 GSA Annual Scientific Meeting Abstracts
  • 2009. Mats Thorslund, M Silverstein. Handbook of Theories of Aging, 629-639
  • 2009. Pär Schön (et al.). The Gerontologist (2009) 49(suppl 2): 442, 442-442
  • 2009. Mats Thorslund. Äldreomsorg (1)
  • 2009. Ilija Batljan, M Lagergren, Mats Thorslund. EUROPEAN JOURNAL OF AGEING 6 (3), 201-211

    We investigate how expected changes in the educational level composition of the older population may affect future prevalence of severe ill-health among older people in Sweden. Previous research has indicated that the number of older people, given educational differentials in mortality and expected changes in educational composition during the next decades, may increase more than expected following official population projections in Sweden. Eight alternative scenario projections for the possible development in the number of people with severe ill-health in Sweden between 2000 and 2035 are presented. Scenario projections, where both morbidity and mortality inequalities by educational level are taken into account, are compared with scenarios in which only age and gender are modelled. The projections are made with both constant and decreasing mortality. The calculations show that the expected increases in severe ill-health as a result from the ageing of the population in the period 2000-2035 might, to a large extent, be counteracted by the increase in the educational level of the Swedish population. We recommend therefore that in projections of the prevalence of ill-health, in addition to the ageing of the population, also changes in educational level should be taken into account.

  • 2009. Ilija Batljan, Mats Thorslund. EUROPEAN JOURNAL OF AGEING 6 (3), 191-200

    Official Swedish demographic projections have systematically underestimated the number of older people. One explanation behind the underestimation may be found in the fact that the demographic projections are not taking into account socio-economic mortality differentials. We performed alternative demographic scenarios based on assumptions of unchanged and continuing declining mortality, with and without taking into account socio-economic gradients in mortality. According to a scenario based on assumption on declining mortality rates per age group, sex and educational level, the number of older persons (65+) in Sweden will increase by 62% during the period 2000-2035. This can be compared to an increase by 54% in a scenario that does not take into account future structural differences in educational levels and the latest trends in socio-economic inequality in life expectancy (the method used by statistical offices). The socio-economic structure of the older population is significantly changing over the years. We project that by year 2035, only 20% of women 80 years and older will have a low educational level, compared to about 75-80% today. The change in socio-economic structure is similar for the older men. Standard demographic projections that do not take into account socio-economic mortality differentials, risk underestimating the number of older people and hiding dramatic changes in population composition. Taking into account socio-economic mortality differentials results in alternative projections giving us new information regarding the future size and socio-economic composition of the older population. We recommend use of this information in health care and long-term care human resources planning or when assessing financial sustainability of health care, long-term care and pension systems in the future.

  • 2009. S I Haider (et al.). Journal of The American Geriatrics Society 57 (1), 62-69

    To investigate whether low educational attainment is associated with polypharmacy and potential inappropriate drug use (IDU) in older people. Cross-sectional register-based study. Sweden.

    Older people aged 75 to 89 who, filled at least one drug prescription between August and October 2005 and, consequently, were listed in the Swedish Prescribed Drug Register (SPDR) (N=626,258). Data were obtained from the SPDR, the inpatient register, and the education register.

    The main outcome measures were polypharmacy (concurrent use of >= 5 drugs), excessive polypharmacy (concurrent use of >= 10 drugs), and potential IDU. Four quality indicators developed by the Swedish National Board of Health and Welfare were used for the assessment of potential IDU: concurrent use of three or more psychotropic drugs, prescription of long-acting benzodiazepines, prescription of anticholinergics, and at least one clinically relevant potential drug-drug interaction (DDI). Comorbidity was measured using the Charlson Comorbidity Index.

