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  • 251.
    Boström, Anita
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Självupplevd påverkan och self-efficacy bland svenska ungdomar relaterat till tobaksvanor och munhälsovanor: En tvärsnittsstudie efter ett skolbaserat preventionsprogram2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The aim was to examine adolescents in the Swedish county of Värmland, their tobacco and oral health habits, and possible associations of these to a tobacco prevention program and their self-efficacy. The sample were students (15-16 years, n = 631) who had undergone a tobacco prevention program in grade 5 and 7. Smoking was more common among girls than among boys (13% vs. 8%), with inverse relationship for snus use (6% vs. 15%). Toothbrushing <2 times/day were more common among boys (21%) than among girls (12%). The girls had as a group, lower self-efficacy. High degree of self-efficacy entailed a greater probability for self-perceived impact of tobacco lessons (p = 0.004). In a multivariate model three significant risk factors for not experiencing influence from tobacco lessons were identified: snus use (OR 2.77, 95% CI 1.42-5.41), low self-efficacy (OR 1.70; 95% CI 1.19-2.42) and living without two adults (OR 1.71; 95% CI 1.17-2.51). Age <15 years (OR 0.65, 95% CI 0.46-0.93) yielded a lower risk for not experiencing influence. Stratified on gender statistical significance persisted regarding all above for girls and living without two adults for boys. 

    The knowledge generated in this study may serve as a base for planning of prevention and promotion strategies in both clinical practice and in schools.

  • 252.
    Boström, Sandra
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Gravida kvinnors kunskap och livsstil i relation till olika hälsorisker: – Kvantitativ tvärsnittsstudie på gravida kvinnor genom onlinebaserad enkätundersökning.2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Inledning: Vi möts allt oftare av forskningsresultat som visar betydelsen av gravida kvinnors livsstil på fostret och sedermera barnets hälsa. De livsstilsfaktorer och dess möjliga hälsorisker som behandlades i denna undersökning var kost, motion, stress samt exponering av kemikalier/miljögifter. Syfte: Syftet var att undersöka gravida kvinnors livsstilsförändring, attityd och kunskap kring olika livsstilsfaktorer som kan påverka fostrets hälsa. Samt vilka informationskällor de använder sig av och om det finns önskemål/behov av mer information inom detta område. Metod: Denna studie genomfördes som en kvantitativ tvärsnittsstudie där de gravida kvinnorna undersöktes genom en onlinebaserad enkät. Resultat: Av de utvalda livsstilsfaktorerna anser majoriteten av deltagarna att följande har en påverkan på fostrets hälsa: ej optimal kost; matprodukter med okända kemikalier samt vistelse i inomhusmiljö med okända kemikalier. De livsstilsfaktorer som deltagarna inte anser påverkar fostrets hälsa är: användning av hygienprodukter; rengöringsmedel och kläder/tyger med okända kemikalier. Majoriteten uppger att de inhämtar information om olika livsstilsfaktorers påverkan på fostrets hälsa från bmm och myndigheters hemsidor men önskar mer av detta inom ett flertal livsstilsfaktorer. Signifikanta samband finns bland annat mellan en hög riskuppfattning och ett hälsosamt beteende under graviditeten samt mellan en hög HLOC Intern för den egna hälsan och en hög HLOC Intern för fostrets hälsa. Diskussion: Användning av vissa produkter med okända kemikalier visade på en relativt låg riskuppfattning bland deltagarna. Detta reslutat går dock emot deras angivna, positiva förändring i och med graviditeten vad gäller undvikandet av kemikalier/miljögifter, vilket kan betyda att studiens deltagare tror sig undvika produkter med okända kemikalier/miljögifter till en hög grad utan att vara medvetna om att många fler produkter kan innehålla kemikalier/miljögifter med negativa hälsoeffekter. Slutsats: Riskuppfattningen kring de olika livsstilsfaktorerna varierar stort. Deltagarna inte är medvetna om vissa produkters hälsorisker vad gäller innehållandet av okända kemikalier. Främsta källan till information är bmm samt myndigheter. Signifikanta samband finns mellan hög riskuppfattning och en hälsosam livsstil under graviditeten. Deltagarna både önskar mer information samt skulle vilja förändra livsstilen inom ett flertal livsstilsfaktorer.

  • 253.
    Bothelius, Kristoffer
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Lu, C.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Stråle, M-M
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Jernelöv, S.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Jansson-Fröjmark, M.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Lindberg, Per
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Kaldo, V.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Internet-based cognitive behavioural therapy for insomnia comorbid with chronic pain2017In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Supplement 1, p. E41-E41Article in journal (Other academic)
  • 254.
    Bozkurt Åhman, Hanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Långtidssjukskrivna kvinnors upplevelser av Arbetslivsintroduktion - med eller utan förberedande insatser2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Långtidssjukskrivningar är ett folkhälsoproblem i Sverige liksom i hela västvärlden, ett problem som är mer utbrett bland kvinnor än bland män. Projekt Vitalis följde 312 kvinnor i Uppsala län som utförsäkrades och som före inskrivning i det arbetsmarknadspolitiska programmet Arbetslivsintroduktion (Intro) randomiserades till två interventionsgrupper samt en kontrollgrupp. Denna uppsats är en delstudie i Vitalis med huvudsaklig avsikt att jämföra studiedeltagarnas erfarenheter och upplevelser av Intro, beroende på om de ingått i Vitalis interventionsgrupper eller i kontrollgruppen. Vitalis genomfördes som en RCT med enkätmätningar vid fem tillfällen. I denna delstudie används enkätmaterial från två mättillfällen, vid projektets start samt efter avslutat deltagande i Intro, 6-7 månader efter projektstart.

     

    Deltagare i interventionsgrupperna upplevde insatser och aktiviteter i Intro som anpassade efter individens behov och förutsättningar i högre grad än dem i kontrollgrupppen. Utlandsfödda upplevde i högre grad än inrikes födda att insatser och aktiviteter i Intro var sämre anpassade efter behov och förutsättningar och mindre meningsfulla, samt att planeringen efter Intro var otydlig. Ensamstående upplevde i allmänhet sin tid i Intro som mer positiv och meningsfull än gifta och sammanboende. Andra resultat som framkom var samband mellan motivation till arbetsåtergång och självskattad hälsa.

     

    Resultaten visar att det finns behov av att utveckla det befintliga programmet Intro och att göra det mer individanpassat. Vidare behövs forskning för att närmare avgränsa vilken typ av förberedande insatser som långtidssjukskrivna kvinnor, och i synnerhet kvinnor födda utomlands, är i behov av för att bättre tillgodogöra sig den arbetsmarknadspolitiska rehabilitering som erbjuds efter långvariga sjukskrivningar.

  • 255.
    Bradby, Hannah
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    International medical migration: A critical conceptual review of the global movements of doctors and nurses2014In: Health, ISSN 1363-4593, E-ISSN 1461-7196, Vol. 18, no 6, p. 580-596Article in journal (Refereed)
    Abstract [en]

    This paper critically appraises the discourse around international medical migration at the turn of the 21st century. A critical narrative review of a range of English-language sources, including grey literature, books and research reports, traces the development and spread of specific causative models. The attribution of causative relations between the movement of skilled medical workers, the provision of health care and population health outcomes illustrates how the global reach of biomedicine has to be understood in the context of local conditions. The need to understand migration as an aspect of uneven global development, rather than a delimited issue of manpower services management, is illustrated with reference to debates about ‘brain drain’ of Africa’s health-care professionals, task-shifting and the crisis in health-care human resources. The widespread presumed cause of shortages of skilled health-care staff in sub-Saharan Africa was overdetermined by a compelling narrative of rich countries stealing poor countries’ trained health-care professionals. This narrative promotes medical professional interests and ignores historical patterns of underinvestment in health-care systems and structures. Sociological theories of medicalization suggest that the international marketization of medical recruitment is a key site where the uneven global development of capital is at work. A radical reconfiguration of medical staffing along the lines of ‘task-shifting’ in rich and poor countries’ health-care systems alike offers one means of thinking about global equity in access to quality care.

  • 256.
    Bradby, Hannah
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Frenz, Margret
    Univ Oxford, Ctr Global Hist, Oxford, England.;Univ Oxford, St Cross Coll, Oxford, England..
    Snow, Stephanie
    Univ Manchester, Ctr Hist Sci Technol & Med, Manchester, Lancs, England..
    Migration and danger: ethnicity and health2016In: Ethnicity and Health, ISSN 1355-7858, E-ISSN 1465-3419, Vol. 21, no 4, p. 333-339Article in journal (Other academic)
  • 257.
    Bradby, Hannah
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology. 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).
    Liabo, Kristin
    Univ Exeter, Med Sch, Exeter, Devon, England.
    Ingold, Anne
    Independent interviewer, Hertfordshire, England.
    Roberts, Helen
    UCL Great Ormond St Inst Child Hlth, Child Hlth Res, London, England.
    Visibility, resilience, vulnerability in young migrants2019In: Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, ISSN 1363-4593, Vol. 23, no 5, p. 533-550Article in journal (Refereed)
    Abstract [en]

    Young unaccompanied asylum seekers have been portrayed as vulnerable, resilient or both. Those granted residency in Europe are offered support by health and social care systems, but once they leave the care system to make independent lives, what part can these services play? Our review of research with migrants who have been in care in Sweden and the United Kingdom found evidence of unmet need, but little research describing their own views of services. The limited published evidence, supplemented by interviews with care leavers in a UK inner city, suggests that in defining health needs, young people emphasise housing, education, employment and friendship over clinical or preventative services. Some felt well supported while others described feeling vulnerable, anxious, angry or sad. These experiences, if linked with the insensitivity of even one professional, could lower young people’s expectations of healthcare to the extent that they avoided contact with service providers. In supporting young migrants’ resilience to meet everyday challenges, friendly support from peers, carers and professionals was important. They needed determined advocacy at key moments. The different challenges for the Swedish and UK health and welfare systems along with the resilience/vulnerability trajectory are described.

  • 258.
    Brand, T.
    et al.
    Leibniz Inst Prevent Res & Epidemiol, Bremen, Germany.
    Samkange-Zeeb, F.
    Leibniz Inst Prevent Res & Epidemiol, Bremen, Germany.
    Knecht, M.
    Univ Bremen, Bremen, Germany.
    Bradby, Hannah
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Padilla, B.
    ISCTE Inst Univ Lisboa, Lisbon, Portugal.
    Pemberton, S.
    Keele Univ, Keele, Staffs, England.
    Phillimore, J.
    Univ Birmingham, Birmingham, W Midlands, England.
    Zeeb, H.
    Leibniz Inst Prevent Res & Epidemiol, Bremen, Germany.
    Unmet needs for healthcare in superdiverse neighbourhoods: results from the UPWEB study2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Supplement: 1, p. 76-76Article in journal (Other academic)
  • 259.
    Brantnell, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care.
    Olsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care.
    von Essen, Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care.
    Psychosocial care via internet, a mode to achieve improved patient care at a lower cost?2011Conference paper (Refereed)
    Abstract [en]

    The primary research objective of the U-CARE Program is to evaluate the clinical efficacy and cost-effectiveness of Internet-based self-managed programs of psychosocial care to patients and significant others. To reach this we have constructed an Internet-based platform. In order to plan for implementation we have carried out a stakeholder analysis and identified possible implementation strategies

  • 260.
    Brantsaeter, Anne Lise
    et al.
    Norwegian Inst Publ Hlth, Dept Exposure & Risk Assessment, Div Environm Med, POB 4404, NO-0403 Oslo, Norway..
    Torjusen, Hanne
    Norwegian Inst Publ Hlth, Dept Exposure & Risk Assessment, Div Environm Med, POB 4404, NO-0403 Oslo, Norway.;Natl Inst Consumer Res SIFO, Oslo, Norway..
    Meltzer, Helle Margrete
    Norwegian Inst Publ Hlth, Dept Exposure & Risk Assessment, Div Environm Med, POB 4404, NO-0403 Oslo, Norway..
    Papadopoulou, Eleni
    Norwegian Inst Publ Hlth, Dept Exposure & Risk Assessment, Div Environm Med, POB 4404, NO-0403 Oslo, Norway..
    Hoppin, Jane A.
    N Carolina State Univ, Ctr Human Hlth & Environm, Dept Biol Sci, Raleigh, NC 27695 USA..
    Alexander, Jan
    Norwegian Inst Publ Hlth, Off Director Gen, POB 4404, NO-0403 Oslo, Norway..
    Lieblein, Geir
    Norwegian Univ Life Sci, Dept Plant Sci, As, Norway..
    Roos, Gun
    Natl Inst Consumer Res SIFO, Oslo, Norway..
    Holten, Jon Magne
    Oikos Organ Norway, Oslo, Norway..
    Swartz, Jackie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience. Vidarkliniken, Jarna, Sweden..
    Haugen, Margaretha
    Norwegian Inst Publ Hlth, Dept Exposure & Risk Assessment, Div Environm Med, POB 4404, NO-0403 Oslo, Norway..
    Organic Food Consumption during Pregnancy and Hypospadias and Cryptorchidism at Birth: The Norwegian Mother and Child Cohort Study (MoBa)2016In: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 124, no 3, p. 357-364Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The etiologies of the male urogenital anomalies hypospadias and cryptorchidism remain unclear. It has been suggested that maternal diet and environmental contaminants may affect the risk of these anomalies via placental or hormonal disturbances. OBJECTIVES: We examined associations between organic food consumption during pregnancy and prevalence of hypospadias and cryptorchidism at birth. METHODS: Our study includes 35,107 women participating in the Norwegian Mother and Child Cohort Study (MoBa) who delivered a singleton male infant. Information about use of six groups of organically produced food (vegetables, fruit, bread/cereal, milk/dairy products, eggs, and meat) during pregnancy was collected by a food frequency questionnaire. Women who indicated that they sometimes, often, or mostly consumed organic foods in at least one of the six food groups were classified as organic food consumers in analyses. Hypospadias and cryptorchidism diagnoses were retrieved from the Medical Birth Registry of Norway. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression. RESULTS: Seventy-four male newborns were diagnosed with hypospadias (0.2%), and 151 with cryptorchidism (0.4%). Women who consumed any organic food during pregnancy were less likely to give birth to a boy with hypospadias (OR = 0.42; 95% CI: 0.25, 0.70, based on 21 exposed cases) than women who reported they never or seldom consumed organic food. Associations with specific organic foods were strongest for vegetable (OR = 0.36; 95% CI: 0.15, 0.85; 10 exposed cases) and milk/dairy (OR = 0.43; 95% CI: 0.17, 1.07; 7 exposed cases) consumption. No substantial association was observed for consumption of organic food and cryptorchidism. CONCLUSIONS: Consumption of organically produced foods during pregnancy was associated with a lower prevalence of hypospadias in our study population. These findings were based on small numbers of cases and require replication in other study populations.

  • 261.
    Brattberg, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Do pain problems in young school children persist into early adulthood?: A 13-year follow-up2004In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 8, no 3, p. 187-199Article in journal (Refereed)
    Abstract [en]

    Design. In a longitudinal study, 335 children ages 8, 11 and 14, first studied in 1989 were followed-up on two occasions in 1991 and 2002. The subjects filled in questionnaires on pain, the first two times in school, the last as a postal survey.

    Purposes. To determine if headache and back pain during the school years were transitory or if they grew into pain problems in adulthood; to determine predictors of pain.

    Results. In the 2002 study, 59% of the women and 39% of the men reported pain at 21, 24 and 27 years. A total of 68 (52 women, 16 men) or 20% of the subjects reported pain symptoms in all three studies. The cumulative incidence rate for the presence of pain in the cohort studied was 31% for 1989–2002 and 43% for 1991–2002. Four of the 10 individuals with pain also reported signs of stress. Three predictors were found: reported back pain in 8–14-year-olds (p<0.0001); reported headaches once a week or more in the same age group (p<0.0001); and a positive response in the ages 10–16 to the question: “Do you often feel nervous?” (OR=2.1, 95% CI 1.3–3.4). When adjusted for age, sex and all psychosocial risk determinants studied in multiple logistic regression, a positive answer to this question was a significant predictor of pain in young adulthood. A positive response by the 10–16-year-olds to “Do you find it difficult to describe your feelings?” was a predictor of pathological anxiety in early adulthood, but stress perceived in childhood/adolescence did not predict future pain or stress.

    Conclusions. Since pain reports in childhood and early adolescence seem to be associated with the report of pain in early adulthood, more attention should be given to the way ill-health is managed in adolescence in this vulnerable group.

  • 262.
    Brattberg, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Internet-based rehabilitation for individuals with chronic pain and burnout: a randomized trial2006In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 29, no 3, p. 221-227Article in journal (Refereed)
    Abstract [en]

    This study investigates utilization of the Internet in the rehabilitation of people on long-term sick leave with chronic pain and/or burnout. Fifty-five people were randomly assigned to two groups: a treatment group (n = 27) that participated in a rehabilitation course over the Internet and a waiting list group (n = 28). The goals were to improve participants' health and increase quality of life, and, for those who were not on permanent disability pensions, to increase work capacity, if possible. A 20-week program, based on 19 films on different themes, was supplemented with written material and a Socratic dialogue over the Internet. Upon completion of the rehabilitation course, statistically significant improvements were observed in the treatment group in comparison to the waiting list group, for variables such as depression, pain, vitality, social function, performance problems involving work or other activities due to physical illness and the presence of stress symptoms. Thirteen of 23 individuals (57%) also increased their work capacity. The number needed to treat regarding recovering from anxiety and depression was 2. For increased work capacity, the number needed to treat was 3. Rehabilitation of people on long-term sick leave carried out over the Internet is a good complement to other rehabilitation programs.

  • 263. Breed, Andrew C.
    et al.
    Breed, Martin F.
    Australian Centre for Evolutionary Biology and Biodiversity (ACEBB), and School of Earth and Environmental Sciences, University of Adelaide.
    Meers, Joanne
    Field, Hume E.
    Evidence of endemic Hendra virus infection in flying-foxes (Pteropus conspicillatus): implications for disease risk management2011In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 6, p. e28816-Article in journal (Refereed)
    Abstract [en]

    This study investigated the seroepidemiology of Hendra virus in a spectacled flying-fox (Pteropus conspicillatus) population in northern Australia, near the location of an equine and associated human Hendra virus infection in late 2004. The pattern of infection in the population was investigated using a serial cross-sectional serological study over a 25-month period, with blood sampled from 521 individuals over six sampling sessions. Antibody titres to the virus were determined by virus neutralisation test. In contrast to the expected episodic infection pattern, we observed that seroprevalence gradually increased over the two years suggesting infection was endemic in the population over the study period. Our results suggested age, pregnancy and lactation were significant risk factors for a detectable neutralizing antibody response. Antibody titres were significantly higher in females than males, with the highest titres occurring in pregnant animals. Temporal variation in antibody titres suggests that herd immunity to the virus may wax and wane on a seasonal basis. These findings support an endemic infection pattern of henipaviruses in bat populations suggesting their infection dynamics may differ significantly from the acute, self limiting episodic pattern observed with related viruses (e.g. measles virus, phocine distemper virus, rinderpest virus) hence requiring a much smaller critical host population size to sustain the virus. These findings help inform predictive modelling of henipavirus infection in bat populations, and indicate that the life cycle of the reservoir species should be taken into account when developing risk management strategies for henipaviruses.

  • 264.
    Broander, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Styrkan i delad kunskap: - Patienter med Systemisk lupus erythematosus erfarenheter av Internet2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund

    En miljon människor i Sverige idag är diagnostiserade med någon form av reumatisk sjukdom. De reumatiska sjukdomarna är en av vår tids folksjukdomar då de drabbar en stor del av befolkningen och därmed påverkar folkhälsan negativt. Cirka sex tusen av de som drabbas av reumatisk sjukdom har diagnosen Systemisk lupus erythematosus (SLE). SLE är en kronisk, autoimmun multisystemsjukdom som skapar inflammationer i kroppen. SLE har varierande symptom och en komplicerad sjukdomsbild, vilket gör att de patienter som drabbas av den ofta har ett stort behov av tillgång till information om sin sjukdom samt ett stort behov av att få stöd i sin sjukdom.

    Syfte

    Syftet med studien var att beskriva vilka erfarenheter patienter med diagnosen Systemisk lupus erythematosus har av Internet som källa till information, stöd och delaktighet.

    Metod

    Studien är en kvalitativ studie som baseras på sex intervjuer med kvinnor med diagnosen SLE.

    Resultat

    Resultatet visar att SLE-patienter använder sig av Internet som källa till information och stöd och att genom att göra detta blir mer välinformerade patienter. Detta ökar i sin tur deras delaktighet i sin sjukdom och vård. Studien visar även att SLE-patienter inte känner att de får tillräckligt gehör av läkare och sjukvård samt att de finner ett socialt stöd i medpatienter på Internet.

    Slutsats

    Studien visar att SLE-patienter har positiva erfarenheter av Internet som källa till information och stöd. Den visar också att Internet möjliggör en ökad delaktighet i deras sjukdom och vård. Delaktigheten baseras dock till stor del på patienternas egna initiativ och behov och studien visar därför att det existerar brister i de möjligheter till delaktighet som sjukvården bör eftersträva med sina patienter. Den visar också att det finns mer att önska av kommunikationen mellan SLE-patienter och deras läkare och sjukvård.

  • 265.
    Brolin Låftman, Sara
    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).
    Östberg, Viveca
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    National data study showed that adolescents living in poorer households and with one parent were more likely to be bullied2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 12, p. 2048-2054Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim of this study was to assess whether sociodemographic household characteristics were associated with which Swedish adolescents were more likely to be bullied.

    Methods

    The data were derived from the Swedish Living Conditions Survey and its child supplements from the survey years 2008-2011. The analyses included information on 3,951 adolescents aged 10-18 years. Exposure to bullying was reported by adolescents and information on sociodemographic household characteristics was reported by parents and obtained from official registers. Binary logistic regression was used to analyse the data.

    Results

    Adolescents were more likely to be bullied if they lived in households with no cash margin, defined as the ability to pay an unexpected bill of 8,000 Swedish Kronor or about 800 Euros, and if they lived with just one custodial parent. In the unadjusted analyses, elevated risks were identified if adolescents lived in working class households and had unemployed and foreign-born parents. However, these associations were at least partly accounted for by other sociodemographic household characteristics, in particular the lack of a cash margin.

    Conclusion

    This study showed that Swedish adolescents living in households with more limited financial resources had an increased risk of being bullied, supporting results from previous international research.

  • 266.
    Brolin Låftman, Sara
    et al.
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Fransson, Emma
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Östberg, Viveca
    Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Sociodemographic inequalities in adolescents’ health-related behaviours: The case of Sweden2016Conference paper (Other academic)
  • 267. Brolin Ribacke, Kim J
    et al.
    van Duinen, Alex J
    Nordenstedt, Helena
    Höijer, Jonas
    Molnes, Ragnhild
    Froseth, Torunn Wigum
    Koroma, A P
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Bolkan, Håkon Angel
    Ekström, AnnaMia
    The Impact of the West Africa Ebola Outbreak on Obstetric Health Care in Sierra Leone.2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 2, article id e0150080Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As Sierra Leone celebrates the end of the Ebola Virus Disease (EVD) outbreak, we can begin to fully grasp its impact on already weak health systems. The EVD outbreak in West Africa forced many hospitals to close down or reduce their activity, either to prevent nosocomial transmission or because of staff shortages. The aim of this study is to assess the potential impact of EVD on nationwide access to obstetric care in Sierra Leone.

    METHODS AND FINDINGS: Community health officers collected weekly data between January 2014-May 2015 on in-hospital deliveries and caesarean sections (C-sections) from all open facilities (public, private for-profit and private non-profit sectors) offering emergency obstetrics in Sierra Leone. This was compared to official data of EVD cases per district. Logistic and Poisson regression analyses were used to compute risk and rate estimates. Nationwide, the number of in-hospital deliveries and C-sections decreased by over 20% during the EVD outbreak. The decline occurred early on in the EVD outbreak and was mainly attributable to the closing of private not-for-profit hospitals rather than government facilities. Due to difficulties in collecting data in the midst of an epidemic, limitations of this study include some missing data points.

    CONCLUSIONS: Both the number of in-hospital deliveries and C-sections substantially declined shortly after the onset of the EVD outbreak. Since access to emergency obstetric care, like C-sections, is associated with decreased maternal mortality, many women are likely to have died due to the reduced access to appropriate care during childbirth. Future research on indirect health effects of health system breakdown should ideally be nationwide and continue also into the recovery phase. It is also important to understand the mechanisms behind the deterioration so that important health services can be reestablished.

  • 268.
    Brooke, Hannah Louise
    et al.
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, POB 210, S-17177 Stockholm, Sweden..
    Talback, Mats
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, POB 210, S-17177 Stockholm, Sweden..
    Hornblad, Jesper
    Natl Board Hlth & Welf, Stockholm, Sweden..
    Johansson, Lars Age
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Ludvigsson, Jonas Filip
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Orebro Univ Hosp, Dept Paediat, Orebro, Sweden.;Univ Nottingham, Sch Med, Div Epidemiol & Publ Hlth, Nottingham, England.;Columbia Univ Coll Phys & Surg, Dept Med, New York, NY USA..
    Druid, Henrik
    Karolinska Inst, Dept Pathol & Oncol, Stockholm, Sweden..
    Feychting, Maria
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, POB 210, S-17177 Stockholm, Sweden..
    Ljung, Rickard
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, POB 210, S-17177 Stockholm, Sweden..
    The Swedish cause of death register2017In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 32, no 9, p. 765-773Article in journal (Refereed)
    Abstract [en]

    Sweden has a long tradition of recording cause of death data. The Swedish cause of death register is a high quality virtually complete register of all deaths in Sweden since 1952. Although originally created for official statistics, it is a highly important data source for medical research since it can be linked to many other national registers, which contain data on social and health factors in the Swedish population. For the appropriate use of this register, it is fundamental to understand its origins and composition. In this paper we describe the origins and composition of the Swedish cause of death register, set out the key strengths and weaknesses of the register, and present the main causes of death across age groups and over time in Sweden. This paper provides a guide and reference to individuals and organisations interested in data from the Swedish cause of death register.

  • 269.
    Bruxvoort, Katia J.
    et al.
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Leurent, Baptiste
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Chandler, Clare I. R.
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Ansah, Evelyn K.
    Ghana Hlth Serv, Res & Dev, Accra, Greater Accra, Ghana..
    Baiden, Frank
    Ensign Coll Publ Hlth, Epidemiol, Kpong, Ghana..
    Björkman, Anders
    Karolinska Inst, Microbiol Tumor & Cell Biol, Stockholm, Sweden..
    Burchett, Helen E. D.
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Clarke, Sian E.
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Cundill, Bonnie
    Univ Leeds, Leeds Inst Clin Trials Res, Leeds, W Yorkshire, England..
    DiLiberto, Debora D.
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Elfving, Kristina
    Univ Gothenburg, Infect Dis, Gothenburg, Sweden..
    Goodman, Catherine
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Hansen, Kristian S.
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England.;Univ Copenhagen, Hlth Serv Res, Copenhagen, Denmark..
    Kachur, Patrick
    US Ctr Dis Control & Prevent, Atlanta, GA USA.;CDC, Malaria Branch, Atlanta, GA 30333 USA..
    Lal, Sham
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Lalloo, David G.
    Univ Liverpool Liverpool Sch Trop Med, Clin Sci & Int Publ Hlth, Liverpool, Merseyside, England..
    Leslie, Toby
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Magnussen, Pascal
    Univ Copenhagen, Ctr Med Parasitol, Copenhagen, Denmark.;Copenhagen Univ Hosp, Ctr Med Parasitol, Copenhagen, Denmark.;Univ Copenhagen, Dept Vet & Anim Sci, Copenhagen, Denmark..
    Mangham-Jefferies, Lindsay
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Mårtensson, Andreas
    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).
    Mayan, Ismail
    Hlth Protect Res Org, Clin Trials, Kabul, Afghanistan..
    Mbonye, Anthony K.
    Minist Hlth, Kampala, Uganda.;Makerere Univ, Sch Publ Hlth, Community Hlth & Behav Sci, Kampala, Uganda..
    Msellem, Mwinyi I.
    Zanzibar Minist Hlth, Zanzibar Malaria Eliminat Programme, Zanzibar, Tanzania..
    Onwujekwe, Obinna E.
    Univ Nigeria, Dept Pharmacol & Therapeut, Enugu, Nigeria.;Univ Nigeria, Pharmacol & Therapeut, Enugu Campus, Enugu, Nigeria..
    Owusu-Agyei, Seth
    Kintampo Hlth Res Ctr, Kintampo, Ghana..
    Rowland, Mark W.
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Shakely, Deler
    Karolinska Inst, Stockholm, Sweden.;Karolinska Inst, Ctr Malaria Res, Stockholm, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Hlth Metr, Gothenburg, Sweden..
    Staedke, Sarah G.
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Vestergaard, Lasse S.
    Univ Copenhagen, Ctr Med Parasitol, Copenhagen, Denmark.;Copenhagen Univ Hosp, Copenhagen, Denmark.;Statens Serum Inst, Dept Infect Dis Epidemiol & Prevent, Copenhagen, Denmark..
    Webster, Jayne
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Whitty, Christopher J. M.
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Wiseman, Virginia L.
    London Sch Hyg & Trop Med, 15-17 Tavistock Pl, London WC1H 9SH, England.;Univ New South Wales, Sch Publ Hlth & Community Med, Sydney, NSW, Australia..
    Yeung, Shunmay
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Schellenberg, David
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    Hopkins, Heidi
    London Sch Hyg & Trop Med, Global Hlth & Dev, London, England..
    The Impact of Introducing Malaria Rapid Diagnostic Tests on Fever Case Management: A Synthesis of Ten Studies from the ACT Consortium2017In: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645, Vol. 97, no 4, p. 1170-1179Article in journal (Refereed)
    Abstract [en]

    Since 2010, the World Health Organization has been recommending that all suspected cases of malaria be confirmed with parasite-based diagnosis before treatment. These guidelines represent a paradigm shift away from presumptive antimalarial treatment of fever. Malaria rapid diagnostic tests (mRDTs) are central to implementing this policy, intended to target artemisinin-based combination therapies (ACT) to patients with confirmed malaria and to improve management of patients with nonmalarial fevers. The ACT Consortium conducted ten linked studies, eight in sub-Saharan Africa and two in Afghanistan, to evaluate the impact of mRDT introduction on case management across settings that vary in malaria endemicity and healthcare provider type. This synthesis includes 562,368 outpatient encounters (study size range 2,400-432,513). mRDTs were associated with significantly lower ACT prescription (range 8-69% versus 20-100%). Prescribing did not always adhere to malaria test results; in several settings, ACTs were prescribed to more than 30% of test-negative patients or to fewer than 80% of test-positive patients. Either an antimalarial or an antibiotic was prescribed for more than 75% of patients across most settings; lower antimalarial prescription for malaria test-negative patients was partly offset by higher antibiotic prescription. Symptomatic management with antipyretics alone was prescribed for fewer than 25% of patients across all scenarios. In community health worker and private retailer settings, mRDTs increased referral of patients to other providers. This synthesis provides an overview of shifts in casemanagement thatmay be expected with mRDT introduction and highlights areas of focus to improve design and implementation of future case management programs.

  • 270.
    Brydsten, Anna
    et al.
    Stockholm Univ, Dept Publ Hlth Sci, SE-10691 Stockholm, Sweden.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    San Sebastian, Miguel
    Umea Univ, Dept Publ Hlth & Clin Med, Epidemiol & Global Hlth Unit, SE-90185 Umea, Sweden.
    Health inequalities between employed and unemployed in northern Sweden: a decomposition analysis of social determinants for mental health2018In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 59Article in journal (Refereed)
    Abstract [en]

    Background: Even though population health is strongly influenced by employment and working conditions, public health research has to a lesser extent explored the social determinants of health inequalities between people in different positions on the labour market, and whether these social determinants vary across the life course. This study analyses mental health inequalities between unemployed and employed in three age groups (youth, adulthood and mid-life), and identifies the extent to which social determinants explain the mental health gap between employed and unemployed in northern Sweden. Methods: The Health on Equal Terms survey of 2014 was used, with self-reported employment (unemployed or employed) as exposure and the General Health Questionnaire (GHQ-12) as mental health outcome. The social determinants of health inequalities were grouped into four dimensions: socioeconomic status, economic resources, social network and trust in institutional systems. The non-linear Oaxaca decomposition analysis was applied, stratified by gender and age groups. Results: Mental health inequality was found in all age groups among women and men (difference in GHQ varying between 0.12 and 0.20). The decomposition analysis showed that the social determinants included in the model accounted for 43-51% of the inequalities among youths, 42-98% of the inequalities among adults and 60-65% among middle-aged. The main contributing factors were shown to vary between age groups: cash margin (among youths and middle-aged men), financial strain (among adults and middle-aged women), income (among men in adulthood), along with trust in others (all age groups), practical support (young women) and social support (middle-aged men); stressing how the social determinants of health inequalities vary across the life course. Conclusions: The health gap between employed and unemployed was explained by the difference in access to economic and social resources, and to a smaller extent in the trust in the institutional systems. Findings from this study corroborate that much of the mental health inequality in the Swedish labour market is socially and politically produced and potentially avoidable. Greater attention from researchers, policy makers on unemployment and public health should be devoted to the social and economic deprivation of unemployment from a life course perspective to prevent mental health inequality.

