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  • 151.
    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)
  • 152.
    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
    Rahkonen, Ossi
    Huurre, Taina
    A Finnish 26-year follow-up study of different pathways from family conditions in adolescence to mental health and economic situation in mid-adulthood.2013Conference paper (Other academic)
  • 153.
    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
    National Institute for Health and Welfare, Finland.
    Karvonen, Sakari
    Natl Inst Hlth & Welf, Dept Hlth & Social Care Syst, Helsinki, Finland.
    Rahkonen, Ossi
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Huurre, Taina
    National Institute for Health and Welfare, Finland.; City Vantaa, Dept Hlth & Social Welf, Vantaa, Finland.
    Pathways from problems in adolescent family relationships to midlife mental health via early adulthood disadvantages – a 26-year longitudinal study2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 5, article id e0178136Article in journal (Refereed)
    Abstract [en]

    Poor childhood family conditions have a long-term effect on adult mental health, but the mechanisms behind this association are unclear. Our aim was to study the pathways from problematic family relationships in adolescence to midlife psychological distress via disadvantages in early adulthood. Participants of a Finnish cohort study at the age of 16 years old in 1983 were followed up at ages 22, 32 and 42 years old (N = 1334). Problems in family relationships were measured with poor relationship with mother and father, lack of parental support in adolescent's individuation process and poor home atmosphere, and mental health was assessed using Kessler's Psychological Distress Scale (K10). We analyzed the indirect effects of adolescent family relations on mental health at age 42 years old via various disadvantages (somatic and psychological symptoms, relationship/marital status, low education/unemployment and heavy drinking) at ages 22 and 32 years old. Problematic adolescent family relationships were associated with midlife psychological distress in women (0.19; 95% CI 0.11, 0.26) and men (0.13; 95% CI 0.04, 0.21). However, after adjustment for adolescent psychological symptoms, the association was only significant for women (0.12; 95% CI 0.04, 0.20). Poor family relationships were associated with various disadvantages in early adulthood. The association from poor family relationships (16 years old) to psychological distress (42 years old) was in part mediated via psychological symptoms in women (0.03; 95% CI 0.01, 0.04) and men (0.02; 95% CI 0.00, 0.04) and in women also via heavy drinking in early adulthood (0.02; 95% CI 0.00, 0.03). Adolescent family relationships have a role in determining adult mental health. Targeted support addressing psychological well-being and hazardous drinking for adolescents with problematic family relationships might prevent disadvantages in early adulthood, and further prevent poor midlife mental health.

  • 154.
    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
    Lintonen, Tomi
    Huurre, Taina
    Development of heavy drinking and psychological symptoms from adolescence to midlife in Finland2016Conference paper (Other academic)
  • 155.
    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
    Lintonen, Tomi
    Huurre, Taina
    Longitudinal associations between development of psychological symptoms and heavy drinking in a 26 year follow-up study.2015Conference paper (Other academic)
  • 156.
    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
    Rahkonen, Ossi
    Karvonen, Sakari
    Huurre, Taina
    A path analysis from problems in family relations in adolescence to mental health in mid-adulthood.2014Conference paper (Other academic)
  • 157.
    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
    Rahkonen, Ossi
    Karvonen, Sakari
    Huurre, Taina
    Pathways from adolescence family relations to mid-adulthood mental health.2014Conference paper (Other academic)
  • 158.
    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
    Rahkonen, Ossi
    Karvonen, Sakari
    Huurre, Taina
    The mediating role of disadvantage in the associations between family conditions in adolescence and mental health and economic situation in mid-adulthood.2014Conference paper (Other academic)
  • 159.
    Berg, Noora
    et al.
    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.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. University of Eastern Finland.
    Lintonen, Tomi
    Tampere University.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Stockholm University.
    The contribution of drinking culture at comprehensive school to heavy episodic drinking from adolescence to midlife2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360XArticle in journal (Refereed)
    Abstract [en]

    Background

    The school context is associated with adolescent alcohol use, but it is not clear whether this association continues into adulthood. This study examined whether exposure to drunkenness oriented drinking culture in 9th grade school class is associated with individuals’ heavy episodic drinking (HED) from adolescence to midlife.

    Methods

    Participants in the ‘Northern Swedish Cohort’ study aged 16 years in 1981 were followed-up when aged 18, 21, 30 and 43 (N = 1080). Individual-level factors were HED, positive attitudes towards drunkenness, early initiation of HED and peer-oriented spare-time. School class-level drinking culture was measured as classmate reported HED, positive attitudes, early initiation of HED and peer-oriented spare time. Multilevel log-binomial regression analyses were adjusted for gender, parental socioeconomic background, family structure and HED at age 16.

    Results

    After adjustment for sociodemographic factors several cross-sectional and longitudinal associations were found between class-level indicators of drinking culture and individual HED. After additional adjustment for age 16 HED, most associations attenuated. The risk ratio (95% confidence interval) for engaging in HED at age 43 was 1.58 (1.03–2.42) times higher for those who at age 16 had many classmates reporting positive attitude towards drunkenness.

    Conclusions

    These findings suggest that drinking culture in school may have a long-lasting impact on drinking habits in adulthood. The associations with HED at follow-ups are likely mediated by HED in adolescence. Studies on alcohol use would benefit from taking into account both individual and contextual factors in a life course perspective.

  • 160.
    Berg, P
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Kartläggning av attityder till cykelhjälmsanvändning hos skolungdomar. Redovisning av en enkätundersökning i Bålsta och Enköping1998In: Socialmedicinsk rapportserie. Institutionen för folkhälso -lch vårdvetenskap, socialmedicin. Uppsala universitet 1998Article in journal (Other academic)
  • 161.
    Berg, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    The connection between socioeconomic and psycho-social factors and bicycle helmet use among school children and teenagers2010Article in journal (Other academic)
  • 162.
    Bergfoth, Emelie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Eriksson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Livskvalitet efter avslutad behandling hos dem som drabbats av leukemi, lymfom eller hjärntumör under barn- och ungdomsåren – en litteraturstudie2009Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim

    The aim of this review of the literature was to investigate the quality of life of survivors of leukemia, lymphoma or brain tumor during childhood.

    Method

    Sixteen studies that examined the quality of life of these groups were reviewed. All studies were based on self-reported data and were published between 1999 and 2009.

    Result

    Several studies compared the survivors’ mental and physical health with that for a healthy population and the results did not differ between these groups. The results do however show that treatment and/or disease may have a negative effect on the quality of life. Radiotherapy and chemotherapy may affect the growth and cause infertility-problems as well as cardiovascular complications. The treatments may also affect the physical and cognitive function. Survivors who had a low education-level, were unemployed and/or had a low income reported lower quality of life. These results indicate that it may be important to provide children with cancer with special education.

  • 163.
    Bergkvist, Hanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    SÄLLSKAPSDJURENS BETYDELSE FÖR ÄLDRE MÄNNISKORS HÄLSA OCH VÄLBEFINNANDE PÅ SÄRSKILT BOENDE2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Hälsa och livskvalité är två aspekter av välbefinnande. Under senare år har intresset för djurens betydelse för människans välbefinnande ökat. Utifrån detta perspektiv kommer intresset för att använda djur som resurser vid vård och behandling då djur anses förebygga ohälsa och starkt bidra till hälsa och livskvalité hos människor. För att bryta tristessen och den enformiga vardagen som äldre ibland upplever på särskilt boende kan sällskapsdjur vara till hjälp. Syfte: Syftet med denna litteraturöversikt är att undersöka sällskapsdjurens betydelse för äldre människors hälsa och välbefinnande på särskilt boende. Metod: Metoden är en litteraturöversikt där 10 st vetenskapliga artiklar från databaserna CINAHL och PubMed har analyserats och delats upp i fyra olika teman utifrån resultaten. Resultat: Resultatet visade på att äldres hälsa och välbefinnande påverkas positivt av att integrera med djur. Social isolering, oro och stress kan minska, och fysisk aktivitet kan öka, med hjälp av olika former av behandlingar och aktiviteter med sällskapsdjur. Detta skapar gynnsamma villkor för ökad livskvalité och en bättre hälsa hos äldre på särskilt boende. Slutsats: Även om mer forskning inom ämnet behövs så tenderar närvaron av djur att ha en positiv inverkan på äldre personer. Sällskapsdjur kan användas inom hälso- och sjukvården för att uppmuntra, aktivera och bidra med glädje och livslust i vardagen.

  • 164.
    Berglund, Anna
    et al.
    Uppsala University, National Centre for Knowledge on Men.
    Lindmark, Gunilla
    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).
    Preconception health and care (PHC)a strategy for improved maternal and child health2016In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 121, no 4, p. 216-221Article, review/survey (Refereed)
    Abstract [en]

    Maternal health status before pregnancy is a decisive factor for pregnancy outcomes and for risk for maternal and infant complications. Still, maternity care does not start until the pregnancy is established and in most low-income settings not until more than half of the pregnancy has passed, which often is too late to impact outcomes. In Western societies preconception care (PCC) is widely recognized as a way to optimize women's health through biomedical and behavioural changes prior to conception with the aim of improving pregnancy outcomes. But the content of PCC is inconsistent and limited to single interventions or preconception counselling to women with chronic illnesses. It has been suggested that PCC should be extended to preconception health and care (PHC), including interventions prior to pregnancy in order to optimize women's health in general, and thereby subsequent pregnancy outcomes, the well-being of the family, and the health of the future child. With this definition, almost every activity that can improve the health of girls and women can be included in the concept. In the World Health Report of 2005 a longitudinal approach to women's wellness and reproductive health was highlighted, and the World Health Organization has proposed a more comprehensive maternal and child health care, also including psychosocial issues and intimate partner violence. The present article gives an overview of the recent literature and discusses contents and delivery of PCC/PHC in Western as well as low-income countries. The article puts special emphasis on why violence against women is an issue for PHC.

  • 165.
    Berglund, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Adherence to drug treatment and interpretation of treatment effects2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Suboptimal adherence to medical treatments is prevalent across several clinical conditions and can lead to treatment failure. Adherence is a far from fully explored phenomenon and there is little knowledge about how patients interpret treatment effects. Commonly used treatment evaluation measures are often relative measures, which may be difficult for lay people and patients to understand.

    The overall aim of this thesis was to investigate factors with relevance to adherence, to estimate treatment effects with the time-based Delay of Event (DoE) measure in anticoagulant preventive treatments, and to explore how lay people responded to the DoE measure, as compared with established measures, regarding treatment decisions and effect interpretation.

    A quantitative population-based cross-sectional design was used for Study I. Study II used data from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) clinical trial and estimated effects as DoEs. Studies III and IV were carried out as randomised survey experiments.

