uu.seUppsala University Publications
Change search
Refine search result
1234567 51 - 100 of 1812
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 51. Al-Murani, F.
    et al.
    Aweko, J.
    Nordin, I.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Delobelle, P.
    Kasujja, Fx.
    Östenson, C.-G.
    Peterson, Stefan S.
    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).
    Daivadanam, Meena
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Alvesson, HM.
    Community and stakeholders' engagement in the prevention and management of Type 2 diabetes: a qualitative study in socioeconomically disadvantaged suburbs in region Stockholm2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1609313Article in journal (Refereed)
    Abstract [en]

    Background: Community-based approaches have been identified as an effective strategy to address the growing burden of noncommunicable diseases (NCDs) worldwide. However, little is known about community as a concept among people living in socioeconomically disadvantaged settings and stakeholders’ interactions and engagement in NCDs prevention and management.

    Objective: The aim of this study was to understand; (1) the meaning of community among people living in socioeconomically disadvantaged suburbs in Region Stockholm and (2) how communities interact and engage with stakeholders at local and regional levels for the prevention and management of type 2 diabetes (T2D).

    Methods: This qualitative study was conducted in three municipalities in Region Stockholm with a high proportion of migrants. Multiple data collection methods were used, including observations of community activities; interviews with community members, representatives of public authorities and NGOs; and group interviews with healthcare providers. Data were analyzed using content analysis.

    Results: Community was perceived as living in close proximity with shared beliefs, values and resources. Although they recognized its social and cultural diversity, community members focused more on the commonalities of living in their neighborhood and less on their differences in country of birth and languages spoken. Several mismatches between awareness of community needs and the available skills and resources among stakeholders for T2D prevention were identified. Stakeholders expressed awareness of T2D risk and interest in addressing it in a culturally appropriate manner.

    Conclusion: Interaction between the communities and stakeholders was limited, as was engagement in T2D prevention and management. This highlights barriers in the collaboration between community, healthcare institutions and other stakeholders which consequently affect the implementation of preventive interventions. Innovative ways to link the community to the healthcare sector and other local government institutions are needed to build the capacity of health systems for T2D prevention in socioeconomically disadvantaged communities.

  • 52.
    Alping, Peter
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Piehl, Fredrik
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden;Stockholm Hlth Serv, Acad Specialist Ctr, Stockholm, Sweden;Karolinska Univ Hosp, Dept Neurol, Stockholm, Sweden.
    Langer-Gould, Annette
    Kaiser Permanente, Southern Calif Permanente Med Grp, Southern Clin & Translat Neurosci, Clin & Translat Neurosci, Pasadena, CA USA;Kaiser Permanente, Southern Calif Permanente Med Grp, Clin & Translat Neurosci, Pasadena, CA USA.
    Frisell, Thomas
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Fink, Katharina
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Fogdell-Hahn, Anna
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Gunnarsson, Martin
    Orebro Univ, Ctr Hlth & Med Psychol, Orebro, Sweden.
    Hillert, Jan
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Kockum, Ingrid
    Stockholm Hlth Serv, Acad Specialist Ctr, Stockholm, Sweden.
    Lycke, Jan
    Univ Gothenburg, Dept Clin Neurosci & Rehabil, Gothenburg, Sweden.
    Nilsson, Petra
    Lund Univ, Dept Clin Sci Neurol, Lund, Sweden.
    Olsson, Tomas
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Salzer, Jonatan
    Umea Univ, Dept Pharmacol & Clin Neurosci, Umea, Sweden.
    Svenningsson, Anders
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.
    Virtanen, Suvi
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Vrethem, Magnus
    Validation of the Swedish Multiple Sclerosis Register: Further Improving a Resource for Pharmacoepidemiologic Evaluations2019In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 30, no 2, p. 230-233Article in journal (Refereed)
    Abstract [en]

    The Swedish Multiple Sclerosis Register is a national register monitoring treatment and clinical course for all Swedish multiple sclerosis (MS) patients, with high coverage and close integration with the clinic. Despite its great value for epidemiologic research, it has not previously been validated. In this brief report, we summarize a large validation of >3,000 patients in the register using clinical chart review in the context of the COMBAT-MS study. While further improving the data quality for a central cohort of patients available for future epidemiologic research, this study also allowed us to estimate the accuracy and completeness of the register data.

  • 53.
    Amiot, Ikraam
    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).
    Coping strategies of men who have been sexually abused in childhood: A qualitative metasynthesis2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Estimates on the prevalence of childhood sexual abuse on boys vary from 8% to 35% globally. These figures are known to be well below the actual numbers that are believed to be much higher than those found in official data. Most cases of childhood sexual abuse are never reported, boys are less likely to report sexual abuse and if they ever do, they do so up to 10-20 years later than girls with similar experiences. This metasynthesis adds to the scarce qualitative literature on coping of male victims. It brings together the types of coping strategies men with histories of childhood sexual abuse use and allows for deeper understanding on how men cope with childhood sexual abuse.

    Aim: To explore coping strategies used by men who have been affected by childhood sexual abuse 

    Method: A qualitative metasynthesis

    Findings: Men affected by childhood sexual abuse reported the use of several coping strategies throughout their lives. These coping strategies were adapted to changes in their social environment. Meaningful inter-personal relationships were found to influence which coping strategies victims would resort to. Not all men felt affected by their experiences of childhood sexual abuse and some reject to be labelled as victims, while others felt empowered by the recognition of their victimhood.

    Conclusion: Men reported using similar coping strategies in different settings, but with different outcomes. Social support and social awareness about male victimisation were found to affect coping strategies used by men who have been affected by childhood sexual abuse.

  • 54.
    Ancillotti, Mirko
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Eriksson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Theology, Department of Theology.
    Veldwijk, Jorien
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Institute of Health Policy and Management, Erasmus University, Bayle (J) building - Campus Woudestein, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands.
    Nihlén Fahlquist, Jessica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Andersson, Dan I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Godskesen, Tove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Ersta Sköndal Bräcke högskola, Stigbergsgatan 30, 100 61 Stockholm, Sweden.
    Public awareness and individual responsibility needed for judicious use of antibiotics: a qualitative study of public beliefs and perceptions2018In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, no 1, article id 1153Article in journal (Refereed)
    Abstract [en]

    Background

    High consumption of antibiotics has been identified as an important driver for the increasing antibiotic resistance, considered to be one of the greatest threats to public health globally. Simply informing the public about this consequence is insufficient to induce behavioral change. This study explored beliefs and perceptions among Swedes, with the aim of identifying factors promoting and hindering a judicious approach to antibiotics use. The study focused primarily on the medical use of antibiotics, also considering other aspects connected with antibiotic resistance, such as travelling and food consumption.

    Methods

    Data were collected through focus group discussions at the end of 2016. Twenty-three Swedes were recruited using an area-based approach and purposive sampling, aiming for as heterogeneous groups as possible regarding gender (13 women, 10 men), age (range 20–81, mean 38), and education level. Interview transcripts were analyzed using qualitative content analysis. The Health Belief Model was used as a theoretical framework.

    Results

    Antibiotic resistance was identified by participants as a health threat with the potential for terrible consequences. The severity of the problem was perceived more strongly than the actual likelihood of being affected by it. Metaphors such as climate change were abundantly employed to describe antibiotic resistance as a slowly emerging problem. There was a tension between individual (egoistic) and collective (altruistic) reasons for engaging in judicious behavior. The individual effort needed and antibiotics overprescribing were considered major barriers to such behavior. In their discussions, participants stressed the need for empowerment, achieved through good health communication from authorities and family physicians.

    Conclusions

    Knowledge about antibiotic consumption and resistance, as well as values such as altruism and trust in the health care system, has significant influence on both perceptions of individual responsibility and on behavior. This suggests that these factors should be emphasized in health education and health promotion. To instead frame antibiotic resistance as a slowly emerging disaster, risks diminish the public perception of being susceptible to it.

  • 55.
    Andersson, Anna Karin
    et al.
    Malardalen Univ, Sch Hlth Care & Welf, Box 883, SE-72123 Vasteras, Sweden..
    Martin, Lene
    Malardalen Univ, Sch Hlth Care & Welf, Box 883, SE-72123 Vasteras, Sweden..
    Strand Brodd, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Almqvist, Lena
    Malardalen Univ, Sch Hlth Care & Welf, Box 883, SE-72123 Vasteras, Sweden..
    Patterns of everyday functioning in preschool children born preterm and at term2017In: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 67, p. 82-93Article in journal (Refereed)
    Abstract [en]

    Background/Aim: Children born preterm are at risk of neonatal complications but the long-term consequences for everyday functioning is not well known. The study aimed to identify patterns of everyday functioning in preschool children born preterm and at term in relation to perinatal data, neonatal risk factors, behaviour, and socioeconomic status. Registry data and data from parent rated questionnaires were collected for 331 children.

    Method: A person-oriented approach with a cluster analysis was used.

    Results: A seven cluster solution explained 65.91% of the variance. Most children (n = 232) showed patterns of strong everyday functioning. A minority of the children (n = 99), showed diverse patterns of weak everyday functioning. Perinatal characteristics, neonatal risk factors and socio-economics did not predict cluster group membership. Children born preterm were represented in all clusters.

    Conclusion, implications: Most preschool children are perceived by their parents with strong everyday functioning despite being born preterm. However small groups of children are, for various reasons, perceived with weak functioning, but preterm birth is not the sole contributor to patterns of weak everyday functioning. More critical for all children's everyday functioning is probably the interaction between individual factors, behavioural factors and contextual factors. To gain a broader understanding of children's everyday functioning. Child Health Services need to systematically consider aspects of body function, activity and in addition participation and environmental aspects.

  • 56.
    Andersson, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Ljungberg, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Sjuksköterskors förutsättningar att handleda studenter2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Nurses conditions when preceptoring students

    Preceptoring student-nurses is a field that concerns all clinical registered nurses. This field has been an obvious task for nurses but not been visible and acknowledged. The aim of this study is to explore what conditions nurses percept they need to precept student in clinical settings.

    Method used is a systematic literature study where 11 scientific articles been critically reviewed and analysed.