  • 271.
    Brydsten, Anna
    et al.
    Umeå universitet, Epidemiologi och global hälsa.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Umeå universitet, Epidemiologi och global hälsa.
    San Sebastian, Miguel
    Umeå universitet, Epidemiologi och global hälsa.
    The impact of economic recession on the association between youth unemployment and functional somatic symptoms in adulthood: a difference-in-difference analysis from Sweden2016In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, article id 230Article in journal (Refereed)
    Abstract [en]

    Background: The impact of macroeconomic conditions on health has been extensively explored, as well as the relationship between individual unemployment and health. There are, however, few studies taking both aspects into account and even fewer studies looking at the relationship in a life course perspective. In this study the aim was to assess the role of macroeconomic conditions, such as national unemployment level, for the long-term relationship between individual unemployment and functional somatic symptoms (FSS), by analysing data from two longitudinal cohorts representing different periods of unemployment level in Sweden.

    Methods: A difference-in-difference (DiD) analysis was applied, looking at the difference over time between recession and pre-recession periods for unemployed youths (age 21 to 25) on FSS in adulthood. FSS was constructed as an index of ten self-reported items of somatic ill-health. Covariates for socioeconomics, previous health status and social environment were included.

    Results: An association was found in the difference of adult FSS between unemployed and employed youths in the pre-recession and recession periods, remaining in the adjusted model for the pre-recession period. The DiD analysis between unemployed youths showed that men had significantly lower adult FSS during the recession compared to men in the pre-recession time.

    Conclusions: Adulthood FSS showed to be significantly lower among unemployed youths, in particular among men, during recession compared to pre-recession times. Since this is a fairly unexplored research field, more research is needed to explore the role of macroeconomic conditions for various health outcomes, long-term implications and gender differences.

  • 272.
    Brydsten, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Hammarström, Anne
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Strandh, Mattias
    Umeå universitet, Institutionen för socialt arbete.
    Johansson, Klara
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Youth unemployment and functional somatic symptoms in adulthood: results from the Northern Swedish cohort2015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 5, p. 796-800Article in journal (Refereed)
    Abstract [en]

    Background: Little is known about the possible long-term health consequences of youth unemployment. Research indicates that unemployment may lead to socioeconomic downward mobility and mental health problems, but we still lack knowledge of the long-term health consequences of youth unemployment. This article examines the potential long-term association between youth unemployment and functional somatic symptoms in adulthood. 

    Methods: The ‘Northern Swedish cohort’ was used with data from five data collections, from 1981 (age 16) until 2007 (age 42). Youth unemployment was measured as months in unemployment between age 16 and 21, and health outcome as functional somatic symptoms (an index of 10 items of self-reported symptoms). Linear regression was used to analyse the relationship between months in youth unemployment and functional somatic symptoms at age 21 and age 42, stratified for women and men and adjusted for potential confounders, such as time spent in education at age 21 and later unemployment between age 21 and 42. 

    Results: Youth unemployment was significantly related to functional somatic symptoms at age 21 for men after controlling for confounders, but not for women. Among men, the association remained for functional somatic symptoms at age 42, after controlling for confounders. 

    Conclusions: Adolescence seems to be a sensitive period during which unemployment could have remaining health effects in adulthood, at least for men, though assumptions of causality are tentative and more research is needed.

  • 273.
    Brännlund, Annica
    et al.
    Umeå universitet, Sociologiska institutionen.
    Hammarström, Anne
    Umeå universitet, Allmänmedicin.
    Higher education and psychological distress: a 27-year prospective cohort study in Sweden2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 2, p. 155-162Article in journal (Refereed)
    Abstract [en]

    Aims: Research identifies a positive link between education and a reduction of psychological distress, but few studies have analysed the long-term impact of education on psychological distress. This study followed the same cohort for 27 years, investigating the association between education and adult psychological distress. Further, it discuss whether the link can be understood through the mediating mechanisms of social and labour-market resources, furthermore, if the mechanisms operate differently for men and women. Method: A 27-year prospective cohort study was performed at ages 16, 18, 21, 30 and 43. The cohort consisted of all students (n = 1083, of which 1001 are included in this study) in their final year of compulsory school in Sweden. Data were collected through comprehensive questionnaires (response rate 96.4%), and analysed with OLS regression, with psychological distress at age 21, 30 and 43 as dependent variable. Baseline psychological distress, measures of social and labour-market resources, and possible educational selection factors were used as independent variables. To compare the overall magnitude of educational differences, a kappa index was calculated. Results: A positive relation between higher education and less psychological distress was found. When becoming older this relation weakens and a link between social and labour-market resources and psychological distress is observed, indicating that education in a long-term perspective operates through the suggested mechanisms. Additionally, the mechanisms work somewhat differently for men than for women: labour-market resources were significant for men and social resources were important for women. Conclusions: Main findings: higher education is positively linked to less psychological distress, and the link can somewhat be understood through the mechanisms of social and labour-market resources.

  • 274.
    Buchner, Denise Lynn
    et al.
    Univ Calgary, Cumming Sch Med, Dept Community Hlth Sci, Calgary, AB, Canada.
    Kitutu, Freddy
    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). Makerere Univ, Pharm Dept, Kampala, Uganda.
    Cross, Donall Eoin
    Aberystwyth Univ, Inst Biol Environm & Rural Sci, Aberystwyth, Dyfed, Wales.
    Nakamoga, Esther
    Makerere Univ, Sch Publ Hlth, Kampala, Uganda.
    Awor, Phyllis
    Makerere Univ, Sch Publ Hlth, Kampala, Uganda.
    A cross-sectional study to identify the distribution and characteristics of licensed and unlicensed private drug shops in rural Eastern Uganda to inform an iCCM intervention to improve health outcomes for children under five years2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 1, article id e0209641Article in journal (Refereed)
    Abstract [en]

    Introduction: Malaria, pneumonia and diarrhea are leading causes of death in young children in Uganda. Between 50-60% of sick children receive treatment from the private sector, especially drug shops. There is an urgent need to improve quality of care and regulation of private drug shops in Uganda. This study was conducted to determine the distribution, the licensing status and characteristics of drug shops in four sub-districts of Kamuli district.

    Methods: This study was part of a pre-post cross sectional study that examined the implementation of an integrated Community Case Management (iCCM) intervention for common childhood illness in rural private drug shops in Kamuli District in Eastern Uganda. This mapping exercise used a snowball sampling technique to identify licensed and unlicensed drug shops and collect information about their characteristics. Data were collected using a questionnaire. GPS data were collected for all drug shops.

    Analysis: Quantitative data were analyzed using SPSS for descriptive statistics. Open ended questions were entered into NVivo 10 and analyzed using thematic analysis strategies.

    Results: In total, 215 drug shops in 284 villages were located. Of these, 123 (57%) were open and consented to an interview. Only 12 (10%) drug shops were licensed, 93 (76%) were unlicensed, and the licensing status of 18 (15%) was unknown. Most respondents were the owner of the drug shop (88%); most drug sellers reported their qualification as nursing assistants (70%). Drug sellers reported licensing fees and costs of contracting an "in-charge" as barriers to licensing. Nearly all drug shops sold drugs for malaria (91%) and antibiotics (79%).

  • 275.
    Budhathoki, Shyam Sundar
    et al.
    BP Koirala Inst Hlth Sci, Sch Publ Hlth & Community Med, Dharan, Nepal.
    Gurung, Rejina
    Golden Community, Jawagal, Nepal.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Thapa, Jeevan
    BP Koirala Inst Hlth Sci, Sch Publ Hlth & Community Med, Dharan, Nepal.
    Ashish, K. C.
    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).
    Does the Helping Babies Breathe Programme impact on neonatal resuscitation care practices?: Results from systematic review and meta-analysis2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 5, p. 806-813Article, review/survey (Refereed)
    Abstract [en]

    Aim: This paper examines the change in neonatal resuscitation practices after the implementation of the Helping Babies Breathe (HBB) programme.

    Methods: A systematic review was carried out on studies reporting the impact of HBB programmes among the literature found in Medline, POPLINE, LILACS, African Index Medicus, Cochrane, Web of Science and Index Medicus for the Eastern Mediterranean Region database. We selected clinical trials with randomised control, quasi-experimental and cross-sectional designs. We used a data extraction tool to extract information on intervention and outcome reporting. We carried out a meta-analysis of the extracted data on the neonatal resuscitation practices following HBB programme using Review Manager.

    Results: Four studies that reported on neonatal resuscitation practices before and after the implementation of the HBB programme were identified. The pooled results showed no changes in the use of stimulation (RR-0.54; 95% CI, 0.21-1.42), suctioning (RR-0.48; 95% CI, 0.18-1.27) and bag-and-mask ventilation (RR-0.93; 95% CI, 0.47-1.83) after HBB training. The proportion of babies receiving bag-and-mask ventilation within the Golden Minute of birth increased by more than 2.5 times (RR-2.67; 95% CI, 2.17-3.28).

    Conclusion: The bag-and-mask ventilation within Golden minute has improved following the HBB programme. Implementation of HBB training improves timely initiation of bag-and-mask ventilation within one minute of birth.

  • 276.
    Bui, Ha Thi Thu
    et al.
    Hanoi Univ Publ Hlth, Fac Social Sci Behav & Hlth Educ, Hanoi, Vietnam.
    Le, Thi Minh
    Hanoi Univ Publ Hlth, Fac Social Sci Behav & Hlth Educ, Hanoi, Vietnam.
    Pham, Tac Van
    Minist Hlth, Hanoi, Vietnam.
    Doan, Duong Thi Thuy
    Hanoi Univ Publ Hlth, Fac Social Sci Behav & Hlth Educ, Hanoi, Vietnam.
    Nguyen, Duy Anh
    Hanoi Obstet & Gynecol Hosp, Hanoi, Vietnam.
    Nguyen, Canh Chuong
    Hanoi Obstet & Gynecol Hosp, Hanoi, Vietnam.
    Duc, Duong Minh
    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. Hanoi Univ Publ Hlth, Fac Social Sci Behav & Hlth Educ, Hanoi, Vietnam.
    The Association Between Gender Inequalities and Women's Utilization of Maternal Health Services: A Cross-Sectional Survey in Eight South Central Coast Provinces, Vietnam2018In: Journal of Public Health Management and Practice, ISSN 1078-4659, E-ISSN 1550-5022, Vol. 24, no 2, p. S19-S27Article in journal (Refereed)
    Abstract [en]

    Background: Gender inequalities influence the utilization of maternal health services in Vietnam, but little research has been published. This study, therefore, aimed to explore the association between gender inequalities and women's utilization of maternal health services in Vietnam.

    Methods: The study was conducted in 8 provinces in the South Central Coast region of Vietnam during August 2013 to May 2014. A total of 907 women who delivered a year prior to the date of interview participated in the study. A multiple logistic regression model was used to examine the association between gender inequalities (including sociodemographic determinants of health) and utilization of 4 or more antenatal care (ANC4+) services, institutional delivery, and ever used contraceptive methods.

    Results: The utilization rate of maternal health services was varied, from 53.9% for ANC4+ to 87.7% for ever used a contraceptive method and 97% for institutional delivery. Ethnicity was identified as the most influential variable out of all sociodemographic determinants of health. Regarding gender inequalities, couple communication was the only variable having significant association with women's utilization of maternal health services.

    Conclusion: Women's equal role within context of their daily life and relations with their husbands (discussing maternal care with husband and having equal income to husband) supported their use of maternal health services. Therefore, there should be concerted efforts from all relevant stakeholders including the health system to focus on disadvantaged women in planning and delivery of maternal health services, especially to ethnic minority women. Male involvement strategy should be implemented to promote maternal health care, especially during the prenatal and postpartum period. To provide more culturally sensitive and right-based approaches in delivery of maternal health services to disadvantaged women in Vietnam, interventions are recommended that promote male involvement, that is, to engage men in service delivery to adapt and ensure the most appropriate and effective maternal health care.

  • 277.
    Bungudo, Binyam Bogale
    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).
    Risk Factors associated with Stillbirths inQuang Ninh province, Viet Nam: A case-referent study2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Stillbirth is one of the hidden global health problems which affects many families with the highest burden in low and middle-income countries amid diversified risk factors.Objective: To identify risk factors contributing to stillbirth in Northern Viet Nam, 2014.Methods: Community-based case-referent study matched for season of delivery with the ratio of one-to-two was conducted in northern Viet Nam. All stillbirths and live-births within one year prior to data collection time were taken as source population, of which, 38 stillbirths and 75randomly selected referents were included in the study. Conditional logistic regression wasundertaken to identify factors associated from each block of variables separately.Results: Respondents with perceived low economic status and having smaller family size than the national average have higher odds of stillbirth compared with their counterparts. Mothers who visited antenatal care in the third trimester of pregnancy were 73% less likely to suffer stillbirth compared to those who did not attend during the third trimester. Not receiving antenatal services was not statistically significant predictor when adjusted for other variables in the block[AOR=8.11(CI: 0.95-68.97), P=0.055]. Being low birthweight and/or born premature gave higher odds of stillbirth compared with normal birthweight and term babies; (AOR=15.31; 95%CI: 1.31-179.50) and (AOR=7.06; 95%CI: 1.10-45.35), respectively.Conclusion: Risk factors of stillbirth are potentially modifiable and more broad-based than clinical factors per se. Therefore, preventive measures should be designed involving partners in a mother-baby dyad continuum of care concept whereby all the distal, intermediate and proximal factors can be comprehensively addressed.

  • 278.
    Burgess, Stephen
    et al.
    Univ Cambridge, Dept Publ Hlth & Primary Care, Cardiovasc Epidemiol Unit, Cambridge, England..
    Bowden, Jack
    Univ Bristol, Sch Social & Community Med, Med Res Council, Integrat Epidemiol Unit, Bristol, Avon, England..
    Fall, Tove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Thompson, Simon G.
    Univ Cambridge, Dept Publ Hlth & Primary Care, Cardiovasc Epidemiol Unit, Cambridge, England..
    Sensitivity Analyses for Robust Causal Inference from Mendelian Randomization Analyses with Multiple Genetic Variants2017In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 28, no 1, p. 30-42Article, review/survey (Refereed)
    Abstract [en]

    Mendelian randomization investigations are becoming more powerful and simpler to perform, due to the increasing size and coverage of genome-wide association studies and the increasing availability of summarized data on genetic associations with risk factors and disease outcomes. However, when using multiple genetic variants from different gene regions in a Mendelian randomization analysis, it is highly implausible that all the genetic variants satisfy the instrumental variable assumptions. This means that a simple instrumental variable analysis alone should not be relied on to give a causal conclusion. In this article, we discuss a range of sensitivity analyses that will either support or question the validity of causal inference from a Mendelian randomization analysis with multiple genetic variants. We focus on sensitivity analyses of greatest practical relevance for ensuring robust causal inferences, and those that can be undertaken using summarized data. Aside from cases in which the justification of the instrumental variable assumptions is supported by strong biological understanding, a Mendelian randomization analysis in which no assessment of the robustness of the findings to violations of the instrumental variable assumptions has been made should be viewed as speculative and incomplete. In particular, Mendelian randomization investigations with large numbers of genetic variants without such sensitivity analyses should be treated with skepticism.

  • 279.
    Burström, Bo
    et al.
    Karolinska Inst, Dept Publ Hlth Sci, Equ & Hlth Policy Res Grp, SE-17177 Stockholm, Sweden..
    Burström, Kristina
    Karolinska Inst, Dept Publ Hlth Sci, Equ & Hlth Policy Res Grp, SE-17177 Stockholm, Sweden.;Karolinska Inst, Dept Learning Informat Management & Eth, Hlth Outcomes & Econ Evaluat Res Grp, Stockholm, Sweden..
    Nilsson, Gunnar
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Tomson, Göran
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Whitehead, Margaret
    Karolinska Inst, Dept Publ Hlth Sci, Equ & Hlth Policy Res Grp, SE-17177 Stockholm, Sweden.;Univ Liverpool, Inst Psychol Hlth & Soc, Dept Publ Hlth & Soc, Liverpool, Merseyside, England..
    Winbland, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Equity aspects of the Primary Health Care Choice Reform in Sweden - a scoping review2017In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 16, article id 29Article in journal (Refereed)
    Abstract [en]

    Background: Good health and equal health care are the cornerstones of the Swedish Health and Medical Service Act. Recent studies show that the average level of health, measured as longevity, improves in Sweden, however, social inequalities in health remain a major issue. An important issue is how health care services can contribute to reducing inequalities in health, and the impact of a recent Primary Health Care (PHC) Choice Reform in this respect. This paper presents the findings of a review of the existing evidence on impacts of these reforms. Methods: We reviewed the published accounts (reports and scientific articles) which reported on the impact of the Swedish PHC Choice Reform of 2010 and changes in reimbursement systems, using Donabedian's framework for assessing quality of care in terms of structure, process and outcomes. Results: Since 2010, over 270 new private PHC practices operating for profit have been established throughout the country. One study found that the new establishments had primarily located in the largest cities and urban areas, in socioeconomically more advantaged populations. Another study, adjusting for socioeconomic composition found minor differences. The number of visits to PHC doctors has increased, more so among those with lesser needs of health care. The reform has had a negative impact on the provision of services for persons with complex needs. Opinions of doctors and staff in PHC are mixed, many state that persons with lesser needs are prioritized. Patient satisfaction is largely unchanged. The impact of PHC on population health may be reduced. Conclusions: The PHC Choice Reform increased the average number of visits, but particularly among those in more affluent groups and with lower health care needs, and has made integrated care for those with complex needs more difficult. Resource allocation to PHC has become more dependent on provider location, patient choice and demand, and less on need of care. On the available evidence, the PHC Choice Reform may have damaged equity of primary health care provision, contrary to the tenets of the Swedish Health and Medical Service Act. This situation needs to be carefully monitored.

  • 280.
    Butler, Eadaoin M.
    et al.
    Univ Auckland, Liggins Inst, Private Bag 92019, Auckland 1142, New Zealand;Better Start Natl Sci Challenge, Auckland, New Zealand.
    Suhag, Alisha
    Univ Auckland, Liggins Inst, Private Bag 92019, Auckland 1142, New Zealand;Univ Bristol, Dept Expt Psychol, Bristol, Avon, England.
    Hong, Ye
    Zhejiang Univ, Childrens Hosp, Dept Endocrinol, Sch Med, 57 Zhugan Ave, Hangzhou 310003, Zhejiang, Peoples R China.
    Liang, Li
    Zhejiang Univ, Sch Med, Affiliated Hosp 1, Hangzhou, Zhejiang, Peoples R China.
    Gong, Chunxiu
    Capital Med Univ, Beijing Childrens Hosp, Beijing, Peoples R China.
    Xiong, Feng
    Chongqing Med Univ, Childrens Hosp, Chongqing, Peoples R China.
    Luo, Feihong
    Fudan Univ, Childrens Hosp Shanghai, Dept Endocrinol, Shanghai, Peoples R China.
    Liu, Geli
    Tianjin Med Univ, Gen Hosp, Tianjin, Peoples R China.
    Chen, Shaoke
    Maternal & Children Hlth Hosp Guangxi Zhuang Auto, Nanning, Peoples R China.
    Taylor, Rachael W.
    Better Start Natl Sci Challenge, Auckland, New Zealand;Univ Otago, Dept Med, Dunedin, New Zealand.
    Cutfield, Wayne S.
    Univ Auckland, Liggins Inst, Private Bag 92019, Auckland 1142, New Zealand;Better Start Natl Sci Challenge, Auckland, New Zealand.
    Fu, JunFen
    Zhejiang Univ, Childrens Hosp, Dept Endocrinol, Sch Med, 57 Zhugan Ave, Hangzhou 310003, Zhejiang, Peoples R China.
    Derraik, Jose G. B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Zhejiang Univ, Childrens Hosp, Dept Endocrinol, Sch Med, 57 Zhugan Ave, Hangzhou 310003, Zhejiang, Peoples R China;Univ Auckland, Liggins Inst, Private Bag 92019, Auckland 1142, New Zealand;Better Start Natl Sci Challenge, Auckland, New Zealand.
    Parental Perceptions of Obesity in School Children and Subsequent Action2019In: CHILDHOOD OBESITY, ISSN 2153-2168, Vol. 15, no 7, p. 459-467Article in journal (Refereed)
    Abstract [en]

    Background: Despite perceiving their child as being above a healthy weight, many parents do not intervene. Little is known about the factors influencing parental action. We assessed parental perception of child's weight status, the prevalence of mitigating parental action, and the underlying factors.

    Methods: We studied 20,242 children and adolescents from 6 centers across China. Anthropometry was measured by research nurses. Parents answered questionnaires, including their perception of their child's weight status, and any subsequent weight treatment.

    Results: A total of 3254 children had obesity (16.1%), with 63.0% correctly perceived as overweight by their parents. These children were more likely to be older (>= 8 years; p < 0.0001), have severe obesity [adjusted relative risk (aRR) 1.41; p < 0.0001], and have mothers with overweight/obesity (aRR 1.15; p < 0.0001). In particular, parents of children aged <8 years were over five times more likely to perceive their child with overweight/obesity as "thin" than parents of teenagers. Conversely, girls, older children/adolescents, and urban youth were more likely to be wrongly perceived by parents as having an overweight issue. Only one in four children (27.8%) with available information received treatment for their perceived weight problem. Children with severe obesity were more likely to be treated (aRR 1.34; p < 0.0001), as were children of mothers with overweight/obesity (aRR 1.18; p = 0.002).

    Conclusions: Only one in four Chinese children perceived as overweight by their parents received treatment for their weight problem. Given that overweight/obesity in childhood tracks into adulthood and many parents did not intervene despite perceiving an overweight problem in their child, interventions for childhood obesity need to extend beyond parental perception of children's weight status.

  • 281.
    Butler, Stephen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Acad Hosp, Ctr Multidisciplinary Pain, Uppsala, Sweden.;St Olavs Hosp, Natl Ctr Complex Disorders, Trondheim, Norway.
    Sleep, widespread pain and restless legs: What is the connection?2017In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, p. 174-175Article in journal (Other academic)
  • 282.
    Butler, Stephen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Acad Hosp, Ctr Multidisciplinary Pain, Uppsala, Sweden.
    The wit and wisdom of Wilbert (Bill) Fordyce (1923 - 2009)2017In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 16, p. 160-163Article, review/survey (Refereed)
  • 283.
    Byrskog, Ulrika
    et al.
    Dalarna Univ, Sch Educ Hlth & Social Studies, S-79188 Falun, 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). Uppsala Univ, Dept Womens & Childrens Hlth, Akad Sjukhuset, S-75185 Uppsala, Sweden..
    Olsson, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Klingberg-Allvin, Marie
    Dalarna Univ, Sch Educ Hlth & Social Studies, S-79188 Falun, Sweden..
    'Moving on' Violence, wellbeing and questions about violence in antenatal care encounters. A qualitative study with Somali-born refugees in Sweden2016In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 40, p. 10-17Article in journal (Refereed)
    Abstract [en]

    Background: Somali-born women constitute one of the largest groups of childbearing refugee women in Sweden after more than two decades of political violence in Somalia. In Sweden, these women encounter antenatal care that includes routine questions about violence being asked. The aim of the study was to explore how Somali-born women understand and relate to violence and wellbeing during their migration transition and their views on being approached with questions about violence in Swedish antenatal care. Method: Qualitative interviews (22) with Somali-born women (17) living in Sweden were conducted and analysed using thematic analysis. Findings: A balancing act between keeping private life private and the new welfare system was identified, where the midwife's questions about violence were met with hesitance. The midwife was, however, considered a resource for access to support services in the new society. A focus on pragmatic strategies to move on in life, rather than dwelling on potential experiences of violence and related traumas, was prominent. Social networks, spiritual faith and motherhood were crucial for regaining coherence in the aftermath of war. Dialogue and mutual adjustments were identified as strategies used to overcome power tensions in intimate relationships undergoing transition. Conclusions: If confidentiality and links between violence and health are explained and clarified during the care encounter, screening for violence can be more beneficial in relation to Somali-born women. The focus on "moving on" and rationality indicates strength and access to alternative resources, but needs to be balanced against risks for hidden needs in care encounters. A care environment with continuity of care and trustful relationships enhances possibilities for the midwife to balance these dual perspectives and identify potential needs. Collaborations between Somali communities, maternity care and social service providers can contribute with support to families in transition and bridge gaps to formal social and care services.

  • 284.
    Byrskog, Ulrika
    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).
    Olsson, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    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).
    Allvin, Marie Klingberg
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Violence and reproductive health preceding flight from war: accounts from Somali born women in Sweden2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, p. 892-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden.

    METHOD:

    Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied.

    RESULTS:

    Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war.

    CONCLUSIONS:

    Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and enhancement of well-being and sexual and reproductive health and rights in receiving countries after migration.

  • 285.
    Byrskog, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Olsson, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    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).
    Allvin, Marie-Klingberg
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Being a bridge: Swedish antenatal care midwives' encounters with Somali-born women and questions of violence; a qualitative study2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, no 1, p. 1-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence.

    METHODS:

    Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis.

    RESULTS:

    The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women's' strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman's access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women.

    CONCLUSION:

    Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives' ability to identify Somali born woman's resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.

  • 286.
    Börnhorst, Claudia
    et al.
    Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology, BIPS GmbH, Bremen, Germany .
    Wijnhoven, Trudy M. A.
    Division of Noncommunicable Diseases and Promoting Health Through the Life-Course, WHO Regional Office for Europe, UN City, Copenhagen, Denmark .
    Kunesova, Marie
    Obesity Management Centre, Institute of Endocrinology, Prague 1, Czech Republic .
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Rito, Ana I.
    National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal .
    Lissner, Lauren
    Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden .
    Duleva, Vesselka
    Department of Food and Nutrition, National Center of Public Health and Analyses, Sofia, Bulgar.
    Petrauskiene, Ausra
    Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania .
    Breda, Joao
    Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology, BIPS GmbH, Bremen, Germany .
    WHO European Childhood Obesity Surveillance Initiative: associations between sleep duration, screen time and food consumption frequencies2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 1, article id 442Article in journal (Refereed)
    Abstract [en]

    Background: Both sleep duration and screen time have been suggested to affect children's diet, although in different directions and presumably through different pathways. The present cross-sectional study aimed to simultaneously investigate the associations between sleep duration, screen time and food consumption frequencies in children.

    Methods: The analysis was based on 10 453 children aged 6-9 years from five European countries that participated in the World Health Organization European Childhood Obesity Surveillance Initiative. Logistic multilevel models were used to assess associations of parent-reported screen time as well as sleep duration (exposure variables) with consumption frequencies of 16 food items (outcome variables). All models were adjusted for age, sex, outdoor play time, maximum educational level of parents and sleep duration or screen time, depending on the exposure under investigation.

    Results: One additional hour of screen time was associated with increased consumption frequencies of 'soft drinks containing sugar' (1.28 [1.19; 1.39]; odds ratio and 99% confidence interval), 'diet/light soft drinks' (1.21 [1.14; 1.29]), 'flavoured milk' (1.18 [1.08; 1.28]), 'candy bars or chocolate' (1.31 [1.22; 1.40]), 'biscuits, cakes, doughnuts or pies' (1.22 [1.14; 1.30]), 'potato chips (crisps), corn chips, popcorn or peanuts' (1.32 [1.20; 1.45]), 'pizza, French fries (chips), hamburgers' (1.30 [1.18; 1.43]) and with a reduced consumption frequency of 'vegetables (excluding potatoes)' (0.89 [0.83; 0.95]) and 'fresh fruits' (0.91 [0.86; 0.97]). Conversely, one additional hour of sleep duration was found to be associated with increased consumption frequencies of 'fresh fruits' (1.11 [1.04; 1.18]) and 'vegetables (excluding potatoes)' (1.14 [1.07; 1.23]).

    Conclusion: The results suggest a potential relation between high screen time exposure and increased consumption frequencies of foods high in fat, free sugar or salt whereas long sleep duration may favourably be related to children's food choices. Both screen time and sleep duration are modifiable behaviours that may be tackled in childhood obesity prevention efforts.

  • 287.
    Cai, Gui-Hong
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Elmstahl, Solve
    Lund Univ, Div Geriatr Med, Dept Hlth Sci, Sweden CRC,Skane Univ Hosp, Malmo, Sweden.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Insomnia symptoms and sleep duration and their combined effects in relation to associations with obesity and central obesity2018In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 46, p. 81-87Article in journal (Refereed)
    Abstract [en]

    Objective: Previous studies have shown that both sleep duration and insomnia have an impact on obesity and central obesity. However, studies of the joint effects of these sleep disorders are still sparse. Methods: The present study utilized data from the Swedish EpiHealth cohort study. Participants (45 - 78 y) were asked to fill out an internet-based questionnaire. Body mass index (BMI) and central obesity (calculated from waist circumference) were based on measured data. Results: A total of 18,823 participants (mean age = 60 ys) were included in this study. The reported prevalence of short (<6 h/night) and long (>9 h/night) sleep duration was 8% and 4% respectively, and insomnia symptoms was 19%. Of the study population, 16% were obese (BMI >= 30 kg/m(2)) and 40% had central obesity. There was a U-shaped association between sleep duration and obesity and central obesity, and significant associations between insomnia symptoms and obesity. When stratifying sleep duration by concurrent insomnia symptoms, there were associations (odds ratios, (95% confidence intervals)) between the combination of both short (1.48, (1.22-1.80)) and long sleep duration (1.77 (1.00 - 3.16)) with insomnia symptoms and obesity and central obesity (1.36 (1.16-1.61) and 2.44 (1.41-3.24) respectively). However, there was no significant association between insomnia symptoms and obesity or central obesity in participants with normal sleep duration. For central obesity there was an association with long sleep duration regardless of insomnia symptoms, while the association with short sleep duration was significant only if insomnia symptoms were present. Conclusions: Both short and long sleep duration, as well as insomnia symptoms, are associated with obesity and central obesity. There is an important joint effect of sleep duration and insomnia symptoms and there is no association between insomnia symptoms and obesity, as long as a normal sleeping time can be attained. This indicates that sleep duration rather than insomnia symptoms per se is of importance for the relationship between sleep and obesity.

  • 288.
    Caminade, Cyril
    et al.
    Univ Liverpool, Inst Infect & Global Hlth, Dept Epidemiol & Populat Hlth, Liverpool CH64 7TE, Merseyside, England;Univ Liverpool, Hlth Protect Res Unit Emerging & Zoonot Infect, Liverpool L69 3GL, Merseyside, England.
    Turner, Joanne
    Univ Liverpool, Inst Infect & Global Hlth, Dept Epidemiol & Populat Hlth, Liverpool CH64 7TE, Merseyside, England.
    Metelmann, Soeren
    Univ Liverpool, Sch Environm Sci, Dept Geog & Planning, Liverpool L69 7ZT, Merseyside, England;Univ Liverpool, Hlth Protect Res Unit Emerging & Zoonot Infect, Liverpool L69 3GL, Merseyside, England.
    Hesson, Jenny C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Univ Liverpool, Inst Infect & Global Hlth, Dept Epidemiol & Populat Hlth, Liverpool CH64 7TE, Merseyside, England.
    Blagrove, Marcus S. C.
    Univ Liverpool, Inst Infect & Global Hlth, Dept Epidemiol & Populat Hlth, Liverpool CH64 7TE, Merseyside, England;Univ Liverpool, Hlth Protect Res Unit Emerging & Zoonot Infect, Liverpool L69 3GL, Merseyside, England.
    Solomon, Tom
    Univ Liverpool, Inst Infect & Global Hlth, Dept Clin Infect Microbiol & Immunol, Liverpool L69 7BE, Merseyside, England;Univ Liverpool, Hlth Protect Res Unit Emerging & Zoonot Infect, Liverpool L69 3GL, Merseyside, England.
    Morse, Andrew P.
    Univ Liverpool, Sch Environm Sci, Dept Geog & Planning, Liverpool L69 7ZT, Merseyside, England;Univ Liverpool, Hlth Protect Res Unit Emerging & Zoonot Infect, Liverpool L69 3GL, Merseyside, England.
    Baylis, Matthew
    Univ Liverpool, Inst Infect & Global Hlth, Dept Epidemiol & Populat Hlth, Liverpool CH64 7TE, Merseyside, England;Univ Liverpool, Hlth Protect Res Unit Emerging & Zoonot Infect, Liverpool L69 3GL, Merseyside, England.
    Global risk model for vector-borne transmission of Zika virus reveals the role of El Nino 20152017In: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 114, no 1, p. 119-124Article in journal (Refereed)
    Abstract [en]

    Zika, a mosquito-borne viral disease that emerged in South America in 2015, was declared a Public Health Emergency of International Concern by the WHO in February of 2016. We developed a climate-driven R-0 mathematical model for the transmission risk of Zika virus (ZIKV) that explicitly includes two keymosquito vector species: Aedes aegypti and Aedes albopictus. The model was parameterized and calibrated using the most up to date information from the available literature. It was then driven by observed gridded temperature and rainfall datasets for the period 1950-2015. We find that the transmission risk in South America in 2015 was the highest since 1950. This maximum is related to favoring temperature conditions that caused the simulated biting rates to be largest and mosquito mortality rates and extrinsic incubation periods to be smallest in 2015. This event followed the suspected introduction of ZIKV in Brazil in 2013. The ZIKV outbreak in Latin America has very likely been fueled by the 2015-2016 El Nino climate phenomenon affecting the region. The highest transmission risk globally is in South America and tropical countries where Ae. aegypti is abundant. Transmission risk is strongly seasonal in temperate regions where Ae. albopictus is present, with significant risk of ZIKV transmission in the southeastern states of the United States, in southern China, and to a lesser extent, over southern Europe during the boreal summer season.

  • 289. Campbell, B
    et al.
    Raherison, C
    Lodge, C J
    Lowe, A J
    Gislason, T
    Heinrich, J
    Sunyer, J
    Gómez Real, F
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Matheson, M C
    Wjst, M
    Dratva, J
    de Marco, R
    Jarvis, D
    Schlünssen, V
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Leynaert, B
    Svanes, C
    Dharmage, S C
    The effects of growing up on a farm on adult lung function and allergic phenotypes: an international population-based study2017In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 72, no 3, p. 236-244Article in journal (Refereed)
    Abstract [en]

    RATIONALE: Evidence has suggested that exposure to environmental or microbial biodiversity in early life may impact subsequent lung function and allergic disease risk.

    OBJECTIVES: To investigate the influence of childhood living environment and biodiversity indicators on atopy, asthma and lung function in adulthood.

    METHODS AND MEASUREMENTS: The European Community Respiratory Health Survey II investigated ∼10 201 participants aged 26-54 years from 14 countries, including participants' place of upbringing (farm, rural environment or inner city) before age 5 years. A 'biodiversity score' was created based on childhood exposure to cats, dogs, day care, bedroom sharing and older siblings. Associations with lung function, bronchial hyper-responsiveness (BHR), allergic sensitisation, asthma and rhinitis were analysed.

    MAIN RESULTS: As compared with a city upbringing, those with early-life farm exposure had less atopic sensitisation (adjusted OR 0.46, 95% CI 0.37 to 0.58), atopic BHR (0.54 (0.35 to 0.83)), atopic asthma (0.47 (0.28 to 0.81)) and atopic rhinitis (0.43 (0.32 to 0.57)), but not non-atopic outcomes. Less pronounced protective effects were observed for rural environment exposures. Women with a farm upbringing had higher FEV1 (adjusted difference 110 mL (64 to 157)), independent of sensitisation and asthma. In an inner city environment, a higher biodiversity score was related to less allergic sensitisation.

    CONCLUSIONS: This is the first study to report beneficial effects of growing up on a farm on adult FEV1. Our study confirmed the beneficial effects of early farm life on sensitisation, asthma and rhinitis, and found a similar association for BHR. In persons with an urban upbringing, a higher biodiversity score predicted less allergic sensitisation, but to a lesser magnitude than a childhood farm environment.

  • 290.
    Canova, Cristina
    et al.
    Univ Padua, Dept Cardiol Thorac & Vasc Sci, Padua, Italy.
    Pitter, Gisella
    Univ Padua, Dept Cardiol Thorac & Vasc Sci, Padua, Italy.
    Zanier, Loris
    Hlth Directorate, Epidemiol Serv, Udine, Italy.
    Simonato, Lorenzo
    Univ Padua, Dept Cardiol Thorac & Vasc Sci, Padua, Italy.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Ludvigsson, Jonas E.
    Columbia Univ, Coll Phys & Surg, Dept Med, New York, NY USA;Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden;Orebro Univ, Orebro Univ Hosp, Dept Pediat, Orebro, Sweden;Univ Nottingham, Sch Med, Div Epidemiol & Publ Hlth, Nottingham, England.
    Risk of Fractures in Youths with Celiac Disease-A Population-Based Study2018In: Journal of Pediatric Surgery Case Reports, ISSN 0022-3476, E-ISSN 2213-5766, Vol. 198, p. 117-120Article in journal (Refereed)
    Abstract [en]

    Objective To assess the risk of any fracture requiring hospital care in a cohort of individuals with celiac disease diagnosed in childhood/adolescence compared with reference individuals matched by age and sex. Study design Our study cohort consisted of 213 635 people born and residing in Friuli-Venezia Giulia Region, Italy, in 1989-2011. We selected, through pathology reports, hospital discharge records, or co-payment exemptions, 1233 individuals with celiac disease (aged 0-17 years at diagnosis) and compared them with 6167 reference individuals matched by sex and year of birth. Fractures were identified through hospital discharge records. We calculated hazard ratios (HRs) for any fracture after celiac disease diagnosis (or index date for reference individuals) with Cox regression and ORs for any fracture before celiac disease diagnosis with conditional logistic regression. Results During the follow-up period (maximum 23 years), 22 individuals with celiac disease (9394 person-years) and 128 reference individuals (47 308 person-years) experienced a fracture. giving an overall HR of 0.87 (95% CI 0.55-1.37). The risk was not modified by sex, age at diagnosis, or calendar period of diagnosis. We obtained similar HRs when excluding fractures occurring after the age of 18 years and adjusting for maternal education or vitamin D supplementation. The odds of previous fracture also did not differ between subjects with celiac disease and reference individuals (22 and 96 cases, respectively: OR 1.15: 95% CI 0.72-1.84). Conclusions We did not find any evidence of an increased risk of fractures during childhood and youth among patients with celiac disease.

  • 291.
    Carlberg, Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Participation in schools for young adolescents with neuropsychiatric disabilities: A cross-sectional study from the Southern part of Sweden2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Participation is essential for the enjoyment and exercise of human rights, however children with disabilities often have restricted participation. Participation means to attend an activity and be engaged while being there. Neuropsychiatric disabilities are a group of cognitive impairments, affecting 10% of all children. There are no studies from Sweden investigating participation in schools for young adolescents with neuropsychiatric disabilities. Aim: Investigate if there are differences between adolescents, with and without neuropsychiatric disabilities regarding participation in school, and also explore external and individual factors associated with restricted participation. Methods: This cross sectional study consisted of data obtained for the research programme LoRDIA. Data was collected from 1520 adolescents aged 12-13 years, from four municipalities in the south of Sweden, year 2013-2014. Multiple logistic regression was conducted to explore the relationship between having a neuropsychiatric disability and participation, and how other factors effected this relationship. Results: Young adolescents with neuropsychiatric disabilities had an increased likelihood of restricted participation in school, in comparison to adolescents without neuropsychiatric disabilities. They were also more at risk of bullying victimization, having more negative relationship to their teachers, coming from families with poorer economy, having lower connectedness to their fathers, being boys and more likely to have tried drugs. Conclusions: Adolescents with neuropsychiatric disabilities are a vulnerable group, who have restricted participation in school, but also a disadvantaged situation in other areas of life. Interventions are needed to ensure their full participation, and further longitudinal research to understand the long term effects of the issue.  

  • 292.
    Carlsson, Ann-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Kostsam hälsa?: – användning och erfarenheter av kosttillskott bland kvinnor i Stockholm2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Inledning: Användningen av kosttillskott har ökat dramatiskt de senaste åren och framförallt bland kvinnor. Trots att Statens Livsmedelsverk gör gällande att kosttillskott inte är nödvändigt för majoriteten av användarna. Användning av kosttillskott kan innebära risker såsom överkonsumtion, bieffekter, läkemedelsinteraktioner och misstagsdopning.

    Syfte: Undersökningens syfte var att förbättra kunskapen och öka förståelsen om kvinnliga användares användning och erfarenheter av kosttillskott. Detta är betydelsefullt för personal inom hälso- och sjukvården för att kunna förbättra det hälsofrämjande arbetet om kosttillskott och för att bättre kunna informera och upplysa om kosttillskott i ett folkhälsovetenskapligt syfte.

    Metod: Undersökningen hade en kvalitativ ansats och semistrukturerad intervjuguide. Undersökningsgruppen bestod av 8 kvinnliga deltagare i åldrarna 36-77 år som rekryterades i en hälsokostaffär i centrala Stockholm. Datamaterialet transkriberades och innehållsanalyserades enligt det fenomenologiska-hermeneutiska perspektivet.

    Resultat: Resultatet visade att informanterna åt kosttillskott regelbundet som ett komplement till kosten. De vanligaste kosttillskotten var Vitamin D, MSM och tillskott av nyponskalspulver. De mest framträdande orsaksfaktorerna till varför kvinnorna hade börjat använda kosttillskott var på grund av rekommendationer samt påverkan från familjemedlemmar. Kvinnorna förväntade sig resultat såsom att känna sig piggare och orka mer. Majoriteten av kvinnorna tyckte att kosttillskotten gav effekt och hade märkt av förbättringar. Informanterna uppskattade sina kunskaper om kosttillskott som relativt goda. Dock åskådliggjordes missuppfattningar kring termen kosttillskott och vad det innebar. Huvudparten av kvinnorna kände inte till dem rekommenderade intagen för vitaminer och mineraler och ansåg inte att det fanns risker med deras egen användning av kosttillskott. Kosttillskott upplevdes som betydelsefullt för informanternas hälsa och välbefinnande.

    Slutsats: Det finns behov av förbättrad information och kunskap om kosttillskott, användning och risker samt ytterligare forskning inom området.

  • 293.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Carrero, Juan-Jesús
    Stenvinkel, Peter
    Bottai, Matteo
    Barany, Peter
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Endostatin, Cathepsin S, and Cathepsin L, and Their Association with Inflammatory Markers and Mortality in Patients Undergoing Hemodialysis2015In: Blood Purification, ISSN 0253-5068, E-ISSN 1421-9735, Vol. 39, no 4, p. 259-265Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/AIMS: Although both endostatin and cathepsins S have been associated with higher mortality, data in patients with end-stage renal disease (ESRD) are scarce.

    METHODS: A longitudinal cohort study of 207 prevalent patients undergoing hemodialysis.

    RESULTS: Cathepsins S and L were associated with soluble receptors for tumor necrosis factor (sTNFR1 and sTNFR2, rho between 0.28 and 0.43, p < 0.001 for all). Weaker or absent associations between endostatin, cathepsins S and L were seen with other inflammatory biomarkers, that is, CRP, interleukin 6, pentraxin 3, and TNF. In Cox and Laplace regression models adjusted for age, sex, dialysis vintage, and diabetes: standard deviation increments of endostatin was associated with a lower mortality (hazard ratio 0.75, 95% confidence interval (CI) 0.57-0.98), and with 6.8 months longer median survival.

    CONCLUSIONS: The high levels of endostatin, cathepsins S and L, and their associations with sTNFR1 and sTNFR2 warrant further studies exploring mortality, and the angiogenic and inflammatory pathways in ESRD.

  • 294.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Carrero, Juan-Jesús
    Stenvinkel, Peter
    Bottai, Matteo
    Barany, Peter
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    High levels of soluble tumor necrosis factor receptors 1 and 2 and their association with mortality in patients undergoing hemodialysis2015In: Cardiorenal medicine, ISSN 1664-3828, Vol. 5, no 2, p. 89-95Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Circulating soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2) are associated with chronic kidney disease (CKD) progression in patients with CKD or diabetes, and with higher mortality. However, data in patients with end-stage renal disease are scarce. Therefore, we analyzed serum levels of sTNFR1 and sTNFR2 and investigated their association with inflammatory markers and mortality in dialysis patients.

    RESEARCH DESIGN AND METHODS: This was a longitudinal cohort study of 207 prevalent patients (median age 66 years, 56% men) undergoing hemodialysis in Stockholm, Sweden. Demographics, clinical characteristics, including comorbidities and laboratory data, were obtained at baseline, together with prospective follow-up for mortality.

    RESULTS: The median sTNFR1 and sTNFR2 levels were 17,680 ng/l [95% confidence interval (CI) 17,023-18,337] and 24,450 ng/l (95% CI 23,721-25,179), respectively. During a follow-up of 31 months (interquartile range, 21-38), 77 patients died. There was no association between the levels of sTNFRs and mortality in Cox regression models, and no consistent trend towards higher or lower mortality was seen in Laplace regression models. sTNFR1 and sTNFR2 levels were highly associated with other inflammatory markers including interleukin-6, pentraxin 3 and TNF-α.

    CONCLUSIONS: Prevalent hemodialysis patients have several-fold higher levels of sTNFRs compared to previous studies in CKD stage 4 patients. As no consistent association between TNFR and mortality was observed, clinical implications of measuring these receptors to predict outcome end-stage renal disease patients provide limited results.

  • 295.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Jansson, Jan-Håkan
    Department of Public Health and Clinical Medicine, Research Unit Skellefteå, Umeå University, Umeå, Sweden.
    Söderberg, Stefan
    Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden.
    Ruge, Toralph
    Dept of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Ärnlöv, Johan
    Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; School of Health and Social Sciences, Dalarna University, Falun, Sweden.
    Levels of soluble tumor necrosis factor receptor 1 and 2, gender, and risk of myocardial infarction in Northern Sweden2018In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 272, p. 41-46Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS:

    Soluble receptors for tumor necrosis factor alpha (sTNFR1 and sTNFR2) have been associated with cardiovascular diseases, and some evidence points towards a difference in associated risk between men and women. We aimed to study the association between sTNFR1 and sTNFR2 and incident myocardial infarctions (MI) and to explore the influence of established cardiovascular risk factors in men and women.

    METHODS:

    We conducted a nested case control study in three large Swedish cohorts, including 533 myocardial infarction cases, and 1003 age-, sex- and cohort-matched controls. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.

    RESULTS:

    An association between circulating sTNFR1 and sTNFR2 and an increased risk for MI was found when comparing cases and controls. The odds ratios were significant after adjustment for established cardiovascular risk factors and C-reactive protein in women (OR 1.44, 95% CI 1.08-1.93 for TNFR1, and 1.61, 95% CI 1.11-2.34 for TNFR2), but was abolished in men. Women with a combination of elevated CRP and values in the upper quartile of TNFR1 or TNFR2 had a 5-fold higher risk of myocardial infarction versus those with normal CRP and values in the lower three quartiles of TNFR1 or TNFR2.

    CONCLUSIONS:

    As the risk estimates for TNFR1 and TNFR2 were higher and remained significant after adjustments for established cardiovascular risk factors in women but not in men, a potential role for TNFR1 and TNFR2 in identifying women with a higher MI risk is possible. The future clinical role of TNFR1 and TNFR2 in combination with CRP to identify high risk patients for coronary heart disease has yet to be determined.

  • 296.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Juhlin, C Christofer
    Larsson, Tobias E
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Soluble tumor necrosis factor receptor 1 (sTNFR1) is associated with increased total mortality due to cancer and cardiovascular causes: Findings from two community based cohorts of elderly2014In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 237, no 1, p. 236-242Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experimental evidence support soluble receptors for tumor necrosis factor alpha as important mediators of the underlying pathology leading to cardiovascular disease and cancer. However, prospective data concerning the relation between circulating soluble tumor necrosis factor receptor-1 (sTNFR1) and mortality in humans are lacking. We aimed to explore and validate the association between sTNFR1 and mortality, and to explore the influence of other established risk factors for mortality, including other inflammatory markers.

    METHODS: The association between serum sTNFR1and the risk for mortality was investigated in two community-based cohorts of elderly: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; women 50%, n = 1005, mean age 70 years, median follow-up 7.9 years) and the Uppsala Longitudinal Study of Adult Men (ULSAM, n = 775, mean age 77 years, median follow-up 8.1 years).

    RESULTS: In total, 101 participants in PIVUS and 274 in ULSAM died during follow-up. In multivariable Cox regression models adjusted for inflammation, lifestyle and established cardiovascular risk factors, one standard deviation (SD) higher sTNFR1 was associated with a hazard ratio (HR) for mortality of 1.37, 95% confidence interval (CI) 1.17-1.60, in PIVUS and HR 1.22, 95% CI 1.10-1.37 in ULSAM. Moreover, circulatingsTNFR1 was associated with cardiovascular mortality (HR per SD of sTNFR1, 1.24, 95% CI 1.07-1.44) and cancer mortality (HR per SD of sTNFR1, 1.32, 95% CI 1.11-1.57) in the ULSAM cohort. High levels of sTNFR1 identified individuals with increased risk of mortality among those with high as well as low levels of systemic inflammation.

    CONCLUSIONS: An association between circulating sTNFR1 and an increased risk for mortality was found and validated in two independent community-based cohorts. The future clinical role of sTNFR1 to identify high risk patients for adverse outcomes and mortality has yet to be determined.

  • 297.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Helmersson-Karlqvist, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Larsson, Tobias E
    Bottai, Matteo
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Urinary Kidney Injury Molecule-1 and the Risk of Cardiovascular Mortality in Elderly Men2014In: Clinical journal of the American Society of Nephrology : CJASN, ISSN 1555-905X, Vol. 9, no 8, p. 1393-1401Article in journal (Refereed)
    Abstract [en]

    Background and objectives

    Kidney injury molecule-1 (KIM-1) has been suggested as a clinically relevant highly specific biomarker of acute kidney tubular damage. However, community-based data on the association between urinary levels of KIM-1 and the risk for cardiovascular mortality are lacking. This study aimed to investigate the association between urinary KIM-1 and cardiovascular mortality.

    Design, setting, participants, & measurements

    This was a prospective study, using the community-based Uppsala Longitudinal Study of Adult Men (N=590; mean age 77 years; baseline period, 1997–2001; median follow-up 8.1 years; end of follow-up, 2008).

    Results

    During follow-up, 89 participants died of cardiovascular causes (incidence rate, 2.07 per 100 person-years at risk). Models were adjusted for cardiovascular risk factors (age, systolic BP, diabetes, smoking, body mass index, total cholesterol, HDL cholesterol, antihypertensive treatment, lipid-lowering treatment, aspirin treatment, and history of cardiovascular disease) and for markers of kidney dysfunction and damage (cystatin C–based eGFR and urinary albumin/creatinine ratio). Higher urinary KIM-1/creatinine (from 24-hour urine collections) was associated with a higher risk for cardiovascular mortality (hazard ratio per SD increase, 1.27; 95% confidence interval [95% CI], 1.05 to 1.54; P=0.01). Participants with a combination of high KIM-1/creatinine (upper quintile, ≥175 ng/mmol), low eGFR (≤60 ml/min per 1.73 m2), and microalbuminuria/macroalbuminuria (albumin/creatinine ratio≥3 g/mol) had a >8-fold increased risk compared with participants with low KIM-1/creatinine (<175 ng/mmol), normal eGFR (>60 ml/min per 1.73 m2), and normoalbuminuria (albumin/creatinine ratio<3 g/mol) (hazard ratio, 8.56; 95% CI, 4.17 to 17.56; P<0.001).

    Conclusions

    These findings suggest that higher urinary KIM-1 may predispose to a higher risk of cardiovascular mortality independently of established cardiovascular risk factors, eGFR, and albuminuria. Additional studies are needed to further assess the utility of measuring KIM-1 in the clinical setting.

  • 298.
    Carlsson, Axel C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Div Family Med, Dept Neurobiol, Care Sci & Soc, Karlskrona, Sweden..
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Carrero, Juan Jesus
    Karolinska Inst, Div Renal Med, Dept Clin Sci, Intervent & Technol, Karlskrona, Sweden..
    Gustafsson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Stenemo, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Dalarna Univ, Sch Hlth & Social Sci, Dalarna, Sweden..
    Use of a proximity extension assay proteomics chip to discover new biomarkers associated with albuminuria2017In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, no 4, p. 340-348Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The underlying mechanisms for the development of albuminuria and the increased cardiovascular risk in patients with elevated albuminuria levels are incompletely understood. We therefore investigated the associations between 80 cardiovascular proteins and the urinary albumin to creatinine ratio (ACR).

    METHODS: We used a discovery/replication approach in two independent community-based cohorts of elderly patients: the Uppsala Longitudinal Study of Adult Men (n = 662; mean age 78 years) and the Prospective Investigation of the Vasculature in Uppsala Seniors (n = 757; mean age 75 years; 51% women). A proteomic chip with a panel of 80 plasma proteins associated with different aspects of cardiovascular disease was analysed. In the discovery cohort, we used a false discovery rate of 5% to take into account the multiple statistical testing. Nominal p values were used in the replication.

    RESULTS: Higher levels of T-cell immunoglobulin mucin-1, placenta growth factor, growth/differentiation factor-15, urokinase plasminogen activator surface receptor and kallikrein-11 were robustly associated with a higher ACR in both cohorts in multivariable linear regression models adjusted for sex, established cardiovascular risk factors, antihypertensive treatment, prevalent cardiovascular disease and glomerular filtration rate (p < 0.02 for all). All associations were also significant in separate analyses of patients without diabetes.

    CONCLUSIONS: We discovered and replicated associations between ACR and five cardiovascular proteins involved in tubular injury, atherosclerosis, endothelial function, heart failure, inflammation, glomerulosclerosis and podocyte injury. Our findings put forward multiplex proteomics as a promising approach to explore novel aspects of the complex detrimental interplay between kidney function and the cardiovascular system.

  • 299.
    Carlsson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Vad krävs för att stanna? Betydelsen av de anställdas upplevda arbetsmiljö2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Healthy workplaces are created through work in several areas with a focus in employee involvement, development, health and work-life balance. In return, this will improve the organization and decrease turnover and thereby bigger opportunities to retain personnel. Aim: The aim was to analyze which health factors in the work environment employees experienced as important for them to stay and to examine the relationship between work environment and turnover intention. Method: A quantitative cross-sectional study was carried out and employees on a company in information technology (n = 114) answered a questionnaire about work environment, health and turnover intention. Results: Main results indicate a significant correlation between variables of work environment and turnover intention. This study indicates that working climate, effort, involvement, health, job satisfaction, reward and work-life balance can explain 14,6 % of the variance of turnover intention. The most important factors for employees to stay were their own capacity building and satisfaction with colleagues and assignments. Conclusions: This study demonstrates that work environment to some part predicts turnover intention, which is consistent with previous studies. This is important for public health in general because health is influenced by work and working life but it could also be immensely important for companies that want to keep their employees if the rivalries are higher in the future.

  • 300.
    Carlsson, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Anderzén, I
    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 Medical Sciences, Occupational and Environmental Medicine.
    Motivationfor return to work and actual return to work among people on long-term sickleave due to pain syndrome or mental health conditions2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    ABSTRACTPurpose:The purpose of this study was to investigate associations between motivation for return towork and actual return to work, or increased employability among people on long-term sick leave.Materials and methods:Data by responses to questionnaires was collected from 227 people on long-term sick leave (mean¼7.9years) due to pain syndrome or mild to moderate mental health conditionswho had participated in a vocational rehabilitation intervention. The participants’motivation for return towork was measured at baseline. At 12-month follow-up, change in the type of reimbursement betweenbaseline and at present was assessed and used to categorise outcomes as:“decreased work and employ-ability”,“unchanged”,“increased employability”,and“increased work”. Associations between baselinemotivation and return to work outcome were analysed using logistic and multinomial regression models.Results:Motivation for return to work at baseline was associated with return to work or increasedemployability at 12-month follow-up in the logistic regression model adjusting for potential confounders(OR 2.44, 95% CI 1.25–4.78).Conclusions:The results suggest that motivation for return to work at baseline was associated withactual chances of return to work or increased employability in people on long-term sick leave due topain syndrome or mild to moderate mental health conditions.

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