    Subjects with low education had a higher probability of polypharmacy (odds ratio (OR)=1.11, 95% confidence interval (CI)=1.10-1.12), excessive polypharmacy (OR=1.15, 95% CI=1.13-1.17), and potential IDU (OR=1.09, 95% CI=1.07-1.17), after adjustment for age, sex, comorbidity, and type of residential area (urban or rural). Decreasing educational attainment was associated with a higher probability of using three or more psychotropic drugs and potential DDIs, whereas the opposite association was observed for anticholinergic drugs. Long-acting benzodiazepines showed no association. Elderly women with low education were slightly more likely to have polypharmacy, excessive polypharmacy, and potential IDU than men with low education. Overall, the ORs were modest and statistically significant because of the large sample size.

    Low educational attainment was associated with a greater likelihood of poypharmacy, excessive polypharmacy, and potential IDU in elderly Swedish persons, even after controlling for age, sex, place of residence, and comorbidity. Women with low education had slightly higher likelihood of receiving polypharmacy and potential IDU than men with low education. The recently established SPDR may be useful for continuous monitoring and for designing interventions to improve drug quality in low-educated elderly people.

  • 2009. Mats Thorslund. Etik och socialtjänst, 81-98
  • 2008. S.I Haider, K Johnell, Mats Thorslund. Clinical Therapeutics 30 (2), 419-427
  • 2008. Kozma Ahacic, Mats Thorslund. Community Dentistry and Oral Epidemiology 36 (2), 118-127
  • 2008. Mats Thorslund, S.E Wånell.
  • 2008. Syed Imran Haider (et al.). European Journal of Clinical Pharmacology 64 (12), 1215-1222

    Objective To examine the association between educational level and the use of newly marketed drugs (NMD) among elderly persons. Methods We conducted a register-based, retrospective, cross-sectional study of 626,258 people aged 75-89 years who filled at least one drug prescription from August to October 2005 and who, consequently, were registered in the Swedish Prescribed Drug Register (SPDR). Data from the SPDR were record-linked to the Swedish National Inpatient Register and the Education Register. Newly marketed drugs were defined as new chemical entities that had been approved in Sweden between 2000 and 2004. Results Overall, NMD were prescribed to 7.3% of the study population. The use of NMD increased with increasing educational level (6.9% for the lowest educated elderly and 8.1% for the highest educated elderly), and education was associated with NMD [odds ratio (OR) 0.82; 95% confidence interval (CI)] 0.80-0.88 for <9 compared with >= 13 years of education) after adjustment for age, sex, type of residential area and number of dispensed drugs. Decreasing educational level was associated with a lower probability of using most of the NMD, especially oseltamivir (adjusted OR 0.16; 95% CI 0.12-0.22 for <9 years of education compared with >= 13 years of education) and ezetimibe. Conclusions This study suggests that education-related inequalities in NMD use may exist even in a healthcare system that claims to ensure a high degree of equity. Future research is required to explain why educational level influences the selection of new drugs and whether it has any impact on health outcomes.

  • 2008. Kozma Ahacic, Robert Kennison, Mats Thorslund. Preventive Medicine 46 (6), 558-564

    Objective. Smoking is related to many later life health outcomes. We examined age, period, and cohort patterns in smoking between 1968 and 2002. Methods. A nationally representative panel study allowed repeated cross-sectional comparisons of ages 18-75 (5 waves n approximate to 5000), and ages 77+ at later waves (2 waves n approximate to 500). Cross-sectional 10-year age group differences in 5 waves, time-lag differences between waves for age groups, and within-cohort differences between waves for 10-year birth cohorts were evaluated using graphs and ordered logistic regressions. Results. Age-period-cohort models suggested that period and age effects dominated smoking patterns, showing decreases over time and age. The 1935-44 and 1945-54 cohorts, however, showed lesser period decline. Moreover, men showed a period reduction of smoking rates but no age related decrease, while women showed an age related decrease but no period effect. The genders' cohort patterns were similar, with higher smoking rates in the last waves for some cohorts, for men the 1945-54 cohort and women the 1935-44 cohort. Conclusions. Cross-sectional studies of cohorts must be aware of age effects. Due to the coming of age of the 1940s' cohorts smoking may increase among women in the oldest age groups.

  • 2007. Kozma Hacic, Marti G. Parker, Mats Thorslund. European journal of ageing 4 (2), 83-91

    By corroborating cross-sectional with longitudinal analyses, this study illustrates how cohort effects can confound trends over age and time. Mobility (walking difficulties) and edentulousness (toothlessness) were studied from 1968 to 2002 in a nationally representative panel aged 18-75 (5 waves, n approximate to 5,000) and ages 77+ at later waves (2 waves, n approximate to 500). Three analyses were done: cross-sectional 10-year age group differences in 5 waves, time-lag differences between waves (shifts across time) for age groups, and within-cohort differences between waves for 10-year birth cohorts followed over time. Complementary age-period-cohort models using logistic regression analysis evaluated differences. Both mobility and edentulousness have earlier been shown to be strongly related to age cross-sectionally. For mobility, cross-sectional and longitudinal analyses showed large changes, whereas time-lag analysis indicated no or marginal changes. Both cross-sectional and longitudinal results showed an exponential curvilinear age dependency for mobility limitations, with limitations becoming more usual in older ages. In contrast, cross-sectional and time-lag analyses of edentulousness showed large differences, whereas longitudinal analysis indicated no or marginal changes. Rates of edentulousness became increasingly lower for successively later cohorts in a curvilinear fashion. These patterns demonstrate that age effects dominated mobility, whereas cohort effects dominated edentulousness. Age-period-cohort models confirmed these findings. The cohort effect of edentulousness implies that the cohorts' movement through time gives a false impression of age and period effects in cross-sectional data.

  • 2007. R Andel (et al.). Journal of Aging & Health 19, 397-415
  • 2007. Mats Thorslund. Vem styr vården?
  • 2007. Lena Måvall, Mats Thorslund. Archives of gerontology and geriatric 45, 137-150
  • 2007. M.G. Parker, Mats Thorslund. The Gerontologist 47, 150-158
  • 2007. K Ahacic (et al.). Aging 19, 187-193
  • 2007. S. I. Haider (et al.). International journal of clinical pharmacology and therapeutics 45 (12), 643-653

    Objective: This study investigates the changes in drug use, polypharmacy and potential drug-drug interactions (DDIs) between educational groups of Swedish elderly over a 10-year period from 1992 - 2002. Methods: We used data from SWEOLD I (n= 512) from 1992 and SWEOLD II from 2002 (n = 561), which are nationally representative surveys of the elderly population in Sweden aged 77 years and older. Both community-based and institutionalized persons were included. Information on drug use was based on personal interviews and all drugs used in the two weeks prior to the studies were recorded. The three outcomes under study were drug use, polypharmacy (concurrent use of five or more drugs), and potential DDIs. Results: In the SWEOLD data from 1992 - 2002, the mean number of drugs used per person increased from 2.5 - 4.4. Overall, 81% of the study participants were drug users in 1992 as compared to 88% in 2002. The prevalence of polypharmacy increased 3-fold (from 18% in 1992 to 42% in 2002) after controlling forage and gender. In both SWEOLD surveys, the less educated reported polypharmacy more often (19% in 1992 and 46% in 2002) than the higher educated (12% in 1992 and 36% in 2002). Potential DDIs also increased, both among the less educated (14% in 1992 to 26% in 2002) and the higher educated (18% in 1992 to 24% in 2002). The most pronounced changes in the consumption of specific drug groups were observed in antithrombotic agents, P-blocking agents, ACE inhibitors, and vitamin B-12 and folic acid. In general, the use of most therapeutic classes increased more among the well educated compared to less educated men between 1992 and 2002, whereas the opposite relationship prevailed among women. Conclusion: This study indicates that the use of drugs, polypharmacy and potential DDIs have increased during 1992 to 2002 among the elderly. These changes were most prominent among the less educated women. Polypharmacy and potential DDIs represent potential health hazards for the elderly. Therefore, the trends of increasing polypharmacy and drug-drug interactions deserve attention and the mechanisms behind should be investigated further.

  • 2006. Kristina Larsson, Mats Thorslund, Ingemar Kåreholt. European Journal of Ageing 3 (1), 22-33

    The objectives were to identify factors that predict the use of home help services and transition into institutional care and to study to what extent care services were targeted according to the individuals’ needs. A further objective was to study whether people who had moved into institutional care facilities had received home help prior to institutionalisation. A community-dwelling sample (n=502) aged 81–100 was twice interviewed and assessed with medical examinations. Their use of public elderly care between 1994/1996 and 2000 was studied using survival analyses. Need factors, according to the Andersen Behavioural Model, were the most important predictors for the use of elderly care. Among people living alone, dementia, functional limitations, and depressive symptoms predicted the use of home help services and institutionalisation. Among non-demented cohabiting people, depressive symptoms and dependence in ADLs increased the likelihood of both home help and institutionalisation. Among cohabiting people with dementia, the effect of dementia was difficult to separate from the effects of ADL limitations and depression. Enabling factors were of importance among cohabiting people. A high level of education increased the likelihood of moving into institutional care, and informal extra-residential care increased the likelihood of both outcomes indicating that elderly care resources had not been targeted solely according to need. Predisposing factors such as age and gender were of importance only among people living alone. Basically the same factors predicted both the receipt of home help and institutionalisation. Only 4% of people living alone and 5% of those cohabiting moved to institutions without previously receiving home help.

  • 2006. Stefan Fors, Mats Thorslund, Marti G Parker. European Journal of Ageing 3 (1), 15-21
  • 2004. Kristina Larsson, Mats Thorslund, Yvonne Forsell. Journal of Aging and Health 16 (5), 641-668

    Objectives: The objective of this article is to investigate predictors of public home help utilization, particularly mental health problems such as dementia and depressive symptoms. Methods: A population-based sample of community-dwelling people aged 81-100 was interviewed and assessed with medical examinations (N = 502). Results: Dementia increased the odds of receiving public home help among people residing alone. Among coresiding people, it increased the odds of receiving home help, but only among those who had extra residential care. Depressive symptoms decreased the odds of receiving home help among people with lower levels of education who lived alone. Depressive symptoms among highly educated people who lived alone and among coresiding people of any educational level were not related to receipt of home help. Discussion: Improvement of screening activities for public home help needs of community-dwelling elders might allow better targeting of limited social resources to the most needy.

  • 2003. Gun-Britt Trydegård, Mats Thorslund. International Journal of Social Welfare 10 (3), 174-184

    This article uses Sweden as an example to describe and analyse municipal variation in services and care for elderly people. Responsibility for these services lies with the municipalities. National statistical data on municipalities are analysed to map out the variations in old-age care; to study compensating factors in the care system; and to explore the connection with municipal structural and political conditions. The overall finding of the bivariate analyses was that most relations with structure and policy were weak or non-existent. The final multivariate model explained only 15% of the variance. The large differences between municipalities makes it more appropriate to talk about a multitude of 'welfare municipalities' rather than one single welfare state. The article concludes that this municipal disparity constitutes a greater threat to the principle of equality in care of the elderly than gender and socio-economic differences.

  • 2002. Kristina Larsson, Mats Thorslund. Research on Aging 24 (3), 308-336

    When facing dependency, the majority of elderly men receive care from spouses whereas elderly women more often rely on relatives or public elder care. This Swedish population-based study of persons between ages 81 and 100 concerns public elder care and informal support in relation to having a coresiding caregiver. Findings indicate that men had higher odds of receiving care when coresident and/or extraresident and/or public home help services were included, compared to women, after controlling for functional and cognitive impairment as well as self-reported need of assistance with instrumental activities of daily living. After controlling also for coresiding, the gender differences disappeared. The main distinction was found between persons living alone and persons coresiding, not between men and women. Thus, when studying use of public elder care and support from relatives or friends, it is vital to include household composition, and thereby the possibility of receiving care from a coresiding caregiver, in the analyses.

Show all publications by Mats Thorslund at Stockholm University

Last updated: May 28, 2018

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