    The study identified three main categories to be important conditions for nurses when preceptoring students. They are about:

    • cooperation
    • knowledge and competence
    • organizational conditions and resource requirement

    To these categories occur a number of sub-categories. They deal with the need of cooperation between university, clinical setting, preceptor and student. Education and preparation of the preceptor is necessary to increase the knowledge of methods when preceptoring. The preceptors' motivation and level of interest in preceptoring is important. To obtain a good quality on preceptorship- the nurse need to be educated, get knowledge about preceptor strategies, get support and time for reflection. They also need feedback and rewards. The workload for the nurse need to be adjusted when preceptoring students so it can take the time needed.

  • 57. Andersson, P
    et al.
    Bratt, J
    Heimburger, M
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Palmblad, J
    Inhibition of neutrophil dependent cytotoxicity for human endothelial cells by ACE inhibitors2014In: Scandinavian Journal of Immunology, ISSN 0300-9475, E-ISSN 1365-3083, Vol. 80, no 5, p. 339-345Article in journal (Refereed)
    Abstract [en]

    Angiotensin-converting enzyme inhibitors (ACEi) have immunomodulating properties and have been suggested to protect against endothelial injury, for example myocardial infarction and reperfusion injury. We tested whether two ACEi (captopril and enalapril), differing in a thiol group, protected human umbilical vein endothelial cells (HUVEC) from cytotoxicity induced by polymorphonuclear neutrophils (PMN) in vitro, when cells were activated by tumour necrosis factor-α (TNFα) or the arachidonate derivative lipoxin-A4 (LXA4), using separate cytotoxicity pathways. When 51Cr labelled HUVEC were treated with captopril (0–500 μm) or enalapril (0–100 μm) for 2 h and then activated by TNFα (100 ng/ml) for 24 h, a significant, dose-dependent reduction of 51Cr release was observed. Similarly, captopril reduced 51Cr release when LXA4 (0.1 μm) was used to stimulate PMN for 4 h. Among previously defined mechanisms of significance for the cytotoxic reaction, expression of ICAM-1, but not intracellular Ca2+ changes in PMN or PMN adherence to HUVEC, were reduced by ACEi treatment. Moreover, both ACEi inhibited HUVEC surface expression of TNFα receptor I (but not II). Thus, these ACEi, particularly captopril, interfere with PMN-induced cytotoxicity for endothelial cells by modulating pro-inflammatory surface receptors, which is a novel effect that might be explored for further therapeutic approaches.

  • 58.
    Andersén, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Christian, Ståhl
    National Centre for Work and Rehabilitation, Department of Medical and Health Sciences, Linköping University.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Larsson, Kjerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Positive experiences of a vocational rehabilitation intervention for individuals on long-term sick leave, the Dirigo project: a qualitative study2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 790Article in journal (Refereed)
    Abstract [en]

    Background: The process of returning to work after long-term sick leave can sometimes be complex. Many factors, (e.g. cooperation between different authorities and the individual as well as individual factors such as health, emotional well-being and self-efficacy) may have an impact on an individual’s ability to work. The aim of this study was to investigate clients’ experiences with an individually tailored vocational rehabilitation, the Dirigo project, and encounters with professionals working on it. The Dirigo project was based on collaboration between rehabilitation authorities, individually tailored interventions and a motivational interviewing approach. 

    Methods: A descriptive qualitative design was used with data collected through interviews. Fourteen individuals on long-term sick leave took part in individual semi-structured interviews. The interviews were analysed using content analysis.

    Results: The analysis showed overall positive experience of methods and encounters with professionals in a vocational rehabilitation project. The positive experiences were based on four key factors: 1. Opportunities for receiving various dimensions of support.  2. Good overall treatment by the professionals. 3. Satisfaction with the working methods of the project, and 4. Opportunities for personal development.

    Conclusions: The main result showed that the clients had an overall positive experience of a vocational rehabilitation project and encounters with professionals who used motivational interviewing as a communication method. The overall positive experience indicated that their interactions with the different professionals may have affected their self-efficacy in general and in relation to transition to work. The knowledge is essential for the professionals working in the area of vocational rehabilitation. However, vocational rehabilitation interventions also need a societal approach to be able to offer clients opportunities for job training and real jobs.

  • 59.
    Andersén, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Larsson, Kjerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Berglund, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Strengthened General Self-Efficacy with Multidisciplinary Vocational Rehabilitation in Women on Long-Term Sick Leave: A Randomised Controlled Trial2018In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 28, no 4, p. 691-700Article in journal (Refereed)
    Abstract [en]

    Purpose To investigate the effects of two vocational rehabilitation interventions on self-efficacy, for women on long-term sick leave ≥ 1 year due to chronic pain and/or mental illness. Methods This study uses data from a randomised controlled trial consisting of two phases and comprising 401 women on long-term sick leave. They were allocated to either (1) a multidisciplinary team assessment and multimodal intervention (TEAM), (2) acceptance and commitment therapy (ACT), or (3) control group. Data were collected through repeated measurements from self-reported questionnaires before intervention, 6 and 12 months later and registry data. Data from measurements of general self-efficacy, sociodemographics, anxiety and depression were analysed with linear regression analyses. Results During the intervention period, the women in the TEAM group’s self-efficacy mean increased from 2.29 to 2.74. The adjusted linear regression model, which included group allocation, sociodemographics, self-efficacy pre-treatment, anxiety and depression showed increased self-efficacy for those in the TEAM intervention at 12 months (B = 0.25, 95% CI 0.10–0.41). ACT intervention had no effect on self-efficacy at 12 months (B = 0.02, 95% CI − 0.16 to 0.19). The results in the adjusted model also showed that higher self-efficacy at pre-treatment was associated with a higher level of self-efficacy at 12 months (B = 0.68, 95% CI 0.54–0.81). Conclusion A multidisciplinary team assessment and multimodal intervention increased self-efficacy in women on sick leave for an extremely long time (mean 7.8 years) who had a low mean level of self-efficacy prior to inclusion. Thus, self-efficacy needs to be addressed in vocational rehabilitation.

  • 60.
    Andersén, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Larsson, Kjerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Pingel, Ronnie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    The relationship between self-efficacy and transition to work or studies in young adults with disabilities2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no 2, p. 272-278Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate perceived self-efficacy in unemployed young adults with disabilities and the association between self-efficacy and transition to work or studies.

    Methods: This prospective cohort study collected data through self-report questionnaires and registry data from a vocational rehabilitation project with young adults, aged 19-29 years. The Swedish Social Insurance Agency, the Swedish Public Employment Service and the participating municipalities identified potential participants to the study. A total of 531 participants were included in the study, of which 249 (47%) were available for analysis. Multinomial logistic regression models were carried out to estimate the associations between self-efficacy, demographic, health and employment status. The latter was coded as: “no transition to work or studies”, “transition to studies”, and “transition to work”.

    Results: A higher level of self-efficacy was associated with increased odds for “transition to work” (OR=2.37, p<0.05). This finding remained consistent when adjusting for possible confounders. The mean value of self-efficacy was low, and participants with lower self-efficacy reported worse self-rated health (p<0.001) compared with participants with higher self-efficacy.

    Conclusions: The results from this study suggest that self-efficacy should be addressed in vocational rehabilitation of young adults with disabilities in order to support their transition and integration into the labour market.

  • 61.
    Anderzén, Ingrid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Demmelmaier, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hansson, Ann-Sophie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Johansson, Per
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economics. Uppsala University, Units outside the University, Office of Labour Market Policy Evaluation.
    Lindahl, Erica
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economics. Uppsala University, Units outside the University, Office of Labour Market Policy Evaluation.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Samverkan i Resursteam: effekter på organisation, hälsa och sjukskrivning2008Report (Other academic)
    Abstract [sv]

    Vi utvärderar samverkansformen Resursteam, som bedrivits som ett försök för att minska långa sjukskrivningar. Resursteam innebär att ett team med hand-läggare från Försäkringskassan, husläkare, sjukgymnast och beteendevetare, vid regelbundna möten bedömer sjukskrivna personers rehabiliteringsbehov och ger förslag på åtgärder. Det övergripande syftet är att skatta effekten av Resursteam på den försäkrades sjukskrivningslängd och självskattade hälsa. Vi har genomfört (i) en kartläggning av verksamheten, (ii) en enkätstudie till sjuk-skrivna som deltagit i Resursteam och till jämförelsepersoner samt (ii) skattat effekten av Resursteam på självskattad hälsa och sjukskrivning. Resultaten är entydiga och visar på inga eller negativa effekter för de personer som ingått i Resursteam. Som exempel kan nämnas att tiden i sjukskrivning förlängs med cirka 20 procent i genomsnitt.

  • 62.
    Androutsos, O
    et al.
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greec.
    Apostolidou, E
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greec.
    Iotova, V
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    Socha, P
    The Children’s Memorial Health Institute, Warsaw, Poland.
    Birnbaum, J
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Moreno, L
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain .
    De Bourdeaudhuij, I
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Koletzko, B
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Process evaluation design and tools used in a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 74-80Article in journal (Refereed)
    Abstract [en]

    Process evaluation (PE) is used for the in-depth evaluation of the implementation process of health promotion programmes. The aim of the current paper was to present the PE design and tools used in the ToyBox-intervention. The PE design was based on a three-step approach, including the identification of ToyBox-specific PE elements (step 1), the development of PE tools and harmonization of procedures (step 2), and the implementation of PE using standardized protocol and tools across the intervention countries (step 3). Specifically, to evaluate the implementation of the intervention, teachers' monthly logbooks were recorded (dose delivered, fidelity, dose received); post-intervention questionnaires were completed by parents/caregivers and teachers (dose received); participation and attrition rates were recorded (recruitment, reach); and audit questionnaires and retrospective information on weather conditions were collected (physical and social environment within which the intervention was implemented). Regarding the teachers' training sessions, the researchers who performed the trainings completed evaluation forms and documented teachers' attendance after each training (dose delivered, fidelity, dose received) and teachers completed evaluation forms after each training (dose received). The PE performed in the ToyBox-intervention may contribute in the evaluation of its effectiveness, guide the revision of the intervention material and provide insights for future health promotion programmes and public health policy.

  • 63.
    Androutsos, O
    et al.
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Katsarou, C
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Payr, A
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Birnbaum, J
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Geyer, C
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Wildgruber, A
    State Institute of Early Childhood Research, Munich, Germany.
    Kreichauf, S
    State Institute of Early Childhood Research, Munich, Germany.
    Lateva, M
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    De Decker, E
    Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
    De Craemer, M
    Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
    Socha, P
    The Children’s Memorial Health Institute, Warsaw, Poland.
    Moreno, L
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain.
    Iotova, V
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    Koletzko, B V
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Designing and implementing teachers' training sessions in a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 48-52Article in journal (Refereed)
    Abstract [en]

    Since school-based interventions are mainly delivered by the school staff, they need to be well-trained and familiarized with the programme's aims, procedures and tools. Therefore, the institute, research group, governmental or non-governmental body in charge of the coordination and implementation of the programme needs to devote time and resources to train the school staff before programme's implementation. This is particularly crucial in multi-centre studies where more than one research teams are involved. Both research teams and school staff need to be trained, using standard protocols and procedures, to ensure that the intervention will be delivered in a standardized manner throughout the intervention centres. The ToyBox-intervention, a multi-component, kindergarten-based, family-involved intervention, focusing on water consumption, snacking, physical activity and sedentary behaviours in preschool children, was implemented over the academic year 2012-2013 in six European countries. As part of this intervention, three teachers' training sessions were delivered to motivate and train teachers in implementing the intervention. The local researchers were trained centrally before delivering the training sessions for the teachers and followed a common protocol using standardized presentations and procedures. The aim of the current paper is to describe the protocol and methodological issues related to the teachers' training sessions conducted within the ToyBox-intervention.

  • 64.
    André, Malin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Lissner, Lauren
    Bengtsson, Calle
    Hallström, Tore
    Sundh, Valter
    Björkelund, Cecilia
    Cohort differences in personality in middle-aged women during a 36-year period: Results from the Population Study of Women in Gothenburg2010In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, no 5, p. 457-464Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate secular trends in personality traits in adult female populations. Methods: Two representative, population-based cohorts of women, 38 (n = 318) and 50 (n = 593) years of age participated in a health examination in 1968 and 2004 in Gothenburg, Sweden. The Eysenck Personality Inventory (EPI) and Cesarec-Marke Personality Schedule (CMPS) were used to measure personality traits. Socioeconomic and lifestyle variables (personal income, education, marital status, children at home, physical activity and smoking) were reported. Results: In both age groups, secular comparisons in psychological profile subscales showed an increase in dominance, exhibition, aggression and achievement. Only small divergences were seen concerning affiliation, guilt feelings, nurturance and succorance. EPI showed a corresponding rise in extroversion. Social data showed a statistically significant increase in percentage of unmarried women, personal income levels, and higher educational achievement. While around 70% of women in 1968-69 had elementary school education only, around 90% had high school or university education in 2004-05. Conclusions: The results indicate major transitions in the adult Swedish female population in the direction of a more stereotypically "male'' personality profile, but not at the expense of traditionally socially important female traits, which remained constant. These results are consistent with the hypothesis that society and the environment influence personality.

  • 65. André, Malin
    et al.
    Vernby, Åsa
    Odenholt, Inga
    Lundborg, Cecilia Stålsby
    Axelsson, Inge
    Eriksson, Margareta
    Runehagen, Arne
    Schwan, Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Mölstad, Sigvard
    Allmänläkare förskrec mindre antibiotika men utnyttjade CRP-test mer: Diagnos–förskrivningsstudier för åren 2000–2005 [General practitioners prescribed less antibiotics but used the CRP test more. Diagnosis-prescription studies in 2000-2005]2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 41, p. 2851-2854Article in journal (Refereed)
  • 66.
    Aneblom, Gunilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    von Essen, Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Women's voices about emergency contraceptive pills "over-the-counter": a Swedish perspective2002In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 66, no 5, p. 339-343Article in journal (Refereed)
    Abstract [en]

    This study aimed to describe women’s experiences with the emergency contraceptive pill (ECP) as a prescription-free over-the-counter (OTC) product. Women (median age 24) who had bought ECP as an OTC product were interviewed in focus groups. Data were analyzed by content analysis. All participants appreciated the OTC availability. Timesaving aspects were seen as important benefits and pharmacies were seen as the right place to sell ECP. The media was the main source of information about OTC, probably due to the debates of the introduction of ECP as an OTC product in Sweden. All women discussed the mechanism of action. The women’s experiences of interacting with the pharmacists were both positive and negative. Inconsistencies in routines with regard to providing ECP and different attitudes toward use of ECP among the pharmacists, were identified. The women expected up-to-date information about ECP and the OTC availability from gynecologists and other health professionals.

  • 67.
    Anmyr, Lena
    et al.
    Department of Clinical Science, Intervention and Technology (CLINTEC), Cochlear Implant Section, Karolinska Institutet, Stockholm, Sweden..
    Larsson, Kjerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation.
    Olsson, Mariann
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden..
    Parents' Stress and Coping Related to Children's Use of a Cochlear Implant: A Qualitative Study2016In: Journal of Social Work in Disability & Rehabilitation, ISSN 1536-710X, E-ISSN 1536-7118, Vol. 15, no 2, p. 150-167Article in journal (Refereed)
    Abstract [en]

    The aim was to increase understanding of parents' experiences of having a child with cochlear implant (CI) and to explore how these related to children's use of CI. Twelve parents of children, full-time users or limited users of CI, participated in the study. Qualitative content analysis showed that the parents of children who used their CI differed from the parents with limited users in how they handled stressors. Support from health care professionals was seen as insufficient. Parents need to get involved in dynamic processes, where health care resources promote parental coping.

  • 68.
    Ansker, Fredrik G.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine.
    Helgason, Asgeir R.
    Ahacic, Kozma
    The beliefs about pros and cons of drinking and intention to change among hazardous and moderate alcohol users: a population-based cross-sectional study2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no 4, p. 566-571Article in journal (Refereed)
    Abstract [en]

    Background: Fundamental to supporting hazardous alcohol users are the rationales for reducing alcohol intake highlighted by the users themselves. This study analyses the relative importance of beliefs about pros and cons of drinking in relation to having an intention to reduce intake among both hazardous and moderate alcohol users. Methods: Intention to change was assessed in a representative sample of Stockholm's population (n = 4278, response rate 56.5%). Alcohol use was assessed using the Alcohol Use Disorders Identification Test measure. A decisional balance inventory was used to examine various beliefs about the pros and cons of drinking, which covered affect changes, social gains and losses, and possible adverse effects. Independent correlations were determined by logistic regression using a backward exclusion procedure (P > 0.05). Results: Higher ratings of importance were generally related to intent, whether or not the contrast was with having no intent or already having made a reduction. This was especially true for hazardous users. Only two beliefs were independently correlated with change among hazardous users: 'Drinking could get me addicted' and 'Drinking makes me more relaxed/less tense' (pseudo-R2 < 0.1). Among moderate users, there was no uniform pattern in the relationships. Conclusions: Unexpectedly, hazardous users with an intent to change rated pro arguments as more important than those with no intent to change. Of the investigated pros and cons, only a few were independently related to intention to change drinking behaviour. These arguments provide interesting topics in consultations. Little support was found for any rational decision making behind the intention to reduce alcohol intake.

  • 69.
    Aqaian, Linda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Positive mental health from the adolescent girls’ perspective: A qualitative study2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Psychosomatic problems are increasing among adolescent girls and levels of life satisfaction, well-being and self-esteem are lower among adolescent girls compared to boys at the same age.

    Aim: The aim of this thesis was to explore adolescent girls’ perceptions of the concept of PMH and to identify influential factors for PMH from their own perspectives.

    Methods: A qualitative explorative study was designed. The data collection was through four semi-structured focus group interviews. Participation in the study was completely voluntary and 14 high school girls aged 16-17 participated in the study. An inductive content analysis was conducted to analyze the collected data.

    Results: Six categories and sixteen subcategories emerged from the data analysis, answered the two objectives of the study and met the purpose of this thesis. The six categories were: 1) when you feel well and things go well; 2) school-related factors, 3) factors at home and at leisure time, 4) key personal characteristics, 5) coping skills and balanced healthy lifestyle, 6) more attention to PMH. The findings showed that PMH was perceived as a two-dimension concept of feeling well and functioning well in life. The main influential factors for PMH was healthy social relations within and outside the family, key characteristics such as optimism, high self-esteem, sense of control, purpose and progress as well as coping skills and paying more attention to PMH.    

    Conclusion: A combination of positive factors promoting feeling well and functioning well in life should be taken into account in the development of mental health promotion approaches and programs to improve PMH among adolescent girls.

  • 70.
    Arefalk, Gabriel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Smokeless Tobacco (Snus) and Cardiovascular Disease: Associations with Heart Failure and Prognosis after Myocardial Infarction2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Previous investigations of snus use (oral moist snuff, a Swedish form of smokeless tobacco) and cardiovascular disease have generally focused on atherosclerotic events such as myocardial infarction and stroke, likely because smoking is such a well-established risk factor for atherosclerotic disease. Smokeless administration of tobacco circumvents most of the atherogenic effects of the combusted products from smoked tobacco, but it is possible that the potent autonomic and hemodynamic effects of snus and nicotine per se are detrimental for cardiovascular tissues.

    The aim of this thesis was to investigate if snus is associated with development of heart failure and the prognosis after myocardial infarction. We used data from Swedish cohort studies and the national quality register for myocardial infarctions (SWEDEHEART), with linkages to national registers.

    Snus use was associated with a higher risk of heart failure in a dose-response manner. This association was specific to non-ischemic heart failure, implying a direct myocardial effect, rather than an atherogenic effect (papers I and II).

    Acute, short-term or long-term outcomes following a myocardial infarction were not consistently worse among snus users relative to snus non-users, although snus use was associated with an increased risk of death after myocardial infarction among never-smokers (paper III).

    Discontinuation of snus use after a myocardial infarction was associated with an almost halved mortality risk, similar to the benefit associated with smoking cessation (paper IV).

    Although smoking was consistently stronger related to all adverse outcomes, and with reservations due to the observational design, the findings from this thesis indicate that snus should not be regarded as harmless. Snus use was associated with a higher risk of heart failure and post-myocardial infarction mortality, which may have public health implications for the risk assessment of snus, and potentially other modes of smokeless nicotine.

    List of papers
    1. Smokeless Tobacco (Snus) and Risk of Heart Failure: Results from Two Swedish Cohorts
    Open this publication in new window or tab >>Smokeless Tobacco (Snus) and Risk of Heart Failure: Results from Two Swedish Cohorts
    Show others...
    2012 (English)In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 19, no 5, p. 1120-1127Article in journal (Refereed) Published
    Abstract [en]

    Background:

    Oral moist snuff (snus) is discussed as a safer alternative to smoking, and its use is increasing. Based on its documented effect on blood pressure, we hypothesized that use of snus increases the risk of heart failure.

    Design:

    Two independent Swedish prospective cohorts; the Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based sample of 1076 elderly men, and the Construction Workers Cohort (CWC), a sample of 118,425 never-smoking male construction workers.

    Methods:

    Cox proportional hazards models were used to investigate possible associations of snus use with risk of a first hospitalization for heart failure.

    Results:

    In ULSAM, 95 men were hospitalized for heart failure, during a median follow up of 8.9 years. In a model adjusted for established risk factors including past and present smoking exposure, current snus use was associated with a higher risk of heart failure [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.03-4.22] relative to non-use. Snus use was particularly associated with risk of non-ischaemic heart failure (HR 2.55, 95% CI 1.12-5.82). In CWC, 545 men were hospitalized for heart failure, during a median follow up of 18 years. In multivariable-adjusted models, current snus use was moderately associated with a higher risk of heart failure (HR 1.28, 95% CI 1.00-1.64) and non-ischaemic heart failure (HR 1.28, 95% CI 0.97-1.68) relative to never tobacco use.

    Conclusion:

    Data from two independent cohorts suggest that use of snus may be associated with a higher risk of heart failure.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-164695 (URN)10.1177/1741826711420003 (DOI)000309527700022 ()21828223 (PubMedID)
    Note

    De två första författarna delar förstaförfattarskapet.

    Available from: 2011-12-22 Created: 2011-12-22 Last updated: 2018-03-22
    2. Smokeless Tobacco (Snus) and Risk of Heart Failure of Ischemic and Non-Ischemic Origin: a Pooled Analysis of Eight Prospective Cohort Studies
    Open this publication in new window or tab >>Smokeless Tobacco (Snus) and Risk of Heart Failure of Ischemic and Non-Ischemic Origin: a Pooled Analysis of Eight Prospective Cohort Studies
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background

    Snus, a Swedish type of smokeless tobacco, has potent acute hemodynamic effects, which could provoke stress on the cardiovascular system, including the myocardium. Snus has, however, not been linked to risk of ischemic heart disease. Therefore, we hypothesized that snus use increases the risk for heart failure of non-ischemic origin.

    Methods

    We conducted a pooled analysis of eight Swedish prospective cohort studies involving individual participant data from 350,711 men. Shared frailty models with random effects at the cohort level, were used to estimate hazard ratios (HRs) with 95 % confidence intervals (CIs) of heart failure in relation to snus use. We investigated dose-response associations, and association with ischemic and non-ischemic heart failure in separate. For positive control purposes, we also investigated associations between smoking and risk of heart failure.

    Results

    During a median follow-up time of 16 years, 5,404 men were hospitalized for heart failure. In models adjusting for age, smoking, previous myocardial infarction and educational level, current snus use was associated with a higher risk of heart failure (HR 1.27, 95 % CI 1.07-1.50), relative to non-current snus use. A dose-response pattern was observed, with higher risk with more snus cans used per week. We observed an association of snus use with non-ischemic heart failure, HR 1.34 (95 % CI 1.11-1.63), but not with ischemic heart failure, HR 1.01 (95 % CI 0.72-1.42). Smoking was more strongly associated with heart failure, particularly of ischemic origin, than snus use.

    Conclusions

    Snus use was associated with a modestly increased risk for heart failure of non-ischemic origin in a dose-response manner. This finding has public health implications for the risk assessment of snus use, and potentially other modes of smokeless use of nicotine.

    National Category
    Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Cardiology; Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-345868 (URN)
    Available from: 2018-03-18 Created: 2018-03-18 Last updated: 2018-03-22
    3. Smokeless Tobacco (Snus) and Outcome of Myocardial Infarction: a SWEDEHEART Study
    Open this publication in new window or tab >>Smokeless Tobacco (Snus) and Outcome of Myocardial Infarction: a SWEDEHEART Study
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background

    Based on effects of nicotine and snus (a smokeless tobacco) on hemodynamics, pro-arrhythmia and remodelling, in combination with indications of increased risk for fatal myocardial infarction (MI) in snus users; we hypothesised that the outcome of an MI may be worse in snus users.

    Methods

    Data was extracted from the SWEDEHEART registry for all patients who underwent coronary angiography in Sweden due to MI between December 2009 and December 2014. In snus users (n=4,950) relative to snus non-users (n=55,412), we compared risks of a large MI (defined as hs-cTnT of  > 10,000 ng/L, cTnT > 10 μg/L or cTnI > 10 μg/L) and death in the acute (in-hospital) setting, and death+HF (a combined endpoint of all-cause death or hospitalization for heart failure) and all-cause death at short- (<28 days) and long-term follow-up. Relations of snus use to outcomes were also analysed in pre-specified subgroups of never, previous and current smokers.

    Results

    A large MI was diagnosed in 10,975 patients. During long-term follow-up (median 1.9 years), 7,758 either died (n=6,044) or were hospitalized due to heart failure (n=1,714). In models adjusting for age, gender, smoking, previous MI and occupational classification (employed, unemployed/sick leave and retired), snus use was not associated with risk of large MI (odds ratio 1.01; 95% confidence interval (CI) 0.93-1.09) or death+HF (long-term Cox proportional hazard ratio (HR) 0.99; 95% CI 0.90-1.10). Nonetheless, among never-smokers snus use was associated with an increased risk for death+HF (long-term HR 1.26, 95% CI 1.03-1.55), driven by a higher mortality risk (long-term HR for death of any cause 1.29, 95% CI 1.02-1.64).

    Conclusions

    In this study, snus use was unrelated to acute, short-term or long-term adverse outcomes after an MI. Among never-smokers, snus use was associated with an increased risk of post-MI death.

    National Category
    Medical and Health Sciences Cardiac and Cardiovascular Systems
    Research subject
    Cardiology; Epidemiology; Medical Science
    Identifiers
    urn:nbn:se:uu:diva-342247 (URN)
    Available from: 2018-03-18 Created: 2018-03-18 Last updated: 2018-06-26
    4. Discontinuation of Smokeless Tobacco and Mortality Risk After Myocardial Infarction
    Open this publication in new window or tab >>Discontinuation of Smokeless Tobacco and Mortality Risk After Myocardial Infarction
    Show others...
    2014 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 130, no 4, p. 325-323Article in journal (Refereed) Published
    Abstract [en]

    Background-Given the indications of increased risk for fatal myocardial infarction (MI) in people who use snus, a moist smokeless tobacco product, we hypothesized that discontinuation of snus use after an MI would reduce mortality risk. Methods and Results-All patients who were admitted to coronary care units for an MI in Sweden between 2005 and 2009 and were <75 years of age underwent a structured examination 2 months after discharge (the baseline of the present study). We investigated the risk of mortality in post-MI snus quitters (n=675) relative to post-MI continuing snus users (n=1799) using Cox proportional hazards analyses. During follow-up (mean 2.1 years), 83 participants died. The mortality rate was 9.7 (95% confidence interval, 5.7-16.3) per 1000 person-years at risk in post-MI snus quitters and 18.7 (14.8-23.6) per 1000 person-years at risk in post-MI continuing snus users. After adjustment for age and sex, post-MI snus quitters had half the mortality risk of post-MI continuing snus users (hazard ratio, 0.51; 95% confidence interval, 0.29-0.91). In a multivariable-adjusted model, the hazard ratio was 0.57 (95% confidence interval, 0.32-1.02). The corresponding estimate for people who quit smoking after MI versus post-MI continuing smokers was 0.54 (95% confidence interval, 0.42-0.69). Conclusions-In this study, discontinuation of snus use after an MI was associated with a nearly halved mortality risk, similar to the benefit associated with smoking cessation. These observations suggest that the use of snus after MI should be discouraged.

    Keywords
    mortality, myocardial infarction, prognosis, risk factors, smokeless tobacco
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:uu:diva-230084 (URN)10.1161/CIRCULATIONAHA.113.007252 (DOI)000339392300009 ()24958793 (PubMedID)
    Available from: 2014-09-03 Created: 2014-08-19 Last updated: 2018-03-18
  • 71.
    Arefalk, Gabriel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Galanti, Rosaria
    Lundberg, Michael
    Ye, Weimin
    Norberg, Margareta
    Lindmark, Krister
    Pedersen, Nancy
    Trolle Lagerros, Ylva
    Bellocco, Rino
    Lager, Anton
    Wennberg, Patrik
    Eriksson, Marie
    Östergren, Per-Olof
    Alfredsson, Lars
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Magnusson, Cecilia
    Smokeless Tobacco (Snus) and Risk of Heart Failure of Ischemic and Non-Ischemic Origin: a Pooled Analysis of Eight Prospective Cohort StudiesManuscript (preprint) (Other academic)
    Abstract [en]

    Background

    Snus, a Swedish type of smokeless tobacco, has potent acute hemodynamic effects, which could provoke stress on the cardiovascular system, including the myocardium. Snus has, however, not been linked to risk of ischemic heart disease. Therefore, we hypothesized that snus use increases the risk for heart failure of non-ischemic origin.

    Methods

    We conducted a pooled analysis of eight Swedish prospective cohort studies involving individual participant data from 350,711 men. Shared frailty models with random effects at the cohort level, were used to estimate hazard ratios (HRs) with 95 % confidence intervals (CIs) of heart failure in relation to snus use. We investigated dose-response associations, and association with ischemic and non-ischemic heart failure in separate. For positive control purposes, we also investigated associations between smoking and risk of heart failure.

    Results

    During a median follow-up time of 16 years, 5,404 men were hospitalized for heart failure. In models adjusting for age, smoking, previous myocardial infarction and educational level, current snus use was associated with a higher risk of heart failure (HR 1.27, 95 % CI 1.07-1.50), relative to non-current snus use. A dose-response pattern was observed, with higher risk with more snus cans used per week. We observed an association of snus use with non-ischemic heart failure, HR 1.34 (95 % CI 1.11-1.63), but not with ischemic heart failure, HR 1.01 (95 % CI 0.72-1.42). Smoking was more strongly associated with heart failure, particularly of ischemic origin, than snus use.

    Conclusions

    Snus use was associated with a modestly increased risk for heart failure of non-ischemic origin in a dose-response manner. This finding has public health implications for the risk assessment of snus use, and potentially other modes of smokeless use of nicotine.

  • 72. Arfken, CL
    et al.
    Jamil, H
    Arnetz, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Marijuana and non-medical prescription drug use among immigrant Arab Americans2012In: New Iraqi Med, Vol. 8, p. 7-13Article in journal (Refereed)
  • 73.
    Arifeen, Shams El
    et al.
    Int Ctr Diarrhoeal Dis Res Icddr B, Dhaka, Bangladesh.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Frongillo, Edward A
    Univ South Carolina, Arnold Sch Publ Hlth, Dept Hlth Promot Educ & Behav, Columbia, SC USA.
    Hamadani, Jena
    Int Ctr Diarrhoeal Dis Res Icddr B, Dhaka, Bangladesh.
    Khan, Ashraful Islam
    Int Ctr Diarrhoeal Dis Res Icddr B, Dhaka, Bangladesh.
    Naved, Ruchira T
    Int Ctr Diarrhoeal Dis Res Icddr B, Dhaka, Bangladesh.
    Rahman, Anisur
    Int Ctr Diarrhoeal Dis Res Icddr B, Dhaka, Bangladesh.
    Raqib, Rubhana
    Int Ctr Diarrhoeal Dis Res Icddr B, Dhaka, Bangladesh.
    Rasmussen, Kathleen M
    Cornell Univ, Div Nutr Sci, Ithaca, NY 14853 USA.
    Ekholm Selling, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Wagatsuma, Yukiko
    Univ Tsukuba, Dept Med, Tsukuba, Ibaraki, Japan.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. London Sch Hyg & Trop Med, Dept Dis Control, London, England.
    Cohort Profile: The Maternal and Infant Nutrition Interventions in Matlab (MINIMat) Cohort in Bangladesh2018In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 6, p. 1737-1738eArticle in journal (Refereed)
  • 74.
    Arkkukangas, Marina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Sundler, Annelie J
    Söderlund, Anne
    Eriksson, Staffan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Johansson, Ann-Christin
    Older persons' experiences of a home-based exercise program with behavioral change support2017In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, no 12, p. 905-913Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It is a challenge to promote exercise among older persons. Knowledge is needed regarding the maintenance of exercise aiming at preventing falls and promoting health and well-being in older persons.

    PURPOSE: This descriptive study used a qualitative inductive approach to describe older persons' experiences of a fall-preventive, home-based exercise program with support for behavioral change.

    METHODS: Semi-structured interviews were conducted with 12 elderly persons aged 75 years or older, and a qualitative content analysis was performed.

    RESULTS: Four categories emerged: facilitators of performing exercise in everyday life, the importance of support, perceived gains from exercise, and the existential aspects of exercise.

    CONCLUSION: With support from physiotherapists (PTs), home-based exercise can be adapted to individual circumstances in a meaningful way. Including exercises in everyday life and daily routines could support the experience of being stronger, result in better physical functioning, and give hope for an extended active life in old age.

  • 75.
    Arnetz, Bengt B
    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.
    Broadbridge, Carissa L
    Ghosh, Samiran
    Longitudinal determinants of energy levels in knowledge workers2014In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 56, no 1, p. 79-85Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Increasingly, workers in the service, welfare, and health care sectors suffer adverse effects (ie, depression, burnout, etc) of "low-energy syndromes." Less is known about energy-based outcomes among knowledge workers. This study aimed to identify determinants of self-rated energy in knowledge workers and examine how these determinants change over time.

    METHODS: In collaboration with a large union and employer federation, 317 knowledge workers in Sweden responded to the health and productivity survey three times.

    RESULTS: At each assessment, worry, satisfaction with eating habits, and work-effectiveness were predictive of energy levels; however, only work-effectiveness covaried with energy over time.

    CONCLUSIONS: This study suggests that perceived work-effectiveness is an important factor in preventing knowledge workers from experiencing "low-energy syndromes." Lifestyle factors also play a role. Therefore, multifaceted interventions for increasing energy are needed.

  • 76.
    Arnetz, Bengt B
    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.
    Broadbridge, Carissa L
    Jamil, Hikmet
    Lumley, Mark A
    Pole, Nnamdi
    Barkho, Evone
    Fakhouri, Monty
    Talia, Yousif Rofa
    Arnetz, Judith E
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Specific Trauma Subtypes Improve the Predictive Validity of the Harvard Trauma Questionnaire in Iraqi Refugees2014In: Journal of Immigrant and Minority Health, ISSN 1557-1912, E-ISSN 1557-1920, Vol. 16, no 6, p. 1055-1061Article in journal (Refereed)
    Abstract [en]

    Trauma exposure contributes to poor mental health among refugees, and exposure often is measured using a cumulative index of items from the Harvard Trauma Questionnaire (HTQ). Few studies, however, have asked whether trauma subtypes derived from the HTQ could be superior to this cumulative index in predicting mental health outcomes. A community sample of recently arrived Iraqi refugees (N = 298) completed the HTQ and measures of posttraumatic stress disorder (PTSD) and depression symptoms. Principal components analysis of HTQ items revealed a 5-component subtype model of trauma that accounted for more item variance than a 1-component solution. These trauma subtypes also accounted for more variance in PTSD and depression symptoms (12 and 10 %, respectively) than did the cumulative trauma index (7 and 3 %, respectively). Trauma subtypes provided more information than cumulative trauma in the prediction of negative mental health outcomes. Therefore, use of these subtypes may enhance the utility of the HTQ when assessing at-risk populations.

  • 77.
    Arnetz, Bengt B.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Ekman, RolfUppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Stress in Health and Disease2006Collection (editor) (Other academic)
    Abstract [en]

    This first book to address the most urgent issues combines a solid research approach with applied individual and stress issues. It focuses on our latest knowledge of various causes of stress and its neuro-cognitive and biological implications. World-renowned authors cover all perspectives: societal, individual, organ and molecular level.

  • 78.
    Arnetz, Bengt B.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Frenzel, L.
    Åkerstedt, T.
    Lisspers, Jan
    The brief fatigue syndrome scale: validation and utilization in fatigue recovery studies2008In: Fatigue Science for Human Health / [ed] Y. Watanabe, B. Evengård, B.H. Natelson, L. A. Jason and H. Kuratsune, Tokyo: Springer , 2008, p. 55-66Chapter in book (Other academic)
  • 79.
    Arnetz, Bengt B.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Hamdan, Thamer A.
    Grzybowski, Mary
    Severson, Rick
    Shukri, Sawsan W.
    Jamil, Hikmet
    War-related mental health disorders among Iraqis 10 years after the 1991 Gulf War: A comparative study of soldiers and civilians living under sustained socio-environmental stress2009In: The New Iraqi Journal of Medicine, ISSN 1817-5562, Vol. 5, no 1, p. 9-21Article in journal (Refereed)
    Abstract [en]

    Background: Prior studies of mental health consequences of the Gulf War (GW) have been confined to Allied forces, limiting the ability to control for important geographically and culturally-related factors. We conducted an epidemiological mental health study among Iraqi soldiers and civilians who are still residing in Iraq. This group has been exposed to sustained socio-environmental stress.

    Methods: A cross-sectional sample of 742 Iraqi GW veterans and 413 civilians responded to a validated mental health survey. The response rate was 96.3%. Mental health disorders, including post traumatic stress disorder (PTSD), were classified using both self-reports and validated scales. War-related exposure was calculated using the sum score of items assessing trauma exposure.

    Results: Iraqi soldiers reported significantly more depression (Odds Ratio [OR] 4.9; 95% confidence interval [CI] 2.2-11.1) and anxiety (OR 3.9; 95% CI, 1.2-13.3) compared to civilians, adjusting for age, education, and smoking. Soldiers closest to Kuwait during the GW reported significantly more depression compared to soldiers deployed further away from the war epicenter (OR 104.6; 95% CI, 28.0-390.8) and anxiety (OR 4.1; 95% CI, 1.5-11.1). The highest self-reported trauma exposure occurred in the southwest of Iraq.

    Conclusion: Iraqi soldiers that took part in the GW are at increased risk suffering from many of the same mental health disorders plaguing Allied soldiers. Soldiers closest to Kuwait were more at risk, suggesting a direct link to war-specific environmental exposures, although self-reported trauma exposure was higher in the southwest of Iraq. The study offers additional insights into the mental health consequences of living under sustained socio-environmental stress, originating from the Iraqi war. The study points out socio-environmental factors worthy of further explorations.

  • 80.
    Arnetz, Bengt B
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Nevedal, Dana C
    Lumley, Mark A
    Backman, Lena
    Lublin, Åke
    Trauma resiliency training for police: psychophysiological and performance effects2009In: Journal of Police and Criminal Psychology, ISSN 0882-0783, Vol. 24, no 1, p. 1-9Article in journal (Refereed)
    Abstract [en]

    The objective of this study is to test the effects of police trauma resilience training on stress and performance during a critical incident police work simulation. Rookie police officers (N = 18) participated in a randomized trial of a 10-week imagery and skills training program versus training as usual. Twelve months later, psychophysiological stress and police work performance were assessed during a live critical incident simulation. Training resulted in significantly less negative mood, less heart rate reactivity, a larger increase in antithrombin, and better police performance compared to controls. Trends for cortisol and self-reported stress also suggested benefits of training. This novel training program is a promising paradigm for improving police well-being, stress resiliency, and optimizing job performance.

  • 81.
    Arnetz, Bengt B
    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.
    Templin, Thomas
    Saudi, Waleed
    Jamil, Hikmet
    Obstructive sleep apnea, posttraumatic stress disorder, and health in immigrants2012In: Psychosomatic Medicine, ISSN 0033-3174, E-ISSN 1534-7796, Vol. 74, no 8, p. 824-831Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine whether obstructive sleep apnea mediates the relationship between posttraumatic stress disorder (PTSD) and psychosomatic and somatic disorders and its implications for self-rated health (SRH) among Iraqi immigrants in the United States.

    METHODS: A random sample of immigrants who had left Iraq before the 1991 Gulf War (n = 145) or after (n = 205) and are residing in metropolitan Detroit responded to a structured interview covering questions on sociodemographics, premigration trauma, SRH, physician-diagnosed and -treated obstructive sleep apnea, somatic disorders, and psychosomatic disorders. Structural equation modeling was used to evaluate the relationship between premigration trauma scores and health, as well as to explore mediating pathways between PTSD, obstructive sleep apnea, and health.

    RESULTS: The prevalence of obstructive sleep apnea among post-Gulf Warimmigrants (30.2%) was significantly higher than among pre-Gulf War immigrants (0.7%; p < .001). Premigration trauma scores were positively associated with depression and PTSD. Structural equation modeling supported a model in which obstructive sleep apnea mediated the relationship between PTSD and psychosomatic and somatic disorders. Premigration trauma also related directly to SRH.

    CONCLUSIONS: Part of the PTSD-associated adverse health effects observed in Iraqi immigrants is mediated by obstructive sleep apnea. Because sleep apnea in the current study is based on medical history and current treatment, there is a need for future confirmatory polysomnographic studies.

  • 82.
    Arnetz, Bengt B.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Åkerstedt, Torbjörn
    Hillert, Lena
    Lowden, Arne
    Kuster, Niels
    Wiholm, Clairy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    The Effects of 884 MHz GSM Wireless Communication Signals on Self-reported Symptoms and Sleep: An Experimental Provocation Study2007In: PIERS online, ISSN 1931-7360, Vol. 3, no 7, p. 1148-1150Article in journal (Refereed)
    Abstract [en]

    In the current study we assessed possible effects of prolonged (3 hours) exposure to 884 MHz GSM wireless communication signals on self-reported symptoms, cognitive function, and electroencephalographically (EEG) recorded sleep. The study group consisted of 36 women and 35 men. Twenty-two women and sixteen men reported symptoms they specifically related to mobile phone use (SG). The rest of the participants reported no mobile phone-related symptoms (NG). Potential participants volunteering for the study were evaluated by physicians, including some biochemical assessments, to rule out medical conditions that could interfere with study variables of interest. Once selected, participants spent three different sessions in the laboratory. The habituation session was followed by two subsequent sessions. In these subsequent sessions, subjects were either exposed to sham exposure (sham) or 884 MHz GSM wireless communication signals for 3 hours (an average of 1.4 W/kg including periods of DTX and Non-DTX. Exposure directed to the left hemisphere). Data was collected before, during and following the exposure/sham sessions. Data collected included self-reported symptoms, including headache, cognitive function, mood, and electroencephalographic recordings. During actual exposure, as compared to sham exposure, sleep initiated one hour after exposure was affected. There was a prolonged latency to reach the first cycle of deep sleep (stage 3). The amount of stage 4 sleep was also decreased in exposed subjects. NG subjects reported more headaches during exposures vs. sham exposure. Neither group (SG and NG) was able to detect the true exposure status more frequently than by chance alone. The study indicates that during laboratory exposure to 884 MHz wireless signals, components of sleep, believed to be important for recovery from daily wear and tear, are adversely affected. Moreover, participants that otherwise have no self-reported symptoms related to mobile phone use, appear to have more headaches during actual radiofrequency exposure as compared to sham exposure. However, subjects were not able to detect the true exposure status more often than would have been expected by statistical chance alone. Additional self-reported findings, biochemical, performance and electrophysiological data are currently being analyzed. Possible health implications from the findings will also be further explored.

  • 83.
    Arnetz, Bengt
    et al.
    Wayne State University School of Medicine, Family Medicine, Detroit, MI.
    Sokol, Robert
    Drutchas, Alexis
    Kruger, Michael
    Jamil, Hikmet
    1991 Gulf War exposures and pregnancy outcomes: a retrospective study of Iraqi immigrants2012In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 206, no 1 S, p. 261-262Article in journal (Refereed)
    Abstract [en]

    We studied 1991 Gulf War (GW)-related environmental exposures and adverse birth outcomes in Iraqis. A random cross-sectional sample of 307 Iraqi families that immigrated to the United States responded to a structured interview covering socioeconomics, lifestyle, environmental exposures, and birth outcome. Data per each family was collected either from the man or the woman in the respective family. The respondents were divided into those that resided in Iraq during and following the GW (post-GW, n=185) and those that had left before (pre-GW, n=122). The primary outcome was lifetime prevalence of adverse birth outcomes, ie, congenital anomalies, stillbirth, low birth weight, and preterm delivery and its relationship to GW exposures. Mean number of adverse birth outcomes increased from 3.43 (SD=2.11) in the pre-GW to 4.63 (SD=2.63) in the post-GW group (P<.001). Mean chemical (Ch) and nonchemical (NCh) environmental exposure scores increased from pre-GW scores of 0.38 units (SD=1.76) and 0.43 (SD=1.86), respectively, to post-GW scores of 5.65 units (SD=6.23) and 7.26 (SD=5.67), P<.001 between groups for both exposures. There was a significant dose-response relationship between Ch environmental exposure (P=.001), but not NCh exposure, and number of adverse birth outcomes. Exposure to burning oil pits and mustard gas increased the risks for specific adverse birth outcomes by 2 to 4 times. Results indicate that Gulf War Ch, but not NCh exposures are related to adverse birth outcomes. Pregnancies in women with a history of war exposures might benefit from more intensive observation.

  • 84.
    Arnetz, Judith E.
    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. Michigan State Univ, Dept Family Med, E Lansing, MI 48824 USA.; Wayne State Univ, Dept Family Med, Detroit, MI USA.;Wayne State Univ, Dept Publ Hlth Sci, Detroit, MI USA.;Wayne State Univ, Detroit, MI 48202 USA..
    Hamblin, Lydia
    Wayne State Univ, Dept Family Med, Detroit, MI USA.;Wayne State Univ, Dept Publ Hlth Sci, Detroit, MI USA.;Wayne State Univ, Dept Psychol, 71 W Warren Ave, Detroit, MI 48202 USA.;Wayne State Univ, Detroit, MI 48202 USA..
    Russell, Jim
    Wayne State Univ, Occupat Hlth Serv, Detroit Med Ctr, Detroit, MI USA.;Wayne State Univ, Detroit, MI 48202 USA..
    Upfal, Mark J.
    Wayne State Univ, Occupat Hlth Serv, Detroit Med Ctr, Detroit, MI USA.;Wayne State Univ, Dept Emergency Med, Detroit, MI USA.;Wayne State Univ, Detroit, MI 48202 USA..
    Luborsky, Mark
    Wayne State Univ, Inst Gerontol, Detroit, MI 48202 USA.;Karolinska Inst, Dept Neurobiol Caring Sci & Soc, S-10401 Stockholm, Sweden.;Wayne State Univ, Detroit, MI 48202 USA..
    Janisse, James
    Wayne State Univ, Dept Family Med, Detroit, MI USA.;Wayne State Univ, Dept Publ Hlth Sci, Detroit, MI USA.;Wayne State Univ, Detroit, MI 48202 USA..
    Essenmacher, Lynnette
    Wayne State Univ, Occupat Hlth Serv, Detroit Med Ctr, Detroit, MI USA.;Wayne State Univ, Detroit, MI 48202 USA..
    Preventing Patient-to-Worker Violence in Hospitals: Outcome of a Randomized Controlled Intervention2017In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, no 1, p. 18-27Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the effects of a randomized controlled intervention on the incidence of patient-to-worker (Type II) violence and related injury in hospitals. Methods: Forty-one units across seven hospitals were randomized into intervention (n = 21) and control (n = 20) groups. Intervention units received unit-level violence data to facilitate development of an action plan for violence prevention; no data were presented to control units. Main outcomes were rates of violent events and injuries across study groups over time. Results: Six months post-intervention, incident rate ratios of violent events were significantly lower on intervention units compared with controls (incident rate ratio [IRR] 0.48, 95% confidence interval [CI] 0.29 to 0.80). At 24 months, the risk for violence-related injury was lower on intervention units, compared with controls (IRR 0.37, 95% CI 0.17 to 0.83). Conclusions: This data-driven, worksite-based intervention was effective in decreasing risks of patient-to-worker violence and related injury.

  • 85.
    Arnetz, Judith E.
    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. Wayne State Univ, Sch Med, Family Med & Publ Hlth Sci, Detroit, MI USA.;Inst Environm Hlth Sci, Detroit, MI USA.;Michigan State Univ, Coll Human Med, Dept Family Med, 788 Serv Rd, E Lansing, MI 48824 USA..
    Zhdanova, Ludmila
    Booth Univ Coll, Dept Psychol, Winnipeg, MB, Canada..
    Arnetz, Bengt B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Inst Environm Hlth Sci, Detroit, MI USA.;Wayne State Univ, Sch Med, Detroit, MI USA.;Michigan State Univ, Coll Human Med, Dept Family Med, 788 Serv Rd, E Lansing, MI 48824 USA..
    Patient Involvement: A New Source of Stress in Health Care Work?2016In: Health Communication, ISSN 1041-0236, E-ISSN 1532-7027, Vol. 31, no 12, p. 1566-1572Article in journal (Refereed)
    Abstract [en]

    Patients have become increasingly well informed with higher expectations to be involved in decision-making processes regarding their care and treatment. However, few studies have examined the impact of patient involvement on health care providers' partnership-building communication. The aim of this study was to measure and explore the self-reported effects of patient involvement on the work of physicians and nurses. A questionnaire survey was distributed among cardiology staff in 12 Swedish hospitals (N=488, response rate 67%). The sample was comprised of registered nurses (RNs, n=303), licensed practical nurses (LPNs, n=132), and physicians (MDs, n=53). Confirmatory factor analysis was used to examine seven questionnaire statements concerning implications of patient involvement for one's clinical work. Regression analyses were used to examine factors associated with staff's partnership-building communication. Analysis confirmed two distinct factors accounting for 57% of the total variance, representing both negativeHasslesand positiveUpliftsaspects of patient involvement. Regression analyses revealed that only positive aspects (i.e., uplifts) of patient involvement predicted staff behavior aimed at involving patients. Working with actively involved patients may be a source of stress, both negative and positive, for health care professionals. By developing work routines for involving patients in their care, health care workplaces may help health care professionals to buffer the negative effects, and enhance the positive effects, of that stress.

  • 86. Arnold, Melina
    et al.
    Freisling, Heinz
    Stolzenberg-Solomon, Rachael
    Kee, Frank
    O'Doherty, Mark George
    Ordóñez-Mena, José Manuel
    Wilsgaard, Tom
    May, Anne Maria
    Bueno-de-Mesquita, Hendrik Bas
    Tjønneland, Anne
    Orfanos, Philippos
    Trichopoulou, Antonia
    Boffetta, Paolo
    Bray, Freddie
    Jenab, Mazda
    Soerjomataram, Isabelle
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Overweight duration in older adults and cancer risk: a study of cohorts in Europe and the United States2016In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 31, no 9, p. 893-904Article in journal (Refereed)
    Abstract [en]

    Recent studies have shown that cancer risk related to overweight and obesity is mediated by time and might be better approximated by using life years lived with excess weight. In this study we aimed to assess the impact of overweight duration and intensity in older adults on the risk of developing different forms of cancer. Study participants from seven European and one US cohort study with two or more weight assessments during follow-up were included (n = 329,576). Trajectories of body mass index (BMI) across ages were estimated using a quadratic growth model; overweight duration (BMI ≥ 25) and cumulative weighted overweight years were calculated. In multivariate Cox models and random effects analyses, a longer duration of overweight was significantly associated with the incidence of obesity-related cancer [overall hazard ratio (HR) per 10-year increment: 1.36; 95 % CI 1.12-1.60], but also increased the risk of postmenopausal breast and colorectal cancer. Additionally accounting for the degree of overweight further increased the risk of obesity-related cancer. Risks associated with a longer overweight duration were higher in men than in women and were attenuated by smoking. For postmenopausal breast cancer, increased risks were confined to women who never used hormone therapy. Overall, 8.4 % of all obesity-related cancers could be attributed to overweight at any age. These findings provide further insights into the role of overweight duration in the etiology of cancer and indicate that weight control is relevant at all ages. This knowledge is vital for the development of effective and targeted cancer prevention strategies.

  • 87. Aro, Antti
    et al.
    Becker, Wulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Pedersen, Jan I.
    Trans fatty acids in the Nordic countries2006In: Scandinavian journal of Food and Nutrition, ISSN 1748-2976, Vol. 50, no 4, p. 151-154Article in journal (Refereed)
    Abstract [en]

    Trans fatty acids (TFA) comprise a variety of positional isomers, mainly with 18 carbon atoms and one double bond (C18:1). They are found in foods of ruminant animal origin and in partially hydrogenated vegetable oils. The isomeric composition of TFA in animal and vegetable foods differs, but no definite differences have been documented between the metabolic and health effects of the different isomers. In the Nordic countries the intake of TFA has declined during the past 1015 years, mainly through reduced use of partially hydrogenated vegetable oils. TFA are mainly found in foods that contain far higher amounts of saturated fatty acids (SFA). The proportion of SFA plus TFA should be kept to one-third of total dietary fatty acids. The problem of excessive consumption of these unfavourable fatty acids should be managed with food-based dietary guidelines in agreement with the Nordic Nutrition Recommendations.

  • 88. Aro, Pertti
    et al.
    Ronkainen, Jukka
    Storskrubb, Tom
    Vieth, Michael
    Engstrand, Lars
    Johansson, Sven-Erik
    Bolling-Sternevald, Elisabeth
    Bolinder, Gunilla
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Talley, Nicholas J.
    Agreus, Lars
    Use of tobacco products and gastrointestinal morbidity: an endoscopic population-based study (the Kalixanda study)2010In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 25, no 10, p. 741-750Article in journal (Refereed)
    Abstract [en]

    The impact of snus (smokeless tobacco or snuff) on gastrointestinal symptoms and pathological findings is largely unknown. The authors aimed to investigate whether the exposure to different forms of tobacco influences upper gastrointestinal symptoms, histology and frequency of Helicobacter pylori infection. A random sample (n = 2,860) of the adult population of two northern Swedish municipalities Kalix and Haparanda (n = 21,610) was surveyed between December 1998 and June 2001 using a validated postal questionnaire assessing gastrointestinal symptoms (response rate 74.2%, n = 2,122) (The Kalixanda Study). A random sub-sample (n = 1,001) of the responders was invited to undergo an esophagogastroduodenoscopy (participation rate 73.3%) including biopsies, Helicobacter pylori culture and serology and symptom assessment and exploration of present and past use of tobacco products. No symptom groups were associated with snus use. Snus users had a significantly higher prevalence of macroscopic esophagitis univariately but snus use was not associated with esophagitis in multivariate analysis. Snus use was associated with basal cell hyperplasia (OR = 1.74, 95% CI: 1.02, 3.00) and with elongation of papillae (OR = 1.79, 95% CI: 1.05-3.05) of the squamous epithelium at the esophago-gastric junction. Current smoking cigarettes was associated with overall peptic ulcer disease (OR = 2.32, 95% CI: 1.04, 5.19) whereas snus use was not. There were no significant association between current Helicobacter pylori infection and different tobacco product user groups. Snus significantly alters the histology of the distal esophagus but does not impact on gastrointestinal symptoms or peptic ulcer disease.

  • 89.
    Arousell, J.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Carlbom, A.
    Malmö Univ, Fac Hlth & Soc, Malmö, Sweden.
    Larsson, Elin
    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.
    Johnsdotter, S.
    Malmö Univ, Fac Hlth & Soc, Malmö, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Unintended consequences of gender equality promotion in Swedish contraceptive counselling2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Supplement: 1, p. 105-105Article in journal (Other academic)
  • 90.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Carlbom, A.
    Malmö Univ, Fac Hlth & Soc, Malmö, Sweden..
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Is multiculturalism bad for swedish abortion care?: Exploring the diversity of religious counselling in public healthcare institutions2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 1, p. 122-122Article in journal (Other academic)
    Abstract [en]

    Background:

    Sweden has one of the most liberal abortion laws in the world, granting women extensive rights to make autonomous reproductive decisions. At the same time, Swedish policy-makers are keen to protect society’s religious diversity. This ambition is reflected in decisions to grant religious leaders the possibility to provide ‘spiritual care’ in public hospitals. Through interviews with religious representatives in public healthcare institutions, we asked: In what ways would they counsel a religious woman who is seeking their advice about abortion? And how does this advice correspond with Swedish policies on, and provision of, abortion care?

    Methods:

    Individual interviews were conducted with religious representatives of the Swedish Church, the Catholic Church, and the Buddhist and Muslim communities. Interviews took place in 2016 and 2017.

    Findings:

    We found that informants saw it as their obligation to provide religious people with abortion advice according to religious norms, giving them limited opportunities to harmonise the content of their counselling with Swedish healthcare laws or regulations. Most informants argued that it was their responsibility to inform women about the wrongdoing of terminating a pregnancy, and to provide suggestions about how women could mitigate the sin in order to gain God’s forgiveness.

    Conclusion:

    Informants appeared inclined to deliver religious recommendations on abortion that were more conservative than what is established in the Swedish Abortion Act.

    Main messages:

    • ‘Spiritual care’ in the question of abortion favours the delivery of religious norms at the possible expense of women’s right to non-judgmental abortion counselling.

    • ‘Spiritual care’ is now an integral part of Swedish healthcare institutions. A critical discussion is needed about the extent to which such services should be in compliance with Swedish laws and public health aims on abortion.

  • 91.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Carlbom, A.
    Malmö Univ, Fac Hlth & Soc, Malmö, Sweden..
    Johnsdotter, S.
    Malmö Univ, Fac Hlth & Soc, Malmö, Sweden..
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Are 'Low Socioeconomic Status' and 'Religiousness' barriers to minority women's contraceptive use in Sweden and Denmark?: A qualitative interrogation of a common argument in health research2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 121-121Article in journal (Other academic)
  • 92.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Carlbom, Aje
    Malmo Univ, Fac Hlth & Soc, S-20506 Malmo, Sweden.
    Johnsdotter, Sara
    Malmo Univ, Fac Hlth & Soc, S-20506 Malmo, 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), International Maternal and Reproductive Health and Migration.
    Are 'low socioeconomic status' and 'religiousness' barriers to minority women's use of contraception? A qualitative exploration and critique of a common argument in reproductive health research2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 75, p. 59-65Article in journal (Refereed)
    Abstract [en]

    Objective: 'Low socioeconomic status' and 'religiousness' appear to have gained status as nearly universal explanatory models for why women in minority groups are less likely to use contraception than other women in the Scandinavian countries. Through interviews with pious Muslim women with immigrant background, living in Denmark and Sweden, we wanted to gain empirical insights that could inform a discussion about what 'low socioeconomic status' and 'religiousness' might mean with regard to women's reproductive decisions.

    Design: Semi-structured interviews were conducted in Denmark and Sweden between 2013 and 2016.

    Findings: We found that a low level of education and a low income were not necessarily obstacles for women's use of contraception; rather, these were strong imperatives for women to wait to have children until their life circumstances become more stable. Arguments grounded in Islamic dictates on contraception became powerful tools for women to substantiate how it is religiously appropriate to postpone having children, particularly when their financial and emotional resources were not yet established.

    Conclusion: We have shown that the dominant theory that 'low socioeconomic status' and 'religiousness' are paramount barriers to women's use of contraception must be problematized. When formulating suggestions for how to provide contraceptive counseling to women in ethnic and religious minority groups in Denmark and Sweden, one must also take into account that factors such as low financial security as well as religious convictions can be strong imperatives for women to use contraception.

    Implications for practice: This study can help inform a critical discussion about the difficulties of using broad group-categorizations for understanding individuals' health-related behavior, as well as the validity of targeted interventions towards large heterogeneous minority groups in Scandinavian contraceptive counseling.

  • 93.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Carlbom, Aje
    Faculty of Health and Society, Malmö University.
    Johnsdotter, Sara
    Faculty of Health and Society, Malmö University.
    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), International Maternal and Reproductive Health and Migration.
    Does Religious Counselling on Abortion Comply with Sweden’s ‘Women‑Friendly’ Abortion Policies?: A Qualitative Exploration Among Religious Counsellors2019In: Sexuality & Culture, ISSN 1095-5143, E-ISSN 1936-4822, Vol. 23, no 4, p. 1230-1249Article in journal (Refereed)
    Abstract [en]

    The abortion discourse in Sweden is marked by historically liberal ideals about women’s inviolable right to make autonomous reproductive decisions. However, to respond to the increase in cultural and religious pluralism building up over several decades, religious organizations have been given opportunities to provide so-called spiritual care in affiliation with Swedish hospitals since the 1980s. In this study we asked: in what ways do religious counsellors, affiliated with Swedish hospitals, construct their ideas on abortion, and how well do their ideas comply with Sweden’s ‘women-friendly’ abortion policies? Through interviews with Protestant, Catho-lic, Muslim, and Buddhist religious counsellors, we wanted to empirically test the presumption underlying the decisions to grant space to religious actors in Swedish healthcare, i.e., that religious counselling serves to complement existing services. We found that it cannot be expected that religious advice on abortion will always comply with Swedish abortion law and with the women-friendly abortion policy that the Swedish state seeks to impose. When policy-makers open up possibilities for diverse norms on abortion to manifest in close affiliation with healthcare institutions, they must be aware that some religious counsellors argue that only God—and not the woman herself—can decide whether a woman can terminate a pregnancy. We argue that the findings in this study speaks to what researchers have referred to as the “diversity-equality paradox”, which highlights the tension between the promotion of religious ideas on abortion on the one hand and the promotion of liberal ideas about women’s reproductive freedom on the other.

  • 94.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    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).
    Johnsdotter, Sara
    Department of Social Work, Malmö University.
    Carlbom, Aje
    Department of Social Work, Malmö University.
    Modes of Governing: A Foucaultian Perspective on Encounters between Healthcare Providers and Muslim Women in Swedish Reproductive HealthcareManuscript (preprint) (Other academic)
    Abstract [en]

    There are probably few groups of patients in Sweden today that arouse as much associations and thoughts as do Muslims from the Middle East. The core dilemma in much of these discussions is whether healthcare providers should adjust the provision of care to Muslims’ divergent religious preferences, or if they would be better off to treat Muslims in the same way as other patients. These debates are often entangled with both a concern about politics of equality (i.e. ambitions to treat everyone the same) and politics of diversity (i.e. to treatpeople from ethnic and religious minority groups differently). Inspired by Foucault’s concept of governmentality, we in this study intended to explore the principles of ‘equality’ and 'diversity’ as governing tools for the shaping of healthcare providers and patients’ conduct. We found that although these governing tools are presented as non-conflicting in health policies, there seems to be an often-present trade-off between diversity and equality ideals in their practical implementation. When these policies are assigned meaning and implemented inpractice, they appear to generate unforeseeable consequences, both for healthcare providers and for the patients. It thus appears that the policies that were introduced with the intention of improving the structure of multicultural care encounters, in some cases, had an opposite effect.

  • 95.
    Arta, Behzad
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Vikten av socialt stöd för ensamkommande barn i relationen till gode mannen: Intervjustudie2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    It is increasingly common for unaccompanied minors to seek asylum as political refugees. The most crucial factors for unaccompanied minors are the time they arrive in Sweden and the manner in which they are received. As one of the people they meet on arrival, their legal guardian is both important and appreciated by unaccompanied children. The purpose of this study has been to gain a deeper understanding of what unaccompanied minors consider to be significant in relation to the legal guardian during the asylum process. Data were collected through nine semi-structured interviews of unaccompanied minors. Data were collected through nine semi-structured interviews. These data were analyzed by qualitative content analysis. The results show that a good relationship with the legal guardian is significant for unaccompanied minors. The study found that participants wanted a legal guardian to be available, and for the legal guardian to see the mission as a relationship, to be informal, and to serve as a substitute for a parent/parents. It also emerged that emotional support is important for unaccompanied minors. The conclusion of the interview-based study was that the legal guardian was an important person in the unaccompanied minors’ lives during the asylum process. Besides receiving practical aid, the children asked for emotional support and expected that their legal guardian would be more like a friend or parent.

  • 96.
    Artursson, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Eriksson Holma, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Tillgänglighet och delaktighet i offentlig miljö för personer med fysisk funktionsnedsättning: En litteraturstudie2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The Swedish Parliament decided in 2000 on a national plan to improve the accessibility to people with disability. Environmental barriers should be removed prior to 2010.

    Purpose. To investigate how accessibility to public environments is described in scientific articles and how it influences participation in social activities for persons with physical functional limitations.

    Method. Review of scientific articles found in four different databases.

    Results. Eleven scientific articles published 2002-2009 were studied and the result showed that accessibility to public environments is found to be of great importance for participation in social activities. For persons with physical functional limitations, level of disability, age and experience of environmental barrioers are utmost importance.

    Conclusion. The result strengthen the necessity of following the national plan from 2000 and thereby increase the possibilities for persons with disability to live according to their own wishes and not be forced to accept environmental barriers.

  • 97.
    Ashish, K. C.
    et al.
    United Nations Childrens Fund, Nepal Country Off, POB 1187,UN House, Kathmandu, Nepal..
    Nelin, Viktoria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Raaijmakers, Hendrikus
    United Nations Childrens Fund, Nepal Country Off, POB 1187,UN House, Kathmandu, Nepal..
    Kim, Hyung Joon
    United Nations Childrens Fund, Nepal Country Off, POB 1187,UN House, Kathmandu, Nepal..
    Singh, Chahana
    United Nations Childrens Fund, Nepal Country Off, POB 1187,UN House, Kathmandu, Nepal..
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Increased immunization coverage addresses the equity gap in Nepal2017In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 95, no 4, p. 261-269Article in journal (Refereed)
    Abstract [en]

    Objective To compare immunization coverage and equity distribution of coverage between 2001 and 2014 in Nepal. Methods We used data from the Demographic and Health Surveys carried out in 2001, 2006 and 2011 together with data from the 2014. Multiple Indicator Cluster Survey. We calculated the proportion, in mean percentage, of children who had received bacille Calmette-Guerin (BCG) vaccine, three doses of polio vaccine, three doses of diphtheria-pertussis-tetanus (DPT) vaccine and measles vaccine. To measure inequities between wealth quintiles, we calculated the slope index of inequality (SII) and relative index of inequality (RII) for all surveys. Findings From 2001 to 2014, the proportion of children who received all vaccines at the age of 12 months increased from 68.8% (95% confidence interval, CI: 67.5-70.1) to 82.4% (95% CI: 80.7-84.0). While coverage of BCG, DPT and measles immunization statistically increased during the study period, the proportion of children who received the third dose of polio vaccine decreased from 93.3% (95% CI: 92.7-93.9) to 88.1% (95% CI: 86.8-89.3). The poorest wealth quintile showed the greatest improvement in immunization coverage, from 58% to 77.9%, While the wealthiest quintile only improved from 84.8% to 86.0%. The SII for children who received all vaccines improved from 0.070 (95% CI: 0.061-0.078) to 0.026 (95% CI: 0.013-0.039) and RII improved from 1.13 to 1.03. Conclusion The improvement in immunization coverage between 2001 and 2014 in Nepal can mainly be attributed to the interventions targeting the disadvantaged populations.

  • 98.
    Ashish, K. C.
    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). Nepal Country Off, United Nations Childrens Fund, Lalitpur, Nepal..
    Wrammert, Johan
    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).
    Nelin, Viktoria
    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).
    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).
    Clark, Robert
    Latter Day St Char, Salt Lake City, UT USA..
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala Univ, Dept Womens & Childrens Hlth, Int Maternal & Child Hlth, Uppsala, Sweden..
    Level of mortality risk for babies born preterm or with a small weight for gestation in a tertiary hospital of Nepal2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 877Article in journal (Refereed)
    Abstract [en]

    Background: Globally, 15 million babies were born prematurely in 2012, with 37.6 % of them in South Asia. About 32.4 million infants were born small for gestational age (SGA) in 2010, with more than half of these births occurring in South Asia. In Nepal, 14 % of babies were born preterm and 39.3 % were born SGA in 2010. We conducted a study in a tertiary hospital of Nepal to assess the level of risk for neonatal mortality among babies who were born prematurely and/or SGA. Methods: This case-control study was completed over a 15-month period between July 2012 and September 2013. All neonatal deaths that occurred during the study period were included as cases and 20 % of women with live births were randomly selected as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analyses were conducted to determine the level of risk for neonatal mortality among babies born preterm and/or SGA. Results: During this period, the hospital had an incidence of preterm birth and SGA of 8.1 and 37.5 %, respectively. In the multivariate model, there was a 12-fold increased risk of neonatal death among preterm infants compared to term. Babies who were SGA had a 40 % higher risk of neonatal death compared to those who were not. Additionally, babies who were both preterm and SGA were 16 times more likely to die during the neonatal period. Conclusions: Our study showed that the risk of neonatal mortality was highest when the baby was born both preterm and SGA, followed by babies who were born preterm, and then by babies who were SGA in a tertiary hospital in Nepal. In tertiary care settings, the risk of mortality for babies who are born preterm and/or SGA can be reduced with low-cost interventions such as Kangaroo Mother Care or improved management of complications through special newborn care or neonatal intensive care units. The risk of death for babies who are born prematurely and/or SGA can thus be used as an indicator to monitor the quality of care for these babies in health facility settings.

  • 99.
    Asif, Akila
    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).
    Maternal satisfaction and recommendation of perinatal health facility: A cross sectional study measuring perceptions of mothers experiences of maternity care at tertiary care hospitals in Nepal2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: To achieve better health outcomes it is important to identify those aspects of health care delivery system that determines patient satisfaction. The health care planners must therefore be cognizant of the opinions and expectations of those who utilize health care facilities to achieve better health outcomes. This also applies to maternal satisfaction. The study aimed to measure mothers satisfaction with maternity care and its association with various socio-demographic characteristics.

    Method: The study presented here is a quantitative cross-sectional study that utilizes secondary data from facility-based survey conducted in 12 different tertiary hospitals of Nepal and included client exit interviews  (n=43756). The maternal satisfaction association with different exposures and potential confounders was determined using multivariate logistic regression analysis. Statistical Package for Social Sciences (SPSS) was used for data analysis.

    Results:. Better information and counselling is seen to be associated with higher satisfaction and recommendation [AOR: 1.67 [1.60-1.75]] and [1.68[1.57-1.80], respectively. Higher level of delivery preparation indicates lower overall satisfaction [AOR: 0.70 [0.66-0.74]]. Mothers were seen to be less satisfied with the religious and cultural aspects of the maternal health services. Mothers age and sex of child was not seen to be significant with any outcome.

    Conclusion: Better information and counselling indicates more satisfaction and recommendation. Mothers delivery preparation is seen as a significant predictor of their overall satisfaction; therefore, this should be a part of education and information strategy for mothers from the different backgrounds.

  • 100.
    Asp, M.
    et al.
    Malardalen Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden..
    Simonsson, B.
    Reg Vastmanland, Competence Ctr Hlth, Vasteras, Sweden..
    Larm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Molarius, A.
    Reg Vastmanland, Competence Ctr Hlth, Vasteras, Sweden..
    The association between physical activity and obesity differs by physical mobility among elderly2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27Article in journal (Other academic)
1234567 51 - 100 of 1812
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf