uu.seUppsala University Publications
Change search
Refine search result
123 1 - 50 of 145
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1. Abel, K. M.
    et al.
    Heuvelman, H. P.
    Joergensen, L.
    Magnusson, C.
    Wicks, S.
    Susser, E.
    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.
    Dalman, C.
    Severe bereavement stress during the prenatal and childhood periods and risk of psychosis in later life: population based cohort study2014In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 348, p. f7679-Article in journal (Refereed)
    Abstract [en]

    Objective To examine the risk of psychosis associated with severe bereavement stress during the antenatal and postnatal period, between conception to adolescence, and with different causes of death. Design Population based cohort study. Setting Swedish national registers including births between 1973 and 1985 and followed-up to 2006. Participants In a cohort of 1 045 336 Swedish births (1973-85), offspring born to mothers exposed to severe maternal bereavement stress six months before conception or during pregnancy, or exposed to loss of a close family member subsequently from birth to 13 years of age were followed until 2006. Admissions were identified by linkage to national patient registers. Main outcome measures Crude and adjusted odds ratios for all psychosis, non-affective psychosis, and affective psychosis. Results Maternal bereavement stress occurring preconception or during the prenatal period was not associated with a significant excess risk of psychosis in offspring (adjusted odds ratio, preconception 1.24, 95% confidence interval 0.96 to 1.62; first trimester 0.95, 0.58 to1.56; second trimester 0.79, 0.46 to 1.33; third trimester 1.14, 0.78 to 1.66). Risks increased modestly after exposure to the loss of a close family member from birth to adolescence for all psychoses (adjusted odds ratio 1.17, 1.04 to 1.32). The pattern of risk was generally similar for non-affective and affective psychosis. Thus estimates were higher after death in the nuclear compared with extended family but remained non-significant for prenatal exposure; the earlier the exposure to death in the nuclear family occurred in childhood (all psychoses: adjusted odds ratio, birth to 2.9 years 1.84, 1.41 to 2.41; 3-6.9 years 1.47, 1.16 to 1.85; 7-12.9 years 1.32, 1.10 to 1.58) and after suicide. Following suicide, risks were especially higher for affective psychosis (birth to 2.9 years 3.33, 2.00 to 5.56; 6.9 years 1.84, 1.04 to 3.25; 7-12.9 years 2.68, 1.84 to 3.92). Adjustment for key confounders attenuated but did not explain associations with risk. Conclusions Postnatal but not prenatal bereavement stress in mothers is associated with an increased risk of psychosis in offspring. Risks are especially high for affective psychosis after suicide in the nuclear family, an effect that is not explained by family psychiatric history. Future studies are needed to understand possible sources of risk and resilience so that structures can be put in place to support vulnerable children and their families.

  • 2.
    Agardh, E.E
    et al.
    Karolinska Institutet.
    Ahlbom, A
    Andersson, T
    Efendic, S
    Grill, V
    Hallqvist, Johan
    Department of Public Health Science, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
    Östenson, C.G
    Karolinska Institutet.
    Socio-economic position at three points in life in association with type 2 diabetes and impaired glucose tolerance in middle-aged Swedish men and women2007In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 36, no 1, p. 84-92Article in journal (Refereed)
    Abstract [en]

    Background

    It has been suggested that low socio-economic position(SEP) during childhood and adolescence predicts risk of adulttype 2 diabetes. We investigated the associations between type2 diabetes and childhood SEP (fathers’ occupational position),participants’ education and adult SEP (participants’occupational position). To determine possible independent associationsbetween early SEP (fathers’ occupational position andparticipants’ education) and disease, we adjusted foradult SEP and factors present in adult life associated withtype 2 diabetes.

     

    Methods

    This cross-sectional study comprised 3128 men and 4821women aged 35–56 years. All subjects have gone througha health examination and answered a questionnaire on lifestylefactors. At the health centre, an oral glucose tolerance testwas administered and identified 55 men and 52 women with previouslyundiagnosed type 2 diabetes. Relative risks (RRs) with 95% CIswere calculated in multiple logistic regression analyses.

     

    Results

    The age-adjusted RRs of type 2 diabetes if having afather with middle occupational position were 2.3 [Confidenceinterval (CI:1.0–5.1) for women and, 2.0 (CI:0.7–5.6)for men]. Moreover, low education was associated with type 2diabetes in women, RR = 2.5 (CI:1.2–4.9). Low occupationalposition in adulthood was associated with type 2 diabetes inwomen, RR = 2.7 (CI:1.3–5.9) and men, RR = 2.9 (CI:1.5–5.7).The associations between early SEP and type 2 diabetes disappearedafter adjustment for adult SEP and factors associated with type2 diabetes.

     

    Conclusion

    The association between type 2 diabetes and low SEPduring childhood and adolescence in middle-aged Swedish subjectsdisappeared after adjustment for adult SEP and adult risk factorsof diabetes.

  • 3. Agardh, Emilie
    et al.
    Allebeck, 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.
    Moradi, Tahereh
    Sidorchuk, Anna
    Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis2011In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 40, no 3, p. 804-818Article, review/survey (Refereed)
    Abstract [en]

    Background We conducted a systematic review and meta-analysis, the first to our knowledge, summarizing and quantifying the published evidence on associations between type 2 diabetes incidence and socio-economic position (SEP) (measured by educational level, occupation and income) worldwide and when sub-divided into high-, middle- and low-income countries. Methods Relevant case-control and cohort studies published between 1966 and January 2010 were searched in PubMed and EMBASE using the keywords: diabetes vs educational level, occupation or income. All identified citations were screened by one author, and two authors independently evaluated and extracted data from relevant publications. Risk estimates from individual studies were pooled using random-effects models quantifying the associations. Results Out of 5120 citations, 23 studies, including 41 measures of association, were found to be relevant. Compared with high educational level, occupation and income, low levels of these determinants were associated with an overall increased risk of type 2 diabetes; [relative risk (RR) = 1.41, 95% confidence interval (CI): 1.28-1.51], (RR = 1.31, 95% CI: 1.09-1.57) and (RR = 1.40, 95% CI: 1.04-1.88), respectively. The increased risks were independent of the income levels of countries, although based on limited data in middle- and low-income countries. Conclusions The risk of getting type 2 diabetes was associated with low SEP in high-, middle- and low-income countries and overall. The strength of the associations was consistent in high-income countries, whereas there is a strong need for further investigation in middle- and low-income countries.

  • 4. Agardh, Emilie E
    et al.
    Ahlbom, Anders
    Andersson, Tomas
    Efendic, Suad
    Grill, Valdemar
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Norman, Anders
    Ostenson, Claes-Göran
    Work stress and low sense of coherence is associated with type 2 diabetes in middle-aged Swedish women.2003In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 26, no 3, p. 719-24Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The risk of type 2 diabetes is suggested to be increased for individuals exposed to stress. We analyzed the association of work stress by high demands, low decision latitude, and job strain (combination of high demands and low decision latitude) with type 2 diabetes. We also studied low sense of coherence (SOC) (a factor for successful coping with stressors) in association with type 2 diabetes. Finally, we investigated the combination of SOC and demands or SOC and decision latitude in association with the disease.

    RESEARCH DESIGN AND METHODS: This cross-sectional study recruited 4821 healthy Swedish women (aged 35-56 years) residing in five municipalities in the Stockholm area. An oral glucose tolerance test identified 52 women with type 2 diabetes. Relative risks (RRs) with 95% CIs were estimated in a logistic multiple regression analysis.

    RESULTS: No association was found between high demands and type 2 diabetes (RR 1.1 [CI 0.5-2.2]). Low decision latitude was associated with type 2 diabetes with a RR of 2.2 (1.0-4.8). The RR of type 2 diabetes with low SOC was 3.7 (1.2-11.2). The combination of low SOC and low decision latitude was associated with type 2 diabetes with a RR of 2.6 (1.2-5.7). Homeostasis model assessment revealed an association of 4.2 (1.2-15.0) between low SOC and insulin resistance.

    CONCLUSIONS: This study provided new evidence that stress factors such as low decision latitude at work and low SOC were associated with type 2 diabetes in middle-aged Swedish women.

  • 5. Agardh, Emilie E
    et al.
    Ahlbom, Anders
    Andersson, Tomas
    Efendic, Suad
    Grill, Valdemar
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Ostenson, Claes-Göran
    Explanations of socioeconomic differences in excess risk of type 2 diabetes in Swedish men and women.2004In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 27, no 3, p. 716-21Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: We investigated to what extent socioeconomic differences in type 2 diabetes risk could be explained by established risk factors (obesity, physical inactivity, smoking, and heredity) and psychosocial factors (low decision latitude at work and low sense of coherence).

    RESEARCH DESIGN AND METHODS: This cross-sectional study comprised 3,128 healthy Swedish men and 4,821 women, aged 35-56 years, living in the Stockholm area. An oral glucose tolerance test identified 55 men and 52 women with type 2 diabetes. The relative contribution of established and psychosocial factors to socioeconomic differences in diabetes risk was assessed by comparing analyses with adjustment for different sets of these factors.