    The results showed that general adherence behaviour was associated with both environmental and social factors. Estimations of DoE showed that stroke or systemic embolism was delayed 181 (95% CI 76 to 287) days through twenty-two months of apixaban use, as compared with  warfarin use. The delay of major and intracranial bleeding was 206 (95% CI 130 to 281) and 392 (95% CI 249 to 535) days, respectively, due to apixaban use for twenty-two months, as compared with  warfarin use. Presenting preventive treatment effects as DoEs to lay people was associated with high willingness to initiate treatment and positive views on treatment benefits and willingness to pay for treatment.

    Non-optimal adherence was partly associated with modifiable factors and it might be possible to increase adherence by managing these factors. Estimations of DoEs in preventive treatments gave information on effects regarding delay of different outcomes; the estimation also provides tools that might be useful for interpreting and communicating treatment effects in clinical decision-making. Lay people seemed to react rationally to variations in DoE magnitude; a higher proportion accepted treatment when the magnitude was greater.

    List of papers
    1. Living environment, social support and informal caregiving are associated with health care seeking behaviour and adherence to medication treatment: a cross-sectional population study
    Open this publication in new window or tab >>Living environment, social support and informal caregiving are associated with health care seeking behaviour and adherence to medication treatment: a cross-sectional population study
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Despite the well-known associations between local environment and health, few studies have focused on environment and health care utiliza-tion, for instance health care seeking behaviour or adherence. This study was aimed at analysing housing type, behaviour based on perceived local outdoor safety, social support, informal caregiving, demographics, socioeconomics, and long-term illness, and associations with health-seeking and adherence behaviours at a population level. This study used data from the Swedish National Public Health Survey 2004–2014, an annually repeated, large sample, cross-sectional, population-based sur-vey study. In all, questionnaires from 100,433 individuals were returned by post, making the response rate 52.9% (100,433/190,000). Descrip-tive statistics and multiple logistic regressions were used to investigate associations between explanatory variables and the outcomes of refrain-ing from seeking care and non-adherence behaviour. Living in rented apartment, lodger, a dorm or other was associated with reporting refrain-ing from seeking care (adjusted OR 1.16, 95% CI 1.00–1.22), and non-adherence (adjusted OR 1.22; 95% CI 1.13–1.31). Refraining from go-ing out due to a perceived unsafe neighbourhood was associated with refraining from seeking care (adjusted OR 1.59, 95% CI 1.51–1.67) and non-adherence (adjusted OR 1.26, 95% CI 1.17–1.36). Social support and status as an informal caregiver was associated with higher odds of refraining from seeking medical care and non-adherence. This study suggests that living in rental housing, refraining from going out due to neighbourhood safety concerns, lack of social support or informal care-giver status are associated with lower health-seeking behaviour and non-adherence to prescribed medication.

    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-379066 (URN)
    Available from: 2019-03-11 Created: 2019-03-11 Last updated: 2019-03-11
    2. Effects of apixaban compared with warfarin as gain in event-free time – a novel assessment of the results of the ARISTOTLE trial
    Open this publication in new window or tab >>Effects of apixaban compared with warfarin as gain in event-free time – a novel assessment of the results of the ARISTOTLE trial
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:uu:diva-379073 (URN)
    Available from: 2019-03-11 Created: 2019-03-11 Last updated: 2019-03-11
    3. Treatment effect expressed as the novel Delay of Event measure is associated with high willingness to initiate preventive treatment - A randomized survey experiment comparing effect measures
    Open this publication in new window or tab >>Treatment effect expressed as the novel Delay of Event measure is associated with high willingness to initiate preventive treatment - A randomized survey experiment comparing effect measures
    2016 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, no 12, p. 2005-2011Article in journal (Refereed) Published
    Abstract [en]

    Objectives: This study aimed to investigate patients' willingness to initiate a preventive treatment and compared two established effect measures to the newly developed Delay of Events (DoE) measure that expresses treatment effect as a gain in event-free time. Methods: In this cross-sectional, randomized survey experiment in the general Swedish population, 1079 respondents (response rate 60.9%) were asked to consider a preventive cardiovascular treatment. Respondents were randomly allocated to one of three effect descriptions: DoE, relative risk reduction (RRR), or absolute risk reduction (ARR). Univariate and multivariate analyses were performed investigating willingness to initiate treatment, views on treatment benefit, motivation and importance to adhere and willingness to pay for treatment. Results: Eighty-one percent were willing to take the medication when the effect was described as DoE, 83.0% when it was described as RRR and 62.8% when it was described as ARR. DoE and RRR was further associated with positive views on treatment benefit, motivation, importance to adhere and WTP. Conclusions: Presenting treatment effect as DoE or RRR was associated with a high willingness to initiate treatment. Practice implications: An approach based on the novel time-based measure DoE may be of value in clinical communication and shared decision making.

    Keywords
    Preventive measures, Adherence, Decision-making, Treatment outcome, Randomized, Survey experiment
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:uu:diva-315088 (URN)10.1016/j.pec.2016.07.028 (DOI)000391223200012 ()27499030 (PubMedID)
    Funder
    Swedish Society of Medicine
    Available from: 2017-02-08 Created: 2017-02-08 Last updated: 2019-03-11Bibliographically approved
    4. Length of time periods in treatment effect descriptions and willingness to initiate preventive therapy: a randomised survey experiment
    Open this publication in new window or tab >>Length of time periods in treatment effect descriptions and willingness to initiate preventive therapy: a randomised survey experiment
    2018 (English)In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 18, article id 106Article in journal (Refereed) Published
    Abstract [en]

    Background Common measures used to describe preventive treatment effects today are proportional, i.e. they compare the proportions of events in relative or absolute terms, however they are not easily interpreted from the patient's perspective and different magnitudes do not seem to clearly discriminate between levels of effect presented to people. Methods In this randomised cross-sectional survey experiment, performed in a Swedish population-based sample (n=1041, response rate 58.6%), the respondents, aged between 40 and 75years were given information on a hypothetical preventive cardiovascular treatment. Respondents were randomised into groups in which the treatment was described as having the effect of delaying a heart attack for different periods of time (Delay of Event,DoE): 1month, 6months or 18months. Respondents were thereafter asked about their willingness to initiate such therapy, as well as questions about how they valued the proposed therapy. ResultsLonger DoE:s were associated with comparatively greater willingness to initiate treatment. The proportions accepting treatment were 81, 71 and 46% when postponement was 18months, 6months and 1month respectively. In adjusted binary logistic regression models the odds ratio for being willing to take therapy was 4.45 (95% CI 2.72-7.30) for a DoE of 6months, and 6.08 (95% CI 3.61-10.23) for a DoE of 18months compared with a DoE of 1month. Greater belief in the necessity of medical treatment increased the odds of being willing to initiate therapy. ConclusionsLay people's willingness to initiate preventive therapy was sensitive to the magnitude of the effect presented as DoE. The results indicate that DoE is a comprehensible effect measure, of potential value in shared clinical decision-making.

    Place, publisher, year, edition, pages
    BMC, 2018
    Keywords
    Medical decision-making, Risk communication, Risk perception, Necessity-concern framework
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:uu:diva-371868 (URN)10.1186/s12911-018-0662-2 (DOI)000450786000002 ()30458757 (PubMedID)
    Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-03-11Bibliographically approved
  • 166.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Andersén, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Carlsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Gustavsson, Catharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    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).
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, SE-17177 Stockholm, Sweden.
    Multidisciplinary Intervention and Acceptance and Commitment Therapy for Return-to-Work and Increased Employability among Patients with Mental Illness and/or Chronic Pain: A Randomized Controlled Trial2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 11, article id 2424Article in journal (Refereed)
    Abstract [en]

    Background: People on long-term sick leave often have a long-lasting process back to work, where the individuals may be in multiple and recurrent states; i.e., receiving different social security benefits or working, and over time they may shift between these states. The purpose of this study was to evaluate the effects of two vocational rehabilitation programs, compared to a control, on return-to-work (RTW) or increased employability in patients on long-term sick leave due to mental illness and/or chronic pain. Methods: In this randomized controlled study, 427 women and men were allocated to either (1) multidisciplinary team management, i.e., multidisciplinary assessments and individual rehabilitation management, (2) acceptance and commitment therapy (ACT), or (3) control. A positive outcome was defined as RTW or increased employability. The outcome was considered negative if the (part-time) wage was reduced or ceased, or if there was an indication of decreased employability. The outcome was measured one year after entry in the project and analyzed using binary and multinomial logistic regressions. Results: Participants in the multidisciplinary team group reported having RTW odds ratio (OR) 3.31 (95% CI 1.39-7.87) compared to the control group in adjusted models. Participants in the ACT group reported having increased employability OR 3.22 (95% CI 1.13-9.15) compared to the control group in adjusted models. Conclusions: This study of vocational rehabilitation in mainly female patients on long-term sick leave due to mental illness and/or chronic pain suggests that multidisciplinary team assessments and individually adapted rehabilitation interventions increased RTW and employability. Solely receiving the ACT intervention also increased employability.

  • 167.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Active Traveling and Its Associations with Self-Rated Health, BMI and Physical Activity: A Comparative Study in the Adult Swedish Population2016In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 13, no 5, article id 455Article in journal (Refereed)
    Abstract [en]

    Active traveling to a daily occupation means that an individual uses an active way of traveling between two destinations. Active travel to work or other daily occupations offers a convenient way to increase physical activity levels which is known to have positive effects on several health outcomes. Frequently used concepts in city planning and regional planning today are to create environments for active commuting and active living. Even then, little research has focused on traveling modes and subjective health outcomes such as self-rated health (SRH). This study aimed to explore and investigate associations between travel mode and health-related outcomes, such as self-rated health (SRH), body mass index (BMI) and overall physical activity, in an adult population in Sweden. A cross-sectional study was conducted in a randomly selected population-based sample (n = 1786, age 45-75 years); the respondents completed a questionnaire about their regular travel mode, demographics, lifestyle, BMI and SRH. Chi-square tests and logistic regressions found that inactive traveling was associated with poor SRH, a greater risk of obesity or being overweight and overall physical inactivity. In addition, lifestyle factors, such as choice of food and smoking habits, were associated with SRH, BMI and overall physical activity.

  • 168.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Health and wellbeing in informal caregivers and non-caregivers: a comparative cross-sectional study of the Swedish a general population2015In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 13, article id 109Article in journal (Refereed)
    Abstract [en]

    Background: Informal caregiving by relatives is a great resource for individuals as well as for society, but the caregiving role is associated with health problems for the caregiver. This study aimed to compare caregivers' self-rated health, number of recent days with poor health and psychological wellbeing with that of non-caregivers in a general Swedish population. Methods: From 2004 to 2013, 90,845 Swedish people completed a postal questionnaire about their health, number of recent days with poor health during last month, psychological wellbeing and if they were performing caregiving or not. Descriptive statistics, chi-square analysis, ANOVA, logistic regressions and negative binomial regression models were used to investigate associations between being a caregiver or not and health and wellbeing. Negative binomial regression was used to assess the relation between caregiver status and recent days with poor health or functioning. Results: Eleven percent reported having a caregiving role. Caregivers reported poorer self-rated health compered to non-caregivers, also in adjusted models; odds ratio (OR): 1.07 with a 95 % confidence interval (CI): 1.01-1.13. Caregivers also reported lower psychological wellbeing compared to non-caregivers; OR: 1.22, CI: 1.15-1.30. Caregiving status was associated with more recent days with poor physical health and more recent days with poor mental health. Conclusions: This study suggests that caregivers have worse perceptions in self-rated health and psychological wellbeing compared with non-caregivers, indicating that the role of caregiver is adversely associated with health. This association also appears in terms of reporting days of poor health in the last month. The underlying mechanism of these associations, including the potential detrimental health effects of being a caregiver, needs to be investigated in longitudinal studies.

  • 169.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Lytsy, Per
    Westerling, Ragnar
    Living environment, social support and informal caregiving are associated with health care seeking behaviour and adherence to medication treatment: a cross-sectional population studyManuscript (preprint) (Other academic)
    Abstract [en]

    Despite the well-known associations between local environment and health, few studies have focused on environment and health care utiliza-tion, for instance health care seeking behaviour or adherence. This study was aimed at analysing housing type, behaviour based on perceived local outdoor safety, social support, informal caregiving, demographics, socioeconomics, and long-term illness, and associations with health-seeking and adherence behaviours at a population level. This study used data from the Swedish National Public Health Survey 2004–2014, an annually repeated, large sample, cross-sectional, population-based sur-vey study. In all, questionnaires from 100,433 individuals were returned by post, making the response rate 52.9% (100,433/190,000). Descrip-tive statistics and multiple logistic regressions were used to investigate associations between explanatory variables and the outcomes of refrain-ing from seeking care and non-adherence behaviour. Living in rented apartment, lodger, a dorm or other was associated with reporting refrain-ing from seeking care (adjusted OR 1.16, 95% CI 1.00–1.22), and non-adherence (adjusted OR 1.22; 95% CI 1.13–1.31). Refraining from go-ing out due to a perceived unsafe neighbourhood was associated with refraining from seeking care (adjusted OR 1.59, 95% CI 1.51–1.67) and non-adherence (adjusted OR 1.26, 95% CI 1.17–1.36). Social support and status as an informal caregiver was associated with higher odds of refraining from seeking medical care and non-adherence. This study suggests that living in rental housing, refraining from going out due to neighbourhood safety concerns, lack of social support or informal care-giver status are associated with lower health-seeking behaviour and non-adherence to prescribed medication.

  • 170.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Living environment, social support, and informal caregiving are associated with healthcare seeking behaviour and adherence to medication treatment: A cross-sectional population study2019In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 27, no 5, p. 1260-1270Article in journal (Refereed)
    Abstract [en]

    Despite the well-known associations between local environment and health, few studies have focused on environment and healthcare utilisation, for instance healthcare seeking behaviour or adherence. This study was aimed at analysing housing type, behaviour based on perceived local outdoor safety, social support, informal caregiving, demographics, socioeconomics, and long-term illness, and associations with health-seeking and adherence behaviours at a population level. This study used data from the Swedish National Public Health Survey 2004-2014, an annually repeated, large sample, cross-sectional, population-based survey study. In all, questionnaires from 100,433 individuals were returned by post, making the response rate 52.9% (100,433/190,000). Descriptive statistics and multiple logistic regressions were used to investigate associations between explanatory variables and the outcomes of refraining from seeking care and non-adherence behaviour. Living in rented apartment, lodger, a dorm or other was associated with reporting refraining from seeking care (adjusted OR 1.16, 95% CI 1.00-1.22), and non-adherence (adjusted OR 1.22; 95% CI 1.13-1.31). Refraining from going out due to a perceived unsafe neighbourhood was associated with refraining from seeking care (adjusted OR 1.59, 95% CI 1.51-1.67) and non-adherence (adjusted OR 1.26, 95% CI 1.17-1.36). Social support and status as an informal caregiver was associated with higher odds of refraining from seeking medical care and non-adherence. This study suggests that living in rental housing, refraining from going out due to neighbourhood safety concerns, lack of social support or informal caregiver status are associated with lower health-seeking behaviour and non-adherence to prescribed medication.

  • 171.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    The influence of locus of control on self-rated health in context of chronic disease: a structural equation modeling approach in a cross sectional study2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, p. 492-Article in journal (Refereed)
    Abstract [en]

    Background: Self-rated health is a robust predictor of several health outcomes, such as functional ability, health care utilization, morbidity and mortality. The purpose of this study is to investigate and explore how health locus of control and disease burden relate to self-rated health among patients at risk for cardiovascular disease. Methods: In 2009, 414 Swedish patients who were using statins completed a questionnaire about their health, diseases and their views on the three-dimensional health locus of control scale. The scale determines which category of health locus of control - internal, chance or powerful others - a patient most identifies with. The data was analyzed using logistic regression and a structural equation modeling approach. Results: The analyses showed positive associations between internal health locus of control and self-rated health, and a negative association between health locus of control in chance and powerful others and self-rated health. High internal health locus of control was negatively associated with the cumulative burden of diseases, while health locus of control in chance and powerful others were positively associated with burden of diseases. In addition, age and education level had indirect associations with self-rated health through health locus of control. Conclusions: This study suggests that self-rated health is positively correlated with internal locus of control and negatively associated with high locus of control in chance and powerful others in patients at high risk for cardiovascular disease. Furthermore, disease burden seems to be negatively associated with self-rated health.

  • 172.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Housing Type and Neighbourhood Safety Behaviour Predicts Self-rated Health, Psychological Well-being and Frequency of Recent Unhealthy Days: A Comparative Cross-sectional Study of the General Population in Sweden2017In: Planning practice + research, ISSN 0269-7459, E-ISSN 1360-0583, Vol. 32, no 4, p. 444-465Article in journal (Refereed)
    Abstract [en]

    This study aimed at analysing associations among housing type, neighbourhood safety behaviour, self-rated health (SRH), psychological well-being and unhealthy days in the general population. From 2004 to 2013, 90,845 Swedes completed a questionnaire about their health, number of days with poor health, psychological well-being, housing type, and whether they refrained from going out based on perception of neighbourhood safety. People not living in private housing and those who did not go out for safety reasons reported lower SRH and psychological well-being and higher frequency of recent unhealthy days and days without work capacity due to poor health.

  • 173.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Social and health-related factors associated with refraining from seeking dental care: A cross-sectional population study2017In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 45, no 3, p. 258-265Article in journal (Refereed)
    Abstract [en]

    Background: Social inequities are considered to affect healthcare utilization, whereas less is known about the factors associated with refraining from seeking dental care. This study aimed to investigate whether people with no social support, long-term illness, caregiver burden and low socioeconomic status (SES) refrained from seeking dental care in higher proportion than the general Swedish population.

    Methods: This study used cross-sectional questionnaire data from repeated nationwide health surveys during 2004-2013 of a total of 90 845 people. The questionnaire included questions on demographic characteristics, social support, long-term illness, caregiving burden, SES and dental care-seeking behaviour. Descriptive statistics, chi-square tests, correlation analyses and logistic regressions were used to investigate associations between independent variables and dental care-seeking behaviour.

    Results: In the total sample, 15.1% of respondents reported refraining from seeking dental care. Having no emotional social support or having no instrumental social support was separately associated with reporting refraining from seeking dental care in adjusted multivariate models (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.18-1.34 and OR: 1.89, 95% CI: 1.67-2.13, respectively). Having a long-term illness was associated with refraining from seeking dental care in adjusted models (adjusted OR: 1.43, 95% CI: 1.35-1.51). Furthermore, being an informal caregiver was associated with refraining from seeking dental care (adjusted OR: 1.15, 95% CI: 1.07-1.23). Low SES was associated with higher refraining from seeking dental care; the strongest association was with having financial problems (adjusted OR: 3.57, 95% CI: 3.19-4.00). Interaction effects were found between education level and SES, and between social support and long-term illness, and the outcome.

    Conclusions: The findings in this study imply that having no social support, having long-term illness, being informal caregiver or having financial problems are factors associated with reporting refraining from seeking dental care, on a population basis.

  • 174.
    Berglund, Lars
    et al.
    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 Public Health and Caring Sciences, Geriatrics.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Hambraeus, Kristina
    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. Falun Cent Hosp, Dept Cardiol, Falun, Sweden.
    Repeated measures of body mass index and waist circumference in the assessment of mortality risk in patients with myocardial infarction2019In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 1, p. 78-82Article in journal (Refereed)
    Abstract [en]

    Aims: Weight loss is recommended for myocardial infarction (MI) patients with overweight or obesity. It has, however, been suggested that obese patients have better prognosis than normal-weight patients have, but also that central obesity is harmful. The aim of this study was to examine associations between repeated measures of body mass index (BMI) and waist circumference (WC), and all-cause mortality.

    Methods and results: A total of 14,224 MI patients aged <75 years in Sweden between the years 2004 and 2013 had measurements of risk factors at hospital discharge. The patients' BMI and WC were recorded in secondary prevention clinics two months and one year after hospital discharge. We collected mortality data up to 8.3 years after the last visit. There were 721 deaths. We used anthropometric measures at the two-month visit and the change from the two-month to the one-year visit. With adjustments for risk factors and the other anthropometric measure the hazard ratio (HR) per standard deviation in a Cox proportional hazard regression model for mortality was 0.64 (95% confidence interval [CI] 0.56-0.74) for BMI and 1.55 (95% CI 1.34-1.79) for WC, and 1.43 (95% CI 1.17-1.74) for a BMI decrease from month two to one year of more than 0.6 kg/m(2). Low BMI and high WC were associated with the highest mortality.

    Conclusion: High WC is harmful regardless of BMI in MI patients. Reduced BMI during the first year after MI is, however, associated with higher mortality, potentially being an indicator of deteriorated health.

  • 175.
    Bergman, Ann-Sofie
    et al.
    Institutionen för socialt arbete, Linnéuniversitetet.
    Rejmer, Annika
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Law, Department of Law.
    "Det är klart att barnen blir lidande": om barns mående i vårdnadstvister2017In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 4, p. 437-446Article in journal (Other academic)
    Abstract [en]

    The article aims to highlight Swedish children’s health in relation to high intensity custody disputes and to relate the results to international research. Empirical data consist of district court acts and parent interviews explored through qualitative content analysis. Regardless of empirical material, the results indicate that children’s reactions are internalizing but also externa-lizing and somatic symptoms. There are also children who react through a developmental delay or regression. In addition, the results show that child-ren with disabilities are over-represented. The results are in line with pre-vious international research indicating that there is a connection between the children’s health, the duration of the conflict, the parents’ health and parental ability. Younger children living with parental custody disputes need attention from a health perspective e.g. by preventive interventions.

  • 176.
    Bergman, Mattias
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Nygren-Brunell, Olivia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Vilakati, Danisile
    Nutrition Council, Ministry of Health, Mbabane, Swaziland.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Siphilile Maternal & Child Hlth NGO, Matsapha, Swaziland; Church Sweden, Uppsala, Sweden.
    Prolonged Exclusive Breastfeeding Through Peer Support: A Cohort Study From a Community Outreach Project in Swaziland2016In: Journal of community health, ISSN 0094-5145, E-ISSN 1573-3610, Vol. 41, no 5, p. 932-938Article in journal (Refereed)
    Abstract [en]

    Swaziland faces great public health challenges, including suboptimal breastfeeding practices and the world's highest prevalence of HIV. The objective of this study was to estimate neonatal and infant mortality rate and rate of exclusive breastfeeding for clients enrolled in a community-based peer support project in peri-urban areas of Swaziland. The intervention builds on the so called "Philani-model" with Mentor Mothers in the community under high level of supervision. Cohort data was collected from journals kept by the Mentor Mothers. Kaplan-Meier and Cox regression were used to analyse data. Neonatal and infant mortality were estimated to 15 respectively 57 per 1000 live births. High level of social vulnerability was associated with risk of neonatal mortality (HR 1.12, CI 95 % 1.01-1.24) while the mother's positive HIV status was associated with infant mortality (HR 2.05, CI 95 % 1.15-3.65). More visits by a Mentor Mother could not be shown to result in lower mortality. The chance to practice exclusive breastfeeding for 6 months was estimated to 50 %. The risk of discontinuing exclusive breastfeeding before 6 months was lower for mothers being unemployed (HR 0.55, CI 95 % 0.44-0.69) or socially vulnerable (HR 0.95, CI 95 % 0.92-0.99) and higher for mothers being HIV positive (HR 1.22, CI 95 % 1.01-1.48). Receiving at least four visits by a Mentor Mother during pregnancy decreased the risk of discontinuing exclusive breastfeeding prematurely (HR 0.82, CI 95 % 0.67-0.99). Peer support with Mentor Mothers thus had a positive impact on exclusive breastfeeding rates in this disadvantaged population.

  • 177.
    Bergman, Åke
    et al.
    Swedish Toxicol Sci Res Ctr Swetox, Sodertalje, Sweden..
    Becher, Georg
    Norwegian Inst Publ Hlth, Oslo, Norway..
    Blumberg, Bruce
    Univ Calif Irvine, Irvine, CA USA..
    Bjerregaard, Poul
    Univ Southern Denmark, Odense, Denmark..
    Bornman, Riana
    Univ Pretoria, Sch Hlth Syst & Publ Hlth, ZA-0002 Pretoria, South Africa..
    Brandt, Ingvar
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Organismal Biology, Environmental toxicology.
    Casey, Stephanie C.
    Univ Calif Irvine, Irvine, CA USA..
    Frouin, Heloise
    Vancouver Aquarium Marine Sci Ctr, Vancouver, BC, Canada..
    Giudice, Linda C.
    Univ Calif San Francisco, San Francisco, CA 94143 USA..
    Heindel, Jerrold J.
    Natl Inst Environm Hlth Sci, Res Triangle Pk, NC USA..
    Iguchi, Taisen
    Natl Inst Basic Biol, Okazaki, Aichi 444, Japan..
    Jobling, Susan
    Brunel Univ London, Uxbridge, Middx, England..
    Kidd, Karen A.
    Univ New Brunswick, New Brunswick, NJ USA..
    Kortenkamp, Andreas
    Brunel Univ London, Uxbridge, Middx, England..
    Lind, P. Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Muir, Derek
    Environm Canada, Burlington, ON L7R 4A6, Canada..
    Ochieng, Roseline
    Aga Khan Univ Hosp, Nairobi, Kenya..
    Ropstad, Erik
    Norwegian Univ Life Sci, Oslo, Norway..
    Ross, Peter S.
    Vancouver Aquarium Marine Sci Ctr, Vancouver, BC, Canada..
    Skakkebaek, Niels Erik
    Univ Copenhagen, Copenhagen Univ Hosp, Copenhagen, Denmark..
    Toppari, Jorma
    Univ Turku, Turku, Finland..
    Vandenberg, Laura N.
    Univ Massachusetts, Amherst, MA 01003 USA..
    Woodruff, Tracey J.
    Univ Calif San Francisco, San Francisco, CA 94143 USA..
    Zoeller, R. Thomas
    Univ Massachusetts, Amherst, MA 01003 USA..
    Manufacturing doubt about endocrine disrupter science - A rebuttal of industry-sponsored critical comments on the UNEP/WHO report "State of the Science of Endocrine Disrupting Chemicals 2012"2015In: Regulatory toxicology and pharmacology, ISSN 0273-2300, E-ISSN 1096-0295, Vol. 73, no 3, p. 1007-1017Article in journal (Other academic)
    Abstract [en]

    We present a detailed response to the critique of "State of the Science of Endocrine Disrupting Chemicals 2012" (UNEP/WHO, 2013) by financial stakeholders, authored by Lamb et al. (2014). Lamb et al.'s claim that UNEP/WHO (2013) does not provide a balanced perspective on endocrine disruption is based on incomplete and misleading quoting of the report through omission of qualifying statements and inaccurate description of study objectives, results and conclusions. Lamb et al. define extremely narrow standards for synthesizing evidence which are then used to dismiss the UNEP/WHO 2013 report as flawed. We show that Lamb et al. misuse conceptual frameworks for assessing causality, especially the Bradford Hill criteria, by ignoring the fundamental problems that exist with inferring causality from empirical observations. We conclude that Lamb et al.'s attempt of deconstructing the UNEP/WHO (2013) report is not particularly erudite and that their critique is not intended to be convincing to the scientific community, but to confuse the scientific data. Consequently, it promotes misinterpretation of the UNEP/WHO (2013) report by non-specialists, bureaucrats, politicians and other decision makers not intimately familiar with the topic of endocrine disruption and therefore susceptible to false generalizations of bias and subjectivity.

  • 178.
    Bergstrom, Aileen
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, S-14183 Huddinge, Sweden..
    Guidetti, Susanne
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, S-14183 Huddinge, Sweden..
    Tham, Kerstin
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, S-14183 Huddinge, Sweden..
    Eriksson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, S-14183 Huddinge, Sweden.
    Association between satisfaction and participation in everyday occupations after stroke2017In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 24, no 5, p. 339-348Article in journal (Refereed)
    Abstract [en]

    Background: Within occupational therapy, it is assumed that individuals are satisfied when participating in everyday occupations that they want to do. However, there is little empirical evidence to show this. Aims: The aim of this study is to explore and describe the relation between satisfaction and participation in everyday occupations in a Swedish cohort, 5 years post stroke. Methods: Sixty-nine persons responded to the Occupational Gaps Questionnaire (OGQ). The questionnaire measures subjective restrictions in participation, i.e. the discrepancy between doing and wanting to do 30 different occupations in everyday life, and satisfaction per activity. Results were analysed with McNemar/chi-square. Results: Seventy percent of the persons perceived participation restrictions. Individuals that did not perceive restrictions in their participation had a significantly higher level of satisfaction (p=.002) compared to those that had restrictions. Participants that performed activities that they wanted to do report between 79 and 100% satisfaction per activity. Conclusion: In this cohort, there was a significant association between satisfaction and participating in everyday occupations one wants to do, showing that satisfaction is an important aspect of participation and substantiates a basic assumption within occupational therapy. The complexity of measuring satisfaction and participation in everyday occupations is discussed.

  • 179.
    Bergström, Anna
    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 Child Health and Nutrition.
    Ugarte Guevara, William J.
    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.
    Eustachio Colombo, Patricia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Knowledge about Sexual and Reproductive Health among School Enrolled Adolescents in Tololar, Nicaragua, A Cross-Sectional Study2018In: Journal of Public Health International, Vol. 1, no 2, p. 27-38Article in journal (Refereed)
    Abstract [en]

    Background: Nicaragua has the highest prevalence of teenage pregnancies in Latin America. Knowledge regarding sexual and reproductive health plays an integral part in sexual behavior. The objective was to assess school going adolescents' knowledge about sexual and reproductive health and possible factors affecting it in the semi-rural community of Tololar, Nicaragua.

    Methods: A cross-sectional study with a self-administered questionnaire on tablets was used for data collection. All 253 registered students at the school present at the time of fieldwork who gave written informed consent were deemed eligible for the study. A total of 225 participants in the ages of 11-19 years were included. Simple linear regression and multiple linear regression were performed analyzing the outcome knowledge. A p-value <0.05 was considered significant.

    Results: The general knowledge about sexual and reproductive health was moderate; however, knowledge gaps were found such as prevailing myths and poor knowledge regarding human immunodeficiency virus (hiv) transmission and contraceptive methods. Being female and single were significant negative determinants of knowledge (p-value < 0.01) and knowledge increased significantly with age (p-value < 0.05). School teachers, websites, social networks, and TV were the most frequently chosen sources of information on the topic.

    Conclusions: Increased education on sexual and reproductive health with new interventions particularly for young females is recommended. Using IT-based materials as a complement may be an effective way to reach out to adolescents.

  • 180.
    Bergström, Malin
    et al.
    Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Fransson, Emma
    Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden.
    Fabian, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hjern, Anders
    Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 2, p. 294-300Article in journal (Refereed)
    Abstract [en]

    AIM: Joint physical custody (JPC), where children spend about equal time in both parent's homes after parental separation, is increasing. The suitability of this practice for preschool children, with a need for predictability and continuity, has been questioned.

    METHODS: In this cross-sectional study, we used data on 3656 Swedish children aged three to five years living in intact families, JPC, mostly with one parent or single care. Linear regression analyses were conducted with the Strengths and Difficulties Questionnaire, completed by parents and preschool teachers, as the outcome measure.

    RESULTS: Children in JPC showed less psychological problems than those living mostly (adjusted B 1.81; 95% CI [0.66 to 2.95]) or only with one parent (adjusted B 1.94; 95% CI [0.75 to 3.13]), in parental reports. In preschool teacher reports, the adjusted Betas were 1.27, 95% CI [0.14 to 2.40] and 1.41, 95% CI [0.24 to 2.58], respectively. In parental reports, children in JPC and those in intact families had similar outcomes, while teachers reported lower unadjusted symptom scores for children in intact families.

    CONCLUSION: Joint physical custody arrangements were not associated with more psychological symptoms in children aged 3-5, but longitudinal studies are needed to account for potential preseparation differences.

  • 181.
    Bergström, Malin
    et al.
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Fransson, Emma
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Modin, Bitte
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Berlin, Marie
    Stockholms universitet, Sociologiska institutionen.
    Gustafsson, Per A.
    Hjern, Anders
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Fifty moves a year: is there an association between joint physical custody and psychosomatic problems in children?2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 8, p. 769-774Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 182.
    Bergström, Malin
    et al.
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Fransson, Emma
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Wells, Michael B.
    Köhler, Lennart
    Hjern, Anders
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Children with two homes: Psychological problems in relation to living arrangements in Nordic 2-9 year olds2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
    Abstract [en]

    Aim: Joint physical custody, children spending equal time in each parents’ respective home after a parental divorce, is particularly common in Nordic compared with other Western countries. Older children have been shown to fare well in this practice but for young children there are few existing studies. The aim of this paper is to study psychological problems in 2- to 9-year-old Nordic children in different family forms. Methods: Total symptom score according to the Strengths and Difficulties Questionnaire as well as scores showing externalizing problems were compared among 152 children in joint physical custody, 303 in single care and 3207 in nuclear families through multiple linear regression analyses. Results: Children in single care had more psychological symptoms than those in joint physical custody (B = 1.08; 95% CI 0.48 to 1.67) and those in nuclear families had the least reported symptoms (B = −0.53; 95% CI −0.89 to −0.17). Externalizing problems were also lower in nuclear families (B = −0.28, 95% CI −0.52 to −0.04) compared with joint physical custody after adjusting for covariates. Conclusions: Young children with non-cohabiting parents suffered from more psychological problems than those in intact families. Children in joint physical custody had a lower total problem score than those in single care after adjusting for covariates. Longitudinal studies with information on family factors before the separation are needed to inform policy of young children’s post-separation living arrangements.

  • 183.
    Berhane, Hanna Y
    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 Child Health and Nutrition.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Jirström, Magnus
    Berhane, Yemane
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Turner, Christopher
    Alsanius, Beatrix W
    Trenholm, Jill E.
    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.
    Mixed blessings:: A qualitative exploration of mothers' experience of child care and feeding in the rapidly urbanizing city of Addis Ababa, Ethiopia2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0207685Article in journal (Refereed)
    Abstract [en]

    Many studies have drawn attention to the vital role mothers have in safeguarding the health and nutritional wellbeing of their children. However, little is known about mothers' experiences and the challenges they face in fulfilling this role in rapidly urbanizing cities in Africa. This study aims to explore child care and feeding practices of mothers with children under five years of age in Addis Ababa, Ethiopia. This qualitative study was conducted using a semi-structured interview guide. A total of thirty-six interviews were conducted with purposively selected participants. All interviews were audio recorded, transcribed verbatim and translated for analysis. We used a thematic analysis approach, which was guided by a resilience framework. The findings are presented as three major themes. 1) 'Mixed blessings-balancing motherhood's expectations'. While mothers identified positively with the social recognition and sense of fulfillment of being a 'good mother', they were ambivalent/torn about earning the necessary income from outside work and fulfilling their duties at home. 2) 'Instabilities due to rampant urban sprawl'. While women expressed a keen desire to balance work and motherhood, the disintegrating social capital, due to large in-migration, market fluctuations and abrupt/forced resettlements to new housing units had left mothers without support for childcare, stressed and exhausted. 3) 'Anchored by faith: a source of resilience to cope with adversities'. In the face of the multiple adversities, mothers cited their strong faith as their most reliable foundation for their resilience. In summary, the societal and environmental changes accompanying the rapid urbanization in low income settings makes combining child care and working outside the home very challenging for mothers. As a result they suffer from fatigue and feelings of isolation. Efforts to improve child feeding and care in urban low-income settings need to consider context appropriate strategies that support mothers with small children.

  • 184.
    Berhane, Hanna Y
    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 Child Health and Nutrition. Addis Continental Inst Publ Hlth, Addis Ababa 267511000, Ethiopia.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Jirström, Magnus
    Lund Univ, Dept Human Geog, S-22362 Lund, Sweden.
    Berhane, Yemane
    Addis Continental Institute of Public Health, 26751/1000 Addis Ababa, Ethiopia.
    Turner, Christopher
    Lund Univ, Dept Human Geog, S-22362 Lund, Sweden;London Sch Hyg & Trop Med, London WC1E 7HT, England.
    Alsanius, Beatrix W
    Swedish Univ Agr Sci, Dept Biosyst & Technol, S-23053 Alnarp, Sweden.
    Trenholm, Jill E.
    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.
    What Influences Urban Mothers' Decisions on What to Feed Their Children Aged Under Five-The Case of Addis Ababa, Ethiopia2018In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 10, no 9, article id 1142Article in journal (Refereed)
    Abstract [en]

    Mothers carry the prime responsibility for childcare and feeding in low-income countries. Understanding their experiences in providing food for their children is paramount to informing efforts to improve the nutritional status of children. Such information is lacking in Sub-Saharan Africa. To understand what influences urban mothers' food acquisition and their motivations for selecting food for their children, 36 in-depth interviews were carried out with mothers having children under five years of age. Interviews were conducted in the local language, audio-recorded, transcribed, and translated into English. Data were analyzed using thematic analysis which led to the identification of four major themes: mothers give-in to a child-driven diet; quick-fix versus the privilege of planning; keen awareness on food safety, nutrition, and diet diversity; and social, familial, and cultural influences. The findings indicate that child feeding practices are influenced by interlinked social and environmental factors. Hence, nutrition education campaigns should focus on targeting not only families but also their children. Attention should also be given to food safety regulations, as well as to the much-needed support of mothers who are struggling to ensure their children's survival in low-income countries.

  • 185.
    Berman, Anne H.
    et al.
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Stockholm, Sweden.
    Bodenlos, Jamie
    Hobart & William Smith Coll, Dept Psychol, Geneva, NY 14456 USA.
    Pekmezi, Dori
    Univ Alabama Birmingham, Sch Publ Hlth, Dept Hlth Behav, Birmingham, AL 35294 USA.
    Lian, Wong Mee
    Natl Univ Singapore, Saw Swee Hock Sch Publ Health, Singapore, Singapore.
    Griva, Konstadina
    Imperial Coll, London, England;Nanyang Technol Univ, Ctr Populat Hlth Sci CePHaS, Lee Kong Chian Sch Med, Singapore, Singapore.
    Åsenlöf, Pernilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Yang, Yanjie
    Harbin Med Univ, Dept Med Psychol, Coll Publ Hlth, Harbin, Heilongjiang, Peoples R China.
    Dekker, Joost
    Vrije Univ Amsterdam Med Ctr, Dept Psychiat, Amsterdam, Netherlands;Vrije Univ Amsterdam Med Ctr, Dept Rehabil Med, Amsterdam, Netherlands.
    Teaching Behavioral Medicine: An Inspirational Workshop2018In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 25, p. S2-S2Article in journal (Other academic)
  • 186.
    Bernadotte af Wisborg, G. F.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Claesson, Cecilia B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Lundberg, O.
    Thorslund, M.
    Drug usage and self-reported health among a cross-sectional population aged over 75 years1996In: Clinical drug investigation, ISSN 1173-2563, E-ISSN 1179-1918, Vol. 12, no 3, p. 156-Article in journal (Refereed)
  • 187.
    Bertilsköld, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Arbetsplatsintroduktioner - chefers erfarenheter och upplevelser samt om introduktion anses ha betydelse för arbetsrelaterat välbefinnande2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: A good working environment creates opportunities for individuals to

    experience well-being at the workplace. Onboarding is the processes through which a new

    employee goes from being an organizational outsider to become an organizational insider

    with the right skills and behaviours that are consistent with what the organization needs.

    Aim: To give examples of set up and efforts of introduction programmes for new employees

    and to investigate managers´ experiences of onboarding and if onboarding programme is

    considered to have an effect on well-being at the workplace.

    Method: A descriptive study was conducted based on twelve interviews and the interview

    material was analysed according to qualitative content analysis.

    Result: Two qualitative content analyses were completed, the first one with Human

    Resources (HR) staff and the second one based on manager interviews. The analysis with HR

    staff resulted in one category; ”The setup of the companies onboarding programmes”, with

    four subcategories and the second analysis resulted in three categories; ”Experiences to learn

    the managerial role”, ”Managers have different needs and starting-points” and ”Factors for

    successful onboarding”. A total of nine subcategories were identified.

    Conclusion: Previous researchs show that social relations are the primary factor for new

    employees to learn their work and managerial role. It is also the foremost factor to experience

    well-being at the workplace. The knowledge and experiences of the interviewed show

    similarities for certain components to consider when to establish onboarding processes in an

    organization. They are; if managers were in-house recruited or externally recruited, their

    manager level, their previous experience of being a manager and opportunities to express

    individual wishes and needs in an onboarding programme.

  • 188. Biglarbegi, Nazanin
    An Invisible Gender-based Violence: Exploring Iranian male university students’ thoughts on street harassment2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background and Aim: Street harassment is an international and trans-cultural phenomenon that has short and long-term negative effects on its individual targets impacting millions of people, mostly women and young girls, everyday. Most studies on the subject have been focused on defining the problem from a law point of view leaving a knowledge gap on how social structures and the various political, economic, and cultural means interact to (re)produce and perpetuate this social phenomenon. This study aims to explore the thoughts of young men in Iran in order to discover possible underlying mechanisms reinforcing street harassment.

     

    Methods: A qualitative study consisted of four focus group discussions, with male university students, was conducted in Tehran, Iran. Thematic analysis was used to analyze the data with social constructionism as the theoretical lens.

     

    Results: Two candidate themes were developed: “Normalization and trivialization of the problem” and “Socio-cultural and political silence”. The first theme represents the discussions about street harassment as normal, inevitable, and harmless. The second theme embodies the systematic silence around the subject of sexual harassment. Both normalization and the silence construct street harassment as an invisible problem not only to men who are not directly harmed by it, but also to the society as a whole which led to developing the overarching theme describing street harassment as “an invisible gender-based violence” in Iran.

    Conclusion: The participants were unaware of the relation between power, gender inequality, and the concept of patriarchy, which in itself is a sign of an androcentric culture. Street harassment was conceptualized as normal and invisible since it doesn’t concern them. However, most participants were eager to discuss the topic developing their arguments as the discussion went on and stating that this topic needs to be discussed and studied which confirms that just providing a safe space and the opportunity for discussions can raise people’s awareness of this social problem.

     

     

    Key words: Street harassment, male university student, conceptualization, Iran

  • 189.
    Binder, Pauline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Gustafsson, Annica
    Department of Woman and Child Health/Division of Reproductive and Perinatal Health Care, Karolinska Institute, Stockholm, Sweden.
    Uvnäs-Moberg, Kerstin
    Swedish University of Agriculture, Skara, Sweden.
    Nissen, Eva
    Department of Woman and Child Health/Division of Reproductive and Perinatal Health Care, Karolinska Institute, Stockholm, Sweden.
    Hi-TENS combined with PCA-morphine as post caesarean pain relief.2011In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 4, p. 547-552Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: to examine effectiveness and overall opiate consumption between high-sensory transcutaneous electrical nerve stimulation (Hi-TENS) combined with patient-controlled analgesia with morphine and patient-controlled analgesia with morphine alone following elective (e.g. scheduled) caesarean birth. DESIGN: randomised, controlled study. SETTING: a county hospital in south-west Sweden. PARTICIPANTS: 42 multiparous women. MEASUREMENTS AND FINDINGS: participants were randomly assigned and connected to patient-controlled analgesia with morphine alone or in combination with Hi-TENS apparatus. Levels of morphine consumed were calculated every third hour during the first 24 hours post partum. Pain and sedation were assessed by visual analogue scale at one, three, six, nine, 12 and 24 hours post partum. Total consumption of morphine differed significantly between the groups: morphine with TENS was 16.2±12.6mg and morphine alone was 33.1±20.9mg (p=0.007). Assessment of pain relief showed no significant difference. Sedation differed significantly between the groups (p=0.045), especially between three and 12 hours post partum (p=0.011). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: pain relief from a combination of Hi-TENS and patient-controlled analgesia with morphine was as effective as patient-controlled analgesia with morphine alone, produced less sedation and reduced morphine use by approximately 50%. Women undergoing a caesarean section should be given the opportunity to make an informed choice about post operative pain relief before surgery. A presumed benefit of this treatment combination is that the mother is more alert and better able to interact with her newborn during the first hours after birth without drowsiness due to large doses of opiates.

  • 190.
    Binder-Finnema, Pauline
    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).
    Mahmud, Asha Omar
    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).
    Johnsdotter, Sara
    Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    ‘I have made children, so what's the problem?’ Retrospective self-circumcision and the sexual and urological health needs of some Somali men in Sweden2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 11, p. 36-40Article in journal (Refereed)
    Abstract [en]

    Unskilled traditional healers are widely blamed for complications to male circumcision performed in low- and middle-income settings. However, attributions of culpability are mostly anecdotal. We identify self-circumcision in adults that was performed during adolescence, hereby termed retrospective self circumcision, and unexpectedly discovered during interviews with Somali men in Sweden in 2010. This study explores the phenomenon with the aim to increase our understanding about the health needs of this group. Two focus group discussions (six and seven participants), one informal discussion with three participants, and 27 individual interviews were conducted in 2010 and 2011 with Somali-Swedish fathers, guided by a hermeneutic, comparative natural inquiry method. Eight participants had performed retrospective self-circumcision while living in rural Somalia. Actions were justified according to strong faith in Islam. Genital physiology was described as adequate for producing children, but physical sensation or characteristics were implied as less than optimal. Few had heard about penile reconstruction. There was hesitation to openly discuss concerns, but men nevertheless encouraged each other to seek care options. Presently no medical platform is available for retrospective self-circumcision. Further systematic exploration is recommended in sexual, reproductive and urological health to increase interest in this phenomenon. Our findings suggest approachability if health communication is enabled within an Islamic context.

  • 191. Biolo, G
    et al.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Muscaritoli, M
    Muscle contractile and metabolic dysfunction is a common feature of sarcopenia of ageing and chronic disease: From sarcopenic obesity to cachexia2014In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, no 5, p. 737-748Article in journal (Refereed)
    Abstract [en]

    Skeletal muscle is the most abundant body tissue accounting for many physiological functions. However, muscle mass and functions are not routinely assessed. Sarcopenia is defined as skeletal muscle loss and dysfunction in aging and chronic diseases. Inactivity, inflammation, age-related factors, anorexia and unbalanced nutrition affect changes in skeletal muscle. Mechanisms are difficult to distinguish in individual subjects due to the multifactorial character of the condition. Sarcopenia includes both muscle loss and dysfunction which induce contractile impairment and metabolic and endocrine abnormalities, affecting whole-body metabolism and immune/inflammatory response. There are different metabolic trajectories for muscle loss versus fat changes in aging and chronic diseases. Appetite regulation and physical activity affect energy balance and changes in body fat mass. Appetite regulation by inflammatory mediators is poorly understood. In some patients, inflammation induces anorexia and fat loss in combination with sarcopenia. In others, appetite is maintained, despite activation of systemic inflammation, leading to sarcopenia with normal or increased BMI. Inactivity contributes to sarcopenia and increased fat tissue in aging and diseases. At the end of the metabolic trajectories, cachexia and sarcopenic obesity are paradigms of the two patient categories. Pre-cachexia and cachexia are observed in patients with cancer, chronic heart failure or liver cirrhosis. Sarcopenic obesity and sarcopenia with normal/increased BMI are observed in rheumatoid arthritis, breast cancer patients with adjuvant chemotherapy and in most of patients with COPD or chronic kidney disease. In these conditions, sarcopenia is a powerful prognostic factor for morbidity and mortality, independent of BMI.

  • 192.
    Bixby, Honor
    et al.
    Imperial College London, London, UK.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Ezzati, Majid
    Imperial College London, London, UK.
    Rising rural body-mass index is the main driver of the global obesity epidemic in adults2019In: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 569, no 7755, p. 260-264Article in journal (Other academic)
    Abstract [en]

    Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3,4,5,6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

  • 193.
    Bjelkmar, Par
    et al.
    Publ Hlth Agcy Sweden, Dept Monitoring & Evaluat, S-17183 Solna, Sweden..
    Hansen, Anette
    Publ Hlth Agcy Sweden, Dept Microbiol, Solna, Sweden..
    Schonning, Caroline
    Publ Hlth Agcy Sweden, Dept Monitoring & Evaluat, S-17183 Solna, Sweden..
    Bergstrom, Jakob
    Publ Hlth Agcy Sweden, Dept Monitoring & Evaluat, S-17183 Solna, Sweden..
    Lofdahl, Margareta
    Publ Hlth Agcy Sweden, Dept Monitoring & Evaluat, S-17183 Solna, Sweden..
    Lebbad, Marianne
    Publ Hlth Agcy Sweden, Dept Microbiol, Solna, Sweden..
    Wallensten, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Publ Hlth Agcy Sweden, Dept Monitoring & Evaluat, S-17183 Solna, Sweden..
    Allestam, Gorel
    Publ Hlth Agcy Sweden, Dept Monitoring & Evaluat, S-17183 Solna, Sweden..
    Stenmark, Stephan
    Umea Univ, Dept Clin Microbiol, Umea, Sweden..
    Lindh, Johan
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology, Microbiology.
    Early outbreak detection by linking health advice line calls to water distribution areas retrospectively demonstrated in a large waterborne outbreak of cryptosporidiosis in Sweden2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 328Article in journal (Refereed)
    Abstract [en]

    Background: In the winter and spring of 2011 a large outbreak of cryptosporidiosis occurred in Skelleftea municipality, Sweden. This study summarizes the outbreak investigation in terms of outbreak size, duration, clinical characteristics, possible source(s) and the potential for earlier detection using calls to a health advice line. Methods: The investigation included two epidemiological questionnaires and microbial analysis of samples from patients, water and other environmental sources. In addition, a retrospective study based on phone calls to a health advice line was performed by comparing patterns of phone calls between different water distribution areas. Results: Our analyses showed that approximately 18,500 individuals were affected by a waterborne outbreak of cryptosporidiosis in Skelleftea in 2011. This makes it the second largest outbreak of cryptosporidiosis in Europe to date. Cryptosporidium hominis oocysts of subtype IbA10G2 were found in patient and sewage samples, but not in raw water or in drinking water, and the initial contamination source could not be determined. The outbreak went unnoticed to authorities for several months. The analysis of the calls to the health advice line provides strong indications early in the outbreak that it was linked to a particular water treatment plant. Conclusions: We conclude that an earlier detection of the outbreak by linking calls to a health advice line to water distribution areas could have limited the outbreak substantially.

  • 194.
    Bjelland, Elisabeth Krefting
    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. Akershus Univ Hosp, Dept Obstet & Gynecol, POB 1000, N-1478 Lorenskog, Norway.
    Hofvind, S.
    Canc Registry Norway, Dept Mammog Screening, POB 5313, N-0304 Oslo, Norway.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Eskild, A.
    Akershus Univ Hosp, Dept Obstet & Gynecol, POB 1000, N-1478 Lorenskog, Norway;Univ Oslo, Inst Clin Med, Campus Ahus,POB 1000, N-1478 Lorenskog, Norway.
    The relation of age at menarche with age at natural menopause: a population study of 336 788 women in Norway2018In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 33, no 6, p. 1149-1157Article in journal (Refereed)
    Abstract [en]

    STUDY QUESTION: Is age at menarche associated with age at menopause or with duration of the reproductive period (interval between menarche and menopause)? SUMMARY ANSWER: The association of age at menarche with age at menopause was weak and non-linear, and the duration of the reproductive period decreased by increasing age at menarche. WHAT IS KNOWN ALREADY: It remains uncertain whether age at menarche is associated with age at menopause. Some studies report that women with early menarche also have early menopause. Other studies report that women with early menarche have late menopause, or they report no association. The duration of the reproductive period may be an indicator of the cumulative endogenous exposure to estrogens and progestogens during life course and is associated with risk of breast cancer and endometrial cancer. STUDY DESIGN, SIZE, DURATION: A retrospective cohort study of 336 788 women, aged 48-71 years, in the BreastScreen Norway during the years 2006-2014 was performed. PARTICIPANTS/MATERIALS, SETTING, METHODS: Information about age at menarche and menopausal status was obtained by self-administered questionnaires. We used time to event approaches to estimate the associations. MAIN RESULTS AND THE ROLE OF CHANCE: Median age at menopause was 51 years in most menarche groups. Women with menarche at age 16 years or age >= 17 years had menopause 1 year later [median: 52 years, interquartile range (IQR): 49-54 years] than women with menarche at age 13 years (median: 51 years, IQR: 49-54 years, reference) (crude hazard ratio (HR) = 0.95; 95% CI: 0.93-0.97 and 0.95; 95% CI: 0.92-0.99, Pnon-linearity < 0.001). The reproductive period decreased with increasing age at menarche (Pnon-linearity < 0.001), and women with menarche at age <= 9 years had 9 years longer median reproductive period than women with menarche at age >= 17 years (median: 43 versus 34 years). Adjustment for year of birth did not change the HR estimates notably. LARGE SCALE DATA: Not applicable. LIMITATIONS, REASONS FOR CAUTION: Information about age at menarche and age at menopause was based on self-reports. Particularly for age at menarche, the long time interval between the event and data collection may have caused imprecise reporting. WIDER IMPLICATIONS OF THE FINDINGS: Our study suggests that age at menarche is a strong indicator for the duration of women's reproductive period. Our findings should encourage studies of the independent role of duration of the reproductive period on the risk of breast cancer and endometrial cancer, since these cancers have been associated with exposure to estrogens and progestogens. STUDY FUNDING/COMPETING INTEREST(S): The present study was funded by the Norwegian Cancer Society [Grant number 6863294-2015]. The authors declare no conflicts of interest.

  • 195.
    Bjermo, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Dietary Fatty Acids and Inflammation: Observational and Interventional Studies2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Dietary fat quality influences the risk of type 2 diabetes and cardiovascular disease. A low-grade inflammation is suggested to contribute to the disease development, often accompanied by obesity. Whereas n-3 polyunsaturated fatty acids (PUFA) have been considered anti-inflammatory, n-6 PUFA have been proposed to act pro-inflammatory. Saturated fatty acids (SFA) act pro-inflammatory in vitro.

    This thesis aimed to investigate effects of different fatty acids on low-grade inflammation in observational and interventional studies. In Paper I and II, fatty acid composition in serum cholesterol esters was used as objective marker of dietary fat quality and related to serum C-reactive protein (CRP) and other circulating inflammatory markers in two population-based cohorts, conducted in middle-aged men and elderly men and women, respectively. In Paper III and IV, the impact of diets differing in fat quality on inflammation and oxidative stress was investigated in randomised controlled studies, in subjects with metabolic syndrome and abdominal obesity.

    In Paper I and II, a low proportion of linoleic acid (18:2 n-6) in serum was associated with higher CRP concentrations, indicating that a low intake of vegetable fats may be related to low-grade inflammation. High CRP concentrations were also associated with high proportions of palmitoleic (16:1) and oleic (18:1) acids and high stearoyl coenzymeA desaturase index, possibly reflecting altered fat metabolism and/or high SFA intake in this population. When comparing two high-fat diets rich in either saturated or monounsaturated fat, and two low-fat diets with or without long-chain n-3 PUFA supplementation during 12 weeks (Paper III), no differences in inflammation or oxidative stress markers were observed. Moreover, a 10-week intervention (Paper IV) with high linoleic acid intake showed no adverse effects on inflammation or oxidative stress. Instead, interleukin-1 receptor antagonist and tumor necrosis factor receptor-2 decreased after linoleic acid intake compared with a diet high in SFA.

    The results in this thesis indicate that dietary n-6 PUFA found in vegetable fats is associated with lower inflammation marker levels, and to some extent reduces systemic inflammation when compared with SFA. Supplementation of n-3 PUFA did not exert any systemic anti-inflammatory effects, maybe due to a relatively low dose.

    List of papers
    1. Serum fatty acid composition and indices of stearoyl-CoA desaturase activity are associated with systemic inflammation: longitudinal analyses in middle-aged men
    Open this publication in new window or tab >>Serum fatty acid composition and indices of stearoyl-CoA desaturase activity are associated with systemic inflammation: longitudinal analyses in middle-aged men
    2008 (English)In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 99, no 6, p. 1186-1189Article in journal (Refereed) Published
    Abstract [en]

    Altered fatty acid (FA) composition is related to insulin resistance and CVD. One possible mediator may be inflammation, but longitudinal data relating FA composition to inflammation taking insulin resistance into account are limited. We investigated the long-term association between FA composition and C-reactive protein (CRP) concentrations in a large population-based cohort study in 767 men followed for 20 years. The association between FA composition in serum cholesteryl esters at age 50 and CRP concentrations at age 70 was investigated using linear regression. In addition, desaturase activities (stearoyl-CoA desaturase-1 (SCD-1), Delta 5- and Delta 6-desaturase) were estimated using FA product-to-precursor ratios. Insulin resistance was measured directly at follow-up by euglycaemic clamp. After adjusting for confounders (smoking, physical activity, alcohol intake, obesity and erythrocyte sedimentation rate) CRP concentrations were inversely associated with the proportion of 18:2n-6 (P=0.002) and positively associated with 16:1n-7 (P=0.008), 18: 1n-9 (P=0.0003), 20:5n-3 (P=0.04) and estimated SCD-1 (P=0.005) and Delta 6-desaturase (P=0.02) activities. After adding insulin resistance to the model, 18: 1n-9, 18:2n-6 and SCD-1 remained significant predictors of CRP. A FA composition indicating low intake of 18:2n-6, high intake of SFA and high SCD-1 activity is, in a Swedish population of middle-aged men, associated with CRP concentrations 20 years later, even independently of obesity and insulin resistance.

    Keywords
    C-reactive protein, fatty acids, SCD-1, inflammation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-17694 (URN)10.1017/S0007114507871674 (DOI)000255955500006 ()18062827 (PubMedID)
    Available from: 2008-08-15 Created: 2008-08-15 Last updated: 2018-02-22Bibliographically approved
    2. Relationships between serum fatty acid composition and multiple markers of inflammation and endothelial function in an elderly population
    Open this publication in new window or tab >>Relationships between serum fatty acid composition and multiple markers of inflammation and endothelial function in an elderly population
    Show others...
    2009 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 203, no 1, p. 298-303Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Fatty acid (FA) composition in serum has been associated with C-reactive protein (CRP), but associations with other markers of inflammation and endothelial function, e.g. adhesion molecules are unknown. We recently suggested a possible role of the lipogenic enzyme stearoyl coenzymeA desaturase-1 (SCD-1) in inflammation. This study investigates the associations between serum FA composition, including SCD-1 index, and various inflammatory and endothelial function markers. METHODS: 264 Swedish men and women aged 70 years participated in this cross-sectional population-based study. FA composition was measured in serum cholesteryl esters and was correlated to inflammatory markers (CRP, interleukin [IL]-2, IL-6, IL-8, tumor necrosis factor [TNF]-alpha, vascular cellular adhesion molecule [VCAM]-1, intercellular adhesion molecule [ICAM]-1, E-selectin, P-selectin, L-selectin, interferon-gamma, and monocyte chemoattractant protein [MCP]-1), using linear regression analysis. SCD-1 activity was estimated by FA product-to-precursor ratio (16:1/16:0). RESULTS: Serum FA composition was significantly associated with CRP and E-selectin but not with other inflammatory markers. After adjusting for BMI, smoking, physical activity, alcohol consumption and lipid-lowering therapy, the proportion of palmitoleic acid and SCD-1 index were positively correlated with CRP concentrations (P=0.003 and P=0.001, respectively). CONCLUSION: A FA composition reflecting high intake of saturated fat and a high SCD-1 index is independently related to CRP concentrations, but not to other markers of inflammation and endothelial function in this population of elderly men and women. Given the absent association between FA composition and the other markers, CRP may be the preferable marker to use when investigating potential relationships between FAs and low-grade inflammation.

    Keywords
    Fatty acids, Inflammation, Endothelial function, SCD-1, C-reactive protein, Adhesion molecules
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-103687 (URN)10.1016/j.atherosclerosis.2008.06.020 (DOI)000264510700045 ()18687433 (PubMedID)
    Available from: 2009-05-20 Created: 2009-05-20 Last updated: 2017-12-13Bibliographically approved
    3. Effects of dietary fat modification on oxidative stress and inflammatory markers in the LIPGENE study
    Open this publication in new window or tab >>Effects of dietary fat modification on oxidative stress and inflammatory markers in the LIPGENE study
    Show others...
    2010 (English)In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 104, no 9, p. 1357-1362Article in journal (Refereed) Published
    Abstract [en]

    Subjects with the metabolic syndrome (MetS) have enhanced oxidative stress and inflammation. Dietary fat quality has been proposed to be implicated in these conditions. We investigated the impact of four diets distinct in fat quantity and quality on 8-iso-PGF2α (a major F2-isoprostane and oxidative stress indicator), 15-keto-13,14-dihydro-PGF2α (15-keto-dihydro-PGF2α, a major PGF2α metabolite and marker of cyclooxygenase-mediated inflammation) and C-reactive protein (CRP). In a 12-week parallel multicentre dietary intervention study (LIPGENE), 417 volunteers with the MetS were randomly assigned to one of the four diets: two high-fat diets (38 % energy (%E)) rich in SFA or MUFA and two low-fat high-complex carbohydrate diets (28 %E) with (LFHCC n-3) or without (LFHCC) 1·24 g/d of very long chain n-3 fatty acid supplementation. Urinary levels of 8-iso-PGF2α and 15-keto-dihydro-PGF2α were determined by RIA and adjusted for urinary creatinine levels. Serum concentration of CRP was measured by ELISA. Neither concentrations of 8-iso-PGF2α and 15-keto-dihydro-PGF2α nor those of CRP differed between diet groups at baseline (P>0·07) or at the end of the study (P>0·44). Also, no differences in changes of the markers were observed between the diet groups (8-iso-PGF2α, P = 0·83; 15-keto-dihydro-PGF2α, P = 0·45; and CRP, P = 0·97). In conclusion, a 12-week dietary fat modification did not affect the investigated markers of oxidative stress and inflammation among subjects with the MetS in the LIPGENE study.

    Keywords
    Dietary fat; Oxidative stress; Inflammation; Metabolic syndrome; LIPGENE study
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-133408 (URN)10.1017/S000711451000228X (DOI)000284015300012 ()20569506 (PubMedID)
    Available from: 2010-11-09 Created: 2010-11-09 Last updated: 2017-12-12Bibliographically approved
    4. Dietary fat modification and liver fat content in abdominal obesity
    Open this publication in new window or tab >>Dietary fat modification and liver fat content in abdominal obesity
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Identifiers
    urn:nbn:se:uu:diva-156073 (URN)
    Available from: 2011-08-02 Created: 2011-07-11 Last updated: 2011-11-10
  • 196.
    Bjermo, Helena
    et al.
    Swedish Natl Food Agcy, Uppsala, Sweden..
    Aune, Marie
    Swedish Natl Food Agcy, Uppsala, Sweden..
    Cantillana, Tatiana
    Swedish Natl Food Agcy, Uppsala, Sweden..
    Glynn, Anders
    Swedish Natl Food Agcy, Uppsala, Sweden..
    Lind, P. Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Ridefelt, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Darnerud, Per Ola
    Swedish Natl Food Agcy, Uppsala, Sweden..
    Serum levels of brominated flame retardants (BFRs: PBDE, HBCD) and influence of dietary factors in a population-based study on Swedish adults2017In: Chemosphere, ISSN 0045-6535, E-ISSN 1879-1298, Vol. 167, p. 485-491Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate associations between serum concentrations of brominated flame retardants and personal characteristics, including diet, in adults participating in a population-based study in Sweden 2010-11. Moreover, observed concentrations were used in a health risk assessment, using published health-based reference values. Serum samples of 170 adult individuals of both sexes were analyzed for 10 PBDE congeners and HBCD by GC-MS. When including concentrations between LOD and LOQ, highest median serum concentration was observed for BDE-153 (1.2 ng/g serum lipid), followed by BDE-209 (0.95 ng/g lipid), BDE-47 (0.49 ng/g lipid) and BDE-100 (0.21 ng/g lipid). Median concentration of HBCD was 0.10 ng/g lipid. A few markedly elevated concentrations of BDE-209, HBCD (77-78 ng/g lipid) and BDE-47 (44 ng/g lipid) were observed. The only statistical significant findings were higher BDE-153 concentrations in men than in women, and positive associations between serum BDE-153 concentrations and consumption of fish (total), beef, mutton and poultry. PBDE concentrations were in accordance with concentrations reported in other European countries but generally lower than those found in North America. Median PBDE serum concentrations observed in adults from Sweden suggest sufficient health protection, when compared with published health-based reference values, although some outliers with high serum concentrations had lower safety margins.

  • 197.
    Bjerneld, Magdalena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Images, Motives, and Challenges for Western Health Workers in Humanitarian Aid2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis presents how humanitarian aid workers were attracted, motivated, recruited, and prepared for fieldwork, and how they reported their work experience directly from the field and when they returned home. Data were derived from interviews with experienced aid workers, focus group discussions with presumptive aid workers, analysis of letters from aid workers in the field on MSFs homepages in Europe, and from interviews with recruitment officers at some of the main humanitarian organisations.

    Health professionals were attracted by the positive images of humanitarian action. They wished to work in teams with like-minded people, and to make a difference in the world. However, this image was not supported by the recruitment officers, or experienced aid workers, who described a complex reality in humanitarian action. The experienced aid workers instead had realised they learned more than they contributed.

    The recruitment system for relief workers would benefit from a more holistic approach, where personalities of the aid workers are more in focus. More time must be spent with the applicants, both recruited and returning aid workers, in order to improve the system. A socialisation approach could help identify the right personnel and to motivate current personnel to continue.

    List of papers
    1. Images of humanitarian disaster work: A study of letters from the field
    Open this publication in new window or tab >>Images of humanitarian disaster work: A study of letters from the field
    (English)Manuscript (Other academic)
    Abstract [en]

    An increasing number of people in western countries want to make an active contribution to the world through humanitarian work. Nevertheless the organisations have to compete to attract the best individuals. WWW has become an important channel for presenting the organisations’ image and attracting potential field workers. This study explored how humanitarian fieldwork, in six European MSF homepages, was presented through letters from the field, in order to attract presumptive humanitarian aid workers. The material was analysed using discourse analysis and content analysis.

    The letters provided a glimpse of how it is to work in the field and the reader gets the idea that it is possible to make a contribution and a difference; it is possible to do much with little means, even if one is not professionally very experienced. It is always enough to try your best. The letters do not show the complexity of disaster work and there are few images of local personnel and their contributions to the field work.

    If the organisations want to provide a more nuanced image of the work, they should encourage the authors of the letters to describe the work of local staff in order to avoid portraying them as victims. This would strengthen the message that MSF’ expatriates are professionals assisting the locals with their knowledge and resources. Both groups deserve full acknowledgement for the important work they do.

    Keywords
    Humanitarian action, images, letters, MSF, discourse analysis
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:uu:diva-100878 (URN)
    Available from: 2009-04-09 Created: 2009-04-09 Last updated: 2015-03-02
    2. Perceptions of Work in Humanitarian Assistance: Interviews With Returning Swedish Health Professionals
    Open this publication in new window or tab >>Perceptions of Work in Humanitarian Assistance: Interviews With Returning Swedish Health Professionals
    2004 (English)In: Disaster Management & Response, ISSN 1540-2487, E-ISSN 1540-2495, Vol. 2, no 4, p. 101-108Article in journal (Refereed) Published
    Abstract [en]

     

    Health personnel volunteering for humanitarian assistance assignments work in increasingly dangerous situations and increasingly complex roles. A qualitative analysis of interviews with returning Swedish aid workers, who collectively had been on 74 missions in 32 different countries, revealed that they felt positive about their contribution, but experienced high levels of stress and frustration. They were also surprised and inadequately prepared for tasks that fell outside their professional health care training, including ones demanding pedagogic and management skills.

    The volunteers perceived their success on humanitarian assistance assignments as being affected not only by their own professional competence and special preparatory training, but also by many other factors. In particular, recruiting organizations could improve volunteer performance by accepting only experienced professionals, requiring special preparatory training, clarifying the exact nature of the work, and providing better support during the assignment. Further analysis of humanitarian assistance as a complex and dynamic system involving multiple ‘actors’ could lead to improved understanding and better performance.

     

    Keywords
    Humanitarian action, aid workers, perception, qualitiative research
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-100876 (URN)10.1016/j.dmr.2004.08.009 (DOI)15448624 (PubMedID)
    Available from: 2009-04-14 Created: 2009-04-09 Last updated: 2017-12-13Bibliographically approved
    3. Motivations, Concerns, and Expectations of Scandinavian Health Professionals Volunteering for Humanitarian Assignments
    Open this publication in new window or tab >>Motivations, Concerns, and Expectations of Scandinavian Health Professionals Volunteering for Humanitarian Assignments
    2006 (English)In: Disaster Management & Response, ISSN 1540-2487, E-ISSN 1540-2495, Vol. 4, no 2, p. 49-58Article in journal (Refereed) Published
    Abstract [en]

    International nongovernmental organizations (NGOs) involved in humanitarian assistance employ millions of volunteers. One of the major challenges for the organizations is the high turnover rate among their personnel. Another is recruiting the right persons. As part of a series of studies investigating factors that affect the recruitment process and the success of assignment, this qualitative study examined health professionals' motivations for volunteering, their various concerns, and their expectations about themselves and the organizations for which they would work. The findings from focus group interviews with potential humanitarian volunteers were considered within the framework of Hertzberg's theory of motivations and Maslow's hierarchy of needs.

    The study has significant implications for personnel policy and practice in the humanitarian sector. Recruitment officers should have the self-actualized person, as described by Maslow, in mind when interviewing candidates. This perspective would make it easier for them to understand the candidates' thoughts and concerns and would lead to more effective interventions. Program officers should have satisfiers and dissatisfiers, as identified by Herzberg, in mind when planning programs. The probability that personnel will leave humanitarian work is lower if they perceive working conditions as good.

     

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-100877 (URN)10.1016/j.dmr.2006.01.002 (DOI)16580984 (PubMedID)
    Available from: 2009-04-14 Created: 2009-04-09 Last updated: 2017-12-13Bibliographically approved
    4. Socialisation of humanitarian aid workers: Interviews with recruitment officers
    Open this publication in new window or tab >>Socialisation of humanitarian aid workers: Interviews with recruitment officers
    (English)Manuscript (Other academic)
    Abstract [en]

    International organisations employ thousands of aid workers for humanitarian aid around the world. One of the problems identified in earlier research is the high turnover of personnel.

    This article is part of a broader research project investigating how humanitarian organisations attract, recruit and prepare expatriate health professionals for field work and how these professionals are utilized in order to identify possible improvements in the human resource management system. The current study describes how recruitment officers in selected large humanitarian organisations perceive humanitarian aid work, how they recruit, prepare, and support their staff in order to achieve high retention, and what concerns and recommendations they have for future work. For the analysis of the interviews content analysis was used.

    The recruitment officers identified the importance of flexibility and diplomacy in complex realities. They confirmed the findings of earlier studies that team work often is a source of frustrations and sometimes disappointment. Their main concern was lack of time to find the right person for the right job, often a person with broad expertise in public health. Another difficulty was to find persons who could take responsibility as leaders and trainers. In order to socialize the newcomers into the organisation short courses and debriefing sessions were used. Persons, who stay too long in the field of humanitarian action and sometimes become cynical to the difficult situation they work in was also discussed as being problematic. This finding contradicts the otherwise frequently discussed question about the high turnover of personnel in humanitarian action. This article argues for the use of socialization theory in order to find sustainable solution to identified problems.

    Keywords
    Humanitarian action, aid workers, socialisation, qualitative research
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:uu:diva-100880 (URN)
    Available from: 2009-04-09 Created: 2009-04-09 Last updated: 2015-03-02
  • 198.
    Bjerneld, Magdalena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Images of humanitarian disaster work: A study of letters from the fieldManuscript (Other academic)
    Abstract [en]

    An increasing number of people in western countries want to make an active contribution to the world through humanitarian work. Nevertheless the organisations have to compete to attract the best individuals. WWW has become an important channel for presenting the organisations’ image and attracting potential field workers. This study explored how humanitarian fieldwork, in six European MSF homepages, was presented through letters from the field, in order to attract presumptive humanitarian aid workers. The material was analysed using discourse analysis and content analysis.

    The letters provided a glimpse of how it is to work in the field and the reader gets the idea that it is possible to make a contribution and a difference; it is possible to do much with little means, even if one is not professionally very experienced. It is always enough to try your best. The letters do not show the complexity of disaster work and there are few images of local personnel and their contributions to the field work.

    If the organisations want to provide a more nuanced image of the work, they should encourage the authors of the letters to describe the work of local staff in order to avoid portraying them as victims. This would strengthen the message that MSF’ expatriates are professionals assisting the locals with their knowledge and resources. Both groups deserve full acknowledgement for the important work they do.

  • 199.
    Bjerneld, Magdalena
    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.
    What has happened during the last two decades?: A follow up study of unaccompanied Somali girls in Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Supplement: 1, p. 101-101Article in journal (Other academic)
  • 200.
    Bjerneld, Magdalena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ahlberg, Beth Maina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Socialisation of humanitarian aid workers: Interviews with recruitment officersManuscript (Other academic)
    Abstract [en]

    International organisations employ thousands of aid workers for humanitarian aid around the world. One of the problems identified in earlier research is the high turnover of personnel.

    This article is part of a broader research project investigating how humanitarian organisations attract, recruit and prepare expatriate health professionals for field work and how these professionals are utilized in order to identify possible improvements in the human resource management system. The current study describes how recruitment officers in selected large humanitarian organisations perceive humanitarian aid work, how they recruit, prepare, and support their staff in order to achieve high retention, and what concerns and recommendations they have for future work. For the analysis of the interviews content analysis was used.

    The recruitment officers identified the importance of flexibility and diplomacy in complex realities. They confirmed the findings of earlier studies that team work often is a source of frustrations and sometimes disappointment. Their main concern was lack of time to find the right person for the right job, often a person with broad expertise in public health. Another difficulty was to find persons who could take responsibility as leaders and trainers. In order to socialize the newcomers into the organisation short courses and debriefing sessions were used. Persons, who stay too long in the field of humanitarian action and sometimes become cynical to the difficult situation they work in was also discussed as being problematic. This finding contradicts the otherwise frequently discussed question about the high turnover of personnel in humanitarian action. This article argues for the use of socialization theory in order to find sustainable solution to identified problems.

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