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  • 101.
    Asztalos Morell, Ildikó
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Uppsala Centre for Russian and Eurasian Studies. Malardalen Univ, Sociol, Vasteras, Sweden.
    The agency of Roma women's NGO in marginalised rural municipalities in Hungary2018In: Gendering Postsocialism: Old Legacies and New Hierarchies / [ed] Gradskova, Y Morell, IA, Routledge, 2018, p. 121-137Conference paper (Refereed)
  • 102.
    Atiya Ali, M.
    et al.
    Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden.
    Strandvik, B.
    Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden.
    Sabel, K-G.
    Borås Children Hospital, SÄS, Borås, Sweden.
    Palme Kilander, C.
    Division of Neonatology, Department of Paediatrics, Karolinska Institutet at Danderyd, Danderyd, Stockholm, Sweden.
    Strömberg, R.
    Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Polyamine levels in breast milk are associated with mothers' dietary intake and are higher in preterm than full-term human milk and formulas2014In: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 27, no 5, p. 459-467Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Polyamine intake from milk is considered essential for post-natal maturation of the immune system and small intestine. The present study aimed to determine polyamine content in human milk after preterm delivery and the association with mothers' dietary intake. In comparison, the polyamine levels were compared with those in term breast milk and some corresponding formulas.

    METHODS: Transitional breast milk was collected from 40 mothers delivering after 24-36 weeks of gestation, and from 12 mothers delivering after full term. Food intake was assessed in mothers delivering preterm babies using a 3-day diary. Polyamines were analysed by high-performance liquid chromatography.

    RESULTS: The dietary intake of polyamines was significantly associated with breast milk content but weaker for spermine than for spermidine and putrescine. Total polyamine level was higher in preterm than term milk and lower in the corresponding formulas. Putrescine, spermidine and spermine contents [mean (SEM)] in preterm milk were 165.6 (25), 615.5 (80) and 167.7 (16) nmol dL(-1) , respectively, with the levels of putrescine and spermidine being 50% and 25% higher than in term milk. The content of spermine did not differ.

    CONCLUSIONS: Dietary intake of polyamines has an impact on the content in breast milk. The difference between human milk after preterm and term delivery might be considered when using donor human milk for preterm infants. The corresponding formulas had lower contents. Further studies are important for determining the relationship between tissue growth and maturation and optimal intake.

  • 103.
    August, Furaha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Pembe, Andrea B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Mpembeni, Rose
    Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Community Health workers can improve male involvement in maternal health: Evidence from rural Tanzania2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 30064Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Male involvement in maternal health is recommended as one of the interventions to improve maternal and newborn health. There have been challenges in realising this action, partly due to the position of men in society and partly due to health system challenges in accommodating men. The aim of this study was therefore to evaluate the effect of Home Based Life Saving Skills training by community health workers on improving male involvement in maternal health in terms of knowledge of danger signs, joint decision-making, birth preparedness, and escorting wives to antenatal and delivery care in a rural community in Tanzania.

    DESIGN:

    A community-based intervention consisting of educating the community in Home Based Life Saving Skills by community health workers was implemented using one district as the intervention district and another as comparison district. A pre-/post-intervention using quasi-experimental design was used to evaluate the effect of Home Based Life Saving Skills training on male involvement and place of delivery for their partners. The effect of the intervention was determined using difference in differences analysis between the intervention and comparison data at baseline and end line.

    RESULTS:

    The results show there was improvement in male involvement (39.2% vs. 80.9%) with a net intervention effect of 41.1% (confidence interval [CI]: 28.5-53.8; p <0.0001). There was improvement in the knowledge of danger signs during pregnancy, childbirth, and postpartum periods. The proportion of men accompanying their wives to antenatal and delivery also improved. Shared decision-making for place of delivery improved markedly (46.8% vs. 86.7%), showing a net effect of 38.5% (CI: 28.0-49.1; p <0.0001). Although facility delivery for spouses of the participants improved in the intervention district, this did not show statistical significance when compared to the comparison district with a net intervention effect of 12.2% (95% CI: -2.8-27.1: p=0.103).

    CONCLUSION:

    This community-based intervention employing community health workers to educate the community in the Home Based Life Saving Skills programme is both feasible and effective in improving male involvement in maternal healthcare.

  • 104.
    August, Furaha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Muhimbili Univ Hlth & Allied Sci, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania..
    Pembe, Andrea B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Muhimbili Univ Hlth & Allied Sci, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania..
    Mpembeni, Rose
    Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Norwegian Univ Sci & Technol, Dept Publ Hlth & Gen Practice, N-7034 Trondheim, Norway..
    Effectiveness of the Home Based Life Saving Skills training by community health workers on knowledge of danger signs, birth preparedness, complication readiness and facility delivery, among women in Rural Tanzania2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 129Article in journal (Refereed)
  • 105.
    August, Furaha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Pembe, Andrea B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Mpembeni, Rose
    Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Men's Knowledge of Obstetric Danger Signs, Birth Preparedness and Complication Readiness in Rural Tanzania2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, p. e0125978-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Men's involvement in reproductive health is recommended. Their involvement in antenatal care service is identified as important in maternal health. Awareness of obstetric danger signs facilitates men in making a joint decision with their partners regarding accessing antenatal and delivery care. This study aims to assess the level of knowledge of obstetric complications among men in a rural community in Tanzania, and to determine their involvement in birth preparedness and complication readiness.

    METHODS: A cross-sectional survey was conducted where 756 recent fathers were invited through a two-stage cluster sampling procedure. A structured questionnaire was used to collect socio-demographic characteristics, knowledge of danger signs and steps taken on birth preparedness and complication readiness. Data were analyzed using bivariate and multivariable logistic regression to determine factors associated with being prepared, with statistically significant level at p<0.05.

    RESULTS: Among the invited men, 95.9% agreed to participate in the community survey. Fifty-three percent could mention at least one danger sign during pregnancy, 43.9% during delivery and 34.6% during the postpartum period. Regarding birth preparedness and complication readiness, 54.3% had bought birth kit, 47.2% saved money, 10.2% identified transport, 0.8% identified skilled attendant. In general, only 12% of men were prepared. Birth preparedness was associated with knowledge of danger signs during pregnancy (AOR = 1.4, 95% CI: 1.8-2.6). It was less likely for men living in the rural area to be prepared (AOR=0.6, 95% CI; 0.5-0.8).

    CONCLUSION: There was a low level of knowledge of obstetric danger signs among men in a rural district in Tanzania. A very small proportion of men had prepared for childbirth and complication readiness. There was no effect of knowledge of danger signs during childbirth and postpartum period on being prepared. Innovative strategies that increase awareness of danger signs as well as birth preparedness and complication readiness among men are required. Strengthening counseling during antenatal care services that involve men together with partners is recommended.

  • 106.
    Augustsson, Titti
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Läkares förhållningssätt till hälsolitteracitet vid patientbemötandet2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Hälsolitteracitet handlar om ”människors kunskap, motivation samt förmåga till att förstå, få tillgång till, värdera och använda sig av hälsoinformation”. Syftet med denna studie var att undersöka hur väl läkare känner till begreppet hälsolitteracitet samt hur de arbetar med hälsolitteracitet i mötet med patienter. Metoden var kvalitativ design med semistrukturerade intervjuer. Resultatet visar på att det svenska begreppet ”Hälsolitteracitet” var ett så gott som helt okänt ord för informanterna. Informanterna arbetar utifrån betydelsen av begreppet hälsolitteracitet genom att individanpassa sina möten med patienter, tydliggöra den verbala kommunikationen genom visuella bilder och skriven text samt använda teach-back och återberättartekniker för att undersöka så att informationen går fram. Ont om tid på grund av ökade krav på administrativ verksamhet gör att informanter upplever att de ibland inte kan fokusera på patienter i den utsträckning de behöver vilket negativt kan inverka på nivån av hälsolitteracitet. Internet upplevs av informanter ha gett patienter ökad kunskap och större tilltro till egen delaktighet i vården och anses därför vara ett utmärkt verktyg för att i framtiden ytterligare möjliggöra det hälsolitterära arbetet. Ökad forskning och ökat medvetande om hälsolitteracitet kan behövas för att bidra till att hälso- och sjukvården blir en mer hälsolitterat organisation.

  • 107.
    Austin, Peter C.
    et al.
    Inst Clin Evaluat Sci, G106,2075 Bayview Ave, Toronto, ON M4N 3M5, Canada.;Univ Toronto, Inst Hlth Management Policy & Evaluat, Toronto, ON, Canada.;Sunnybrook Res Inst, Schulich Heart Res Program, Toronto, ON, Canada..
    Wagner, Philippe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Lund Univ, Unit Social Epidemiol, Fac Med, Malmo, Sweden..
    Merlo, Juan
    Lund Univ, Unit Social Epidemiol, Fac Med, Malmo, Sweden.;Region Skane, Ctr Primary Hlth Care Res, Malmo, Sweden..
    The median hazard ratio: a useful measure of variance and general contextual effects in multilevel survival analysis2017In: Statistics in Medicine, ISSN 0277-6715, E-ISSN 1097-0258, Vol. 36, no 6, p. 928-938Article in journal (Refereed)
    Abstract [en]

    Multilevel data occurs frequently in many research areas like health services research and epidemiology. A suitable way to analyze such data is through the use of multilevel regression models (MLRM). MLRM incorporate cluster-specific random effects which allow one to partition the total individual variance into between-cluster variation and between-individual variation. Statistically, MLRM account for the dependency of the data within clusters and provide correct estimates of uncertainty around regression coefficients. Substantively, the magnitude of the effect of clustering provides a measure of the General Contextual Effect (GCE). When outcomes are binary, the GCE can also be quantified by measures of heterogeneity like the Median Odds Ratio (MOR) calculated from a multilevel logistic regression model. Time-to-event outcomes within a multilevel structure occur commonly in epidemiological and medical research. However, the Median Hazard Ratio (MHR) that corresponds to the MOR in multilevel (i.e., 'frailty') Cox proportional hazards regression is rarely used. Analogously to the MOR, the MHR is the median relative change in the hazard of the occurrence of the outcome when comparing identical subjects from two randomly selected different clusters that are ordered by risk. We illustrate the application and interpretation of the MHR in a case study analyzing the hazard of mortality in patients hospitalized for acute myocardial infarction at hospitals in Ontario, Canada. We provide R code for computing the MHR. The MHR is a useful and intuitive measure for expressing cluster heterogeneity in the outcome and, thereby, estimating general contextual effects in multilevel survival analysis.

  • 108.
    Aweko, Juliet
    et al.
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    De Man, Jeroen
    Inst Trop Med, Dept Publ Hlth, Antwerp, Belgium.
    Absetz, Pilvikki
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Joensuu, Finland.
    Östenson, Claes-Göran
    Karolinska Univ Hosp, Dept Mol Med & Surg, Stockholm, Sweden.
    Peterson, Stefan Swartling
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Mölsted Alvesson, Helle
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    Daivadanam, Meena
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    Patient and Provider Dilemmas of Type 2 Diabetes Self-Management: A Qualitative Study in Socioeconomically Disadvantaged Communities in Stockholm2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 9, article id 1810Article in journal (Refereed)
    Abstract [en]

    Studies comparing provider and patient views and experiences of self-management within primary healthcare are particularly scarce in disadvantaged settings. In this qualitative study, patient and provider perceptions of self-management were investigated in five socio-economically disadvantaged communities in Stockholm. Twelve individual interviews and four group interviews were conducted. Semi-structured interview guides included questions on perceptions of diabetes diagnosis, diabetes care services available at primary health care centers, patient and provider interactions, and self-management support. Data was analyzed using thematic analysis. Two overarching themes were identified: adopting and maintaining new routines through practical and appropriate lifestyle choices (patients), and balancing expectations and pre-conceptions of self-management (providers). The themes were characterized by inherent dilemmas representing confusions and conflicts that patients and providers experienced in their daily life or practice. Patients found it difficult to tailor information and lifestyle advice to fit their daily life. Healthcare providers recognized that patients needed support to change behavior, but saw themselves as inadequately equipped to deal with the different cultural and social aspects of self-management. This study highlights patient and provider dilemmas that influence the interaction and collaboration between patients and providers and hinder uptake of self-management advice.

  • 109.
    Awor, Phyllis
    et al.
    Makerere Univ, Sch Publ Hlth, Kampala, Uganda.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Makerere Univ, Sch Publ Hlth, Kampala, Uganda;Unicef, New York, NY USA.
    Gautham, Meenakshi
    London Sch Hyg & Trop Med, London, England.
    Delivering child health interventions through the private sector in low and middle income countries: challenges, opportunities, and potential next steps2018In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 362, article id k2950Article, review/survey (Refereed)
  • 110.
    Awor, Phyllis
    et al.
    Centre for International Health, Department of Global Public Health and Primary Health Care, University of Bergen, Norway.
    Wamani, Henry
    School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
    Tylleskar, Thorkild
    Centre for International Health, Department of Global Public Health and Primary Health Care, University of Bergen, Norway.
    Jagoe, George
    Medicines for Malaria Venture, Geneva, Switzerland.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Increased access to care and appropriateness of treatment at private sector drug shops with integrated management of malaria, pneumonia and diarrhoea: a quasi-experimental study in Uganda2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 12, p. e115440-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Drug shops are a major source of care for children in low income countries but they provide sub-standard care. We assessed the feasibility and effect on quality of care of introducing diagnostics and pre-packaged paediatric-dosage drugs for malaria, pneumonia and diarrhoea at drug shops in Uganda.

    METHODS:

    We adopted and implemented the integrated community case management (iCCM) intervention within registered drug shops. Attendants were trained to perform malaria rapid diagnostic tests (RDTs) in each fever case and count respiratory rate in each case of cough with fast/difficult breathing, before dispensing recommended treatment. Using a quasi-experimental design in one intervention and one non-intervention district, we conducted before and after exit interviews for drug seller practices and household surveys for treatment-seeking practices in May-June 2011 and May-June 2012. Survey adjusted generalized linear models and difference-in-difference analysis was used.

    RESULTS:

    3759 (1604 before/2155 after) household interviews and 943 (163 before/780 after) exit interviews were conducted with caretakers of children under-5. At baseline, no child at a drug shop received any diagnostic testing before treatment in both districts. After the intervention, while no child in the non-intervention district received a diagnostic test, 87.7% (95% CI 79.0-96.4) of children with fever at the intervention district drug shops had a parasitological diagnosis of malaria, prior to treatment. The prevalence ratios of the effect of the intervention on treatment of cough and fast breathing with amoxicillin and diarrhoea with ORS/zinc at the drug shop were 2.8 (2.0-3.9), and 12.8 (4.2-38.6) respectively. From the household survey, the prevalence ratio of the intervention effect on use of RDTs was 3.2 (1.9-5.4); Artemisinin Combination Therapy for malaria was 0.74 (0.65-0.84), and ORS/zinc for diarrhoea was 2.3 (1.2-4.7).

    CONCLUSION:

    iCCM can be utilized to improve access and appropriateness of care for children at drug shops.

  • 111. Awor, Phyllis
    et al.
    Wamani, Henry
    Tylleskar, Thorkild
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Drug seller adherence to clinical protocols with integrated management of malaria, pneumonia and diarrhoea at drug shops in Uganda2015In: Malaria Journal, ISSN 1475-2875, E-ISSN 1475-2875, Vol. 14, article id 277Article in journal (Refereed)
    Abstract [en]

    Background: Drug shops are usually the first source of care for febrile children in Uganda although the quality of care they provide is known to be poor. Within a larger quasi-experimental study introducing the WHO/UNICEF recommended integrated community case management (iCCM) of malaria, pneumonia and diarrhoea intervention for community health workers in registered drug shops, the level of adherence to clinical protocols by drug sellers was determined. Methods: All drug shops (N = 44) in the intervention area were included and all child visits (N = 7,667) from October 2011-June 2012 to the participating drug shops were analysed. Drug shops maintained a standard iCCM register where they recorded the children seen, their symptoms, diagnostic test performed, treatments given and actions taken. The proportion of children correctly assessed and treated was determined from the registers. Results: Malaria management: 6,140 of 7,667 (80.1%) total visits to drug shops were of children with fever. 5986 (97.5%) children with fever received a malaria rapid diagnostic test (RDT) and the RDT positivity rate was 78% (95% CI 77-79). 4,961/5,307 (93.4%) children with a positive RDT received artemisinin combination therapy. Pneumonia management: after respiratory rate assessment of children with cough and fast/difficult breathing, 3,437 (44.8%) were categorized as "pneumonia", 3,126 (91.0%) of whom received the recommended drug-amoxicillin. Diarrhoea management: 2,335 (30.5%) child visits were for diarrhoea with 2,068 (88.6%) correctly treated with oral rehydration salts and zinc sulphate. Dual/Triple classification: 2,387 (31.1%) children had both malaria and pneumonia and 664 (8.7%) were classified as having three illnesses. Over 90% of the children with dual or triple classification were treated appropriately. Meanwhile, 381 children were categorized as severely sick (with a danger sign) with 309 (81.1%) of them referred for appropriate management. Conclusion: With the introduction of the iCCM intervention at drug shops in Eastern Uganda, it was possible to achieve high adherence to the treatment protocols, which is likely compatible with increased quality of care.

  • 112.
    Axelsson, Marie-Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Medarbetarpulsens betydelse för det hälsofrämjande arbetet vid Arbetsförmedlingen. - En kvalitativ studie av sektionschefers upplevelse2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Arbetsförmedlingens höga sjukfrånvaro är alarmerande och åtgärder måste vidtas för att förhindra att ännu fler arbetar sig sjuka och att de som är sjukskrivna har möjlighet att rehabiliteras tillbaka till arbetet. Arbetsförmedlingen arbetar långsiktigt med att uppnå hälsofrämjande och högpresterande arbetsplatser och fokusera på att få ner sjukfrånvaron genom ett systematiskt arbete med att fånga upp arbetsmiljörisker genom att arbeta med friskfaktorer. Ett verktyg behövdes för att snabbt kunna identifiera problem och åtgärda dem. Under 2017 togs en ny medarbetarundersökning fram som snabbt skulle få fram arbetsmiljörisker och som skulle skapa förutsättningar att agera på rätt saker i rätt tid. I slutet av 2017 lanserade Arbetsförmedlingen den nya medarbetarundersökningen Medarbetarpulsen. Syfte: Studiens syfte är att undersöka sektionschefers erfarenhet och upplevelse av att använda medarbetarundersökningen Medarbetarpulsen för att förbättra arbetsmiljön inom Arbetsförmedlingen. Metod: Data har samlats in genom sju semistrukturerade intervjuer som analyserats genom en kvalitativ innehållsanalys. Resultat och slutsats: Medarbetarpulsen kan vara det verktyg som förbättrar arbetsmiljön, sänker sjukfrånvaron och kan ge Arbetsförmedlingen hälsofrämjande arbetsplatser. Resultaten från enkäten ger varje medarbetare möjlighet att påverka sin egen hälsa och arbetsgruppen kan påverka sin egen arbetssituation genom åtgärder som behövs eller att göra mer av det som redan fungerar. Utmaningen blir att få alla medarbetare att svara på frågorna och vara aktiva i diskussionerna i arbetsgruppen. Sektionscheferna måste vara modiga för de kommer att tvingas ta i obekväma frågor både i arbetsgruppen och med den enskilde individen för att lyckas driva hela processen i mål.

  • 113.
    Axemo, Pia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Wijwardena, Kumudu
    Department of Community Medicine Health, University of Sri Jayewardenepura, Colombo.
    Fonseka, Ruvani
    Joint Doctoral Program in Public Health, University of California, San Diego/San Diego State University, United States of America.
    Cooray, Sharika
    United Nations Population Fund, Colombo, Sri Lanka.
    Darj, Elisabeth
    Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
    Training university teachers and students in Sri Lanka on Gender Based Violence: testing of a participatory training program2018In: MedEdPublisher, ISSN 2312–7996Article in journal (Refereed)
    Abstract [en]

    In all societies, violence is a social problem and violation of human rights. Changing attitudes and behaviors, which accept violence atindividual and societal levels are key components in prevention strategies.

    The aim of this study was to produce educational material on Gender Based Violence (GBV). A participatory study design including educators and university students was used to create four teaching modules. The teaching was evaluated by descriptive surveys before andafter the training and focus group discussions followed the training session. The questionnaire covered attitudes to gender, violence and laws. One hundred eleven teachers and 25 students representing different faculties and universities participated in separate workshops in three Sri Lankan universities. The students lacked knowledge of the meaning of GBV, consequences and existing laws. Women held more gender-equitable attitudes. Both women and men favoured equal participation of work and decision in the households. Male undergraduates showed less accepting attitudes toward rape or blaming women for rape Three categories emerged after the FGDs; Maketraining module compulsory and teacher led; Mind your own business; What can be done.

    The newly prepared and context specific material was well-received by educators and students and they provided valuable inputs, which improved the educational modules.

  • 114.
    Backlund, Amanda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Främjande av folkhälsan i Sverige: Riksdagspartiernas visioner och arbete2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: With an increasing life expectancy and a reduction of premature mortality, health is considered good among the Swedish population. Nevertheless, there is a need of addressed interventions against mental illness, inequality in health, eating habits and sedentary, for example. The Swedish government has published a wide-ranging national public health policy, but there is a gap in knowledge regarding the political parties concrete visions and work in the fields of public health.

    Purpose: The purpose of this study was to investigate visions and work among Swedish political parties in various fields of public health.

    Method: The study was conducted with a qualitative study design and had an inductive approach. Data was collected by a questionnaire and seven out of eight parties answered. Collected material was analyzed with inspiration from Giorgis qualitative analysis.

    Results: The result displayed a wide spectrum of visions and efforts. The parties ideas and efforts were mostly containing the healthcare sector. They want to see clearer commitments, accessibility and focus on preventive interventions. Regarding school they intend to focus their efforts on student health and increase the rate of sports and sex education. In addition, they want a variety of community interventions to be performed.

    Conclusion: Besides their visions, the political parties want to tackle public health issues by practicing politics, support interventions, research and develop policies and amplify knowledge efforts.

  • 115.
    Backman, Elina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Informerat val i samband med KUB-test: Jämförelse av landsting med två olika tillvägagångssätt vid förmedling av information om fosterdiagnostik2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    I Sverige erbjuds alla gravida kvinnor information om fosterdiagnostik. Landstingens självstyre gör att tillvägagångssätten för hur man förmedlar information om fosterdiagnostik är olika (mer eller mindre tydlig tvåstegsprocess). Kombinerat ultraljud och biokemiskt prov (KUB) är ett screeningverktyg för kromosomavvikelser.

    Studiens syfte var att undersöka om det fanns skillnader mellan landsting med mer eller mindre tydlig tvåstegsprocess avseende informerat val, beslutskonflikt respektive nöjdhet med informationsmötet. Studien avsåg även undersöka eventuella skillnader mellan den gravida kvinnan och hennes partner. Vidare ämnade undersökningen studera om det finns samband mellan informerat val och beslutskonflikt, samt informerat val och nöjdhet med informationsmötet.

    Andelen som gjorde ett informerat val var 13,3%. Resultatet visade inga signifikanta skillnader mellan landstingen. Däremot fanns en signifikant skillnad i informerat val vid landstingen med mindre tydlig tvåstegsprocess, där fler partners gjorde ett informerat val. Kunskapsnivån ökade efter informationsmötet i båda landstingen. Attityden förändrades inte signifikant. Dock fanns en tendens till att den blev mer negativ efter informationsmötet, men inte bland kvinnorna i landstinget med mindre tydlig tvåstegsprocess, där andelen som är positiva till KUB ökade. Sambandsanalyserna visade att det fanns ett positivt samband mellan informerat val och upplevelse av effektivt beslutsfattande och negativt samband mellan informerat val och gravid kvinna.

    Det fanns få skillnader mellan landstingen som hade mer eller mindre tydlig tvåstegsprocess. Andelen personer som gjorde ett informerat val var lågt, orsaken var att attityd och genomförande inte överensstämde. Mer forskning behövs för att studera anledningen till icke informerade val i samband med KUB.

  • 116.
    Bahrami, Azita
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Distriktssköterskans upplevelse av att möta utländska föräldrar inom barnhälsovården2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Every year, many immigrants from different countries around the world come to Sweden with different languages, cultures, attitudes and traditions. This leads to communication difficulties in meeting with authorities such as health care. The purpose of this study is to describe the experiences of the district nurse to respond to foreign parents in child health care. Work method is an exploratory design with a qualitative approach. A total of eight BVC district nurses who had long experience in child health care were interviewed. District nurses were selected from three clinics in immigrant dense areas. All the interviews were analyzed according to content analysis. The results include four main categories: cultural discrepancies impact on communications, the importance of language for communication, conveying information pathways. The results from this study show that the district nurse's knowledge of immigrants' cultures and the language barrier among immigrants are key factors in order to have a good meeting and good communication with foreign parents. Education on different cultures of BVC district nurses, and improvement of language skills among immigrants are key areas to focus on. District nurses skills and cultural competence is increasing recognition of the foreign parents' thoughts and perceptions, which can be facilitating the meeting with foreign parents. Parents' literacy in the Swedish language reduces communication problems for the district nurse and also for themselves and increases the opportunity for integration.

  • 117.
    Baker, Tim
    et al.
    Karolinska Univ Hosp, Dept Anaesthesia Intens Care & Surg Serv, Stockholm, Sweden.;Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden..
    Schell, Carl Otto
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden.;Nykoping Hosp, Sormland Cty Council, Dept Internal Med, Nykoping, Sweden..
    Lugazia, Edwin
    Muhimbili Univ Hlth & Allied Sci, Dept Anaesthesia & Intens Care, Dar Es Salaam, Tanzania..
    Blixt, Jonas
    Karolinska Univ Hosp, Dept Anaesthesia Intens Care & Surg Serv, Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden..
    Mulungu, Moses
    Muhimbili Natl Hosp, Dept Anaesthesia & Intens Care, Dar Es Salaam, Tanzania..
    Castegren, Markus
    Karolinska Univ Hosp, Dept Anaesthesia Intens Care & Surg Serv, Stockholm, Sweden..
    Eriksen, Jaran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Univ, Huddinge Hosp, Karolinska Inst, Dept Lab Med,Div Clin Pharmacol, Stockholm, Sweden..
    Konrad, David
    Karolinska Univ Hosp, Dept Anaesthesia Intens Care & Surg Serv, Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden..
    Vital Signs Directed Therapy: Improving Care in an Intensive Care Unit in a Low-Income Country2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 12, article id e0144801Article in journal (Refereed)
    Abstract [en]

    Background Global Critical Care is attracting increasing attention. At several million deaths per year, the worldwide burden of critical illness is greater than generally appreciated. Low income countries (LICs) have a disproportionally greater share of critical illness, and yet critical care facilities are scarce in such settings. Routines utilizing abnormal vital signs to identify critical illness and trigger medical interventions have become common in high-income countries but have not been investigated in LICs. The aim of the study was to assess whether the introduction of a vital signs directed therapy protocol improved acute care and reduced mortality in an Intensive Care Unit (ICU) in Tanzania. Methods and Findings Prospective, before-and-after interventional study in the ICU of a university hospital in Tanzania. A context-appropriate protocol that defined danger levels of severely abnormal vital signs and stipulated acute treatment responses was implemented in a four week period using sensitisation, training, job aids, supervision and feedback. Acute treatment of danger signs at admission and during care in the ICU and in-hospital mortality were compared pre and post-implementation using regression models. Danger signs from 447 patients were included: 269 pre-implementation and 178 post-implementation. Acute treatment of danger signs was higher post-implementation (at admission: 72.9% vs 23.1%, p<0.001; in ICU: 16.6% vs 2.9%, p<0.001). A danger sign was five times more likely to be treated post-implementation (Prevalence Ratio (PR) 4.9 (2.9-8.3)). Intravenous fluids were given in response to 35.0% of hypotensive episodes post-implementation, as compared to 4.1% pre-implementation (PR 6.4 (2.5-16.2)). In patients admitted with hypotension, mortality was lower post-implementation (69.2% vs 92.3% p = 0.02) giving a numbers-needed-to-treat of 4.3. Overall in-hospital mortality rates were unchanged (49.4% vs 49.8%, p = 0.94). Conclusion The introduction of a vital signs directed therapy protocol improved the acute treatment of abnormal vital signs in an ICU in a low-income country. Mortality rates were reduced for patients with hypotension at admission but not for all patients.

  • 118. Baker, Ulrika
    et al.
    Okuga, Monica
    Waiswa, Peter
    Manzi, Fatuma
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Hanson, Claudia
    Bottlenecks in the implementation of essential screening tests in antenatal care: Syphilis, HIV, and anemia testing in rural Tanzania and Uganda2015In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 130 Suppl 1, p. S43-S50Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To identify and compare implementation bottlenecks for effective coverage of screening for syphilis, HIV, and anemia in antenatal care in rural Tanzania and Uganda; and explore the underlying determinants and perceived solutions to overcome these bottlenecks.

    METHODS: In this multiple case study, we analyzed data collected as part of the Expanded Quality Management Using Information Power (EQUIP) project between November 2011 and April 2014. Indicators from household interviews (n=4415 mothers) and health facility surveys (n=122) were linked to estimate coverage in stages of implementation between which bottlenecks can be identified. Key informant interviews (n=15) were conducted to explore underlying determinants and analyzed using a framework approach.

    RESULTS: Large differences in implementation were found within and between countries. Availability and effective coverage was significantly lower for all tests in Uganda compared with Tanzania. Syphilis screening had the lowest availability and effective coverage in both countries. The main implementation bottleneck was poor availability of tests and equipment. Key informant interviews validated these findings and perceived solutions included the need for improved procurement at the central level.

    CONCLUSION: Our findings reinforce essential screening as a missed opportunity, caused by a lack of integration of funding and support for comprehensive antenatal care programs.

  • 119.
    Baker, Ulrike
    et al.
    Univ Malawi, Dept Family Med, Coll Med, Blantyre, Malawi;Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy Res, Stockholm, Sweden;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, Huddinge, Sweden.
    Petro, Arafumin
    Ifakara Hlth Inst, Hlth Syst Impact Evaluat & Policy HSIEP, Dar Es Salaam, Tanzania.
    Marchant, Tanya
    London Sch Hyg & Trop Med, Dept Dis Control, London, England.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy Res, Stockholm, Sweden;Makerere Sch Publ Hlth, Kampala, Uganda;UNICEF, Hlth Sect, Programme Div, New York, NY USA.
    Manzi, Fatuma
    Ifakara Hlth Inst, Hlth Syst Impact Evaluat & Policy HSIEP, Dar Es Salaam, Tanzania.
    Bergström, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). UCL, Inst Global Hlth, London, England.
    Hanson, Claudia
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy Res, Stockholm, Sweden;London Sch Hyg & Trop Med, Dept Dis Control, London, England.
    Health workers' experiences of collaborative quality improvement for maternal and newborn care in rural Tanzanian health facilities: A process evaluation using the integrated 'Promoting Action on Research Implementation in Health Services' framework2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 12, article id e0209092Article in journal (Refereed)
    Abstract [en]

    Background: Quality Improvement (OI) approaches are increasingly used to bridge the quality gap in maternal and newborn care (MNC) in Sub Saharan Africa. Health workers typically serve as both recipients and implementers of QI activities; their understanding, motivation, and level of involvement largely determining the potential effect. In support of efforts to harmonise and integrate the various QI approaches implemented in parallel in Tanzanian health facilities, our objective was to investigate how different components of a collaborative QI intervention were understood and experienced by health workers, and therefore contributed positively to its mechanisms of effect.

    Materials and methods: A qualitative process evaluation of a collaborative QI intervention for MNC in rural Tanzania was carried out. Semi-structured interviews were conducted with 16 health workers in 13 purposively sampled health facilities. A deductive theory-driven qualitative content analysis was employed using the integrated Promoting Action on Research Implementation in Health services (i-PARI HS) framework as a lens with its four constructs innovation, recipients, facilitation, and context as guiding themes.

    Results: Health workers valued the high degree of fit between QI topics and their everyday practice and appreciated the intervention's comprehensive approach. The use of run-charts to monitor progress was well understood and experienced as motivating. The importance and positive experience of on-site mentoring and coaching visits to individual health facilities was expressed by the majority of health workers. Many described the parallel implementation of various health programs as a challenge.

    Conclusion: Components of QI approaches that are well understood and experienced as supportive by health workers in everyday practice may enhance mechanisms of effect and result in more significant change. A focus on such components may also guide harmonisation, to avoid duplication and the implementation of parallel programs, and country ownership of QI approaches in resource limited settings.

  • 120.
    Bandstein, Marcus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Mwinyi, Jessica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Ernst, Barbara
    eSwiss Medical & Surgical Center, Interdisciplinary Obesity Center, St. Gallen, Switzerland..
    Thurnheer, Martin
    eSwiss Medical & Surgical Center, Interdisciplinary Obesity Center, St. Gallen, Switzerland..
    Schultes, Bernd
    eSwiss Medical & Surgical Center, Interdisciplinary Obesity Center, St. Gallen, Switzerland.
    Schiöth, Helgi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    A genetic variant in proximity to the gene LYPLAL1 is associated with lower hunger feelings and increased weight loss following Roux-en Y gastric bypass surgery2016In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, no 9, p. 1050-1055Article in journal (Refereed)
    Abstract [en]

    Objective: Bariatric surgery is the most efficient treatment of severe obesity. We investigated to what extent BMI- or waist-hip ratio (WHR)-related genetic variants are associated with excess BMI loss (EBMIL) two years after Roux-en-Y gastric bypass (RYGB) surgery, and elucidated the affected biological pathways.

    Methods: Two-hundred fifty-one obese patients (age: 4310.7, preoperative BMI: 45.16.1kg/m(2), 186 women) underwent RYGB surgery and were followed up after two years with regard to BMI. Patients were genotyped for 32 single-nucleotide polymorphisms (SNPs) that were investigated with regard to their impact on response to RYGB and preoperatively measured Three Factor Eating Questionnaire (TFEQ) scores.

    Results: Homozygous T carriers of the SNP rs4846567 in proximity to the Lysophospholipase-like 1 (LYPLAL1) gene showed a 7% higher EBMIL compared to wild-type and heterozygous carriers (p=0.031). TT-allele carriers showed furthermore lower scores for Hunger (74%, p<0.001), lower Disinhibition (53%, p<0.001), and higher Cognitive restraint (21%, p=0.017) than GG/GT carriers in the TFEQ. Patients within the lowest quartile of Hunger scores had a 32% greater EBMIL compared to patients in the highest quartile (p<0.001).

    Conclusion: The LYPLAL1 genotype is associated with differences in eating behavior and loss of extensive body weight following RYGB surgery. Genotyping and the use of eating behavior-related questionnaires may help to estimate the RYGB-associated therapy success.

  • 121. Banefelt, J.
    et al.
    Liede, A.
    Mesterton, J.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Hernandez, R. K.
    Sobocki, P.
    Persson, Bo-Eric
    Uppsala University.
    Survival and clinical metastases among prostate cancer patients treated with androgen deprivation therapy in Sweden2014In: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 38, no 4, p. 442-447Article in journal (Refereed)
    Abstract [en]

    Objectives: To examine the incidence of metastases and clinical course of prostate cancer patients who are without confirmed metastasis when initiating androgen deprivation therapy (ADT). Methods: Retrospective cohort study conducted using electronic medical records from Swedish outpatient urology clinics linked to national mandatory registries to capture medical and demographic data. Prostate cancer patients initiating ADT between 2000 and 2010 were followed from initiation of ADT to metastasis, death, and/or end of follow-up. Results: The 5-year cumulative incidence (CI) of metastasis was 18%. Survival was 60% after 5 years; results were similar for bone metastasis-free survival. The 5-year CI of castration-resistant prostate cancer (CRPC) was 50% and the median survival from CRPC development was 2.7 years. Serum prostate-specific antigen (PSA) levels and PSA doubling time were strong predictors of bone metastasis, any metastasis, and death. Conclusion: This study provides understanding of the clinical course of prostate cancer patients without confirmed metastasis treated with ADT in Sweden. Greater PSA values and shorter PSA doubling time (particularly <= 6 months) were associated with increased risk of bone metastasis, any metastasis, and death.

  • 122. Barber, RM
    et al.
    Fullman, N
    Sorensen, RJD
    Bollyky, T
    McKee, M
    Nolte, E
    Abajobir, AA
    Abate, KH
    Abbafati, C
    Abbas, KM
    Abd-Allah, F
    Abdulle, AM
    Ärnlöv, Johan
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Younis, MZ
    Yu, C
    Zaidi, Z
    El Sayed Zaki, M
    Zambrana-Torrelio, C
    Zapata, T
    Zenebe, ZM
    Zodpey, S
    Zoeckler, L
    Zuhlke, LJ
    Murray, CJL
    Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015.2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 390, no 10091, p. 231-266Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.

    METHODS: We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time.

    FINDINGS: Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015.

    INTERPRETATION: This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world.

    FUNDING: Bill & Melinda Gates Foundation.

  • 123.
    Bardel, Annika
    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, Centrum för klinisk forskning i Sörmland (CKFD).
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    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).
    Rosengren, Annika
    Sahlgren Acad, Dept Heart & Lung Dis, Gothenburg, Sweden.
    Johansson, Saga
    Sahlgren Acad, Dept Heart & Lung Dis, Gothenburg, Sweden.
    Eriksson, Henry
    Sahlgren Acad, Dept Heart & Lung Dis, Gothenburg, Sweden.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Age and sex related self-reported symptoms in a general population across 30 years: Patterns of reporting and secular trend2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 2, article id e0211532Article in journal (Refereed)
    Abstract [en]

    Objective To study age and sex specific prevalence of 30 symptoms in random samples from the general population and to analyze possible secular trends across time. Study population The study was based on data from eight on-going Swedish cohort studies, with baseline investigations performed between 1973 and 2003. Samples were drawn from the general population of the cities of Gothenburg and Eskilstuna, and of Uppsala County. Overall, 20,160 subjects were sampled, 14,470 (71.8%) responded, of whom 12.000 were unique subjects, and 2548 were part of more than one sample. Methods The Complaint score sub-scale of the Gothenburg Quality of Life instrument, listing 30 general symptoms was used. Responders were asked to indicate which symptoms they had experienced during the last three months. Results Women reported on average 7.8 symptoms, and men 5.3 (p<0.0001). Women reported higher prevalence than men for 24 of the 30 symptoms. In multivariate analyses four patterns of prevalence across age were identified in both men and women; increasing prevalence, decreasing, stable and biphasic prevalence. The symptoms in the various pattern groups differed somewhat between men and women. However, symptoms related to strain were prominent among symptoms decreasing with age. Moreover, there were secular trends. Across all symptoms reporting prevalence increased over time in men (p<0.001) as well as in women (p<0.0001). Conclusions Women reported higher total symptom prevalence than men. Symptoms related to health generally increased with age, while symptoms related to stress decreased markedly. Significant secular trends across time regarding symptom prevalence were found.

  • 124.
    Bask, Miia
    Karlstad University, Centre for Research on Child and Adolescent Mental Health, Karlstad, Sweden.
    Internalizing and Externalizing Problem Behavior among Swedish Youth: Explaining Multiple Disadvantages2011Conference paper (Refereed)
  • 125.
    Bask, Miia
    et al.
    Norwegian Social Research (NOVA), Oslo Metropolitan University, Oslo, Norway.
    Ristikari, Tiina
    National Institute for Health and Welfare, Helsinki, Finland.
    Haapakorva, Pasi
    National Institute for Health and Welfare, Helsinki, Finland.
    Gissler, Mika
    National Institute for Health and Welfare, Helsinki, Finland.
    Timing and Duration of Childhood Economic Hardship and Early Adulthood Obstacles2017Conference paper (Refereed)
  • 126.
    Bastholm Rahmner, Pia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Gustafsson, Lars L.
    Larsson, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Tomson, Göran
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Variations in understanding the drug-prescribing process: a qualitative study among Swedish GPs2009In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 26, no 2, p. 121-127Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A majority of doctor-patient meetings result in the patient getting a prescription. This underlines the need for a high-quality prescription process. While studies have been made on single therapeutic drug groups, a complete study of the physicians' general thought process that comprises the prescription of all drugs still remains to be made. OBJECTIVE: To identify variations in ways of understanding drug prescribing among GPs. METHODS: A descriptive qualitative study was conducted with 20 Swedish physicians. Informants were recruited purposively and their understandings about prescribing were studied in semi-structured interviews. Data were analysed using a phenomenographic approach. RESULTS: Five categories were identified as follows: (A) GP prescribed safe, reliable and well-documented drugs for obvious complaints; (B) GP sought to convince the patient of the most effective drug treatment; (C) GP chose the best drug treatment taking into consideration the patient's entire life situation; (D) GP used clinical judgement and close follow-up to minimize unnecessary drug prescribing and (E) GP prescribed drugs which are cheap for society and environmentally friendly. The categories are interrelated, but have different foci: the biomedical, the patient and the society. Each GP had more than one view but none included all five. The findings also indicate that complexity increases when a drug is prescribed for primary or secondary prevention. CONCLUSIONS: GPs understand prescribing differently despite similar external circumstances. The most significant factor to influence prescribing behaviour was the physician's patient relation approach. GPs may need to reflect on difficulties they face while prescribing to enhance their understandings.

  • 127.
    Basu, Samar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation.
    Harris, Holly
    Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, .
    Wolk, Alicja
    Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, .
    Rossary, Adrien
    Chaire d'Excellence Program, Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, CRNH-Auvergne, INRA-UDA, Clermont-Ferrand, France;.
    Caldefie-Chézet, Florence
    Chaire d'Excellence Program, Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, CRNH-Auvergne, INRA-UDA, Clermont-Ferrand, France;.
    Vasson, Marie-Paule
    Chaire d'Excellence Program, Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, CRNH-Auvergne, INRA-UDA, Clermont-Ferrand, France;.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Inflammatory F2-isoprostane, prostaglandin F2α, pentraxin 3 levels and breast cancer risk: The Swedish Mammography Cohort2016In: Prostaglandins, Leukotrienes and Essential Fatty Acids, ISSN 0952-3278, E-ISSN 1532-2823, Vol. 113, p. 28-32Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Breast cancer is a common cancer among women. Identifying cellular participation of F2-isoprostane, prostaglandin F2α (PGF2α) and pentraxin 3 (PTX3) in cancer we evaluated whether their prediagnostic systemic levels that originate from different inflammatory pathways were associated with breast cancer risk.

    METHODS: Seventy-eight breast cancer cases diagnosed after blood collection and 797 controls from the Swedish Mammography Cohort were analysed for urinary F2-isoprostane, PGF2α and plasma PTX3 levels.

    RESULTS: None of the biomarkers investigated were significantly associated with breast cancer risk. However, there was the suggestion of an inverse association with PTX3 with multivariable adjusted ORs (95% CI) of 0.56 (95% CI=0.29-1.06) and 0.67 (95% CI=0.35-1.28) for the second and third tertiles, respectively (ptrend=0.20). No associations were observed between F2-isoprostane (OR=0.87; 95% CI=0.48-1.57; ptrend=0.67) and PGF2α metabolite (OR=1.03; 95% CI=0.56-1.88; ptrend=0.91) comparing the top to bottom tertiles.

    CONCLUSIONS: The systemic levels of F2-isoprostane, PGF2α and PTX3 witnessed in women who later developed breast cancer may not provide prognostic information regarding tumor development in spite of their known involvement in situ cellular context. These observations may indicate that other mechanisms exist in controlling cellular formation of F2-isoprostane, PGF2α and PTX3 and their systemic availability in breast cancer patients.

  • 128.
    Bean, Christopher G.
    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
    Stress Research Institute, 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, 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-up2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 3, p. 475-481Article 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.

  • 129.
    Bean, Christopher
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Kosmadopoulos, Anastasi
    Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, QC, Canada.
    Hutchinson, Amanda
    School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, SA, Australia.
    Matthews, Raymond
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Sargent, Charli
    Appleton Institute for Behavioural Science, Central Queensland University, Adelaide, SA, Australia.
    Stengård, Johanna
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Winefield, Helen
    School of Psychology, University of Adelaide, Adelaide, SA, Australia.
    Adams, Robert
    The Health Observatory, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia.
    Short sleep, psychosocial work stressors, and measures of obesity: results from an Australian cohort study2019Conference paper (Refereed)
    Abstract [en]

    Introduction: Short sleep and workplace stress are both established risk factors for overweight and obesity, yet few studies have considered how these two factors may intersect. The aim of this study was to establish the associations between these two exposures and their relative associations with body mass index (kg/m2 ) and waist circumference (cm).

    Methods: A cross-sectional design sampled current employees (N=423) from an Australian cohort using a computer-assisted telephone interview and clinic-measured height, weight, and waist circumference. Short sleep (≤6h/ night) was reported by 25.8% of the participants. Psychosocial work stressors were defined using the Job Demand-ControlSupport (JDCS) model and calculated at the subscale level (psychological demands; skill discretion; decision authority; coworker support; supervisor support). General linear models were used to assess associations between short sleep, the JDCS subscales (split at median), and BMI and waist circumference.

    Results: Separate analyses identified short sleep and a lack of skill discretion at work as predictors of both BMI and waist circumference. Furthermore, when both predictors were entered in the same model, each was associated with elevated BMI (b=1.79, p=.003; b=1.08, p=.045) and waist circumference (b=4.20, p=.005; b=2.97, p=.028). Short sleep was also associated with high perceived psychological demands at work (b=1.81, p=.003). All models were adjusted for gender, age, work hours, blue vs. white collar job, and household income.

    Discussion: These findings indicate the importance of considering the interplay between short sleep and psychosocial work stressors, and their respective associations with measures of overweight Sleep Sci. 2019;12(Supl.3):1-75 26 and obesity. Further research using longitudinal data is needed to model potential mechanisms (e.g., behavioral and physiological). A novel feature was the subscale consideration of the prominent JDCS model of work stress. Advocacy for both improved habitual sleep (e.g., ≥7h/night) and job redesign to increase skill discretion at work may promote lower levels of overweight and obesity for employees.

  • 130.
    Bean, Christopher
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Pingel, Ronnie
    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.
    Berg, Noora
    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.
    Poor peer relations in adolescence, social support in early adulthood, and depressive symptoms in later adulthood: evaluating mediation and interaction using four-way decomposition analysis2019In: Annals of Epidemiology, ISSN 1047-2797, E-ISSN 1873-2585, Vol. 29, p. 52-59Article in journal (Refereed)
    Abstract [en]

    Purpose: Supportive social relations are associated with good mental health, yet few studies have considered the prospective importance of adolescent peer relations for adult mental health and the potential mechanisms involved.

    Methods: Participants (n=941) were sourced from the Northern Swedish Cohort, a prospective study comprising school students aged 16 in 1981. Integrating life course epidemiology with four-way decomposition analysis, this paper considers the controlled direct effect of poor peer relations at age 16 on depressive symptoms at age 43, the pure indirect effect mediated by the availability of social support at age 30, and potential interactions between the exposure and the mediator.

    Results: After controlling for gender, baseline depressive symptoms and parental socioeconomic position, poor peer relations at age 16 were associated with depressive symptoms at age 43, largely irrespective of social support at age 30. Nonetheless, poor peer relations in adolescence were associated with poorer social support at age 30, and mediation accounted for a modest proportion (pure indirect effect 10%) of the association between poor peer relations and depressive symptoms at age 43.

    Conclusions: Policies to foster constructive peer relations for adolescents at school are encouraged; such policies may promote both the availability of social support and better mental health across the life course.

  • 131.
    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, Pekka
    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.
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Preventive Medicine. 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.
    Youth participation in Active Labour Market Programs (ALMPs) during boom/recession and mental health: a 20-year follow-up2019Conference paper (Refereed)
  • 132.
    Beckman, Linda
    et al.
    Karlstad Univ, Dept Publ Hlth Sci, Karlstad, Sweden..
    Janson, Staffan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Karlstad Univ, Dept Publ Hlth Sci, Karlstad, Sweden..
    von Kobyletzki, Laura
    Karlstad Univ, Dept Publ Hlth Sci, Karlstad, Sweden.;Lund Univ, Dept Dermatol, Skane Univ Hosp, Malmo, Sweden..
    Associations between neurodevelopmental disorders and factors related to school, health, and social interaction in schoolchildren: Results from a Swedish population-based survey2016In: Disability and Health Journal, ISSN 1936-6574, E-ISSN 1876-7583, Vol. 9, no 4, p. 663-672Article in journal (Refereed)
    Abstract [en]

    Background: Children and adolescents with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) are more likely to be surrounded by different risk factors. In order to work preventively with decreasing ADHD and ASD symptoms, there is a need of more knowledge concerning risk factors. Objective: This study aimed to investigate school, health, lifestyle and social interactions association with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) among schoolchildren aged 6-17 years. Methods: Data for 18,416 children and adolescents aged 6-17 years in the county of Varmland, Sweden, from the school year 2012/2013 and 2013/2014 were obtained from the Student Health Database, which includes information on health examinations by school nurses and self-reported information of mental and physical health, social relations, physical activity, and school conditions. Results: Of all participants, 2.4% reported only ADHD and 1.6% reported only ASD. The results confirmed that ADHD or ASD was significantly associated with worse school experiences, lower socioeconomic status, less physical activity, more substance use, weaker social network and more impairments than those without ADHD or ASD. Conclusions: Knowledge of risk or protective factors during school years is needed to develop interventions to reduce symptoms of neurodevelopmental disorders in children and adolescents.

  • 133.
    Beijer, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Lampa, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Nilsson, Peter M.
    SUS Malmö, Dept Clin Sci, Malmö, Sweden.
    Elmståhl, Sölve
    Lund Univ, Malmö Univ Hosp, Dept Hlth Sci, Div Geriatr Med, Malmö, Sweden.
    Pedersen, Nancy L.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Physical activity may compensate for prolonged TV time regarding pulse rate-a cross-sectional study2018In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, no 4, p. 247-254Article in journal (Refereed)
    Abstract [en]

    Background: Regular exercise reduces pulse rate, but it is less clear how prolonged sitting time affects pulse rate. Our hypothesis was that high physical activity could compensate for prolonged sitting time regarding the pulse rate.

    Methods: Regression analysis was performed on cross-sectional data including 47,457 men and women based on two Swedish cohort studies, EpiHealth (18–45 years) and LifeGene (45–75 years). Self-reported leisure time physical activity was given in five levels, from low (level 1) to vigorous (level 5), and television time was used as a proxy of sitting time.

    Results: A higher physical activity (level 4 compared to level 1) was associated with a lower pulse rate in middle-aged females (-2.7 beats per minute [bpm]; 95% CI -3.3 to -2.2) and males (-4.0 bpm; 95% CI -4.7 to -3.4). The relationship between physical activity and pulse rate was strongest in the young. A prolonged television time (3 h compared to 1 h per day) was associated with a slightly higher pulse rate in middle-aged females (+0.6 bpm; 95% CI +0.3 to +0.8) and males (+0.9 bpm; 95% CI +0.7 to +1.2). Among participants with a prolonged television time (3 h), those with a high physical activity (level 4) had a lower pulse rate compared to those with a low physical activity (level 1).

    Conclusions: A prolonged television time was associated with a high pulse rate, while high physical activity was associated with a low pulse rate. The results suggest that a high physical activity could compensate for a prolonged television time regarding pulse rate.

  • 134.
    Beijer, Ulla
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Birath, Christina Scheffel
    Stockholm Ctr Dependency Disorders, Stockholm, Sweden.
    DeMarinis, Valerie
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Theology, Department of Theology, The Social Sciences of Religion, Psychology of Religions. Innlandet Hosp Trust, Publ Mental Hlth, Brumunddal, Norway.
    af Klinteberg, Britt
    Karolinska Inst, Stockholm, Sweden;Stockholm Univ, Karolinska Inst, Psychol, Stockholm, Sweden.
    Facets of Male Violence Against Women With Substance Abuse Problems: Women With a Residence and Homeless Women2018In: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, Vol. 33, no 9, p. 1391-1411Article in journal (Refereed)
    Abstract [en]

    The aims of this study were to investigate the type and extent to which women with substance abuse problems have been exposed to male violence during their lifetime, and to examine possible differences between women with a residence (WR) and homeless women (HW). The total sample included 79 women (WR, n = 35; HW, n = 44; M age = 47.8 years). Of the total sample, 72 women (91%) had experienced different kinds of male violence, 88% from former partners, and 26% from male friends or acquaintances. Of the 72 women, 71% further reported Countless occasions of violent events, and 36% had been forced to commit criminal acts. Abused women who had been forced to commit criminal acts were significantly more frequently found to be homeless, have reported parental alcohol and/or drug problems, have witnessed domestic violence in childhood, have been victims of sexual violence, have used illicit drugs as a dominant preparation, and have injected illicit drugs. Almost half of the abused women (46%) met criteria for posttraumatic stress disorder (PTSD), where HW showed an almost 4-time higher risk (RR 3.78) than WR. In conclusion there is a particular vulnerability in women with substance abuse to male violence, which has an important impact on their health status. Thus, from a public health perspective, it is suggested that for those women who have experienced male violence, treatment protocols need to include both assessing and addressing the impact of such experience in relation to substance abuse as well as concomitant health concerns.

  • 135. Bellamy, David
    et al.
    Bouchard, Jacques
    Henrichsen, Svein
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Langhammer, Arnulf
    Reid, Jim
    van Weel, Chris
    Buist, Sonia
    International Primary Care Respiratory Group (IPCRG) Guidelines: management of chronic obstructive pulmonary disease (COPD)2006In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 15, no 1, p. 48-57Article in journal (Refereed)
  • 136.
    Ben Mosbah, Hgqer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    "I was like a rose, now I look like a thorn" An exploratory study of women injecting drug users (WIDU) in Tunisia2016Independent thesis Advanced level (degree of Master (Two Years)), 30 credits / 45 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of this master thesis was to explore contexts of initiation of substance use and to describe the social, physical and mental health situation of women injecting drug users (WIDU) in Tunisia.

    Relevance: In North Africa, people who inject drugs are an important risk group in the HIV epidemic. There is evidence that WIDU are even more vulnerable. However, in Arabic Muslim societies, rehabilitation, treatment for this subpopulation and research on this issue are scarce.

    Method: A qualitative study was conducted. Six in-depth interviews with WIDU in Tunis were recorded, transcribed and inductivelyanalyzed using thematic analysis.

    Findings: Four themes were identified. The first theme describes situation of women before dependence. Women were brought up within patriarchal cultural norms where they were victimized. The second theme is related to the circumstances of initiation of drug use characterized by the wish for escape and pursue of pleasures. The third theme describes the dependence, withdrawal and consequences on everyday life. Final and fourth theme is related to the way out of addiction.

    Conclusion and recommendations: The socio-ecological model and the gender relational theory helped to interpret the findings.WIDU in Tunisia suffer from marginalization and from social and health inequalities due to their gender and to their dependence. This puts them at a higher risk of violence, abuse, health hazards and blood-borne and HIV infections. Thus, awareness and policies should be designed in order to alleviate the stigma and bring services closer to this subpopulation.

  • 137.
    Benedict, Christian
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Axelsson, Tomas
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular Medicine.
    Söderberg, Stefan
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Schiöth, Helgi B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    The fat mass and obesity-associated gene (FTO) is linked to higher plasma levels of the hunger hormone ghrelin and lower serum levels of the satiety hormone leptin in older adults2014In: Diabetes, ISSN 0012-1797, E-ISSN 1939-327X, Vol. 63, no 11, p. 3955-3959Article in journal (Refereed)
    Abstract [en]

    The mechanisms through which common polymorphisms in the fat mass and obesity-associated gene (FTO) drive the development of obesity in humans are poorly understood. By using C: ross-sectional data from 985 elderly (50% females) who participated at age 70 years in the Prospective Investigation of the Vasculature in Uppsala Seniors, circulating levels of ghrelin and leptin were measured after an overnight fast. In addition, subjects were genotyped for FTO rs17817449 (AA, n=345 (35%); AC/CA, n=481 (48.8%); CC, n=159 (16.1%). Linear regression analyses controlling for sex, self-reported physical activity level, fasting plasma glucose, and body mass index were utilized. A positive relationship between the number of FTO C risk alleles and plasma ghrelin levels was found (P=0.005; relative plasma ghrelin difference between CC and AA carriers = ∼9%). In contrast, serum levels of the satiety enhancing hormone leptin were inversely linked to the number of FTO C risk alleles (P=0.001; relative serum leptin difference between CC and AA carriers = ∼11%). These associations were also found when controlling for waist circumference. The present findings suggest that FTO may facilitate weight gain in humans by shifting the endocrine balance from the satiety hormone leptin toward the hunger promoting hormone ghrelin.

  • 138.
    Bengs, Carita
    et al.
    Umeå universitet, Sociologiska institutionen.
    Johansson, Eva
    Umeå universitet, Allmänmedicin.
    Danielsson, Ulla EB
    Umeå universitet, Allmänmedicin.
    Lehti, Arja
    Umeå universitet, Allmänmedicin.
    Hammarström, Anne
    Umeå universitet, Allmänmedicin.
    Gendered portraits of depression in Swedish newspapers2008In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 18, no 7, p. 962-973Article in journal (Refereed)
    Abstract [en]

    Mass media are influential mediators of information, knowledge, and narratives of health and illness. In this article, we report on an examination of personal accounts of illness as presented in three Swedish newspapers, focusing on the gendered representation of laypersons' experiences of depression. A database search identified all articles mentioning depression during the year 2002. Twenty six articles focusing on personal experiences of depression were then subjected to a qualitative content analysis. We identified four themes: displaying a successful facade, experiencing a cracking facade, losing and regaining control, and explaining the illness. We found both similarities and differences with regard to gendered experiences. The mediated accounts of depression both upheld and challenged traditional gender stereotypes. The women's stories were more detailed, relational, emotionally oriented, and embodied. The portrayal of men was less emotional and expressive, and described a more dramatic onset of depression, reflecting hegemonic patterns of masculinity.

  • 139.
    Benta, Humayra
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Association of self-reported physical aspect of workplace environment and hypertension - a cross sectional study in UK2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction      

    Hypertension is the leading cause of cardiovascular disease, which is responsible for 9.4 million death per year. The characteristics of the physical environment of the workplace may influence exposure to the risk of hypertension. The aim of this study is to increase the knowledge of to what extent of physical workplace environment is associated with hypertension.

    Method

    A cross-sectional study was conducted using UK Biobank data including 256,617 participants, aged 39-71 years. The exposure variable included information about the physical aspects of the workplace environment. The outcome variable was hypertension, defined by the average of two blood pressure measurement, systolic blood pressure >140 mmHg and diastolic blood pressure >90 mmHg. The association was calculated using logistic regression.

    Result

    Both crude (OR 1.21, CI 1.14-1.28) and adjusted analysis (OR 1.07, CI 1.01-1.12) showed an association between exposure to chemicals in the workplace and hypertension. This association was constant when controlling for possible confounders in three models. Other physical aspects of the workplace environment did not show any statistically significant association with hypertension. To assess whether this association was modified by job satisfaction, the analysis was further stratified by work/ job satisfaction, but it was concluded that work/ job satisfaction does not act as an effect modifier of the association between workplace environment and hypertension.

    Conclusion

    Chemical exposure may increase the risk of hypertension in the workplace among the workers. This knowledge emphasizes the importance to formulate preventive measures in the workplace for better health outcome of workers.

  • 140. Berfenstam, R
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sjukdomsstatistik på försäkringsmaterial: PM återgiven i "Diagnostik - nyhet som kommer från RFV"1966In: Tidskrift för Allmän Försäkring, Vol. 5, p. 286-94Article in journal (Refereed)
  • 141.
    Berg, Noora
    National Institute for Health and Welfare, Finland.
    Accumulation of disadvantage from adolescence to midlife: A 26-year follow-up study of 16-year old adolescents2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    There is a wide range of evidence that childhood conditions are associated with adult wellbeing and disadvantage. However, in many cases, there is still a lack of knowledge on how and why these associations are formed. The life-course perspective examines these longitudinal mechanisms linking wellbeing and disadvantage in different life phases and tries to understand the continuities and discontinuities of individual lives. Information on these longitudinal associations is needed in order to be able to affect adverse life paths. For several decades, it has been suggested that disadvantage is a multidimensional concept that encompasses several dimensions of life such as health, social relations, socioeconomic factors and risky behaviour. Different forms of disadvantage are known to correlate, but less is known about how these disadvantages are interlocked in time. Accumulation of disadvantage refers to these processes, where previous disadvantages affect subsequent disadvantage. Mortality can be seen as an extreme end point of accumulation of disadvantage. The multidimensional approach to disadvantage is still underutilized in research in many ways. Often the focus has been in socioeconomic and health related forms of disadvantage or in risky behaviour, but rarely studies have taken several different dimensions of life into account simultaneously. The general aim of this study was to examine accumulation of disadvantage from adolescence to midlife in a life-course perspective. This study approaches the concept of disadvantage from a multidimensional perspective covering life dimensions of health, social relations, socioeconomic factors and risky behaviour. This study is a part of wider follow-up study Stress, Development and Mental Health –Study (TAM-project), which is carried out at the National Institute for Health and Welfare (THL). The study has prospectively followed up a Finnish urban age cohort at the ages of 16, 22, 32 and 42. The original study population included all Finnish speaking ninth-grade pupils attending secondary schools in the spring of 1983 in Tampere, Finland. In the first phase of the study, 2194 pupils (96.7%) aged 16 years completed a self-administered questionnaire during school hours. In three later phases the study cohort was followed up using postal questionnaires when the subjects were 22 (n=1656, 75.5%), 32 (n=1471, 67.0%) and 42 (n=1334, 60.7%) years old. This study examined multidimensional disadvantage using life-course models of clustered disadvantage, chain of risk and accumulation and found support for all of them. According to the results of this study, several individual and clustered forms of disadvantage in adolescence were associated with mortality before midlife. Lack of educational plans or uncertainty of them at age 16 was the strongest single predictor of mortality. Multiple simultaneous forms of disadvantage related to social relations, risky behaviour and own and parental socioeconomic factors were associated with mortality. This was the case also when disadvantage extended to many dimensions of disadvantage simultaneously. We found that poor family relationships in adolescence played a role in chains of disadvantages lasting all the way to midlife. The pathways from poor family relationships to economic adversity in midlife were shaped by low education and poor mental health in 5 early adulthood in women. In men this association was found to be shaped by early adult education, but it was explained by poor school performance already at age 16, indicating that those men with poor family relationships are already in adolescence on a disadvantage trajectory that will continue into adulthood regardless of whether they have problems in family relationships. The pathways to poor mental health in midlife were shaped mainly by mental health in early adulthood and in women also by heavy drinking. In the final life-course model we focused on accumulation of heavy drinking and examined it by using trajectory models. The results indicate that women of the steady high alcohol trajectory from adolescence to midlife had an increased risk of experiencing almost all measured disadvantages at age 42 (health, social relations, socioeconomic factors). In men, those who increased their drinking or drank steadily heavily had an increased risk for experiencing health and economic disadvantage in midlife. Frequent heavy drinking in adolescence did not leave 'a scar' that would associate with midlife disadvantage, if the drinking was reduced after adolescence. Childhood and adolescent disadvantages have long-term effects on wellbeing/disadvantage all the way to midlife, but they do not inexorably determine people's lives, also conditions in other life phases shape the life course. This provides many possibilities for preventive actions that should be targeted, not only to early years of life, but to later life phases as well. Our results highlight the importance of targeting interventions to improving the family relationships, supporting the educational career of the disadvantaged and preventing detrimental alcohol use

    List of papers
    1. A 26-year follow-up study of heavy drinking trajectories from adolescence to mid-adulthood and adult disadvantage
    Open this publication in new window or tab >>A 26-year follow-up study of heavy drinking trajectories from adolescence to mid-adulthood and adult disadvantage
    Show others...
    2013 (English)In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 48, no 4, p. 452-7Article in journal (Refereed) Published
    Abstract [en]

    AIMS: The aim of the study was to identify heavy drinking trajectories from age 16 to 42 years and to examine their associations with health, social, employment and economic disadvantage in mid-adulthood.

    METHODS: Finnish cohort study's participants who were 16 years old in 1983 were followed up at age 22, 32 and 42 (n = 1334). Heavy drinking was assessed at every study phase and based on these measurements trajectories of heavy drinking were identified. The trajectory groups were then examined as predictors of disadvantage at age 42.

    RESULTS: Five distinct heavy drinking trajectories were identified: moderate (35%), steady low (22%), decreasing (9%), increasing (11%) and steady high (23%). Frequencies of the trajectory groups differed by gender. Using the moderate trajectory as a reference category, women in the steady high trajectory had an increased risk of experiencing almost all disadvantages at age 42. In men, increasing and steady high groups had an increased risk for experiencing health and economic disadvantage.

    CONCLUSION: Steady high female drinkers and steady high and increasing male drinkers had the highest risk for disadvantage in mid-adulthood. By identifying heavy drinking trajectories from adolescence to mid-adulthood we can better predict long-term consequences of heavy alcohol use and plan prevention and intervention programmes.

    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-318825 (URN)10.1093/alcalc/agt026 (DOI)23531717 (PubMedID)
    Available from: 2017-03-28 Created: 2017-03-28 Last updated: 2017-11-29
    2. Nuoruusiän huono-osaisuus ja sen kasautumisen yhteys kuolleisuuteen. Seurantatutkimus 16-vuotiaista nuorista
    Open this publication in new window or tab >>Nuoruusiän huono-osaisuus ja sen kasautumisen yhteys kuolleisuuteen. Seurantatutkimus 16-vuotiaista nuorista
    2011 (Finnish)In: Sosiaalilääketieteellinen Aikakauslehti, Vol. 48, no 3, p. 168-181Article in journal (Refereed) Published
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-318831 (URN)
    Available from: 2017-03-28 Created: 2017-03-28 Last updated: 2017-11-21
    3. Pathways from poor family relationships in adolescence to economic adversity in mid-adulthood
    Open this publication in new window or tab >>Pathways from poor family relationships in adolescence to economic adversity in mid-adulthood
    Show others...
    2016 (English)In: Advances in Life Course Research, ISSN 1569-4909, E-ISSN 1879-6974Article in journal (Refereed) In press
    Abstract [en]

    Previous studies have found that troubled childhood family conditions have long-term detrimental effects on a person’s economic situation in adulthood. However, the mechanisms behind these effects are unclear. The aim of this study was to examine the associations between poor adolescent family relationships and the economic adversity in mid-adulthood and whether different adversities in early adulthood mediate this association.

    Participants of a Finnish cohort study at 16 years in 1983 were followed up when aged 22, 32 and 42 (N = 1334). Family relationships were measured according to adolescents’ perceived lack of emotional parental support (e.g. My mother is close to me (reversed)), lack of parental support in the individuation process and poor atmosphere at home. We analysed the direct effects of poor family relationships at age 16 on the economic adversity at age 42 and also indirect effects via various adversities at ages 22 and 32. The examined adversities were poor somatic and mental health, lack of an intimate relationship, low education and heavy drinking.

    Poor adolescent family relationships were associated with economic adversity in mid-adulthood. For women, poor relationships were associated with their economic adversity (42y) through poor mental health and low education in early adulthood. For men, the effect was transmitted via low education, although this was not the case after adjusting for school achievement in adolescence.

    The quality of family relationships in adolescence is associated with an individual’s economic situation well into mid-adulthood in women. Moreover, this association was not explained by family structure and parental SEP in adolescence. Early promotion of parent-child interaction, as well as health and education of individuals from troubled family conditions, might reduce economic inequality in adulthood.

    National Category
    Sociology
    Identifiers
    urn:nbn:se:uu:diva-318829 (URN)10.1016/j.alcr.2016.07.001 (DOI)
    Available from: 2017-03-28 Created: 2017-03-28 Last updated: 2017-11-29
  • 142.
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Huono-osaisuuden kasautuminen nuoruusiästä keski-ikään.: Lectio praecursoria2017In: Sosiaalilääketieteellinen aikakauslehti, ISSN 0355-5097, Vol. 54, no 2, p. 159-164Article in journal (Other academic)
  • 143.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. National Institute for Health and Welfare, Finland.
    Huurre, Taina
    Kiviruusu, Olli
    Aro, Hillevi
    Nuoruusiän huono-osaisuus ja sen kasautumisen yhteys kuolleisuuteen. Seurantatutkimus 16-vuotiaista nuorista2011In: Sosiaalilääketieteellinen Aikakauslehti, Vol. 48, no 3, p. 168-181Article in journal (Refereed)
  • 144.
    Berg, Noora J.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Natl Inst Hlth & Welf, POB 30, Helsinki 00271, Finland.
    Kiviruusu, Olli H.
    Natl Inst Hlth & Welf, POB 30, Helsinki 00271, Finland.
    Lintonen, Tomi P.
    Finnish Fdn Alcohol Studies, Helsinki, Finland;Univ Tampere, Tampere, Finland.
    Huurre, Taina M.
    Natl Inst Hlth & Welf, POB 30, Helsinki 00271, Finland.
    Longitudinal prospective associations between psychological symptoms and heavy episodic drinking from adolescence to midlife2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 4, p. 420-427Article in journal (Refereed)
    Abstract [en]

    Aim: This study examined whether development of psychological symptoms (PS) differed between persons with different longitudinal profiles of heavy episodic drinking (HED) from adolescence to midlife. In addition, the reciprocal associations between PS and HED were studied. Methods: Participants of a Finnish cohort study in 1983 at age 16 (N = 2194) were followed up at ages 22 (N = 1656), 32 (N = 1471), and 42 (N = 1334). HED was assessed with frequency of intoxication (16-22 years) and having six or more drinks in a session (32-42 years). Using latent class analysis, the participants were allocated to steady high, increased, moderate, and steady low groups according to their longitudinal profiles of HED. The PS scale (16-42 years) covered five mental complaints. The latent growth curve of PS was estimated in the HED groups for comparisons. In addition, the prospective associations between symptoms and HED were examined using cross-lagged autoregressive models. Results: PS grew from 16 to 32 years, but declined after that, with women having higher level of PS than men. PS trajectory followed a path at highest and lowest level in the steady high and steady low HED groups, respectively. Symptoms predicted later HED, but the association in the opposite direction was not found. Conclusions: The more the HED trajectory indicated frequent HED, the higher was the level of PS throughout the follow-up. Results support the self-medication hypothesis, suggesting that alcohol is used to ease the burden of PS. More attention should be paid to alcohol use of people with mental symptoms in health services.

  • 145.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. National Institute for Health and Welfare, Helsinki, Finland.
    Kiviruusu, Olli
    National Insitute for Health and Welfare, Helsinki, Finland.
    Bean, Christopher
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Huurre, Taina
    National Institute for Health and Welfare, Helsinki, Finland.
    Lintonen, Tomi
    Finnish Foundation for Alcohol studies, Helsinki, Finland.; University of Tampere, Tampere, Finland.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Social relationships in adolescence and heavy episodic drinking from youth to midlife in Finland and Sweden: examining the role of individual, contextual and temporal factors2018In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 1000Article in journal (Refereed)
    Abstract [en]

    Background

    Applying the Process-Person-Context-Time (PPCT) model of the bioecological theory, this study considers whether proximal processes between the individual and the microsystem (social relationships within family, peer group and school) during adolescence are associated with heavy episodic drinking (HED), from youth to midlife, and whether the macro level context (country) plays a role in these associations.

    Methods

    Participants of two prospective cohort studies from Finland and Sweden, recruited in 1983/1981 at age 16 (n = 2194/1080), were followed-up until their forties using postal questionnaires. Logistic regression analysis was used to examine associations between social relationships at age 16 and HED (at least monthly intoxication or having six or more units of alcohol in one occasion) at ages 22/21, 32/30 and 42/43. Additive interactions between microsystem settings, as well as between settings and country, were also considered.

    Results

    Consistent with the PPCT model, we found individual, contextual and temporal aspects to be associated with drinking habits. Higher levels of poor family relationships were associated with an increased likelihood of HED (ages 22/21 and 32/30) in both Finnish women and men and Swedish men. Higher levels of peer contact were associated with an increased likelihood of HED in both Finnish women (ages 32 and 42) and men (ages 22 and 32), and Swedish men (age 21). In contrast with the other groups, poorer relationships with classmates were associated with an increased likelihood of HED (age 30) for Swedish women only. For women, the combined effect of having both daily peer contact and living in Finland for HED at age 42/43 was statistically distinguishable from a pure additive effect.

    Conclusions

    Micro and to a lesser extent macro level contexts are associated with heavy episodic drinking well into adulthood. The most relevant processes in the adolescent microsystem occur in family and peer settings. However, long-lasting protective or risk-raising effects between different settings and later HED were not found. Promoting good relationships across different contexts during adolescence may reduce the incidence of HED in adulthood.

  • 146.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.
    Kiviruusu, Olli
    Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.
    Huurre, Taina
    Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.;Department of Health and Social Welfare, City of Vantaa, Vantaa, Finland.
    Lintonen, Tomi
    Finnish Foundation for Alcohol Studies, Helsinki, Finland.;Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland.
    Virtanen, Pekka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Associations between unemployment and heavy episodic drinking from adolescence to midlife in Sweden and Finland2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 2, p. 258-263Article in journal (Refereed)
    Abstract [en]

    Background

    Unemployment and alcohol use have often been found to correlate and to act as risk factors for each other. However, only few studies have examined these associations at longitudinal settings extending over several life phases. Moreover, previous studies have mostly used total consumption or medical diagnoses as the indicator, whereas subclinical measures of harmful alcohol use, such as heavy episodic drinking (HED), have been used rarely. The aim of this study was to examine the associations between HED and unemployment from adolescence to midlife in two Nordic countries.

    Methods

    Participants of separate cohort studies from Sweden and Finland were recruited at age 16 in 1981/1983 and followed up at ages 21/22, 30/32 and 43/42, (n = 1080/2194), respectively. Cross-lagged autoregressive models were used to determine associations between HED and unemployment.

    Results

    In the Swedish cohort, HED at ages 16 and 30 in men and HED at age 21 in women were associated with subsequent unemployment. In the Finnish cohort, we found corresponding associations at age 16 in women and at age 22 in men. However, the gender differences were not statistically significant. The associations from unemployment to HED were non-significant in both genders, in both cohorts and at all ages.

    Conclusions

    Our results suggest that heavy drinkers are more likely to experience unemployment in subsequent years. The associations from HED to unemployment seem to exist through the life course from adolescence to midlife. More emphasis should be put on reducing alcohol related harms in order to improve labour-market outcomes.

  • 147.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. National Institute for Health and Welfare, Finland.
    Kiviruusu, Olli
    National Institute for Health and Welfare, Finland.
    Huurre, Taina
    National Institute for Health and Welfare, Finland.
    Lintonen, Tomi
    Finnish Foundation for Alcohol Research.
    Virtanen, Pekka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. University of Tampere.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Unemployment and heavy episodic drinking from adolescence to midlife in Sweden and Finland2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no suppl. 3Article in journal (Other academic)
  • 148.
    Berg, Noora
    et al.
    National Institute for Health and Welfare, Finland.
    Kiviruusu, Olli
    Karvonen, Sakari
    Kestilä, Laura
    Lintonen, Tomi
    Rahkonen, Ossi
    Huurre, Taina
    A 26-year follow-up study of heavy drinking trajectories from adolescence to mid-adulthood and adult disadvantage2013In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 48, no 4, p. 452-7Article in journal (Refereed)
    Abstract [en]

    AIMS: The aim of the study was to identify heavy drinking trajectories from age 16 to 42 years and to examine their associations with health, social, employment and economic disadvantage in mid-adulthood.

    METHODS: Finnish cohort study's participants who were 16 years old in 1983 were followed up at age 22, 32 and 42 (n = 1334). Heavy drinking was assessed at every study phase and based on these measurements trajectories of heavy drinking were identified. The trajectory groups were then examined as predictors of disadvantage at age 42.

    RESULTS: Five distinct heavy drinking trajectories were identified: moderate (35%), steady low (22%), decreasing (9%), increasing (11%) and steady high (23%). Frequencies of the trajectory groups differed by gender. Using the moderate trajectory as a reference category, women in the steady high trajectory had an increased risk of experiencing almost all disadvantages at age 42. In men, increasing and steady high groups had an increased risk for experiencing health and economic disadvantage.

    CONCLUSION: Steady high female drinkers and steady high and increasing male drinkers had the highest risk for disadvantage in mid-adulthood. By identifying heavy drinking trajectories from adolescence to mid-adulthood we can better predict long-term consequences of heavy alcohol use and plan prevention and intervention programmes.

  • 149.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. National Institute for Health and Welfare, Finland.
    Kiviruusu, Olli
    Karvonen, Sakari
    Kestilä, Laura
    Lintonen, Tomi
    Rahkonen, Ossi
    Huurre, Taina
    Adult consequences of binge drinking trajectories from adolescence to adulthood. A 26-year prospective follow-up study.2011Conference paper (Other academic)
  • 150.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. National Institute for Health and Welfare.
    Kiviruusu, Olli
    Karvonen, Sakari
    Rahkonen, Ossi
    Huurre, Taina
    A 26-year follow-up study on psychological symptoms trajectory from adolescence to mid-adulthood and adult disadvantage.2012Conference paper (Other academic)
1234567 101 - 150 of 1812
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