    RESULTS: The relative risks (RRs) for type 2 diabetes in middle and low socioeconomic groups in men were 2.4 (95% CI 1.0-5.3) and 2.9 (1.5-5.7), respectively, and in women 3.2 (1.5-6.6) and 2.7 (1.3-5.9), respectively. In men, the RRs decreased to 1.9 (0.8-4.4) and 2.1 (1.0-4.2) after adjustment for established risk factors; no further change was found when psychosocial factors were included. In women, the RRs changed to 2.4 (1.1-5.2) and 1.6 (0.7-3.8) by including established risk factors and to 2.3 (1.0-5.1) and 1.9 (0.8-4.3) by inclusion of psychosocial factors. After adjustment for both established and psychosocial factors, the RRs were 1.4 (0.6-3.6) and 1.0 (0.4-2.5), respectively.

    CONCLUSIONS: In men, the excess risk of type 2 diabetes was partly explained by established risk factors (36-42%), whereas psychosocial factors had no effect. In women, most of the socioeconomic differences in type 2 diabetes were explained by simultaneous adjustment for established risk factors and psychosocial factors (81-100%).

  • 6. Agardh, Emilie E
    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.
    Ljung, Rickard
    Peterson, Stefan
    Moradi, Tahereh
    Allebeck, Peter
    Burden of type 2 diabetes attributed to lower educational levels in Sweden2011In: Population Health Metrics, ISSN 1478-7954, E-ISSN 1478-7954, Vol. 9, p. 60-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Type 2 diabetes is associated with low socioeconomic position (SEP) in high-income countries. Despite the important role of SEP in the development of many diseases, no socioeconomic indicator was included in the Comparative Risk Assessment (CRA) module of the Global Burden of Disease study. We therefore aimed to illustrate an example by estimating the burden of type 2 diabetes in Sweden attributed to lower educational levels as a measure of SEP using the methods applied in the CRA.

    METHODS: To include lower educational levels as a risk factor for type 2 diabetes, we pooled relevant international data from a recent systematic review to measure the association between type 2 diabetes incidence and lower educational levels. We also collected data on the distribution of educational levels in the Swedish population using comparable criteria for educational levels as identified in the international literature. Population attributable fractions (PAF) were estimated and applied to the burden of diabetes estimates from the Swedish burden of disease database for men and women in the separate age groups (30-44, 45-59, 60-69, 70-79, and 80+ years).

    RESULTS: The PAF estimates showed that 17.2% of the diabetes burden in men and 20.1% of the burden in women were attributed to lower educational levels in Sweden when combining all age groups. The burden was, however, most pronounced in the older age groups (70-79 and 80+), where lower educational levels contributed to 22.5% to 24.5% of the diabetes burden in men and 27.8% to 32.6% in women.

    CONCLUSIONS: There is a considerable burden of type 2 diabetes attributed to lower educational levels in Sweden, and socioeconomic indicators should be considered to be incorporated in the CRA.

  • 7. Ahlbom, Anders
    et al.
    Alfredsson, Lars
    Andersson, Tomas
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Strömberg, Ulf
    Fler nivåer, färre skillnader: Aktuell analys av sjukhusens vårdresultat kanske ger missvisande bild2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 1-2, p. 9-10Article in journal (Other academic)
  • 8. Ahlbom, Anders
    et al.
    Feychting, Maria
    Gustavsson, Annika
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Johansen, Christoffer
    Kheifets, Leeka
    Olsen, Jörgen H
    Occupational magnetic field exposure and myocardial infarction incidence.2004In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 15, no 4, p. 403-8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Studies on healthy volunteers have seen reduced heart rate variability after exposure to extremely low-frequency electric and magnetic fields (EMF). Because reduced heart rate variability has been linked to cardiovascular disease risk, it has been hypothesized that exposure to EMF might increase the risk of cardiovascular disease. One epidemiologic study has shown increased mortality from cardiovascular conditions in utility workers with elevated exposure to magnetic fields, but several other epidemiologic studies have failed to confirm this result. We tested the hypothesis that occupational EMF exposure increases the risk of myocardial infarction in a large population-based case-control study of myocardial infarction, with detailed information on potential confounders.

    METHODS: We used data from the SHEEP study, which is a population-based case-control study of acute myocardial infarction in Stockholm. Occupational EMF exposure was based on job titles 1, 5, and 10 years before diagnosis. We used 2 approaches to classify exposure: first, specific individual job titles with presumed elevated EMF exposure, and second, classification of subjects according to a job-exposure matrix.

    RESULTS: We found no increased risk of myocardial infarction in subjects classified as having elevated EMF exposure. For the highest exposure category of > or = 0.3 microT according to the job-exposure matrix, the adjusted relative risk was = 0.57 (95% confidence interval = 0.36-0.89).

    CONCLUSIONS: The results of this study do not support the hypothesis that occupational EMF exposure increases the risk of myocardial infarction.

  • 9. Alfredsson, Lars
    et al.
    Hammar, Niklas
    Fransson, Eleonor
    de Faire, Ulf
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Knutsson, Anders
    Nilsson, Tohr
    Theorell, Töres
    Westerholm, Peter
    Job strain and major risk factors for coronary heart disease among employed males and females in a Swedish study on work, lipids and fibrinogen.2002In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 28, no 4, p. 238-48Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to analyze the relationship of job strain (high psychological job demands and low decision latitude) to hypertension, serum lipids, and plasmafibrinogen.

    METHODS: The study population consisted of employed persons between the ages of 15 and 64 years in the counties of Stockholm, Västernorrland, and Jämtland, Sweden. The data collection was carried out during 1992-1998. A total of 10,382 subjects participated in a medical examination and completed a questionnaire.

    RESULTS: No strong associations were found between job strain and plasma fibrinogen. The males reporting job strain had lower levels of total cholesterol and high-density lipoprotein cholesterol than the other males. Similar tendencies were found for the females. The females, but not the males, with job strain had an increased prevalence of hypertension when compared with the subjects with relaxed psychosocial work characteristics. In the subgroups of younger males and females an adverse association between job strain and the ratio between low-density and high-density lipoprotein cholesterol was noted.

    CONCLUSIONS: The results do not support the hypothesis that job strain has an adverse impact on serum total cholesterol and plasma fibrinogen levels. They suggest that an increased risk of coronary heart disease in association with job strain, if causal, is mediated by other factors, possibly partly by hypertension and low levels of high-density lipoprotein cholesterol.

  • 10.
    Bean, Christopher
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. School of Psychology, University of Adelaide, Australia.
    Pingel, Ronnie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    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.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    A 4-way decomposition analysis of poor social relations and depressive symptoms over the life-course2017In: European Journal of Public Health, Volume 27, Issue Suppl 3, 2017Conference paper (Refereed)
  • 11.
    Bean, Christopher
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Westerlund, Hugo
    Stockholm University.
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    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. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Group activity participation at age 21 and depressive symptoms during boom and recession in Sweden: a 20-year follow-up2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360XArticle in journal (Refereed)
    Abstract [en]

    Background: Organized group activities (e.g. sports or arts clubs) have long been noted as important developmental settings for youth, yet previous studies on the relationships between participation and mental health outcomes have focused on short-term effects among school-aged adolescents. The subsequent period of life, emerging adulthood, has been largely overlooked despite being another important life stage where individuals face new existential challenges and may benefit from group activity participation. The potential for macroeconomic conditions to modify these relationships has also not been considered.

    Methods: Participants (n = 1654) comprise two cohorts, born in either 1965 (n = 968) or 1973 (n = 686), from the same middle-sized industrial town in Northern Sweden. Both cohorts completed detailed questionnaires at age 21 (macroeconomic boom for Cohort 65, recession for Cohort 73) and approximately 20 years follow-up (age 43 for Cohort 65, age 39 for Cohort 73). General linear models were used to assess concurrent and prospective associations between regular group activity participation and depressive symptoms, as well as the potential interaction with boom/recession.

    Results: After controlling for sociodemographic factors, regular group activity participation at age 21 was associated with lower depressive symptoms, both concurrently and at follow-up. Those exposed to recession at age 21 reported higher depressive symptoms at the time but there was no interaction between cohort (boom/recession) and group activity participation.

    Conclusions: Regular group activity participation during emerging adulthood is associated with lower depressive symptoms uniformly in times of boom and recession. Beneficial effects of such participation may contribute to better mental health over 20 years.

  • 12.
    Bennet, A. M.
    et al.
    Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm.
    Van Maarle, M.
    Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm.
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Preventive Medicine.
    Morgenstern, R.
    Unit of Biochemical Toxicology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Frostegård, J.
    Wiman, B.
    Division of Coagulation Research, Karolinska University Hospital, Stockholm, Sweden.
    Prince, J. A.
    de Faire, U.
    Association of TNF-α serum levels and TNFA promoter polymorohisms with risk of myocardial infarction2006In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 187, no 2, p. 408-414Article in journal (Refereed)
    Abstract [en]

    Elevated levels of tumor necrosis factor-alpha (TNF-α), and presence of polymorphisms of the TNFA gene have been implicated in cardiovascular disease pathogenesis. We explored the relationship between polymorphisms in the TNFA gene (−1031C/T, −863C/A −857T/C, −308G/A, −238G/A), protein levels of TNF-α and their association to myocardial infarction (MI) using a sample of 1213 post-MI patients and 1561 healthy controls. MI risk was higher among men with elevated TNF-α levels, with the highest compared to the lowest TNF-α quartile giving a 70% risk increase (OR [95% CI]: 1.7 [1.1; 2.6]). Obese subjects who also had elevated TNF-α levels were at even higher risk for MI (OR [95% CI]: 3.4 [2.1; 5.6]). Higher TNF-α levels were seen among smokers (but not among non-smokers) carrying the −857T allele. Furthermore, a rare haplotype occurred more frequently among the cases than the controls. Elevated TNF-α levels are associated with increased MI risk. Obese subjects with elevated TNF-a levels, and carriers of polymorphisms in or near TNFA are particularly susceptible to the hazards of smoking, results which may have implications for cardiovascular preventive measures.

  • 13. Bennet, Anna M
    et al.
    Brismar, Kerstin
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Reuterwall, Christina
    De Faire, Ulf
    The risk of myocardial infarction is enhanced by a synergistic interaction between serum insulin and smoking.2002In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 147, no 5, p. 641-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the relationship between levels of serum insulin, the homeostasis model assessment (HOMA) and IGF-binding protein-1 (IGFBP-1) as factors related to myocardial infarction (MI) risk, and their interaction with lifestyle-related risk factors.

    DESIGN: The Stockholm epidemiology programme (SHEEP), a case-control study, consisting of 749 first-time MI cases (510 men, 239 women) and 1101 healthy controls (705 men, 396 women) was used.

    METHODS: The risk of developing MI was assessed by calculating odds ratios (OR) and synergistic interactions (SI) between serum insulin, IGFBP-1, HOMA and other variables related to MI risk (including smoking) in men and women.

    RESULTS: Subjects with elevated levels of insulin and HOMA (>75th percentile) had increased MI risks when compared with individuals with low levels. ORs for elevated insulin and HOMA (adjusted for age and residential area) for men: insulin 1.6 (95% confidence interval (CI) 1.3-2.1) and HOMA 1.5 (95% CI 1.1-1.9) and for women: insulin 2.1 (95% CI 1.5-2.9) and HOMA 1.9 (95% CI 1.3-2.8). Women with low levels of IGFBP-1 (<10th percentile) showed a tendency towards elevated MI risk even if this was not statistically significant (OR 1.5 (95% CI 0.9-2.6)). Smokers with high levels of serum insulin had greatly increased MI risk (OR for men: 4.7 (95% CI 3.0-7.2) and OR for women: 8.1 (95% CI 4.5-14.8)). SI scores based upon these interactions were statistically significant.

    CONCLUSIONS: These results might have preventive cardiovascular implications as they clearly suggest that subjects with insulin resistance are particularly susceptible to the hazards of smoking.

  • 14. Berglind, Niklas
    et al.
    Ljungman, Petter
    Möller, Jette
    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.
    Nyberg, Fredrik
    Rosenqvist, Mårten
    Pershagen, Göran
    Bellander, Tom
    Air Pollution Exposure: A Trigger for Myocardial Infarction?2010In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 7, no 4, p. 1486-1499Article in journal (Refereed)
    Abstract [en]

    The association between ambient air pollution exposure and hospitalization for cardiovascular events has been reported in several studies with conflicting results. A case-crossover design was used to investigate the effects of air pollution in 660 first-time myocardial infarction cases in Stockholm in 1993-1994, interviewed shortly after diagnosis using a standard protocol. Air pollution data came from central urban background monitors. No associations were observed between the risk for onset of myocardial infarction and two-hour or 24-hour air pollution exposure. No evidence of susceptible subgroups was found. This study provides no support that moderately elevated air pollution levels trigger first-time myocardial infarction.

  • 15. Bigert, C
    et al.
    Klerdal, K
    Hammar, N
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Gustavsson, P
    Time trends in the incidence of myocardial infarction among professional drivers in Stockholm 1977-96.2004In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 61, no 12, p. 987-91Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate time trends in the incidence of first myocardial infarction (MI) among bus, taxi, and lorry drivers in Stockholm.

    METHODS: In this population based case-control study, all first events of acute MI among men aged 40-69 in Stockholm County 1977-96 were identified using registers of hospital discharges and deaths. Controls were selected randomly from the general population. National censuses were used for information on occupational titles. A total of 20,364 cases and 136,342 controls were included in the study. Among these, 1183 cases and 6072 controls had worked as drivers.

    RESULTS: During 1977-84 the MI incidence was higher in all three driver groups than among other manual workers. There was a decline in MI incidence among drivers as well as in the general population during the study period. The decline was greater among drivers than among other manual workers. During 1985-96 the relative risk remained increased compared to other manual workers among taxi and lorry drivers, but not among bus drivers.

    CONCLUSIONS: Despite a reduced MI incidence for professional drivers in recent years, preventive measures to reduce the risk of MI in these occupational groups, and in particular among taxi and lorry drivers, continue to be of importance.

  • 16. Bigert, Carolina
    et al.
    Gustavsson, Per
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Hogstedt, Christer
    Lewné, Marie
    Plato, Nils
    Reuterwall, Christina
    Schéele, Patrik
    Myocardial infarction among professional drivers.2003In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 14, no 3, p. 333-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Professional drivers are at an increased risk of myocardial infarction but the underlying causes for this increased risk are uncertain.

    METHODS: We identified all first events of myocardial infarction among men age 45-70 years in Stockholm County for 1992 and 1993. We selected controls randomly from the population. Response rates of 72% and 71% resulted in 1067 cases and 1482 controls, respectively. We obtained exposure information from questionnaires. We calculated odds ratios (ORs), with and without adjustment for socioeconomic status, tobacco smoking, alcohol drinking, physical inactivity at leisure time, overweight status, diabetes and hypertension.

    RESULTS: The crude OR among bus drivers was 2.14 (95% confidence interval = 1.34-3.41), among taxi drivers 1.88 (1.19-2.98) and among truck drivers 1.66 (1.22-2.26). Adjustment for potential confounders gave lower ORs: 1.49 (0.90-2.45), 1.34 (0.82-2.19) and 1.10 (0.79-1.53), respectively. Additional adjustment for job strain lowered the ORs only slightly. An exposure-response pattern (by duration of work) was found for bus and taxi drivers.

    CONCLUSIONS: The high risk among bus and taxi drivers was partly explained by unfavorable life-style factors and social factors. The work environment may contribute to their increased risk. Among truck drivers, individual risk factors seemed to explain most of the elevated risk.

  • 17. Bjorkenstam, Charlotte
    et al.
    Moller, Jette
    Ringback, Gunilla
    Salmi, 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
    An Association between Initiation of Selective Serotonin Reuptake Inhibitors and Suicide - A Nationwide Register-Based Case-Crossover Study2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 9, p. e73973-Article in journal (Refereed)
    Abstract [en]

    Background: Treatment with selective serotonin reuptake inhibitors (SSRI) is one of the most common treatments for depression. It is however not clear whether or not there is an increased short-term suicide risk during initiation with SSRI. Methods: A register-based nationwide case-crossover study including 5,866 suicides, 1,698 women and 4,168 men, from the Death Register 2007-2010 in Sweden. SSRI initiation was defined as a dispensed prescription of SSRI within 28 days prior to the date of suicide with no previous dispensed prescription of SSRI within 4 months prior that prescription. The control period took place one year earlier. Odds ratio (OR) was estimated using conditional logistic regression. Result: During the 28 day period prior to suicide 48 women and 138 men were exposed to SSRI initiation (while not being exposed in the control period) and 22 women and 43 men were exposed in the control period (while not being exposed in the case period). The OR for suicide after initiation with SSRI was 2.7 (95% CI: 1.6-44) for women, and 4.3 (95% CI: 3.0-6.1) for men. The highest OR was found 8-11 days after initiation with SSRI 9.7 (95% CI: 3.0-31.7) for women and men combined. Conclusion: The main limitation in this study is confounding by indication, but the descriptive question is however not confounded by indication. Together with plausible biological mechanisms and previous clinical and epidemiological observations our findings, linking initiation of SSRI to increased short-term suicide risk, deserve further attention specifically in the clinical setting.

  • 18. Bjorkenstam, Emma
    et al.
    Bjorkenstam, Charlotte
    Vinnerljung, Bo
    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
    Juvenile delinquency, social background and suicide-a Swedish national cohort study of 992 881 young adults2011In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 40, no 6, p. 1585-1592Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As the suicide rates in young adults do not show a clear decline, it is important to elucidate possible risk factors. Juvenile delinquency has been pointed out as a possible risk behaviour.

    METHODS: This register-based cohort study comprises the birth cohorts between 1972 and 1981 in Sweden. We followed 992,881 individuals from the age of 20 years until 31 December 2006, generating 10 210 566 person-years and 1482 suicides. Juvenile delinquency was defined as being convicted of a crime between the ages of 15 and 19 years. Estimates of risk of suicide were calculated as incidence rate ratio (IRR) with 95% confidence intervals (CIs) using Poisson regression analysis with adjustment for potential confounding by their own and their parents' mental illness or substance abuse, parental education, single parenthood, social assistance, adoption and foster care.

    RESULTS: Among females, 5.9%, and among males, 17.9%, had at least one conviction between the ages 15 and 19 years. In the fully adjusted model, females with one conviction had a suicide risk of 1.7 times higher (95% CI 1.2-2.4), the corresponding IRR for men was 2.0 (95% CI 1.7-2.4) and 5.7 (95% CI 2.5-13.1) and 6.6 (95% CI 5.2-8.3), for women and men with five or more convictions. The effect of severe delinquency on suicide was independent of parental educational level.

    CONCLUSIONS: This study supports the hypothesis that individuals with delinquent behaviour in late adolescence have an increased risk of suicide as young adults. Regardless of causality issues, repeated juvenile offenders should be regarded by professionals in health, social and correctional services who come into contact with this group as a high-risk group for suicide.

  • 19. Björkenstam, Charlotte
    et al.
    Johansson, Lars Age
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Nordström, Peter
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Fugelstad, 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.
    Ljung, Rickard
    Suicide or undetermined intent?: A register-based study of signs of misclassification2014In: Population Health Metrics, ISSN 1478-7954, E-ISSN 1478-7954, Vol. 12, article id 11Article in journal (Refereed)
    Abstract [en]

    Background: Several studies have concluded that some deaths classified as undetermined intent are in fact suicides, and it is common in suicide research in Europe to include these deaths. Our aim was to investigate if information on background variables would be helpful in assessing if deaths classified as undetermined intent should be included in the analyses of suicides. Methods: We performed a register study of 31,883 deaths classified as suicides and 9,196 deaths classified as undetermined intent in Sweden from 1987 to 2011. We compared suicide deaths with deaths classified as undetermined intent with regard to different background variables such as sex, age, country of birth, marital status, prior inpatient care for self-inflicted harm, alcohol and drug abuse, psychiatric inpatient care, and use of psychotropics. We also performed a multivariate analysis with logistic regression. Results: Our results showed differences in most studied background factors. Higher education was more common in suicides; hospitalization for self-inflicted harm was more common among female suicides as was prior psychiatric inpatient care. Deaths in foreign-born men were classified as undetermined intent in a higher degree and hospitalization for substance abuse was more common in undetermined intents of both sexes. Roughly 50% of both suicide and deaths classified as undetermined intent had a filled prescription of psychotropics during their last six months. Our multivariate analysis showed male deaths to more likely be classified as suicide than female: OR: 1.13 (1.07-1.18). The probability of a death being classified as suicide was also increased for individuals aged 15-24, being born in Sweden, individuals who were married, and for deaths after 1987-1992. Conclusion: By analyzing Sweden's unique high-validity population-based register data, we found several differences in background variables between deaths classified as suicide and deaths classified as undetermined intent. However, we were not able to clearly distinguish these two death manners. For future research we suggest, separate analyses of the two different manners of death.

  • 20. 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.

  • 21. Björkenstam, E.
    et al.
    Hjern, A.
    Mittendorfer-Rutz, E.
    Vinnerljung, B.
    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, R.
    Multi-Exposure and Clustering of Adverse Childhood Experiences, Socioeconomic Differences and Psychotropic Medication in Young Adults2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 1, p. e53551-Article in journal (Refereed)
    Abstract [en]

    Purpose: Stressful childhood experiences have negative long-term health consequences. The present study examines the association between adverse childhood experiences, socioeconomic position, and risk of psychotropic medication in young adulthood. Methods: This register-based cohort study comprises the birth cohorts between 1985 and 1988 in Sweden. We followed 362 663 individuals for use of psychotropic medication from January 2006 until December 2008. Adverse childhood experiences were severe criminality among parents, parental alcohol or drug abuse, social assistance recipiency, parental separation or single household, child welfare intervention before the age of 12, mentally ill or suicidal parents, familial death, and number of changes in place of residency. Estimates of risk of psychotropic medication were calculated as odds ratio (OR) with 95% confidence intervals (CIs) using logistic regression analysis. Results: Adverse childhood experiences were associated with increased risks of psychotropic medication. The OR for more than three adverse childhood experiences and risk of psychotropic medication was for women 2.4 (95% CI 2.3-2.5) and for men 3.1 (95% CI 2.9-3.2). The risk of psychotropic medication increased with a higher rate of adverse childhood experiences, a relationship similar in all socioeconomic groups. Conclusions: Accumulation of adverse childhood experiences increases the risk of psychotropic medication in young adults. Parental educational level is of less importance when adjusting for adverse childhood experiences. The higher risk for future mental health problems among children from lower socioeconomic groups, compared to peers from more advantaged backgrounds, seems to be linked to a higher rate of exposure to adverse childhood experiences.

  • 22. Björkenstam, Emma
    et al.
    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.
    Dalman, Christina
    Ljung, Rickard
    Risk of new psychiatric episodes in the year following divorce in midlife: Cause or selection? A nationwide registerbased study of 703,960 individuals2013In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 59, no 8, p. 801-804Article in journal (Refereed)
    Abstract [en]

    Aims: To examine if divorce is associated with an increased risk of psychiatric disorder. Methods: A register-based cohort study of all married or divorced individuals aged 45-54 in Sweden in 2006. After exclusion of 129,669 individuals with a history of psychiatric care in 1987-2005, we followed 703,960 persons for psychiatric disorder during 2007, measured as psychiatric inpatient care, outpatient care and use of psychotropic medication. Marital trajectories were taken into consideration. Data were analysed using Poisson regression. Results: Divorced women and men had a higher risk for psychiatric inpatient care compared to married (ORwomen = 3.2, 95%CI = 1.6-6.3, ORmen = 3.3, 95%CI = 2.0-5.4). The longer the marriage, the lower the risk for psychiatric disorders. Lower educational level increased the risk for psychiatric inpatient care. Conclusions: In conclusion, our study supports both the selection hypothesis, linking healthy individuals to long and stable marriages, and the social causation hypothesis, linking the stress of recent divorce to increased psychiatric disorder for both women and men.

  • 23. Björkenstam, Emma
    et al.
    Ljung, Rickard
    Burström, Bo
    Mittendorfer-Rutz, Ellenor
    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.
    Weitoft, Gunilla Ringbäck
    Quality of medical care and excess mortality in psychiatric patients: a nationwide register-based study in Sweden2012In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 1, p. e000778-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess overall and cause-specific mortality and the quality of somatic care among psychiatric patients.

    DESIGN: A register-based cohort study.

    SETTING: All individuals aged 20-79 years in Sweden in 2005.

    PARTICIPANTS: In total 6 294 339 individuals.

    PRIMARY OUTCOME MEASURE: The individuals were followed for mortality in 2006 and 2007, generating 72 187 deaths. Psychiatric patients were grouped according to their diagnosis in the National Patient Register. Mortality risk of psychiatric patients was compared with that of non-psychiatric patients. Estimates of RR of mortality were calculated as incidence rate ratios (IRRs) with 95% CIs using Poisson regression analysis. Psychiatric patients were compared with non-psychiatric patients for three healthcare quality indicators: the proportion of avoidable hospitalisations, case death rate after myocardial infarction and statin use among diabetic patients.

    RESULTS: Compared with individuals with no episodes of treatment for mental disorder, psychiatric patients had a substantially increased risk of all studied causes of death as well as death from conditions considered amenable to intervention by the health service, that is, avoidable mortality. The highest mortality was found among those with another mental disorder, predominantly substance abuse (for women, an IRR of 4.7 (95% CI 4.3 to 5.0) and for men, an IRR of 4.8 (95% CI 4.6 to 5.0)). The analysis of quality of somatic care revealed lower levels of healthcare quality for psychiatric patients, signalling failures in public health and medical care.

    CONCLUSION: This study shows a marked increase in excess mortality, suggesting a lower quality of somatic healthcare in psychiatric patients.

  • 24. Bohman, Tony
    et al.
    Alfredsson, Lars
    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.
    Vingård, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Skillgate, Eva
    The influence of self-reported leisure time physical activity and the body mass index on recovery from persistent back pain among men and women: a population-based cohort study2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. 385-Article in journal (Refereed)
    Abstract [en]

    Background: There is limited knowledge about leisure time physical activity and the body mass index (BMI) as prognostic factors for recovery from persistent back pain. The aim of this study was to assess the influence of leisure time physical activity and BMI on recovery from persistent back pain among men and women in a general population. Methods: The study population (n=1836) in this longitudinal cohort study consisted of participants reporting persistent back pain in the baseline questionnaire in 2002-2003. Data on leisure time physical activity, BMI and potential confounders were also collected at baseline. Information on recovery from persistent back pain (no back pain periods >= 7 days during the last 5 years) was obtained from the follow-up questionnaire in 2007. Log-binomial models were applied to calculate Risk Ratios with 95 percent Confidence Intervals (CI) comparing physically active and normal weight groups versus sedentary and overweight groups. Results: Compared to a sedentary leisure time, all measured levels of leisure time physical activity were associated with a greater chance of recovery from persistent back pain among women. The adjusted Risk Ratios was 1.46 (95% CI: 1.06, 2.01) for low leisure time physical activity, 1.51 (95% CI: 1.02, 2.23) for moderate leisure time physical activity, and 1.67 (95% CI: 1.08, 2.58) for high leisure time physical activity. There were no indications that leisure time physical activity influenced recovery among men, or that BMI was associated with recovery from persistent back pain either among men or among women. Conclusions: Regular leisure time physical activity seems to improve recovery from persistent back pain among women.

  • 25. Bohman, Tony
    et al.
    Alfredsson, Lars
    Jensen, Irene
    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.
    Vingård, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Skillgate, Eva
    Does a healthy lifestyle behaviour influence the prognosis of low back pain among men and women in a general population? A population-based cohort study2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 12, article id e005713Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To study the influence of healthy lifestyle behaviour on the prognosis of occasional low back pain among men and women in a general population.

    DESIGN:

    Cohort study with a 4-year follow-up.

    SETTINGS:

    General population in Stockholm County, Sweden.

    PARTICIPANTS:

    The study sample comprised 3938 men and 5056 women aged 18-84 from the Stockholm Public Health Cohort reporting occasional low back pain in the baseline questionnaire 2006.

    MEASURES:

    Lifestyle factors and potential confounders were assessed at baseline. The lifestyle factors smoking habits, alcohol consumption, leisure physical activity and consumption of fruit and vegetables were dichotomised using recommendations for a health-enhancing lifestyle and combined to form the exposure variable 'healthy lifestyle behaviour'. The exposure was categorised into five levels according to the number of healthy lifestyle factors met. The follow-up questionnaire in 2010 gave information about the outcome, long duration troublesome low back pain. Crude and adjusted binomial regression models were applied to estimate the association between the exposure and the outcome analysing men and women separately.

    RESULTS:

    The risk of developing long duration troublesome low back pain among women with occasional low back pain decreased with increasing healthy lifestyle behaviour (trend test: p=0.006). 21% (28/131) among women with no healthy lifestyle factor (reference) experienced the outcome compared to 9% (36/420) among women with all four factors. Compared to the reference group, the risk was reduced by 35% (RR 0.65, 95% CI 0.44 to 0.96) for women with one healthy lifestyle factor and 52% (RR 0.48, 95% CI 0.31 to 0.77) for women with all four healthy lifestyle factors. There were no clear associations found among men.

    CONCLUSIONS:

    Healthy lifestyle behaviour seems to decrease the risk of developing long duration troublesome low back pain among women with occasional low back pain and may be recommended to improve the prognosis.

  • 26. Boström, G
    et al.
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Haglund, B J
    Romelsjö, A
    Svanström, L
    Diderichsen, F
    Socioeconomic differences in smoking in an urban Swedish population. The bias introduced by non-participation in a mailed questionnaire.1993In: Scandinavian journal of social medicine, ISSN 0300-8037, Vol. 21, no 2, p. 77-82Article in journal (Refereed)
    Abstract [en]

    Stockholm Health of the Population Study is a cross-sectional study carried out from 1984-85. Postal questionnaires, telephone interviews and health interviews were used to get information from a sample of 5,199 persons, 18-64 years of age, on health status, risk exposures, healthcare consumption and social factors. Non-participation with respect to the postal questionnaire was 36.8%. With subsequent telephone interviews and an invitation to a health interview, non-participation was reduced to 17.8%. The estimated prevalence of daily smoking increased from 36.1% to 38.7. The non-responders had a higher prevalence of daily smoking in all sub-groups. This effect of the efforts to reduce non-participation differed socially. The prevalence of smoking for men, 40-64 years of age, who were reached by telephone was 60.3%. Male professionals and intermediate non-manual workers, 40-64 years of age reached by telephone had a prevalence of smoking, which was twice as high as for the responders of the questionnaire (62.5 and 26.8%, respectively). In the younger age-group, non-responders had the same socioeconomic pattern in smoking as the responders. Independent of socioeconomic group, there was a tendency of ill or disabled smokers to respond more quickly than healthy smokers. Using a postal questionnaire with a high non-response rate might lead to an overestimation of socioeconomic differences and an underestimation of smoking prevalence.

  • 27.
    Carlsson, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Englund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    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.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Early multidisciplinary assessment was associated with longer periods of sick leave: A randomized controlled trial in a primary health care centre2013In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, no 3, p. 141-146Article in journal (Refereed)
    Abstract [en]

    Objective

    To study the effects on sick leave from an early multidisciplinary assessment at a primary health care centre. Design. Randomized controlled trial.

    Setting

    Patients who saw GPs at a primary health care centre in mid-Sweden and asked for a sickness certificate for psychiatric or musculoskeletal diagnoses were invited to participate. Patients included were sick-listed for less than four weeks; 33 patients were randomized either to an assessment within a week by a physiotherapist, a psychotherapist, and an occupational therapist or to "standard care". The therapists used methods and tools they normally use in their clinical work.

    Main outcome measure

    Proportion of patients still sick-listed three months after randomization, total and net days on sick leave, and proportion who were on part-time sick leave.

    Results

    At follow-up after three months, in contrast to the pre-trial hypothesis, there was a trend toward a higher proportion of patients still sick-listed in the intervention group (7/18) as compared with the control group (3/15). The intervention group also had significantly longer sick-listing periods (mean 58 days) than the control group (mean 36 days) (p = 0.038). The proportion of patients who were part time sick-listed was significantly higher in the intervention group (10/18) than in the control group (2/15) (p = 0.027).

    Conclusions

    In this study an early multidisciplinary assessment was associated with longer periods on sick leave and more individuals on part-time sick leave.

  • 28.
    Carlsson, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    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.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Gustavsson, Catharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Motivation for return to work and actual return to work among people on long-term sick leave due to pain syndrome or mental health conditionsManuscript (preprint) (Other academic)
  • 29. Carrasquilla, Germán D
    et al.
    Berglund, Anita
    Gigante, Bruna
    Landgren, Britt-Marie
    de Faire, Ulf
    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.
    Leander, Karin
    Does menopausal hormone therapy reduce myocardial infarction risk if initiated early after menopause?: A population-based case-control study2014In: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 22, no 6, p. 598-606Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study aims to assess whether the timing of menopausal hormone therapy initiation in relation to onset of menopause and hormone therapy duration is associated with myocardial infarction risk.

    METHODS: This study was based on the Stockholm Heart Epidemiology Program, a population-based case-control study including 347 postmenopausal women who had experienced a nonfatal myocardial infarction and 499 female control individuals matched for age and residential area. Odds ratios (with 95% CIs) for myocardial infarction were calculated using logistic regression.

    RESULTS: Early initiation of hormone therapy (within 10 y of onset of menopause or before age 60 y), compared with never use, was associated with an odds ratio of 0.87 (95% CI, 0.58-1.30) after adjustments for lifestyle factors, body mass index, and socioeconomic status. For late initiation of hormone therapy, the corresponding odds ratio was 0.97 (95% CI, 0.53-1.76). For hormone therapy duration of 5 years or more, compared with never use, the adjusted odds ratio was 0.64 (95% CI, 0.35-1.18). For hormone therapy duration of less than 5 years, the odds ratio was 0.97 (95% CI, 0.63-1.48).

    CONCLUSIONS: Neither the timing of hormone therapy initiation nor the duration of therapy is significantly associated with myocardial infarction risk.

  • 30. Clark, Alice
    et al.
    Lange, Theis
    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.
    Jennum, Poul
    Rod, Naja Hulvej
    Sleep Impairment and Prognosis of Acute Myocardial Infarction: A Prospective Cohort Study2014In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 37, no 5, p. 851-U215Article in journal (Refereed)
    Abstract [en]

    Study Objectives: Impaired sleep is an established risk factor for the development of cardiovascular disease, whereas less is known about how impaired sleep affects cardiovascular prognosis. The aim of this study is to determine how different aspects of impaired sleep affect the risk of case fatality and subsequent cardiovascular events following first-time acute myocardial infarction (AMI). Design: Prospective cohort study. Setting: The Stockholm Heart Epidemiology Program, Sweden. Participants: There were 2,246 first-time AMI cases. Measurements and Results: Sleep impairment was assessed by the Karolina Sleep Questionnaire, which covers various indices of impaired sleep: disturbed sleep, impaired awakening, daytime sleepiness, and nightmares. Case fatality, defined as death within 28 days of initial AMI, and new cardiovascular events within up to 10 y of follow-up were identified through national registries. In women, disturbed sleep showed a consistently higher risk of long-term cardiovascular events: AMI (hazard ratio [HR] = 1.69; 95% confidence interval [CI] 0.95-3.00), stroke (HR = 2.61; 95% CI: 1.19-5.76), and heart failure (HR = 2.43; 95% CI: 1.18-4.97), whereas no clear effect of impaired sleep on case fatality was found in women. In men, a strong effect on case fatality (odds ratio = 3.27; 95% CI: 1.76-6.06) was observed in regard to impaired awakening; however, no consistent effect of impaired sleep was seen on long-term cardiovascular prognosis. Conclusion: Results suggest sex-specific effects of impaired sleep that differ by short-and long-term prognosis. Sleep complaints are frequent, easily recognizable, and potentially manageable. Evaluation of sleep complaints may, even if they represent prognostic markers rather than risk factors, provide additional information in clinical risk assessment that could benefit secondary cardiovascular prevention.

  • 31. Diderichsen, F
    et al.
    Allebeck, P
    Bexell, A
    Hammarström, A
    Hansson, B S
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Janlert, U
    Lynöe, N
    Sandlund, M
    Westerling, R
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    [The challenges of social medicine: improved public health and effective health policy demand strong and unified social medicine].1990In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 87, no 1-2, p. 48-9Article in journal (Refereed)
  • 32. Diderichsen, F
    et al.
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Trends in occupational mortality among middle-aged men in Sweden 1961-1990.1997In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 26, no 4, p. 782-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Many European countries have in recent decades reported growing socioeconomic differentials in mortality. While these trends have usually paralleled high unemployment and increasing income disparities, Sweden had low unemployment and narrowing income differences. This study describes trends, 1961-1990, in total and cardiovascular mortality among men, 45-69 years of age, in major occupational classes in Sweden.

    METHODS: From census data four cohorts were created from those enumerated in 1960, 1970, 1980 and 1985. Through record linkage with the Swedish cause of death registry the mortality in each cohort was followed for 5-10 years. Age-standardized mortality trends 1961-1990 were calculated for occupational groups, categorized according to sector of the economy.

    RESULTS: The increase in mortality among middle-aged men in Sweden 1965-1980 was mainly a result of increasing cardiovascular mortality among industrial workers and farmers. In the 1980s the trend for these groups changed into a last decrease in mortality similar to that for non-manual occupations for the whole period. Consequently the rate ratio for industrial workers in comparison with men having a professional/managerial type of occupation increased from 0.98 to 1.43. The slowest decrease is now found among unqualified occupations in services and transportation.

    CONCLUSIONS: While Sweden, during the period studied, had narrowing income differentials and low unemployment this result points to the importance of working conditions in understanding trends and distribution of male adult mortality.

  • 33. Engström, Karin
    et al.
    Hallqvist, Johan
    Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Stockholm.
    Möller, Jette
    Laflamme, Lucie
    Do episodes of peer victimization trigger physical injury?: A case-crossover study of Swedish school children2005In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 33, no 1, p. 19-25Article in journal (Refereed)
    Abstract [en]

    AIMS

    The aim of this study was to investigate how long the effect of peer victimization on the occurrence of physical injury lasts and whether the effect varies according to how frequently an injured child is victimized.

    METHODS

    A case-crossover design was employed. Children aged 10-15 years residing in Stockholm County during two consecutive school years were eligible as cases. Further inclusion criteria were that the children had been hospitalized or called back for a medical check-up due to a physical injury. Information on children's exposure to peer victimization at school was gathered in interviews, and on their social characteristics through a questionnaire filled in by parents. A total of 575 children were included.

    RESULTS

    Our analyses show that there is an increase in risk of unintentional injury after an episode of peer victimization shortly after the end of exposure to victimization (RR = 5.5) but not thereafter. The risk is substantially higher among children seldom victimized (RR = 49.9) than among those victimized on a more regular basis (RR = 2.5). The extent to which family social circumstances modify the risk is difficult to establish from the material at hand.

    CONCLUSION

    Peer victimization may trigger the occurrence of unintentional injuries in childhood and the effect is short lasting. The results need to be replicated and special attention should be given to separating lesson time from break time to avoid confounding by time of day.

  • 34. Engström, Karin
    et al.
    Mattson, Fredrik
    Järleborg, Anders
    Hallqvist, Johan
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Contextual social capital as a risk factor for poor self-rated health: a multilevel analysis2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 66, no 11, p. 2268-2280Article in journal (Refereed)
    Abstract [en]

    In this study, we critically examine whether contextual social capital (CSC) is associated with self-rated health, with an emphasis on the problem of confounding. We also examine different components of CSC and their association with self-rated health. Finally, we look at differences in susceptibility between different socio-demographic groups. We use the cross-sectional base line study of the Stockholm Public Health Cohort, conducted in 2002. A postal questionnaire was answered by 31,182 randomly selected citizens, 18-84 years old, in Stockholm County. We used four measures of social capital: horizontal (civic trust and participation), vertical (political trust and participation), cognitive (civic and political trust) and structural (civic and political participation). CSC was measured at parish level from aggregated individual data, and multilevel regression procedures were employed. We show a twofold greater risk of poor self-rated health in areas with very low CSC compared with areas with very high CSC. Adjustments for individual socio-demographic factors, contextual economic factors and individual social capital lowered the excess risk. Simultaneous adjustment for all three forms of confounding further weakened the association and rendered it insignificant. Cognitive and structural social capital show relatively similar associations with self-rated health, while horizontal CSC seems to be more strongly related to self-rated health than vertical CSC. In conclusion, whether there is none or a moderate association between CSC and self-rated health, depends on the extent to which individual social capital is seen as a mediator or confounder. The association with self-rated health is similar independent of the measure of CSC used. It is also similar in different socio-demographic groups.

  • 35.
    Fransson, Eleonor
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Preventive Medicine.
    de Faire, Ulf
    Ahlbom, Anders
    Reuterwall, Christina
    Hallqvist, Johan
    Centre of Public Health, Stockholm County Council, Karolinska Hospital, Stockholm, Sweden.
    Alfredsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Preventive Medicine.
    The effect of leisure-time physical activity on the risk of acute myocardial infarction depending on body mass index: a population-based case-control study2006In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 7, no 296Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    High body mass index (BMI) and lack of physical activity have been recognized as important risk factors for coronary heart disease. The aim of the present study was to evaluate whether leisure-time physical activity compensates for the increased risk of acute myocardial infarction associated with overweight and obesity.

    METHODS

    Data from the SHEEP (Stockholm Heart Epidemiology Program) study were used. The SHEEP study is a large Swedish population-based case-control study, comprising 1204 male and 550 female cases, and 1538 male and 777 female controls, conducted in Stockholm County, Sweden, during the period 1992-1994. Odds ratios (OR), together with 95 % confidence intervals (95% CI), were calculated using unconditional logistic regression, as estimates of the relative risks.

    RESULTS

    Regular leisure-time physical activity was associated with a decreased risk of myocardial infarction among lean, normal-weight and overweight subjects, but not among obese subjects. Obese (BMI > or = 30) and physically active persons had an almost twofold risk of myocardial infarction, compared with normal-weight and sedentary persons (OR 1.85, 95% CI 1.07-3.18). The results were similar for men and women.

    CONCLUSION

    While regular leisure-time physical activity seems to provide protection against myocardial infarction among lean, normal-weight and overweight subjects, this does not appear to be the case in obese subjects

  • 36. Fransson, Eleonor
    et al.
    De Faire, Ulf
    Ahlbom, Anders
    Reuterwall, Christina
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Alfredsson, Lars
    The risk of acute myocardial infarction: interactions of types of physical activity.2004In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 15, no 5, p. 573-82Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Leisure time physical activity has previously been shown to be protective against cardiovascular disease. We estimated the influence of exercise, occupational physical activity, and household work with regard to risk of acute myocardial infarction (MI). Special interest was focused on potential interaction among these aspects of physical activity.

    METHOD: We analyzed data from a large population-based case-control study conducted in Stockholm, Sweden, 1992-1994. Cases comprised 1204 men and 550 women, age 45-70 years, who experienced their first MI during the study period. The controls, 1538 men and 777 women, were randomly selected from the study base, matched on sex, age, and hospital catchment area. The results were adjusted for several potential confounding factors.

    RESULTS: Exercise, walking or standing at work, and doing demanding household work were all associated with decreased risk of acute MI; the estimated relative risks (RRs) ranged from 0.31 to 0.90 when all cases (fatal and nonfatal) were considered. In contrast, lifting or carrying at work, and an occupational workload perceived to be strenuous, were related to an increased risk of MI (RRs ranging from 1.10-1.57). We observed a synergistic benefit from exercise and walking or standing at work, and from household work and walking or standing at work.

    CONCLUSION: Aerobic physical activities such as exercise or walking at work seemed to reduce the risk of MI, whereas anaerobic activities such as heavy lifting at work were related to increased risk of MI.

  • 37. Froberg, Frida
    et al.
    Modin, Bitte
    Rosendahl, Ingvar K.
    Tengstrom, Anders
    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.
    The Association Between Compulsory School Achievement and Problem Gambling Among Swedish Young People2015In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 56, no 4, p. 420-428Article in journal (Refereed)
    Abstract [en]

    Purpose: We aimed to examine the association between school grades at the age of 16 years and problem gambling at the age of 17-25 years among Swedish females and males. Methods: In a cohort design, we followed the 16-to 24-year-old participants in the representative Swedish Longitudinal Gambling Study for 2 years, 2008/2009 and 2009/2010, generating 3,816 person-years of follow-up time. The outcome, incidence of mild and moderate/severe gambling problems, was measured by the Problem Gambling Severity Index in telephone interviews. The exposure was register-linked information about final grades in compulsory school. The association between school grades and problem gambling was estimated in multinomial logistic regressions. Results: Low and average school grades were associated with increased incidence of mild and moderate/severe problem gambling compared to high grades, adjusted for sociodemographic characteristics, psychological distress, and alcohol use. Low grades, compared to high grades, were associated with a higher risk of mild gambling problems for adolescent males, whereas the incidence proportion of moderate/severe problem gambling was high for males aged 20-25 years with low grades, among whom unemployment was also very high. Furthermore, we found a strong and graded association between school grades and moderate/severe problem gambling for women in both age groups, despite a low prevalence of gambling participation among females compared to males. Conclusions: Our findings show that Swedish youth with low school achievement have an increased risk of gambling problems up to 8 years after school graduation, after control for confounding from sociodemographic characteristics, psychological distress, and alcohol use, and that this association is stronger for females than males.

  • 38. Fröberg, Frida
    et al.
    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.
    Tengström, Anders
    Psychosocial health and gambling problems among men and women aged 16-24 years in the Swedish National Public Health Survey2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 3, p. 427-433Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study aimed to explore the association between psychosocial health, gambling and gambling problems in a nationally representative sample of Swedish youth aged 16-24 years. Another aim was to examine whether these associations were different between young men and women. METHODS: Data were from the cross-sectional Swedish National Public Health Survey in 2004-07. With a response rate of 60.1%, the sample consisted of 19 016 youth. Using a sex-stratified multinomial logistic regression, we estimated associations between psychosocial health variables and gambling and gambling problems. RESULTS: Among males, we found that the higher the alcohol consumption, the higher the likelihood of gambling and gambling problems. Men with high alcohol consumption had an almost four times higher likelihood of gambling problems than men with no or low alcohol consumption (OR 3.94, 95% CI: 2.17-7.14). Moreover, young male victims of violence were more than twice as likely to have gambling problems than non-victims (OR 2.35, 95% CI: 1.39-3.99). Among young women, we found an inverse association between high alcohol consumption and gambling problems (OR 0.15, 95% CI: 0.05-0.44), opposite that of the young men. Furthermore, psychological distress (OR 6.15, 95% CI: 2.15-17.60) and suicidality (OR 2.88, 95% CI: 1.16-7.17) were associated with higher probabilities of gambling problems among young women. CONCLUSION: Alcohol use, violence victimization and poor mental health are associated with gambling problems among Swedish youth, however, with important sex differences. Prevention of youth gambling should consider sex differences and psychosocial health in addition to gambling.

  • 39. Fröberg, Frida
    et al.
    Rosendahl, Ingvar K
    Abbott, Max
    Romild, Ulla
    Tengström, Anders
    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.
    The Incidence of Problem Gambling in a Representative Cohort of Swedish Female and Male 16-24 Year-Olds by Socio-demographic Characteristics, in Comparison with 25-44 Year-Olds2015In: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 31, no 3, p. 621-641Article in journal (Refereed)
    Abstract [en]

    We aimed to estimate the incidence of a first episode of problem gambling among Swedish 16-24 year-olds by demographic and socio-economic characteristics, and to compare the incidence between 16-24 and 25-44 year-olds, and between young women and men. Other aims were to estimate the proportions of recovery and incidence in recurrent problem gambling, and prevalence of problem gambling among 16-44 year-olds in Sweden. We selected 4,358 participants aged 16-44 from the nationally representative Swedish Longitudinal Gambling Study in 2008/2009 and 2009/2010. The primary outcome measure was a first episode of problem gambling during 12 months before the follow-up as measured by the Problem Gambling Severity Index among participants without a history of problem gambling at baseline. The incidence proportion of a first episode of problem gambling among 16-24 year-olds was 2.26 % (95 % confidence interval 1.52-3.36); three times lower among females (1.14; 0.42-3.07 %) than males (3.32; 2.19-5.01 %). Young age and household financial problems were associated with first episode problem gambling among young women. Among 25-44 year-olds, the incidence proportion of a first episode of problem gambling was 0.81 % (0.41-1.56). Recovery from problem gambling was high, in particular among females. Individual transitions from problem gambling to recovery and to recurrent problem gambling, between baseline and follow-up, were common regardless of age. This study adds further evidence to research suggesting that there is a high mobility in and out of problem gambling over time on an individual level. The high incidence of first episode problem gambling among youth in Sweden stresses the importance of prevention of problem gambling at an early age.

  • 40. Grann, Martin
    et al.
    Sturidsson, Knut
    Haggård-Grann, Ulrika
    Hiscoke, Ulrika L
    Alm, Per-Olof
    Dernevik, Mats
    Gumpert, Clara
    Hallqvist, Johan
    Centre for Violence Prevention (CVP), Karolinska Institute, P.O. Box 23000, SE-104 35 Stockholm, Sweden.
    Hallquist, Tommy
    Kullgren, Gunnar
    Långström, Niklas
    Lotterberg, Malin
    Nordström, Kristina
    Ståhle, Birgitta
    Woodhouse, Anni
    Methodological development: structured outcome assessment and community risk monitoring (SORM)2005In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 28, no 4, p. 442-456Article in journal (Refereed)
    Abstract [en]

    This paper describes an effort to develop a clinical tool for the continuous monitoring of risk for violence in forensic mental health clients who have left their institutions and who are dwelling in the community on a conditional release basis. The model is called Structured Outcome Assessment and Community Risk Monitoring (SORM). The SORM consists of 30 dynamic factors and each factor in SORM is assessed in two ways: The current absence, presence or partial och intermittent presence of the factors, which is an actuarial (systematized and 'objective') assessment. Secondly, the risk effect, i.e. whether the presence/absence of factors currently increases, decreases or is perceived as unrelated to violence risk, is a clinical (or impressionistic) assessment. Thus, the factors considered via the SORM can be coded as risk factors or protective factors (or as factors unimportant to risk of violence) depending on circumstances that apply in the individual case. Further, the SORM has a built-in module for gathering idiographical information about risk-affecting contextual factors. The use of the SORM and its potential as a risk monitoring instrument is illustrated via preliminary data and case vignettes from an ongoing multicenter project. In this research project, patients leaving any of the 9 participating forensic hospitals in Sweden is assessed at release on a variety of static background factors, and the SORM is then administered every 30 days for 2 years.

  • 41.
    Grape Viding, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Osika, Walter
    Theorell, Töres
    Kowalski, J
    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.
    Bojner Horwitz, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    The Culture palette: a randomized intervention study for women with burnout symptoms in Sweden2015In: British Journal of Medical Practitioners, ISSN 1757-8515, Vol. 8, no 2, article id a813Article in journal (Refereed)
    Abstract [en]

    Burnout is common among women in Sweden. Cultural activities, i.e. arts, have benefitted different patient populations and may have potential for treating this group as well. Aim: To evaluate possible health effects of regular cultural activities for women with burnout symptoms with focus on exhaustion level. Methods: 48 women (mean age 54) were randomly assigned either to a cultural activity group (intervention group) or to a control group. Four health care centers were the settings for a “Culture Palette” comprised of six different cultural activity packages: interactive theater, movie, vocal improvisation and drawing, dance, mindfulness training and musical show. The activity packages were offered once a week over a period of three months. Standardized questionnaires; the Karolinska Exhaustion Disorder Scale ( KEDS), Sense of Coherence (SOC), Toronto Alexithymia Scale (TAS) and Self-rated health were used at baseline, in month three and at follow-up in month six. Qualitative interviews with patients, cultural producers and health care staff were conducted at month three and month six. Results: Burnout symptoms/exhaustion (P< .001) and alexithymia (P=0.007) as well as self-rated health (P<0.001) improved more in the intervention group than in the control group with clinically relevant effect variances. There was no statistical evidence of any difference in the development of SOC between the intervention and the control group. The healthcare staff were also positively affected although they did not participate in the cultural activities. Conclusion: Regular cultural activities affected this group of women beneficially with enhanced health and decreased levels of exhaustion.

  • 42. Gray, Linsay
    et al.
    Merlo, Juan
    Mindell, Jennifer
    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.
    Tafforeau, Jean
    O'Reilly, Dermot
    Regidor, Enrique
    Næss, Oyvind
    Kelleher, Cecily
    Helakorpi, Satu
    Lange, Cornelia
    Leyland, Alastair H
    International differences in self-reported health measures in 33 major metropolitan areas in Europe2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no 1, p. 40-47Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The increasing concentration of populations into large conurbations in recent decades has not been matched by international health assessments, which remain largely focused at the country level. We aimed to demonstrate the use of routine survey data to compare the health of large metropolitan centres across Europe and determine the extent to which differences are due to socio-economic factors.

    METHODS:

    Multilevel modelling of health survey data on 126 853 individuals from 33 metropolitan areas in the UK, Republic of Ireland, Sweden, Norway, Finland, Spain, Belgium and Germany compared general health, longstanding illness, acute sickness, psychological distress and obesity with the average for all areas, accounting for education and social class.

    RESULTS:

    We found some areas (Greater Glasgow; Greater Manchester, Cheshire and Merseyside; Northumberland, Tyne and Wear and South Yorkshire) had significantly higher levels of poor health. Other areas (West Flanders and Antwerp) had better than average health. Differences in individual socio-economic circumstances did not explain findings. With a few exceptions, acute sickness levels did not vary.

    CONCLUSION:

    Health tended to be worse in metropolitan areas in the north and west of the UK and the central belt and south east of Germany, and more favourable in Sweden and north west Belgium, even accounting for socio-economic composition of local populations. This study demonstrated that combining national health survey data covering different areas is viable but not without technical difficulties. Future comparisons between European regions should be made using standardized sampling, recruitment and data collection protocols, allowing proper monitoring of health inequalities.

  • 43. Gustavsson, P
    et al.
    Plato, N
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Hogstedt, C
    Lewné, M
    Reuterwall, C
    Schéele, P
    A population-based case-referent study of myocardial infarction and occupational exposure to motor exhaust, other combustion products, organic solvents, lead, and dynamite. Stockholm Heart Epidemiology Program (SHEEP) Study Group.2001In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 12, no 2, p. 222-8Article in journal (Refereed)
    Abstract [en]

    This case-referent study investigated the risk of myocardial infarction from occupational exposure to motor exhaust, other combustion products, organic solvents, lead, and dynamite. We identified first-time, nonfatal myocardial infarctions among men and women 45-70 years of age in Stockholm County from 1992 through 1994. We selected referent subjects from the population to match the demographic characteristics of the cases. A lifetime history of occupations was obtained by questionnaire. The response rate was 81% for the cases and 74% for the referents, with 1,335 cases and 1,658 referents included in the study. An occupational hygienist assessed occupational exposures, coding the intensity and probability of exposure for each subject. We adjusted relative risk estimates for tobacco smoking, alcohol drinking, hypertension, diabetes mellitus, overweight, and physical inactivity at leisure time. The relative risk of myocardial infarction was 2.11 (95% confidence interval = 1.23-3.60) among those who were highly exposed and 1.42 (95% confidence interval = 1.05-1.92) among those who were intermediately exposed to combustion products from organic material. We observed an exposure-response pattern, in terms of both maximum exposure intensity and cumulative dose. Exposure to dynamite and organic solvents was possibly associated with an increased risk. The other exposures were not consistently associated with myocardial infarction.

  • 44. Haggård-Grann, Helena
    et al.
    Hallqvist, Johan
    Dept. of Public Health Sciences Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
    Långström, Niklas
    Möller, Jette
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Preventive Medicine.
    Short-term effects of psychiatric symptoms and interpersonal stressors on criminal violence: a case cross-over study2006In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 41, no 7, p. 532-540Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The aim of the study was to analyse the triggering or acute risk effect of psychiatric symptoms and interpersonal stressors on criminal violence.

    METHOD:

    One hundred and thirty three violent offenders were recruited from a forensic psychiatric evaluation (FPE) unit and a national prison evaluation unit in Sweden during 2002-2003, and were interviewed about trigger exposures. A case-crossover design was used eliminating long-term within individual confounding.

    RESULTS:

    Suicidal ideation or parasuicide within 24 h before the violent event conferred a ninefold risk increase. In contrast, violent ideation did not trigger criminal violence. Hallucinations yielded a fourfold risk increase, whereas paranoid thoughts were associated with a small and statistically non-significant risk increase. Acute conflicts with others and being denied psychiatric care within 24 h before violence also increased the risk of acting violently.

    CONCLUSIONS:

    Some tested psychiatric symptoms and stressors triggered criminal violence, whereas others did not. The case-crossover design may be particularly useful for the study of triggers of violence.

  • 45. Haggård-Grann, Ulrika
    et al.
    Hallqvist, Johan
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
    Långström, Niklas
    Möller, Jette
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Preventive Medicine.
    The role of alcohol and drugs in triggering criminal violence: a case-crossover study2006In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 101, no 1, p. 100-108Article in journal (Refereed)
    Abstract [en]

    AIMS:

    To investigate the triggering effects of alcohol, illegal substances and major classes of prescribed psychotropic drugs on criminal violence.

    DESIGN:

    A case-crossover design, using each subject as its own control.

    SETTING AND PARTICIPANTS:

    A consecutive sample of 133 violent offenders was recruited from a forensic psychiatric evaluation unit and a national prison evaluation unit in Sweden during 2002-03.

    MEASUREMENTS:

    Offenders were assessed with structured interviews. Risk estimates were based on hazard periods of 24 hours. We used standard Mantel-Haenszel methods for statistical analyses.

    FINDINGS:

    A 13.2-fold increase of risk of violence [95% confidence interval (CI): 8.2-21.2] was found within 24 hours of alcohol consumption. This increase in violence risk was similar among individuals combining alcohol with benzodiazepines [Relative risk (RR) = 13.2, 95% CI: 4.9-35.3]. Use of benzodiazepines alone in regular doses (RR = 0.4, 95% CI: 0.2-0.5) or antidepressants [selective serotonin reuptake inhibitors (SSRIs) or tricyclics] (RR = 0.4, 95% CI: 0.3-0.8) was associated with a lowered risk for violence.

    CONCLUSIONS:

    This study confirmed that alcohol is a strong trigger of criminal violence. Benzodiazepines in combination with alcohol caused no further increase of violence risk. Benzodiazepines in regular doses and antidepressants may inhibit violence, but further studies are needed to verify causality. The case-crossover method can contribute to research on the proximal causes of criminal violence.

  • 46.
    Hallqvist, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Ahlbom, A
    Diderichsen, F
    Reuterwall, C
    How to evaluate interaction between causes: a review of practices in cardiovascular epidemiology.1996In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 239, no 5, p. 377-82Article in journal (Refereed)
    Abstract [en]

    To increase the knowledge of interaction or synergy between risk factors in an important task in medical research. Still, current literature in cardiovascular epidemiology reflects major misconceptions as how to evaluate interaction. This paper presents Rothman's model of causation from which strict empirical criteria of interaction can be derived. In principle, the method to apply consists of comparing risk differences for one risk factor of interest across strata of the other. Commonly used but incorrect approaches are exemplified and discussed. These include reporting risk of disease among those with combined exposure, comparing relative risks for one exposure after stratification by level of the other, and including an interaction term in the regression model and drawing conclusions from its P-value.

  • 47.
    Hallqvist, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Diderichsen, F
    Theorell, T
    Reuterwall, C
    Ahlbom, A
    Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude? Results from Stockholm Heart Epidemiology Program (SHEEP).1998In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 46, no 11, p. 1405-15Article in journal (Refereed)
    Abstract [en]

    The objectives are to examine if the excess risk of myocardial infarction from exposure to job strain is due to interaction between high demands and low control and to analyse what role such an interaction has regarding socioeconomic differences in risk of myocardial infarction. The material is a population-based case-referent study having incident first events of myocardial infarction as outcome (SHEEP: Stockholm Heart Epidemiology Program). The analysis is restricted to males 45-64 yr of age with a more detailed analysis confined to those still working at inclusion. In total, 1047 cases and 1450 referents were included in the analysis. Exposure categories of job strain were formed from self reported questionnaire information. The results show that high demands and low decision latitude interact with a synergy index of 7.5 (95% C.I.: 1.8-30.6) providing empirical support for the core mechanism of the job strain model. Manual workers are more susceptible when exposed to job strain and its components and this increased susceptibility explains about 25-50% of the relative excess risk among manual workers. Low decision latitude may also, as a causal link, explain about 30% of the socioeconomic difference in risk of myocardial infarction. The distinction between the interaction and the causal link mechanisms identifies new etiologic questions and intervention alternatives. The specific causes of the increased susceptibility among manual workers to job strain and its components seem to be an interesting and important research question.

  • 48.
    Hallqvist, Johan
    et al.
    Department of Public Health Science Karolinska Institutet Stockholm, Sweden.
    Fritzell, Johan
    De Leon, Antonio Ponce
    Stjärne, Maria K
    Interactions with income2006In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 17, no 3, p. 343-343Article in journal (Other academic)
  • 49.
    Hallqvist, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Lundberg, M
    Diderichsen, F
    Ahlbom, A
    Socioeconomic differences in risk of myocardial infarction 1971-1994 in Sweden: time trends, relative risks and population attributable risks.1998In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 27, no 3, p. 410-5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The general trend in incidence of myocardial infarction (MI) in the Stockholm area changed from increasing to decreasing around 1980. The objective of this study is to examine time trends in incidence in major socioeconomic strata, relative risk between socioeconomic groups and population risk attributable to socioeconomic differences during this period.

    METHODS: All cases of MI from 1971 to 1986 were identified from hospital discharge and cause-of-death registers. Person-years for each year of follow-up were calculated from the population register in the Stockholm region 1971-1986. Census registers were used for information on socioeconomic status. Register information was individually linked through the Swedish personal identification number. Supplementary information for 1992-1994 was taken from the case-control study SHEEP (Stockholm Heart Epidemiology Program).

    RESULTS: The decline in MI risk among male high- and middle-level employees started in 1976 and in male manual workers in 1981. For women incidence increased from 1971 to 1986 among manual workers and decreased among high- and middle-level employees. The increase over time of the relative risk from low socioeconomic position continued into the 1990s. Despite the reduction of the category of manual workers, the population attributable risk from socioeconomic differences also increased over time. The process of social change influencing the size of the socioeconomic groups contributes to the change in time trends of MI morbidity.

    CONCLUSIONS: The increase over time of relative and population attributable risks of MI from low socioeconomic status add to the public health importance of social inequity.

  • 50.
    Hallqvist, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Lynch, John
    Bartley, Mel
    Lang, Thierry
    Blane, David
    Can we disentangle life course processes of accumulation, critical period and social mobility? An analysis of disadvantaged socio-economic positions and myocardial infarction in the Stockholm Heart Epidemiology Program.2004In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 58, no 8, p. 1555-62Article in journal (Refereed)
    Abstract [en]

    The accumulation hypothesis would propose that the longer the duration of exposure to disadvantaged socio-economic position, the greater the risk of myocardial infarction. However there may be a danger of confounding between accumulation and possibly more complex combinations of critical periods of exposure and social mobility. The objective of this paper is to investigate the possibility of distinguishing between these alternatives. We used a population based case-control study (Stockholm Heart Epidemiology Programme) of all incident first events of myocardial infarction among men and women, living in the Stockholm region 1992-94. The analyses were restricted to men 53-70 years, 511 cases and 716 controls. From a full occupational history each subject was categorized as manual worker or non-manual at three stages of the life course, childhood (from parent's occupation), at the ages 25-29 and 51-55, resulting in 8 possible socio-economic trajectories. We found a graded response to the accumulation of disadvantaged socio-economic positions over the life course. However, we also found evidence for effects of critical periods and of social mobility. A conceptual analysis showed that there are, for theoretical reasons, only a limited number of trajectories available, too small to form distinct empirical categories of each hypothesis. The empirical task of disentangling the life course hypotheses of critical period, social mobility and accumulation is therefore comparable to the problem of separating age, period, and cohort effects. Accordingly, the interpretation must depend on prior knowledge of more specific causal mechanisms.

123 1 - 50 of 145
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf