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  • 1. Astell-Burt, Thomas
    et al.
    Mitchell, Richard
    Hartig, Terry
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Institute for Housing and Urban Research.
    The association between green space and mental health varies across the lifecourse. A longitudinal study2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 6, p. 578-583Article in journal (Refereed)
    Abstract [en]

    Background Epidemiological studies on green space and health have relied almost exclusively on cross-sectional designs, restricting understanding on how this relationship could vary across the lifecourse. Methods We used multilevel linear regression to analyse variation in minor psychiatric morbidity over nine annual waves of the British Household Panel Survey (1996-2004). The sample was restricted to residents of urban areas who remained within their neighbourhoods for at least 12 months. The 12-item General Health Questionnaire and confounders were reported for 29 626 male and 35 781 female observations (person-years). This individual-level dataset was linked to a measure of green space availability within each ward of residence. Regression models included age, gender, employment status, household tenure, marital status, education, smoking status and household income. Results When not considering age, green space was associated with better mental health among men, but not women. Interaction terms fitted between age and green space revealed variation in the association between green space and mental health across the lifecourse and by gender. For men, the benefit of more green space emerged in early to mid-adulthood. Among older women, a curvilinear association materialised wherein those with a moderate availability of green space had better mental health. Conclusions These findings illustrate how the relationship between urban green space and health can vary across the lifecourse, and they highlight the need for longitudinal studies to answer why green space may be better for health at some points in the lifecourse than others.

  • 2. Bahmanyar, S.
    et al.
    Sparén, P.
    Rutz, Mittendorfer
    Hultman, Christina M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Risk of suicide among operated and non-operated patients hospitalised for peptic ulcers2009In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 63, no 12, p. 1016-1021Article in journal (Refereed)
    Abstract [en]

    Background: Some small studies have reported high risk of suicide after surgical treatment for peptic ulcer. The aim of the present study was to explore the risk of suicide in hospitalised gastric ulcer and duodenal ulcer patients separately among operated and non-operated cohorts. Methods: Retrospective cohorts of 163 579 non-operated patients with gastric ulcer or duodenal ulcer and 28 112 patients with surgical treatment for ulcer, recorded in the Swedish Inpatient Register since 1965, were followed from the first hospitalisation, or operation for the surgery cohort, until death, any cancer, emigration, or 31 December 2003. Standardised mortality ratios (SMRs) were calculated, and Poisson regression produced adjusted relative risk estimates among operated and non-operated patients. Results: Non-operated patients hospitalised for peptic ulcer showed a 70% excess risk of suicide (SMR 1.7, 95% CI 1.6 to 1.9) and those who underwent operation had a 60% increased risk (SMR 1.6, 95% CI 1.4 to 1.8). The risk of suicide was very high during the first year after hospitalisation (SMR 4.0, 95% CI 3.4 to 4.7) and more marked among women, patients under 70 and patients hospitalised without complications of ulcer. Both gastric ulcer and duodenal ulcer patients had high risk of suicide completion. Conclusion: Hospitalised patients with gastric ulcer or duodenal ulcer have an increased risk of suicide regardless of surgical treatment. These patients, especially women, are at very high risk during the first year after first hospitalisation/operation. The evaluation and management of suicidal thoughts in patients in medical settings should be further considered.

  • 3.
    Bergström, Malin
    et al.
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Fransson, Emma
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Modin, Bitte
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Berlin, Marie
    Stockholms universitet, Sociologiska institutionen.
    Gustafsson, Per A.
    Hjern, Anders
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Fifty moves a year: is there an association between joint physical custody and psychosomatic problems in children?2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 8, p. 769-774Article in journal (Refereed)
    Abstract [en]

    Background: In many Western countries, an increasing number of children with separated parents have joint physical custody, that is, live equally much in their parent's respective homes. In Sweden, joint physical custody is particularly common and concerns between 30% and 40% of the children with separated parents. It has been hypothesised that the frequent moves and lack of stability in parenting may be stressful for these children.

    Methods: We used data from a national classroom survey of all sixth and ninth grade students in Sweden (N=147839) to investigate the association between children's psychosomatic problems and living arrangements. Children in joint physical custody were compared with those living only or mostly with one parent and in nuclear families. We conducted sex-specific linear regression analyses for z-transformed sum scores of psychosomatic problems and adjusted for age, country of origin as well as children's satisfaction with material resources and relationships to parents. Clustering by school was accounted for by using a two-level random intercept model.

    Results: Children in joint physical custody suffered from less psychosomatic problems than those living mostly or only with one parent but reported more symptoms than those in nuclear families. Satisfaction with their material resources and parent–child relationships was associated with children's psychosomatic health but could not explain the differences between children in the different living arrangements.

    Conclusions: Children with non-cohabitant parents experience more psychosomatic problems than those in nuclear families. Those in joint physical custody do however report better psychosomatic health than children living mostly or only with one parent. Longitudinal studies with information on family factors before and after the separation are needed to inform policy of children's postseparation living arrangements.

  • 4. Björkenstam, Charlotte
    et al.
    Weitoft, Gunilla Ringbäck
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Nordström, Peter
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Ljung, Rickard
    School grades, parental education and suicide: a national register-based cohort study2011In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 65, no 11, p. 993-998Article in journal (Refereed)
    Abstract [en]

    Background

    To investigate whether school performance is a risk factor for suicide death later in life and, if so, to what extent this is explained by intergenerational effects of parental education.

    Methods

    This population-based cohort study comprises national birth cohorts between 1972 and 1981 in Sweden. We followed 898 342 students, graduating between 1988 and 1997 from the 9 years of compulsory school, equivalent to junior high school, until 31 December 2006, generating 11 148 758 person-years and 1490 suicides. Final school grades, in six categories, and risk of suicide were analysed with Poisson regression.

    Results

    The incidence rate ratio (RR) for suicide death for students with the lowest grades was 4.57 (95% CI 2.82 to 7.40) for men and 2.67 (1.42 to 5.01) for women compared to those with highest grades after adjustment for a number of sociodemographic and parental morbidity variables, such as year of graduation, parental education, lone parenthood, household receiving social welfare or disability pension, place of schooling, adoption, maternal age and parent's mental illness. Students with grades in the middle categories had RRs in between. These relationships were not modified by parental education.

    Conclusions

    The strong association between low school grades and suicide in youth and young adulthood emphasises the importance of both primary and secondary prevention in schools.

  • 5. Cohen, Joachim
    et al.
    Bilsen, Johan
    Fischer, Susanne
    Löfmark, Rurik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Norup, Michael
    van der Heide, Agnes
    Miccinesi, Guido
    Deliens, Luc
    End-of-life decision-making in Belgium, Denmark, Sweden and Switzerland: does place of death make a difference?2007In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 61, no 12, p. 1062-1068Article in journal (Refereed)
    Abstract [en]

    Objective: To examine differences in end-of-life decision-making in patients dying at home, in a hospital or in a care home. Design: A death certificate study: certifying physicians from representative samples of death certificates, taken between June 2001 and February 2002, were sent questionnaires on the end-of-life decision-making preceding the patient's death. Setting: Four European countries: Belgium (Flanders), Denmark, Sweden, and Switzerland (German-speaking part). Main outcome measures: The incidence of and communication in different end-of-life decisions: physician-assisted death, alleviation of pain/symptoms with a possible life-shortening effect, and non-treatment decisions. Results: Response rates ranged from 59% in Belgium to 69% in Switzerland. The total number of deaths studied was 12 492. Among all non-sudden deaths the incidence of several end-of-life decisions varied by place of death. Physician-assisted death occurred relatively more often at home (0.3-5.1%); non-treatment decisions generally occurred more often in hospitals (22.4-41.3%), although they were also frequently taken in care homes in Belgium (26.0%) and Switzerland (43.1%). Continuous deep sedation, in particular without the administration of food and fluids, was more likely to occur in hospitals. At home, end-of-life decisions were usually more often discussed with patients. The incidence of discussion with other caregivers was generally relatively low at home compared with in hospitals or care homes. Conclusion: The results suggest the possibility that end-of-life decision-making is related to the care setting where people die. The study results seem to call for the development of good end-of-life care options and end-of-life communication guidelines in all settings.

  • 6.
    Derraik, José G B
    et al.
    Liggins Institute, University of Auckland, New Zealand.
    Ahlsson, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lundgren, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Jonsson, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Cutfield, Wayne S
    Liggins Institute, University of Auckland, New Zealand.
    First-borns have greater BMI and are more likely to be overweight or obese: a study of sibling pairs among 26 812 Swedish women2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 1, p. 78-81Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A number of large studies have shown phenotypic differences between first-borns and later-borns among adult men. In this study, we aimed to assess whether birth order was associated with height and BMI in a large cohort of Swedish women.

    METHODS: Information was obtained from antenatal clinic records from the Swedish National Birth Register over 20 years (1991-2009). Maternal anthropometric data early in pregnancy (at approximately 10-12 weeks of gestation) were analysed on 13 406 pairs of sisters who were either first-born or second-born (n=26 812).

    RESULTS: Early in pregnancy, first-born women were of BMI that was 0.57 kg/m(2) (2.4%) greater than their second-born sisters (p<0.0001). In addition, first-borns had greater odds of being overweight (OR 1.29; p<0.0001) or obese (OR 1.40; p<0.0001) than second-borns. First-borns were also negligibly taller (+1.2 mm) than their second-born sisters. Of note, there was a considerable increase in BMI over the 18-year period covered by this study, with an increment of 0.11 kg/m(2) per year (p<0.0001).

    CONCLUSIONS: Our study corroborates other large studies on men, and the steady reduction in family size may contribute to the observed increase in adult BMI worldwide.

  • 7.
    Eriksson, Leif
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Nga, Nguyen T
    Research Institute for Child Health, Hanoi, Vietnam.
    Hoa, Dinh T Phuong
    Hanoi University of Public Health, Vietnam.
    Duc, Duong M
    Hanoi University of Public Health, Vietnam.
    Bergström, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. Institute for Global Health, University College London, London, UK.
    Wallin, Lars
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Huy, Tran Q
    Department of Medical Services Administration, Ministry of Health, Nursing office, Hanoi, Vietnam.
    Thuy, Nguyen T
    Vietnam-Sweden Uong Bi General Hospital, Uong Bi, Vietnam.
    Do, Tran Thanh
    National Institute of Nutrition (NIN), Ministry of Health, Hanoi, Vietnam.
    Lien, Pham T L
    Research Institute for Child Health, Hanoi, Vietnam.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. London School of Hygiene & Tropical Medicine, London, UK.
    Ekholm Selling, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Secular trend, seasonality and effects of a community-based intervention on neonatal mortality: follow-up of a cluster-randomised trial in Quang Ninh province, Vietnam2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 9, p. 776-782Article in journal (Refereed)
    Abstract [en]

    Background: Little is know about whether the effects of community engagement interventions for child survival in low-income and middle-income settings are sustained. Seasonal variation and secular trend may blur the data. Neonatal mortality was reduced in a cluster-randomised trial in Vietnam where laywomen facilitated groups composed of local stakeholders employing a problem-solving approach for 3 years. In this analysis, we aim at disentangling the secular trend, the seasonal variation and the effect of the intervention on neonatal mortality during and after the trial.

    Methods: In Quang Ninh province, 44 communes were allocated to intervention and 46 to control. Births and neonatal deaths were assessed in a baseline survey in 2005, monitored during the trial in 2008–2011 and followed up by a survey in 2014. Time series analyses were performed on monthly neonatal mortality data.

    Results: There were 30 187 live births and 480 neonatal deaths. The intervention reduced the neonatal mortality from 19.1 to 11.6 per 1000 live births. The reduction was sustained 3 years after the trial. The control areas reached a similar level at the time of follow-up. Time series decomposition analysis revealed a downward trend in the intervention areas during the trial that was not found in the control areas. Neonatal mortality peaked in the hot and wet summers.

    Conclusions: A community engagement intervention resulted in a lower neonatal mortality rate that was sustained but not further reduced after the end of the trial. When decomposing time series of neonatal mortality, a clear downward trend was demonstrated in intervention but not in control areas.

    Trial registration number: ISRCTN44599712, Post-results.

  • 8.
    Eriksson, Margaretha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Cnattingius, Sven
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Tibblin, Gösta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Factors associated with birth weight in Sweden: The study of men born in 19131997In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 51, no 1, p. 19-23Article in journal (Refereed)
  • 9.
    Gemmill, Alison
    et al.
    Univ Calif Berkeley, Dept Demog, Berkeley, CA 94720 USA..
    Falconi, April
    Univ Calif Berkeley, Sch Publ Hlth, Berkeley, CA 94720 USA..
    Karasek, Deborah
    Univ Calif Berkeley, Sch Publ Hlth, Berkeley, CA 94720 USA..
    Hartig, Terry
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Institute for Housing and Urban Research. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Anderson, Elizabeth
    Univ Calif Berkeley, Sch Publ Hlth, Berkeley, CA 94720 USA..
    Catalano, Ralph
    Univ Calif Berkeley, Sch Publ Hlth, Berkeley, CA 94720 USA..
    Do macroeconomic contractions induce or 'harvest' suicides?: A test of competing hypotheses2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 11, p. 1071-1076Article in journal (Refereed)
    Abstract [en]

    Background Researchers often invoke a mortality displacement or 'harvesting' mechanism to explain mortality patterns, such that those with underlying health vulnerabilities die sooner than expected in response to environmental phenomena, such as heat waves, cold spells and air pollution. It is unclear if this displacement mechanism might also explain observed increases in suicide following economic contraction, or if suicides are induced in persons otherwise unlikely to engage in self-destructive behaviour. Here, we test two competing hypotheses explaining an observed increase in suicides following unemployment-induction or displacement. Methods We apply time series methods to monthly suicide and unemployment data from Sweden for the years 2000-2011. Tests are conducted separately for working age (20-64 years old) men and women as well as older (aged 65 years and older) men and women. Results Displacement appeared among older men and women; an unexpected rise in unemployment predicted an increase in suicides 6 months later, followed by a significant decrease 8 months later. Induction appeared among working age men, but not among working age women; an unexpected rise in unemployment predicted an increase in suicides 4-6 months later. Conclusions Displacement and induction both appear to have operated following unexpected labour market contractions in Sweden, though with different population segments.

  • 10.
    Grönqvist, Hans
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economics.
    Norström, Thor
    The Great Recession, Unemployment and Suicide2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738Article in journal (Refereed)
  • 11.
    Gustafsson, Per E
    et al.
    Umeå universitet, Allmänmedicin.
    Janlert, Urban
    Umeå universitet, Epidemiologi och global hälsa.
    Theorell, Töres
    Westerlund, Hugo
    Hammarström, Anne
    Umeå universitet, Allmänmedicin.
    Socioeconomic status over the life course and allostatic load in adulthood: results from the Northern Swedish Cohort2011In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 65, p. 986-992Article in journal (Refereed)
    Abstract [en]

    Background Although several studies have reported rather consistent associations between socioeconomic status (SES) and allostatic load (AL), so far no study has examined the influence of SES over the life course on AL. The aim of the present study was to investigate the association between SES over the life course and AL in mid-adulthood, guided by the conceptual models of cumulative risk, critical period and social chain of risk.

    Methods The sample comprises a 27-year prospective cohort (n=1071) from northern Sweden. Participants (n=855, 79.8%) completed questionnaires at the ages of 16, 21, 30 and 43 years. A health examination was performed at age 43 years after an overnight fast, including physical examination and blood sampling, and participants completed 1-day salivary cortisol sampling (four samples). SES was based on parental occupation at age 16 years and participants' own occupation at ages 21, 30 and 43 years. Information on daily smoking, snuff use, high alcohol consumption and physical inactivity was reported by the participants. An AL index was constructed from tertiles of 12 biological parameters.

    Results Cumulative socioeconomic disadvantage was related to AL in both women and men. The association was largely explained by health behaviours in men, but was independent of health behaviours in women. In women, an association was observed between AL and SES in adolescence, whereas in men only current SES was related to AL, independently of current health behaviours.

    Conclusions SES over the life course influences the level of multi-systemic dysregulation in mid-adulthood, with the strongest support for the cumulative risk model.

  • 12.
    Hammarström, Anne
    et al.
    Umeå universitet, Allmänmedicin.
    Johansson, Klara
    Umeå universitet, Allmänmedicin.
    Annandale, Ellen
    Ahlgren, Christina
    Umeå universitet, Sjukgymnastik.
    Aléx, Lena
    Umeå universitet, Institutionen för omvårdnad.
    Christianson, Monica
    Umeå universitet, Institutionen för omvårdnad.
    Elwer, Sofia
    Umeå universitet, Allmänmedicin.
    Eriksson, Carola
    Umeå universitet, Allmänmedicin.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Sjukgymnastik.
    Gilenstam, Kajsa
    Umeå universitet, Idrottsmedicin.
    Gustafsson, Per E.
    Umeå universitet, Allmänmedicin.
    Harryson, Lisa
    Umeå universitet, Sociologiska institutionen.
    Lehti, Arja
    Umeå universitet, Professionell utveckling.
    Stenberg, Gunilla
    Umeå universitet, Sjukgymnastik.
    Verdonk, Petra
    Central gender theoretical concepts in health research: the state of the art2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 2, p. 185-190Article in journal (Refereed)
    Abstract [en]

    Despite increasing awareness of the importance of gender perspectives in health science, there is conceptual confusion regarding the meaning and the use of central gender theoretical concepts. We argue that it is essential to clarify how central concepts are used within gender theory and how to apply them to health research. We identify six gender theoretical concepts as central and interlinked-but problematic and ambiguous in health science: sex, gender, intersectionality, embodiment, gender equity and gender equality. Our recommendations are that: the concepts sex and gender can benefit from a gender relational theoretical approach (ie, a focus on social processes and structures) but with additional attention to the interrelations between sex and gender; intersectionality should go beyond additive analyses to study complex intersections between the major factors which potentially influence health and ensure that gendered power relations and social context are included; we need to be aware of the various meanings given to embodiment, which achieve an integration of gender and health and attend to different levels of analyses to varying degrees; and appreciate that gender equality concerns absence of discrimination between women and men while gender equity focuses on women's and men's health needs, whether similar or different. We conclude that there is a constant need to justify and clarify our use of these concepts in order to advance gender theoretical development. Our analysis is an invitation for dialogue but also a call to make more effective use of the knowledge base which has already developed among gender theorists in health sciences in the manner proposed in this paper.

  • 13.
    Harryson, Lisa
    et al.
    Umeå universitet, Allmänmedicin.
    Novo, Mehmet
    Umeå universitet, Allmänmedicin.
    Hammarström, Anne
    Umeå universitet, Allmänmedicin.
    Is gender inequality in the domestic sphere associated with psychological distress among women and men? Results from the Northern Swedish Cohort.2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 3, p. 271-276Article in journal (Refereed)
    Abstract [en]

    Aim The aim of this study was to analyse whether gender inequality in the domestic sphere was associated with psychological distress among women and men.

    Methods In a cohort study, all pupils in the last year of compulsory school in a middle-sized industrial town in northern Sweden were followed until the age of 42. For this study a sample of cohabiting participants (n¼372 women, 352 men) was selected. Gender inequality was measured as perceptions of gender inequality in the couple relationship, time spent on household work, responsibility for domestic work and childcare, and was analysed in relation to psychological distress, after taking possible background variables as well as earlier health status into account.

    Results In the multivariate analyses, perception of gender inequality in the couple relationship was associated with psychological distress for both women (OR 2.23, CI 1.20 to 4.18) and men (OR 3.51, CI 1.69 to 7.31). For women only, taking whole responsibility for domestic work was associated with the outcome (OR 2.17, CI 1.05 to 4.48). For men, taking less than half of the responsibility for domestic work was associated with psychological distress (OR 2.25, CI 1.24 to 3.91).

    Conclusions Gender inequality in the domestic sphere seems to be an important determinant of psychological distress for both women and men.

  • 14. Hemmingsson, T.
    et al.
    Melin, B.
    Allebeck, P.
    Lundberg, Ingvar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Cognitive ability in adolescence and mortality in middle age: a prospective life course study2009In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 63, no 9, p. 697-702Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: An association between childhood cognitive ability measured by IQ tests and mortality has been reported recently. It is not clear from those studies to what extent the increased relative risk associated with lower IQ scores may be attenuated by adjustment for other risk factors. This study aims to investigate the association between cognitive ability measured at age 18-20 years and mortality among middle-aged men adjusting for risk factors for mortality over the life course. METHODS: Data on cognitive ability, and other risk factors for premature mortality (indicators of mental health and social adjustment and behavioural factors), were collected among 49 321 men, born in 1949-51, at conscription for compulsory military training in 1969-70. Information on socioeconomic factors in childhood and adulthood, as well as information on mortality, was collected through national registers. RESULTS: Cognitive ability showed an inverse and graded association with mortality between 40 and 53 years of age (1297 cases, crude hazard ratio (HR) 1.15, 95% CI 1.12 to 1.18, for one-point decrease on the nine-point IQ scale). Adjustment for indicators of social misbehaviour, mental health problems and behavioural risk factors, measured in late adolescence, and adult social circumstances strongly attenuated the increased risks of mortality, and it was no longer significantly increased (adjusted HR 1.02, 95% CI 0.99 to 1.06, for one-point decrease on the nine-point IQ scale). CONCLUSION: The association between IQ and mortality among men below 54 years of age was almost completely attenuated by adjustment for risk factors captured by our measures of achieved social positions.

  • 15.
    Johansson, Lars Age
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Comparing hospital discharge records with death certificates: can the differences be explained?2002In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. April, no 4, p. 301-308Article in journal (Refereed)
  • 16.
    Kennedy, Beatrice
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Örebro Univ, Sch Med Sci, Clin Epidemiol & Biostat, S-70281 Örebro, Sweden.
    Chen, Ruoqing
    Örebro Univ, Sch Med Sci, Clin Epidemiol & Biostat, S-70281 Örebro, Sweden;Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Fang, Fang
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Valdimarsdottir, Unnur
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden;Univ Iceland, Sch Hlth Sci, Fac Med, Ctr Publ Hlth Sci, Reykjavik, Iceland;Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA.
    Montgomery, Scott
    Orebro Univ, Sch Med Sci, Clin Epidemiol & Biostat, S-70281 Orebro, Sweden;UCL, Dept Epidemiol & Publ Hlth, London, England;Karolinska Inst, Karolinska Univ Hosp, Clin Epidemiol Unit, Stockholm, Sweden.
    Larsson, Henrik
    Orebro Univ, Sch Med Sci, Clin Epidemiol & Biostat, S-70281 Orebro, Sweden;Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Fall, Katja
    Orebro Univ, Sch Med Sci, Clin Epidemiol & Biostat, S-70281 Orebro, Sweden;Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 6, p. 496-501Article in journal (Refereed)
    Abstract [en]

    Background While compromised stress resilience constitutes a recognised risk factor for somatic and psychiatric disease development in general, the knowledge about how individual variation in vulnerability to stress may specifically influence the long-term risks of disadvantageous health behaviours is limited. Methods In this Swedish cohort study, we aimed to investigate the association between stress resilience in late adolescence and adult use of addictive substances. We included 9381 men with information on psychological stress resilience measured during military conscription examinations, who later responded to an extensive health survey (mean age 34.0 +/- 7.2 years) including detailed information on substance use. We modelled continuous outcomes using linear regression, binary outcomes with logistic regression and other categorical outcomes with multinomial logistic regression. Results We found that low stress resilience in adolescence conferred increased risks of all studied measures of addictive behaviour. After adjusting for childhood socioeconomic information, low stress resilience was associated with adult current regular smoking (relative risk ratio: 5.85, 95% CI 4.32 to 7.93), higher nicotine dependence scores (beta: 0.76, 95% CI 0.29 to 1.23), hazardous use of alcohol (>14 alcoholic drink-equivalents per week, OR: 1.72, 95% CI 1.37 to 2.16), DSM-IV criteria for alcohol dependence (OR: 1.74, 95% CI 1.35 to 2.25), and drug use (OR: 1.77, 95% CI 1.51 to 2.08). The results remained largely unchanged after further adjustments for adult educational attainment and occupation as well as for additional conscription covariates. Conclusion Low stress resilience in late adolescence appears to be associated with an increased risk of disadvantageous and addictive health behaviours in adulthood.

  • 17. Kuh, D
    et al.
    Ben-Shlomo, Y
    Lynch, J
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Power, C
    Life course epidemiology.2003In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 57, no 10, p. 778-83Article in journal (Refereed)
  • 18. Kölegård Stjärne, M
    et al.
    Diderichsen, F
    Reuterwall, C
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Socioeconomic context in area of living and risk of myocardial infarction: results from Stockholm Heart Epidemiology Program (SHEEP).2002In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 56, no 1, p. 29-35Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVE: To analyse if socioeconomic characteristics in area of living affect the risk of myocardial infarction in a Swedish urban population, and to evaluate to what extent the contextual effect is confounded by the individual exposures.

    DESIGN: A population based case-referent study (SHEEP).

    SETTING: Cases (n=1631) were all incident first events of myocardial infarction during 1992-1994. The study base included all Swedish citizens aged 45-70 years, living in Stockholm metropolitan area during these years. The social context of all metropolitan parishes (n=89) was determined by routine statistics on 21 socioeconomic indicators. A factor analysis of the socioeconomic indicators resulted in three dimensions of socioeconomic deprivation, which were analysed separately as three different contextual exposures.

    MAIN RESULTS: The main characteristics of the extracted factors were; class structure, social exclusion and poverty. Among men, there were increased relative risks of similar magnitudes (1.28 to 1.33) in the more deprived areas according to all three dimensions of the socioeconomic context. However, when adjusting for individual exposures, the poverty factor had the strongest contextual impact. The contextual effects among women showed a different pattern. In comparison with women living the most affluent areas according to the class structure index, women in the rest of Stockholm metropolitan area had nearly 70% higher risk of myocardial infarction after adjustment for individual social exposures.

    CONCLUSIONS: The results suggest that the socioeconomic context in area of living increases the risk of myocardial infarction. The increased risk in only partially explained by individual social factors (the compositional effect).

  • 19. Laflamme, L
    et al.
    Engström, K
    Möller, J
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Is perceived failure in school performance a trigger of physical injury? A case-crossover study of children in Stockholm County.2004In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 58, no 5, p. 407-11Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate whether perceived failure in school performance increases the potential for children to be physically injured.

    SUBJECTS: Children aged 10-15 years residing in the Stockholm County and hospitalised or called back for a medical check up because of a physical injury during the school years 2000-2001 and 2001-2002 (n = 592).

    METHODS: A case-crossover design was used and information on potential injury triggers was gathered by interview. Information about family socioeconomic circumstances was gathered by a questionnaire filled in by parents during the child interview (response rate 87%).

    RESULTS: Perceived failure in school performance has the potential to trigger injury within up to 10 hours subsequent to exposure (relative risk = 2.70; 95% confidence intervals = 1.2 to 5.8). The risk is significantly higher among pre-adolescents and among children from families at a higher education level.

    CONCLUSIONS: Experiencing feelings of failure may affect children's physical safety, in particular among pre-adolescents. Possible mechanisms are perceptual deficits and response changes occasioned by the stress experienced after exposure.

  • 20. Leineweber, Constanze
    et al.
    Westerlund, Hugo
    Theorell, Töres
    Kivimäki, Mika
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Alfredsson, Lars
    Covert coping with unfair treatment at work and risk of incident myocardial infarction and cardiac death among men: Prospective cohort study2011In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 65, no 5, p. 420-425Article in journal (Refereed)
    Abstract [en]

    Background Covert coping with unfair treatment at work-occurring when an employee does not show the "aggressor" that he/she feels unfairly treated-has been found to be associated with cardiovascular risk factors. This study examined whether covert coping also predicts incident coronary heart disease.

    Methods A prospective cohort study (the WOLF Stockholm study) of workplaces in the Stockholm area, Sweden. The participants were 2755 men with no history of myocardial infarction at baseline screening in 1992-1995. The main outcome measure was hospitalisation due to myocardial infarction or death from ischaemic heart disease until 2003 obtained from national registers (mean follow-up 9.8 +/- 0.9 years).

    Results Forty-seven participants had myocardial infarction or died from ischaemic heart disease during follow-up. After adjustment for age, socioeconomic factors, risk behaviours, job strain and biological risk factors at baseline, there was a dose-response relationship between covert coping and risk of incident myocardial infarction or cardiac death (p for trend=0.10). Men who frequently used covert coping had a 2.29 (95% CI 1.00 to 5.29) times higher risk than those who did not use coping. Restricting the analysis to direct coping behaviours only strengthened this association (p for trend=0.02).

    Conclusions In this study, covert coping is strongly related to increased risk of hard-endpoint cardiovascular disease.

  • 21. Ljung, R
    et al.
    Hallqvist, Johan
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
    Accumulation of adverse socioeconomic position over the entire life course and the risk of myocardial infarction among men and women: Results from the Stockholm Heart Epidemiology Program (SHEEP)2006In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 60, no 12, p. 1080-1084Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Accumulation of adverse socioeconomic position over the life course is assumed to increase the risk of myocardial infarction.

    OBJECTIVE:

    To analyse in detail whether the accumulation of adverse socioeconomic position over the life course increases the risk of myocardial infarction, using yearly information on individual socioeconomic position from birth to disease onset.

    DESIGN:

    Case-control study of risk factors for incident myocardial infarction (Stockholm Heart Epidemiology Program).

    SETTING:

    All Swedish citizens born during 1922-49 and living in Stockholm County during 1992-4.

    PARTICIPANTS:

    550 female and 1204 male patients and 777 female and 1538 male controls. Every year in manual work was added to calculate a proportion of the whole life course spent in adverse socioeconomic position.

    RESULTS:

    With increasing proportion of life spent in adverse socioeconomic position, we found an increasing risk of myocardial infarction. The relative risk of myocardial infarction was 2.36 (95% confidence interval (CI) = 1.79 to 3.11) for men and 2.54 (95% CI = 1.70 to 3.78) for women who, over the entire life course, had always been in adverse socioeconomic position compared with those who had never been in adversity. We also found a strong increase in risk from being in adversity for only a few years, indicating important selection processes.

    CONCLUSIONS:

    Accumulated experience of adverse socioeconomic position over the entire life course increases the risk of myocardial infarction for men and women, but it is not a pure accumulation process as "how" and "when" the accumulation occurs also seems to have a role. The accumulation effect is partly mediated by the acquisition of health-damaging experiences.

  • 22. Lundin, Andreas
    et al.
    Lundberg, Ingvar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Hallsten, Lennart
    Ottosson, Jan
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economic History.
    Hemmingsson, Tomas
    Unemployment and mortality: a longitudinal prospective study on selection and causation in 49 321 Swedish middle-aged men2010In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 64, no 1, p. 22-28Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Unemployment is associated with increased risk of mortality. It is, however, not clear to what extent this is causal, or whether other risk factors remain uncontrolled for. The aim of this study was to investigate the association between unemployment and all cause and cause specific mortality, adjusting for indicators of mental disorder, behavioural risk factors, and social factors over the life course. METHODS: This study was based on a cohort of 49 321 Swedish males born 1949/51, tested for compulsory military conscription in 1969/70. Data on employment/unemployment 1990-1994 was based on information from the Longitudinal Register of Education and Labour Market Statistics. Information on childhood circumstances was drawn from National Population and Housing Census 1960. Information on psychiatric diagnosis and behavioral risk factors was collected at conscription testing in 1969/70. Data on mortality and hospitalisation 1973-2004 was collected in national registers. RESULTS: An increased risk of mortality 1995-2003 was found among individuals who experienced 90 days or more of unemployment during 1992-1994, compared with those still employed (all cause mortality HR = 1.91, 95 % CI: 1.58-2.31. Adjustment for risk factors measured along the life-course considerably lowered the relative risk (all cause mortality HR = 1.30, 95 % CI: 1.06-1.58). Statistically significant increased relative risk was found during the first four years of follow up (all cause mortality, adjusted HR = 1.57, 95 % CI: 1.13-2.18, but not the following four (all cause mortality, adjusted HR = 1.17, 95 % CI: 0.91-1.50). CONCLUSION: Our results suggest that a substantial part of the increased relative risk of mortality associated with unemployment may be attributable to confounding by individual risk factors.

  • 23.
    Mackenbach, Johan
    et al.
    Department of Public Health, Erasmus MC,Rotterdam, the Netherlands.
    Hoffmann, R
    Khoshaba, B
    Plug, I
    Rey, G
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Pärna, K
    Jougla, E
    Alfonso, J
    Looman, C
    McKee, M
    Using 'amenable mortality' as indicator of healthcare effectiveness in international comparisons: results of a validation study2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 2, p. 139-146Article in journal (Refereed)
    Abstract [en]

    Background and study aims

    There is widespread consensus on the need for better indicators of the effectiveness of healthcare. We carried out an analysis of the validity of amenable mortality as an indicator of the effectiveness of healthcare, focusing on the potential use in routine surveillance systems of between-country variations in rates of mortality. We assessed whether the introduction of specific healthcare innovations coincided with declines in mortality from potentially amenable causes in seven European countries. In this paper, we summarise the main results of this study and illustrate them for four conditions.

    Data and methods

    We identified 14 conditions for which considerable declines in mortality have been observed and for which there is reasonable evidence in the literature of the effectiveness of healthcare interventions to lower mortality. We determined the time at which these interventions were introduced and assessed whether the innovations coincided with favourable changes in the mortality trends from these conditions, measured using Poisson linear spline regression. All the evidence was then presented to a Delphi panel.

    Main results

    The timing of innovation and favourable change in mortality trends coincided for only a few conditions. Other reasons for mortality decline are likely to include diffusion and improved quality of interventions and in incidence of diseases and their risk factors, but there is insufficient evidence to differentiate these at present. For most conditions, a Delphi panel could not reach consensus on the role of current mortality levels as measures of effectiveness of healthcare.

    Discussion and conclusions

    Improvements in healthcare probably lowered mortality from many of the conditions that we studied but occurred in a much more diffuse way than we assumed in the study design. Quantification of the contribution of healthcare to mortality requires adequate data on timing of innovation and trends in diffusion and quality and in incidence of disease, none of which are currently available. Given these gaps in knowledge, between-country differences in levels of mortality from amenable conditions should not be used for routine surveillance of healthcare performance. The timing and pace of mortality decline from amenable conditions may provide better indicators of healthcare performance.

  • 24. Manrique-Garcia, Edison
    et al.
    Sidorchuk, Anna
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Moradi, Tahereh
    Socioeconomic position and incidence of acute myocardial infarction: a meta-analysis2011In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 65, no 4, p. 301-309Article in journal (Refereed)
    Abstract [en]

    Background

    A negative socioeconomic gradient is established for coronary heart disease (CHD) mortality and survival, while socioeconomic patterning of disease incidence is less well investigated. To study socioeconomic inequalities in the incidence of acute myocardial infarction (AMI), the major component of CHD, a meta-analysis was undertaken to summarise existing evidence on the issue.

    Methods

    A systematic search was performed in PubMed and EMBASE databases for observational studies on AMI incidence and socioeconomic position (SEP), published in English to April 2009. A random-effects model was used to pool the risks estimates from the individual studies.

    Results

    Among 1181 references, 70 studies fulfilled the inclusion criteria. An overall increased risk of AMI among the lowest SEP was found for all three indicators: income (pooled RR 1.71, 95% CI 1.43 to 2.05), occupation (pooled RR 1.35, 95% CI 1.19 to 1.53) and education (pooled RR 1.34, 95% CI 1.22 to 1.47). The strongest associations were seen in high-income countries such as USA/Canada and Europe, while the results were inconsistent for middle and low-income regions.

    Conclusion

    AMI incidence is associated with low SEP. The nature of social stratification at the level of economic development of a country could be involved in the differences of risk of AMI between social groups.

  • 25. Masso Gonzalez, EL
    et al.
    Johansson, Saga
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Garcia Rodriguez, LA
    Trends in the prevalence and incidence of diabetes in the UK: 1996-20052009In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 63, no 4, p. 332-336Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To estimate the incidence and prevalence of type 1 and type 2 diabetes in the UK general population from 1996 to 2005. METHODS: Using the Health Improvement Network database, patients with type 1 or type 2 diabetes were identified who were 10-79 years old between 1996 and 2005. Prevalent cases (n = 49 999) were separated from incident cases (n = 42 642; type 1 = 1256, type 2 = 41 386). Data were collected on treatment patterns in incident cases, and on body mass index in prevalent and incident cases. RESULTS: Diabetes prevalence increased from 2.8% in 1996 to 4.3% in 2005. The incidence of diabetes in the UK increased from 2.71 (2.58-2.85)/1000 person-years in 1996 to 4.42 (4.32-4.53)/1000 person-years in 2005. The incidence of type 1 diabetes remained relatively constant throughout the study period; however, the incidence of type 2 diabetes increased from 2.60 (2.47-2.74)/1000 person-years in 1996 to 4.31 (4.21-4.42)/1000 person-years in 2005. Between 1996 and 2005, the proportion of individuals newly diagnosed with type 2 diabetes who were obese increased from 46% to 56%. Treatment with metformin increased across the study period, while treatment with sulphonylureas decreased. CONCLUSIONS: The prevalence and incidence of type 2 diabetes have increased in the UK over the past decade. This might be primarily explained by the changes in obesity prevalence. Also, there was a change in drug treatment pattern from sulphonylureas to metformin.

  • 26.
    Michaëlsson, Karl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Bergström, Reinhold
    Holmberg, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Mallmin, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Wolk, Alicja
    Ljunghall, Sverker
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Calcium intake among women aged 40-76 in Sweden: Study Group MRS SWEA. Multiple Risk Survey on Swedish Women for Eating Assessment1996In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 50, no 5, p. 577-578Article in journal (Refereed)
  • 27.
    Musafili, Aimable
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Baribwira, Cyprien
    Maternal and Child Health, Pediatric HIV-AIDS, PMTCTRwanda Program of the Institute of Human Virology, School of Medicine, University of Maryland, Kigali, Rwanda.
    Binagwaho, Agnes
    Ministry of Health, Kigali, Rwanda.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Ekholm Selling, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Trends and social differentials in child mortality inRwanda 1990–2010: results from three demographicand health surveys2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 9, p. 834-840Article in journal (Refereed)
    Abstract [en]

    Background Rwanda has embarked on ambitious programmes to provide equitable health services and reduce mortality in childhood. Evidence from other countries indicates that advances in child survival often have come at the expense of increasing inequity. Our aims were to analyse trends and social differentials in mortality before the age of 5 years in Rwanda from 1990 to 2010. Methods We performed secondary analyses of data from three Demographic and Health Surveys conducted in 2000, 2005 and 2010 in Rwanda. These surveys included 34 790 children born between 1990 and 2010 to women aged 15-49 years. The main outcome measures were neonatal mortality rates (NMR) and under-5 mortality rates (U5MR) over time, and in relation to mother's educational level, urban or rural residence and household wealth. Generalised linear mixed effects models and a mixed effects Cox model (frailty model) were used, with adjustments for confounders and cluster sampling method. Results Mortality rates in Rwanda peaked in 1994 at the time of the genocide (NMR 60/1000 live births, 95% CI 51 to 65; U5MR 238/1000 live births, 95% CI 226 to 251). The 1990s and the first half of the 2000s were characterised by a marked rural/urban divide and inequity in child survival between maternal groups with different levels of education. Towards the end of the study period (2005-2010) NMR had been reduced to 26/1000 (95% CI 23 to 29) and U5MR to 65/1000 (95% CI 61 to 70), with little or no difference between urban and rural areas, and household wealth groups, while children of women with no education still had significantly higher U5MR. Conclusions Recent reductions in child mortality in Rwanda have concurred with improved social equity in child survival. Current challenges include the prevention of newborn deaths.

  • 28.
    Möller, Christina Ström
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Häggström, Jonas
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Wiberg, Bernice
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Age and follow-up time affect the prognostic value of the ECG and conventional cardiovascular risk factors for stroke in adult men2007In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 61, no 8, p. 704-712Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To explore whether the predictive power of mid-life ECG abnormalities and conventional cardiovascular risk factors for future stroke change over a 30-year follow-up period, and whether a repeated examination improves their predictive power. DESIGN AND SETTING: Longitudinal population-based study. PARTICIPANTS: 2,322 men aged 50 years, with a follow-up period of 30 years. 1,221 subjects were re-examined at age 70 years MAIN OUTCOME MEASURE: Risk for fatal and non-fatal stroke during three decades of follow-up. Investigations included resting ECG and traditional cardiovascular risk factors. RESULTS: When measured at age 50 years, ST segment depression and T wave abnormalities, together with ECG-left ventricular hypertrophy, were of importance only during the first 20 years, but regained importance when re-measured at age 70 years. Blood pressure was a significant predictor for stroke over all three decades of follow-up. In elderly people only, there is evidence that apolipoprotein A1 may protect from future stroke. CONCLUSION: Mid-life values for blood pressure and ECG abnormalities retain their predictive value over long follow-up periods even though they improved in predictive power when re-measured in elderly people. Despite lower prevalence, ECG abnormalities had greater impact at age 50 years than at age 70 years. By contrast, apolipoprotein A1 was protective for future stroke only at age 70 years.

  • 29. Möller, Jette
    et al.
    Theorell, Töres
    de Faire, Ulf
    Ahlbom, Anders
    Hallqvist, Johan
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden .
    Work related stressful life events and the risk of myocardial infarction: Case-control and case-crossover analyses within the Stockholm heart epidemiology programme (SHEEP)2005In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 59, no 1, p. 23-30Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVES:

    Recent changes in labour market conditions and in the organisation of work in developed societies have increased exposure to work related stress. The question is whether this also implies an increased risk of myocardial infarction, either through the triggering effect of acute stress, or through accumulation of stress over several months.

    DESIGN:

    A case-control and a case-crossover study design was applied.

    SETTING:

    The Stockholm heart epidemiology programme (SHEEP), in Stockholm County during 1992 to 1994.

    PARTICIPANTS:

    Patients with a first episode of non-fatal acute myocardial infarction, a total of 1381 men and women, responded to questionnaires and participated in interviews and health examinations.

    MAIN RESULTS:

    The case-crossover analysis showed triggering effects of sudden, short term situations of increased work load or work competition. Having "had a high pressure deadline at work" entailed a sixfold increase in risk of myocardial infarction (OR = 6.0 95% CI (1.8 to 20.4)) during the next 24 hours. The importance of work related life events as risk factors for myocardial infarction was supported by the case-control analysis. However, no support was found for the hypothesis that an accumulation of stressful life events over a period of 12 months increases the risk of myocardial infarction.

    CONCLUSION:

    Specific work related stressful life events seem to be potential triggers of the onset of myocardial infarction.

  • 30.
    Nilsson, Kent
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Leppert, Jerzy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Simonsson, B.
    Starrin, B.
    Sense of coherence and psychological well-being: improvement with age2010In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 64, no 4, p. 347-352Article in journal (Refereed)
    Abstract [en]

    Background Psychological well-being is important for individuals, communities and health services throughout the world because of the costs associated with psychological ill-health and the loss of quality of life for those affected and their relatives. Following a salutogenic approach, there is a link between health-promoting resources, such as generalised resistance resources and a positive state of health. Generalised resistance resources have been proposed to relate to an individual's sense of coherence (SOC). The objectives of the present study were (i) to investigate SOC in relation to age and sex, (ii) to investigate psychological wellbeing in relation to age and sex, and (iii) to investigate the relationship between generalised resistance resources and psychological well-being. Methods A random sample of 43 598 respondents (54% female) aged 18-85 years participated in the present study via a postal survey questionnaire. SOC was measured by the SOC-13 and well-being by the General Health Questionnaire-12 questionnaire. Results Males had both stronger SOC and well-being compared to females. There was a relationship between SOC and age, with stronger SOC in the older age groups. There was a larger proportion of individuals who experienced well-being as a function of age. In addition, an increase in SOC was related to a decrease in psychological well-being, that is, a stronger SOC corresponded to higher well-being. Conclusion Males showed a stronger SOC and more well-being than females. Moreover, SOC and well-being increased with age in both sexes. Our findings suggest that SOC may develop over a entire lifetime.

  • 31.
    Ohlsson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Hanning, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Inequity of access to ACE inhibitors in Swedish heart failure patients: a register-based study2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 1, p. 97-103Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Several international studies suggest inequity in access to evidence-based heart failure (HF) care. Specifically, studies of ACE inhibitors (ACEIs) point to reduced ACEI access related to female sex, old age and socioeconomic position. Thus far, most studies have either been rather small, lacking diagnostic data, or lacking the possibility to account for several individual-based sociodemographic factors. Our aim was to investigate differences, which could reflect inequity in access to ACEIs based on sex, age, socioeconomic status or immigration status in Swedish patients with HF.

    METHODS:

    Individually linked register data for all Swedish adults hospitalised for HF in 2005-2010 (n=93,258) were analysed by multivariate regression models to assess the independent risk of female sex, high age, low employment status, low income level, low educational level or foreign country of birth, associated with lack of an ACEI dispensation within 1 year of hospitalisation. Adjustment for possible confounding was made for age, comorbidity, Angiotensin receptor blocker therapy, period and follow-up time.

    RESULTS:

    Analysis revealed an adjusted OR for no ACEI dispensation for women of 1.31 (95% CI 1.27 to 1.35); for the oldest patients of 2.71 (95% CI 2.53 to 2.91); and for unemployed patients of 1.59 (95% CI 1.46 to 1.73).

    CONCLUSIONS:

    Access to ACEI treatment was reduced in women, older patients and unemployed patients. We conclude that access to ACEIs is inequitable among Swedish patients with HF. Future studies should include clinical data, as well as mortality outcomes in different groups.

  • 32.
    Ohlsson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Hanning, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Inequity of access to ACE inhibitors in Swedish heart failure patients: a register-based study2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 1, p. 97-103Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several international studies suggest inequity in access to evidence-based heart failure (HF) care. Specifically, studies of ACE inhibitors (ACEIs) point to reduced ACEI access related to female sex, old age and socioeconomic position. Thus far, most studies have either been rather small, lacking diagnostic data, or lacking the possibility to account for several individual-based sociodemographic factors. Our aim was to investigate differences, which could reflect inequity in access to ACEIs based on sex, age, socioeconomic status or immigration status in Swedish patients with HF.

    METHODS: Individually linked register data for all Swedish adults hospitalised for HF in 2005-2010 (n=93 258) were analysed by multivariate regression models to assess the independent risk of female sex, high age, low employment status, low income level, low educational level or foreign country of birth, associated with lack of an ACEI dispensation within 1 year of hospitalisation. Adjustment for possible confounding was made for age, comorbidity, Angiotensin receptor blocker therapy, period and follow-up time.

    RESULTS: Analysis revealed an adjusted OR for no ACEI dispensation for women of 1.31 (95% CI 1.27 to 1.35); for the oldest patients of 2.71 (95% CI 2.53 to 2.91); and for unemployed patients of 1.59 (95% CI 1.46 to 1.73).

    CONCLUSIONS: Access to ACEI treatment was reduced in women, older patients and unemployed patients. We conclude that access to ACEIs is inequitable among Swedish patients with HF. Future studies should include clinical data, as well as mortality outcomes in different groups.

  • 33. Palmlöf, Lina
    et al.
    Skillgate, Eva
    Alfredsson, Lars
    Vingård, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Magnusson, Cecilia
    Lundberg, Michael
    Holm, Lena W.
    Does income matter for troublesome neck pain?: A population-based study on risk and prognosis2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 11, p. 1063-1070Article in journal (Refereed)
    Abstract [en]

    Background Studies have shown associations between higher income and better health, but income has not been studied in relation to neck pain. The aims of this cohort study were to assess the sex-specific role of disposable income for onset and prognosis of neck pain in the general population and if economic stress influences such potential associations. Methods Two subcohorts were identified in the Stockholm Public Health Cohort with data from 2002. Cohort I (risk cohort) included persons without neck pain (n = 8348). Cohort II (prognostic cohort) included persons with occasional neck pain during the previous 6 months (n =0 523). Both cohorts were assessed for long duration troublesome neck pain (LDNP) in 2007. Individual income was defined as aggregated annual family income in 2002 with each family member assigned a weighted consumption share, based on salary, pensions and social benefits. LDNP in 2007 was defined as having had troublesome neck pain lasting for three or more consecutive months the previous 5 years. Association between income and LDNP, considering potential confounding, was investigated by multivariable logistic regression. Economic stress was tested as effect modifier between income and LDNP. Results In both cohorts, associations were found between lower income and a higher risk for LDNP. The results were similar between the sexes. Economic stress modified the associations in both cohorts. Conclusions Low income may be a risk as well as prognostic factor for developing LDNP. Furthermore, the results indicate that economic stress may be an underlying factor to consider when studying associations between income and neck pain.

  • 34. Patel, Swatee P.
    et al.
    Rodriguez, Alina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Little, Mark P.
    Elliott, Paul
    Pekkanen, Juha
    Hartikainen, Anna-Liisa
    Pouta, Anneli
    Laitinen, Jaana
    Harju, Terttu
    Canoy, Dexter
    Jaervelin, Marjo-Riitta
    Associations between pre-pregnancy obesity and asthma symptoms in adolescents2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 9, p. 809-814Article in journal (Refereed)
    Abstract [en]

    Background The high prevalence of children's asthma symptoms, worldwide, is unexplained. We examined the relation between maternal pre-pregnancy weight and body mass index (BMI), and asthma symptoms in adolescents.

    Methods Data from 6945 adolescents born within the Northern Finland Birth Cohort 1986 were used. Prospective antenatal and birth outcome data, including maternal pre-pregnancy weight and BMI, and asthma symptoms in adolescent offspring at age 15-16 years, were employed. Logistic regression analyses were performed to examine the associations between relevant prenatal factors and asthma symptoms during adolescence.

    Results Current wheeze (within the past year) was reported by 10.6% of adolescents, and physician-diagnosed asthma by 6.0%. High maternal pre-pregnancy BMI was a significant predictor of wheeze in the adolescents (increase per kilogram per square metre unit; 2.7%, 95% CI 0.9 to 4.4 for ever wheeze; 3.5%, 95% CI 1.3 to 5.8 for current wheeze), and adjusting for potential confounders further increased the risk (2.8%, 95% CI 0.5 to 5.1; 4.7%, 95% CI 1.9 to 7.7, respectively). High maternal pre-pregnancy weight, in the top tertile, also significantly increased the odds of current wheeze in the adolescent by 20% (95% CI 4 to 39), and adjusting for potential confounders further increased the risk (OR=1.52, 95% CI 1.19 to 1.95). Results were similar for current asthma. Furthermore, these significant associations were observed only among adolescents without parental history of atopy but not among those with parental history of atopy.

    Conclusions The association demonstrated here between maternal pre-pregnancy overweight and obesity, and asthma symptoms in adolescents suggests that increase in asthma may be partly related to the rapid rise in obesity in recent years.

  • 35. Peter, R
    et al.
    Siegrist, J
    Hallqvist, Johan
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden .
    Reuterwall, C
    Theorell, T
    Psychosocial work environment and myocardial infarction: improving risk estimation by combining two complementary job stress models in the SHEEP Study2002In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 56, no 4, p. 294-300Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Associations between two alternative formulations of job stress derived from the effort-reward imbalance and the job strain model and first non-fatal acute myocardial infarction were studied. Whereas the job strain model concentrates on situational (extrinsic) characteristics the effort-reward imbalance model analyses distinct person (intrinsic) characteristics in addition to situational ones. In view of these conceptual differences the hypothesis was tested that combining information from the two models improves the risk estimation of acute myocardial infarction.

    METHODS: 951 male and female myocardial infarction cases and 1147 referents aged 45-64 years of The Stockholm Heart Epidemiology (SHEEP) case-control study underwent a clinical examination. Information on job stress and health adverse behaviours was derived from standardised questionnaires.

    RESULTS: Multivariate analysis showed moderately increased odds ratios for either model. Yet, with respect to the effort-reward imbalance model gender specific effects were found: in men the extrinsic component contributed to risk estimation, whereas this was the case with the intrinsic component in women. Controlling each job stress model for the other in order to test the independent effect of either approach did not show systematically increased odds ratios. An improved estimation of acute myocardial infarction risk resulted from combining information from the two models by defining groups characterised by simultaneous exposure to effort-reward imbalance and job strain (men: odds ratio 2.02 (95% confidence intervals (CI) 1.34 to 3.07); women odds ratio 2.19 (95% CI 1.11 to 4.28)).

    CONCLUSIONS: Findings show an improved risk estimation of acute myocardial infarction by combining information from the two job stress models under study. Moreover, gender specific effects of the two components of the effort-reward imbalance model were observed.

  • 36.
    Rajan, Gita
    et al.
    Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Stockholm Cty Council, Acad Primary Healthcare Ctr, Stockholm, Sweden..
    Ljunggren, Gunnar
    Stockholm Cty Council, Publ Healthcare Serv Comm Adm, Stockholm, Sweden.;Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Stockholm, Sweden..
    Wändell, Per
    Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Stockholm Cty Council, Acad Primary Healthcare Ctr, Stockholm, Sweden..
    Wahlström, Lars
    Karolinska Inst, Ctr Psychiat Res, Stockholm, Sweden..
    Svedin, Carl-Göran
    Linkoping Univ, Fac Med, Dept Clin & Expt Med, Barnafrid Child & Adolescent Psychiat, Linkoping, Sweden..
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden .
    Diagnoses of sexual abuse and their common registered comorbidities in the total population of Stockholm2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 6, p. 592-598Article in journal (Refereed)
    Abstract [en]

    Background: Prior research based on self-reports has proven sexual abuse to be a risk factor for pain and psychiatric disorders. However, less is known about how this is reflected within the healthcare system. The aim of this study was to study the 2-year prevalence of diagnosis of sexual abuse and concomitant conditions.

    Methods: Using data from VAL, the study population included all living persons in Stockholm County, Sweden, between 1 January 2008 and 31 December 2014 (N=2 549 496). Diagnoses of sexual abuse were identified during 2013-2014, with information on the concomitant conditions somatic pain, depression, anxiety, psychotic disorders and bipolar disorders, stress disorders and alcohol and substance abuse. All diagnoses were prospectively registered. Age and neighbourhood socioeconomic status-adjusted ORs with 95% CIs for individuals with a diagnosis of sexual abuse, using individuals without sexual abuse as referents, were calculated.

    Results: Girls at the ages 13-17 years had the highest 2-year prevalence (0.69%) of sexual abuse followed by girls 5-12 years (0.11%), and girls 0-4 years (0.04%). For women 45 years and older the 2-year prevalence rates were substantially lower (0.008-0.004%). The highest 2-year prevalence of sexual abuse in men was seen in boys 5-12 (0.03%) years. The total 2-year prevalence of diagnoses of sexual abuse among the population in the material was 0.04%. The highest ORs of comorbidities for girls (ages 017 years) with sexual abuse versus those without sexual abuse were: Stress disorder; 15.7 (13.1 to 18.9), drug abuse; 10.0 (7.7 to 13.0), and alcohol abuse; 9.7(7.8 to 12.0). For boys (ages 0-17 years), the highest ORs of comorbidities were: Stress disorder 12.4 (6.0 to 25.7), anxiety disorders; 5.5 (2.6 to 11.5), and alcohol abuse; 3.9 (1.4 to 11.3). The highest ORs of comorbidities for women (18-) with sexual abuse versus those without sexual abuse were: alcohol abuse; 19.3 (12.6 to 29.6), drug abuse; 16.7 (10.7 to 26.1) and psychotic disorders; 15.3 (8.0 to 29.4). For men (18-) the highest ORs of comorbidities were: alcohol abuse; 25.8 (15.2 to 43.9), anxiety disorders; 14.3 (8.5 to 24.2) stress disorder; 12.9 (7.5 to 22.1) and drug abuse; 12.9 (6.9 to 24.1).

    Conclusions: Diagnoses of drug and alcohol abuse, psychotic, bipolar, stress anxiety disorders, depression and somatic pain are more common among individuals with a diagnosis of sexual abuse than among individuals without a diagnosis of sexual abuse.

  • 37. Rasmussen, F
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Life table methods applied to use of medical care and of prescription drugs in early childhood1989In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 43, no 2, p. 140-46Article in journal (Refereed)
    Abstract [en]

    Life table methods were applied to analyses of longitudinal data on the use of medical care during the first 5 years of life among all 1701 children born in a Swedish semirural municipality. Cumulative proportions of the children who had used particular types of medical care or prescription drugs at least once by certain ages were estimated. By the fifth birthday, 98% had made at least one visit to any physician and 82% at least one visit to a paediatrician. By the fifth birthday at least one prescription for antibiotics had been purchased at a pharmacy by 82%; and 33% had been admitted to inpatient hospital care at least once (excluding immediate postnatal care). Acute conditions and more chronic diseases were also studied using these methods. At least one visit to a physician at a primary health care centre had been made for acute otitis media in 65% of 5 year olds and for atopic dermatitis in 8%.

  • 38.
    Richardson, Elizabeth A.
    et al.
    School of GeoSciences, University of Edinburgh.
    Mitchell, Richard
    Public Health and Health Policy Section, University of Glasgow.
    Hartig, Terry
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Institute for Housing and Urban Research.
    de Vries, Sjerp
    Wageningen University, Wageningen .
    Astell-Burt, Thomas
    School of Sciences and Health, University of Western Sydney (UWS).
    Frumkin, Howard
    School of Public Health, University of Washington.
    Green cities and health: A question of scale?2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 2, p. 160-165Article in journal (Refereed)
    Abstract [en]

    Background Cities are expanding and accommodating an increasing proportion of the world's population. It is important to identify features of urban form that promote the health of city dwellers. Access to green space has been associated with health benefits at both individual and neighbourhood level. We investigated whether a relationship between green space coverage and selected mortality rates exists at the city level in the USA.

    Methods An ecological cross-sectional study. A detailed land use data set was used to quantify green space for the largest US cities (n=49, combined population of 43 million). Linear regression models were used to examine the association between city-level ‘greenness’ and city-level standardised rates of mortality from heart disease, diabetes, lung cancer, motor vehicle fatalities and all causes, after adjustment for confounders.

    Results There was no association between greenness and mortality from heart disease, diabetes, lung cancer or automobile accidents. Mortality from all causes was significantly higher in greener cities.

    Conclusions While considerable evidence suggests that access to green space yields health benefits, we found no such evidence at the scale of the American city. In the USA, greener cities tend also to be more sprawling and have higher levels of car dependency. Any benefits that the green space might offer seem easily eclipsed by these other conditions and the lifestyles that accompany them. The result merits further investigation as it has important implications for how we increase green space access in our cities.

  • 39. Ruigomez, A
    et al.
    Garcia Rodriguez, LA
    Hasselgren, G
    Johansson, S
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Overall mortality among patients surviving an episode of peptic ulcer bleeding2000In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 54, p. 130-133Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVE: The authors investigated whether patients who have survived an acute episode of peptic ulcer bleeding (PUB) have an excess long term all cause mortality compared with the general population free of PUB.

    DESIGN: Follow up study of previously identified cohort of patients with a PUB episode and a general population cohort.

    SETTING: The source population included all people aged 30 to 89 years, registered with general practitioners in the United Kingdom.

    PATIENTS: All patients alive one month after the PUB episode constituted the cohort of PUB patients (n = 978). A control group of 5000 people was randomly sampled from the source population. The same eligibility criteria as for patients with PUB were applied to the control series. Also, controls had to be free of PUB before start date.

    MAIN RESULTS: Relative risk of mortality among PUB patients was 2.1, 95% CI: 1.7, 2.6) compared with the general population. This increased mortality risk occurred mainly in the patients less than 60 years old. No difference was observed between men and women. The excess mortality was not only circumscribed to deaths attributable to recurrent gastrointestinal bleed, but also cardiovascular, cancer and other causes.

    CONCLUSIONS: People who have survived an acute episode of PUB have a reduced long term survival compared with the general population. This reduction was stronger among middle age patients than in the elderly.

  • 40.
    Serra-Majem, L
    et al.
    Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain; Community Nutrition Research Centre, Science Park of the University of Barcelona, Barcelona, Spain.
    MacLean, D
    Department of Community Health and Epidemiology, Dalhovile University, Canada.
    Ribas, L
    Community Nutrition Research Centre, Science Park of the University of Barcelona, Barcelona, Spain.
    Brulé, D
    Bureau of Nutritional Sciences, Food Directorate, Ottawa, Canada.
    Sekula, W
    National Food and Nutrition Institute, Warsaw, Poland.
    Prattala, R
    National Public Health Institute, Helsinki, Finland.
    Garcia-Closas, R
    Community Nutrition Research Centre, Science Park of the University of Barcelona, Barcelona, Spain.
    Yngve, Agneta
    Preventive Nutrition Unit, Karolinska Institutet, Sweden.
    Lalonde, M
    Health Promotion and Programs Branch, Health Canada, Ottawa, Canada.
    Petrasovits, A
    Health Promotion and Programs Branch, Health Canada, Ottawa, Canada.
    Comparative analysis of nutrition data from national, household, and individual levels: results from a WHO-CINDI collaborative project in Canada, Finland, Poland, and Spain2003In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 57, no 1, p. 74-80Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVE: This project determined to what extent data on diet and nutrition, which were collected in a non-uniform manner, could be harmonised and pooled for international and national comparison.

    DESIGN: Direct comparisons of dietary data between studies were made using food balance sheets (FBS), household budget surveys (HBS), and individual dietary data (IDS); comparisons were also made within countries. Differences in study design and methodological approaches were taken into consideration. Data from research projects from the following four World Health Organisation (WHO) Countrywide Integrated Noncommunicable Disease Intervention (CINDI) countries were included-Canada, Finland, Poland, and Spain.

    MAIN RESULTS: FBS overestimated food consumption and nutrient intake compared to IDS. Results between HBS and IDS were quite similar, except for fish, meat, pulses and vegetables, which were underestimated by HBS, and sugar and honey and cereals, which were overestimated. Percentages of energy from fat, carbohydrates and proteins were higher when estimated from FBS, HBS, and IDS respectively.

    CONCLUSIONS: Results suggest that estimations from these three sources of dietary data are difficult to compare because they are measuring different levels of dietary information. The understanding of their relations may be important in formulating and evaluating a nutrition policy.

  • 41. Skillgate, Eva
    et al.
    Vingård, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Josephson, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Theorell, Töres
    Alfredsson, Lars
    Life events and the risk of low back and neck/shoulder pain of the kind people are seeking care for: results from the MUSIC-Norrtalje case-control study2007In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 61, no 4, p. 356-361Article in journal (Refereed)
    Abstract [en]

    Objective: To expand the knowledge about the occurrence of life events, and how they affect the risk of low back and neck/shoulder pain. Design: A population-based case-control study. Setting: Men and women 20-59-years old, living in and not working outside the municipality of Norrtalje, Sweden, from November 1993 to November 1997. Participants: Cases (n = 1 148) were defined as all subjects from the study base who sought healthcare for a new episode of low back and/or neck/shoulder pain by any of the care givers in the municipality. Controls (n = 1 700) were selected as a stratified random sample from the study base, considering sex and age. Study subjects were interviewed about life events and critical life changes. Critical life changes were defined as events that brought about a marked psychosocial change. Odds ratios (ORs) associated with different numbers of life events or critical life changes were calculated. Results: Having experienced at least two life events during the preceding 5 years was associated with an increased risk of neck/shoulder pain (OR = 1.6, 95% CI 1.1 to 2.4). At least two critical life changes were associated with an increased risk of neck/shoulder pain (OR = 1.9, 95% CI 1.3 to 2.7). In general, no associations were observed in relation to risk of low back pain. Conclusion: Life events and critical life changes are of importance for the risk of neck/shoulder pain of the kind that people are seeking care for. The study provides useful information for clinical practice and for future aetiological research on neck/shoulder pain.

  • 42. Theorell, Töres
    et al.
    Hammarström, Anne
    Umeå universitet, Allmänmedicin.
    Gustafsson, Per E.
    Umeå universitet, Allmänmedicin.
    Magnusson Hanson, Linda
    Janlert, Urban
    Umeå universitet, Epidemiologi och global hälsa.
    Westerlund, Hugo
    Job strain and depressive symptoms in men and women: a prospective study of the working population in Sweden2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 1, p. 78-82Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several prospective studies have indicated increased risk of developing depressive symptoms in employees who report psychologically demanding and uncontrollable work (job strain). There are diverging findings regarding gender differences in this relationship. The aim was to analyse whether men and women differ with regard to the prospective relationship between adverse psychosocial work environment and depressive symptoms during a 2-year period.

    METHOD: The Swedish Longitudinal Occupational Survey of Health cohort based on representative recruitment of working men and women in Sweden was used. 2731 men and 3446 women had answered questions regarding work environment and mental health in 2008 and 2010. Psychological demands, decision authority, age and income as well as depressive symptoms in 2008 were used as predictors of depressive symptoms in 2010.

    RESULTS: Women reported less decision authority at work and their demand level developed more unfavourably than did men's-resulting in increased job strain gap between men and women from 2008 to 2010. The relationship between demand and decision authority (and job strain) on one hand and depressive symptoms on the other hand was not statistically different in men and women.

    CONCLUSIONS: Overall, women reported higher levels of job strain than men. In Sweden, job strain was as strongly related to depressive symptoms among men as among women.

  • 43.
    Trasande, Leonardo
    et al.
    New York University (NYU) School of Medicine, New York, New York, USA NYU Wagner School of Public Service, New York, New York, USA Department of Nutrition, NYU Steinhardt School of Culture, Education and Human Development, Food & Public Health, New York, New York, USA NYU College of Global Public Health, New York University, New York, New York, USA.
    Lampa, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Lind, P. Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Population attributable risks and costs of diabetogenic chemical exposures in the elderly2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 2, p. 111-114Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A previous analysis examined the contribution of endocrine disruptor exposures (endocrine-disrupting chemicals, EDCs) to adult diabetes, but was limited to effects of phthalates in middle-aged women and did not simultaneously examine multiple EDCs which are known to coexist in the environment. We therefore endeavoured to quantify potential reductions in diabetes and disease costs that could result from reducing synthetic chemical diabetogenic exposures in the elderly in Europe.

    METHODS: We leveraged the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study (∼1000 participants), which has measured exposure to phthalates; dichlorodiphenyltrichloroethylene; polychlorinated biphenyls (PCBs) and perfluoroalkyl substances to examine their independent contribution to diabetes. We estimated risk reductions assuming identical 25% reductions across levels of 4 selected compounds (PCB 153, monoethylphthalate, dichlorodiphenyldichloroethylene and perfluorononanoic acid), and diabetes costs saved in European men and women if diabetogenic exposures are limited.

    RESULTS: Reduction of chemical exposures was associated with a 13% (95% CI 2% to 22%) reduction in prevalent diabetes, compared with 40% resulting from an identical (25%) reduction in body mass index (BMI) in cross-sectional analyses. Extrapolating to Europe, 152 481 cases of diabetes in Europe and €4.51 billion/year in associated costs could be prevented, compared with 469 172 cases prevented by reducing BMI.

    CONCLUSIONS: These findings support regulatory and individual efforts to reduce chemical exposures to reduce the burden and costs of diabetes.

  • 44.
    Trasande, Leonardo
    et al.
    NYU, Sch Med, New York, NY USA.;NYU, Wagner Sch Publ Serv, New York, NY USA.;NYU, Coll Global Publ Hlth, New York, NY USA..
    Lind, P. Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lampa, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Dismissing manufactured uncertainties, limitations and competing interpretations about chemical exposures and diabetes2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 9, p. 942-942Article in journal (Other academic)
  • 45. Tsutsumi, A
    et al.
    Theorell, T
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Reuterwall, C
    de Faire, U
    Association between job characteristics and plasma fibrinogen in a normal working population: a cross sectional analysis in referents of the SHEEP Study. Stockholm Heart Epidemiology Program.1999In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 53, no 6, p. 348-54Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVE: To explore the association between job characteristics and plasma fibrinogen concentrations.

    DESIGN: Cross sectional design.

    SETTING: The Greater Stockholm area.

    SUBJECTS: A total of 1018 men and 490 women aged 45-70 who were randomly selected from the general population during 1992-1994. They were all employed and had no history of myocardial infarction.

    MAIN RESULTS: The self reported job characteristics were measured by a Swedish version of the Karasek demand-control questionnaire. For inferred scoring of job characteristics, psychosocial exposure categories (job control and psychological demands) were assigned by linking each subject's occupational history with a work organisation exposure matrix. Job strain was defined as the ratio between demands and control. In univariate analyses, expected linear trends were found in three of four tests of association between high plasma fibrinogen and low control (the self reported score for women and the inferred score for both sexes), in one of four tests of association between high plasma fibrinogen and high demands (the inferred score for women) and in two of four tests of association between high plasma fibrinogen and job strain (the inferred score for both sexes). Multiple logistic regression analyses showed that men in the inferred job strain group have an increased risk of falling into the increased plasma fibrinogen concentration group (above median level of the distribution) (odds ratio (OR) 1.2; 95% CI 1.0, 1.5) after adjustment for the variables that were associated with plasma fibrinogen in the univariate analyses. In women, low self reported control, high inferred demand, and inferred job strain were significantly associated with increased plasma fibrinogen concentration (OR 1.3; 95% CI 1.0, 1.8, OR 1.5; 95% CI 1.0, 2.2, OR 1.5; 95% CI 1.1, 2.2, respectively).

    CONCLUSIONS: These results indicate that adverse job characteristics may be related to plasma fibrinogen concentrations and this relation is more relevant in female workers. The clearest evidence for psychosocial effects on plasma fibrinogen seems to be with job control and the associations are clearer for the objective than for the self report variables.

  • 46.
    Virtanen, Marianna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Stress Research Institute, Stockholm University, Stockholm, Sweden .
    Magnusson Hanson, Linda
    Stress Research Institute, Stockholm University, Stockholm, Sweden .
    Goldberg, Marcel
    Population-Based Epidemiologic Cohorts Unit, Inserm UMS 011, Villejuif, France; Faculty of Medicine, Paris Descartes University, Paris, France .
    Zins, Marie
    Population-Based Epidemiologic Cohorts Unit, Inserm UMS 011, Villejuif, France; Faculty of Medicine, Paris Descartes University, Paris, France .
    Stenholm, Sari
    Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland .
    Vahtera, Jussi
    Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland .
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden ; Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden .
    Kivimäki, Mika
    Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK .
    Long working hours, anthropometry, lung function, blood pressure and blood-based biomarkers:: cross-sectional findings from the CONSTANCES study2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 2, p. 130-135Article in journal (Refereed)
    Abstract [en]

    Background Although long working hours have been shown to be associated with the onset of cardiometabolic diseases, the clinical risk factor profile associated with long working hours remains unclear. We compared the clinical risk profile between people who worked long hours and those who reported being never exposed to long hours.

    Methods A cross-sectional study in 22 health screening centres in France was based on a random population-based sample of 75 709 participants aged 18–69 at study inception in 2012–2016 (the CONSTANCES study). The data included survey responses on working hours (never, former or current exposure to long working hours), covariates and standardised biomedical examinations including anthropometry, lung function, blood pressure and standard blood-based biomarkers.

    Results Among men, long working hours were associated with higher anthropometric markers (Body Mass Index, waist circumference and waist:hip ratio), adverse lipid levels, higher glucose, creatinine, white blood cells and higher alanine transaminase (adjusted mean differences in the standardised scale between the exposed and unexposed 0.02–0.12). The largest differences were found for Body Mass Index and waist circumference. A dose–response pattern with increasing years of working long hours was found for anthropometric markers, total cholesterol, glucose and gamma-glutamyltransferase. Among women, long working hours were associated with Body Mass Index and white blood cells.

    Conclusion In this study, men who worked long hours had slightly worse cardiometabolic and inflammatory profile than those who did not work long hours, especially with regard to anthropometric markers. In women, the corresponding associations were weak or absent.

  • 47.
    Wennberg, Patrik
    et al.
    Umeå universitet, Allmänmedicin.
    Gustafsson, Per
    Umeå universitet, Allmänmedicin.
    Howard, Bethany
    Wennberg, Maria
    Umeå universitet, Näringsforskning.
    Hammarström, Anne
    Umeå universitet, Allmänmedicin.
    Television viewing over the life course and the metabolic syndrome in mid-adulthood: a longitudinal population-based study2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 10, p. 928-933Article in journal (Refereed)
  • 48. Westerlund, Hugo
    et al.
    Gustafsson, Per E
    Umeå universitet, Allmänmedicin.
    Theorell, Töres
    Janlert, Urban
    Umeå universitet, Epidemiologi och global hälsa.
    Hammarström, Anne
    Umeå universitet, Allmänmedicin.
    Parental academic involvement in adolescence, academic achievement over the life course and allostatic load in middle age: a prospective population-based cohort study2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 6, p. 508-513Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parental involvement in their children's studies, particularly in terms of academic socialisation, has been shown to predict academic achievement, and is thus a candidate modifiable factor influencing life course socioeconomic circumstances. Socioeconomic disadvantage is thought to impact on health over the life course partly by allostatic load, that is, cumulative biological risk. We sought to elucidate the role of parental involvement at age 16 on the life course development of allostatic load.

    METHODS: In a population-based cohort (365 women and 352 men, 67% of the eligible participants), we examined the association between parental involvement in their offspring's studies, measured by teacher and pupil ratings at age 16 and an allostatic load index summarising 12 physiological risk markers at age 43. Mediation through life course academic and occupational achievement was assessed by entering school grades, adult educational achievement and socioeconomic position at age 43 in a linear regression analysis in a stepwise manner and testing for mediation.

    RESULTS: Parental interest in their offspring's studies during the last year of compulsory school-rather than the parent's social class or availability of practical academic support-was found to predict adult allostatic load (β=-0.12, 95% CI -0.20 to -0.05). Further adjustments indicated that academic achievement over the life course mediated a large part of the effect of parental interest on allostatic load.

    CONCLUSIONS: Parental interest in their offspring's studies may have protective effects by decreasing the likelihood of a chain of risk involving low academic achievement, low socioeconomic position and high accumulated physiological stress.

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