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  • 151. Aldén, Lina
    et al.
    Björklund, Anders
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Hammarstedt, Mats
    Early Health and School Outcomes for Children with Lesbian Parents: Evidence from Sweden2017Report (Other academic)
    Abstract [en]

    Sweden was early to legalize same-sex partnership (1995), to allow same-sex couples to adopt children (2003), and to offer same-sex couples fertility treatment through the national health system (2005). Using population data, we identify children of lesbian parents as those whose biological mother was a registered same-sex partner no later than six months after the child's birth. The number of such children increased markedly from 1995 to 2010 with a total of 750 children for the whole period. We find that boys and girls with lesbian parents had 2.4 percent lower birth weight than other children, a difference that is statistically significant from zero at the 5 percent level. Girls, but not boys, also have a higher probability of having a low birth weight. We follow these children until age ten and observe diseases of the respiratory system. Boys with lesbian parents have a significantly lower probability of such diseases (-3.4 percentage points), and girls with lesbian parents an insignificantly higher probability (+2.4 percentage points). Our analysis of school outcomes at age ten uses a small sample so precision is low. The point estimates show that boys with lesbian parents outperform other children by around 10 percentiles higher test scores in Math and Swedish. These differences are barely significant, while estimates for girls are lower and not significant. For all outcomes, we find that children with lesbian parents benefit from their mother's socio-economic status, whereas they suffer in terms of birth weight from having been exposed to fertility treatment.

  • 152.
    Alehagen, Urban
    et al.
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Johansson, Peter
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Björnstedt, Mikael
    Division of Pathology F42, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Rosén, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Post, Claes
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Aaseth, Jan
    Research Department, Innlandet Hospital Trust and Hedmark University College, Norway.
    Relatively high mortality risk in elderly Swedish subjects with low selenium status2016In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 70, no 1, p. 91-96Article in journal (Refereed)
    Abstract [en]

    Background/Objectives: 

    The daily dietary intake of selenium (Se), an essential trace element, is still low in Sweden in spite of decades of nutritional information campaigns and the effect of this on the public health is presently not well known. The objective of this study was to determine the serum Se levels in an elderly Swedish population and to analyze whether a low Se status had any influence on mortality.

    Subjects/Methods: 

    Six-hundred sixty-eight (n=668) elderly participants were invited from a municipality and evaluated in an observational study. Individuals were followed for 6.8 years and Se levels were re-evaluated in 98 individuals after 48 months. Clinical examination of all individuals included functional classification, echocardiography, electrocardiogram and serum Se measurement. All mortality was registered and endpoints of mortality were assessed by Kaplan–Meier plots, and Cox proportional hazard ratios adjusted for potential confounding factors were calculated.

    Results: 

    The mean serum Se level of the study population (n=668) was 67.1 μg/l, corresponding to relatively low Se intake. After adjustment for male gender, smoking, ischemic heart disease, diabetes, chronic obstructive pulmonary disease and impaired heart function, persons with serum Se in the lowest quartile had 43% (95% confidence interval (CI): 1.02–2.00) and 56% (95% CI: 1.03–2.36) increased risk for all-cause and cardiovascular mortality, respectively. The result was not driven by inflammatory effects on Se concentration in serum.

    Conclusion: 

    The mean serum Se concentration in an elderly Swedish population was 67.1 μg/l, which is below the physiological saturation level for several selenoprotein enzymes. This result may suggest the value of modest Se supplementation in order to improve the health of the Swedish population.

  • 153.
    Alehagen, Urban
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Slind Olsen, Renate
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. County Hospital Ryhov, Sweden.
    Länne, Toste
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Matussek, Andreas
    County Hospital Ryhov, Sweden.
    Wågsäter, Dick
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    PDGF-D gene polymorphism is associated with increased cardiovascular mortality in elderly men2016In: BMC Medical Genetics, ISSN 1471-2350, E-ISSN 1471-2350, Vol. 17, no 62Article in journal (Refereed)
    Abstract [en]

    Background: Platelet-derived growth factor (PDGF) D has been reported to be active in fibroblasts, and in areas of myocardial infarction. In this longitudinal study we evaluated the association between PDGF-D polymorphism and cardiovascular mortality, and attempted to discover whether specific genotype differences regarding risk could be observed, and if gender differences could be seen. Methods: Four hundred seventy-six elderly community participants were included in this study. All participants underwent a clinical examination, echocardiography, and blood sampling including PDGF-D single nucleotide polymorphism (SNP) analyses of the rs974819 A/A, G/A and G/G SNP. The follow-up time was 6.7 years. Results: No specific genotype of rs974819 demonstrated increased cardiovascular mortality in the total population, however, the male group with genotypes A/A and G/A demonstrated an increased risk that persisted in a multivariate evaluation where adjustments were made for well-known cardiovascular risk factors (2.7 fold compared with the G/G genotype). No corresponding finding was observed in the female group. Conclusion: We report here for the first time that the genotypes G/A or A/A of the SNP rs974819 near PDGF-D exhibited a 2.7 fold increased cardiovascular mortality risk in males. Corresponding increased risk could not be observed in either the total population and thus not in the female group. However, the sample size is was small and the results should be regarded as hypothesis-generating, and thus more research in the field is recommended.

  • 154. Aleksandrova, Krasimira
    et al.
    Jenab, Mazda
    Leitzmann, Michael
    Bueno-de-Mesquita, Bas
    Kaaks, Rudolf
    Trichopoulou, Antonia
    Bamia, Christina
    Lagiou, Pagona
    Rinaldi, Sabina
    Freisling, Heinz
    Carayol, Marion
    Pischon, Tobias
    Drogan, Dagmar
    Weiderpass, Elisabete
    Jakszyn, Paula
    Overvad, Kim
    Dahm, Christina C.
    Tjonneland, Anne
    Bouton-Ruault, Marie-Christine
    Kuehn, Tilman
    Peppa, Eleni
    Valanou, Elissavet
    La Vecchia, Carlo
    Palli, Domenico
    Panico, Salvatore
    Sacerdote, Carlotta
    Agnoli, Claudia
    Tumino, Rosario
    May, Anne
    van Vulpen, Jonna
    Borch, Kristin Benjaminsen
    Oyeyemi, Sunday Oluwafemi
    Ramon Quiros, J.
    Bonet, Catalina
    Sanchez, Maria-Jose
    Dorronsoro, Miren
    Navarro, Carmen
    Barricarte, Aurelio
    van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Key, Timothy J.
    Khaw, Kay-Tee
    Wareham, Nicholas
    Assi, Nada
    Ward, Heather A.
    Aune, Dagfinn
    Riboli, Elio
    Boeing, Heiner
    Physical activity, mediating factors and risk of colon cancer: insights into adiposity and circulating biomarkers from the EPIC cohort2017In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 6, p. 1823-1835Article in journal (Refereed)
    Abstract [en]

    There is convincing evidence that high physical activity lowers the risk of colon cancer; however, the underlying biological mechanisms remain largely unknown. We aimed to determine the extent to which body fatness and biomarkers of various biologically plausible pathways account for the association between physical activity and colon cancer. We conducted a nested case-control study in a cohort of 519 978 men and women aged 25 to 70 years followed from 1992 to 2003. A total of 713 incident colon cancer cases were matched, using risk-set sampling, to 713 controls on age, sex, study centre, fasting status and hormonal therapy use. The amount of total physical activity during the past year was expressed in metabolic equivalent of task [MET]-h/week. Anthropometric measurements and blood samples were collected at study baseline. High physical activity was associated with a lower risk of colon cancer: relative risk a parts per thousand<yen>91 MET-h/week vs < 91 MET-h/week = 0.75 [95% confidence interval (CI): 0.57 to 0.96]. In mediation analyses, this association was accounted for by waist circumference: proportion explained effect (PEE) = 17%; CI: 4% to 52%; and the biomarkers soluble leptin receptor (sOB-R): PEE = 15%; 95% CI: 1% to 50% and 5-hydroxyvitamin D (25[OH]D): PEE = 30%; 95% CI: 12% to 88%. In combination, these factors explained 45% (95% CI: 20% to 125%) of the association. Beyond waist circumference, sOB-R and 25[OH]D additionally explained 10% (95% CI: 1%; 56%) and 23% (95% CI: 6%; 111%) of the association, respectively. Promoting physical activity, particularly outdoors, and maintaining metabolic health and adequate vitamin D levels could represent a promising strategy for colon cancer prevention.

  • 155. Aleksandrova, Krasimira
    et al.
    Pischon, Tobias
    Jenab, Mazda
    Bueno-de-Mesquita, H Bas
    Fedirko, Veronika
    Norat, Teresa
    Romaguera, Dora
    Knüppel, Sven
    Boutron-Ruault, Marie-Christine
    Dossus, Laure
    Dartois, Laureen
    Kaaks, Rudolf
    Li, Kuanrong
    Tjønneland, Anne
    Overvad, Kim
    Quirós, José Ramón
    Buckland, Genevieve
    Sánchez, María José
    Dorronsoro, Miren
    Chirlaque, Maria-Dolores
    Barricarte, Aurelio
    Khaw, Kay-Tee
    Wareham, Nicholas J
    Bradbury, Kathryn E
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Palli, Domenico
    Krogh, Vittorio
    Tumino, Rosario
    Naccarati, Alessio
    Panico, Salvatore
    Siersema, Peter D
    Peeters, Petra HM
    Ljuslinder, Ingrid
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ericson, Ulrika
    Ohlsson, Bodil
    Weiderpass, Elisabete
    Skeie, Guri
    Borch, Kristin
    Rinaldi, Sabina
    Romieu, Isabelle
    Kong, Joyce
    Gunter, Marc J
    Ward, Heather A
    Riboli, Elio
    Boeing, Heiner
    Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study2014In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 12, no 1, p. 168-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors are individually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of this study was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factors - healthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore the association of this index with CRC incidence using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. METHODS: In the EPIC cohort, a total of 347,237 men and women, 25- to 70-years old, provided dietary and lifestyle information at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC cases were identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazards regression models and population attributable risks (PARs) have been calculated. RESULTS: After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors, the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70 to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors; P-trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; P for trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend <0.0001) for rectal cancer, respectively (P-difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) were attributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index. CONCLUSIONS: Combined lifestyle factors are associated with a lower incidence of CRC in European populations characterized by western lifestyles. Prevention strategies considering complex targeting of multiple lifestyle factors may provide practical means for improved CRC prevention.

  • 156. Aleman, J
    et al.
    Brännström, Inger
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Liljestrand, J
    Peña, R
    Persson, L A
    Steidinger, J
    Saving more neonates in hospital: an intervention towards a sustainable reduction in neonatal mortality in a Nicaraguan hospital1998In: Tropical doctor, ISSN 0049-4755, E-ISSN 1758-1133, Vol. 28, no 2, p. 88-92Article in journal (Refereed)
    Abstract [en]

    A process of change was initiated in a Nicaraguan regional hospital in order to achieve a sustainable reduction of early neonatal mortality. A series of organizational, educational and hygienic measures was introduced, involving all staff in antenatal care, delivery care and neonatal care. Neonatal mortality decreased from 56/1000 live births in 1985 to 11/1000 in 1993. A commission of maternal and child health, a weekly perinatal audit, the active involvement of all staff and dedicated work of key individuals, as well as national policy decisions, are considered important determinants of the process. Keeping neonatal mortality in focus through continuous analysis of care routines, and through external exchange of ideas is important in order to sustain improvements and to decrease further the mortality.

  • 157.
    Alemu, Andinet Worku
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Determinants of survival in adult HIV patients on antiretroviral therapy in Oromiyaa, Ethiopia2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, article id 5398Article in journal (Refereed)
    Abstract [en]

    Background: The antiretroviral treatment (ART) scale-up service has been a recent development in Ethiopia, but its impact on mortality has not been well investigated. The aim of this study was to assess the early survival outcome of the scale-up service by utilizing routine hospital data.

    Methods: All adult HIV/AIDS patients who started on antiretroviral treatment in Shashemene and Assela hospitals from January 1, 2006 to May 31, 2006 were included and followed up for 2 years. Data were extracted from standard patient medical registrations. Kaplan-Meier curves were used to estimate survival probability and the Cox proportional hazard model was applied to determine predictors of mortality. Two alterative assumptions (real case and worst case) were made in determining predictors of mortality.

    Results: The median age of patients was 33 years and 57% were female. Eighty-five percent had CD4 <200 cells/mu L with a median CD4 count of 103 cells/mu L. The median survival time was 104.4 weeks. A total of 28 (10.3%) deaths were observed during the 2-year period and 48 patients (18%) were lost to follow up. The majority of deaths occurred in the first 4 months of treatment. In multivariate analysis, 2-year survival was significantly associated with the clinical stage of the disease, baseline hemoglobin, and cotrimoxazole prophylaxis therapy (CPT) at or before ART initiation in both assumptions. The median CD4 count and body weight showed a marked improvement during the first 6 months of treatment, followed by stagnation thereafter.

    Conclusion: The study has shown an overall low mortality but a high loss to follow-up rate of the cohort. Advanced clinical stage, anemia, low body weight, and lack of CPT initiation were independent predictors of mortality - but not gender. CPT initiation should be encouraged in routine HIV care services, and patient retention mechanisms have to be strengthened. Stagnation in immunological and weight recovery after the first 6 months should be further investigated. The utilization of routine data should be encouraged in order to facilitate appropriate decision making.

  • 158. Alemu, Yihun Mulugeta
    et al.
    Awoke, Worku
    Wilder-Smith, Annalies
    Institute of Public Health, Heidelberg University, Heidelberg, Germany; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
    Determinants for tuberculosis in HIV-infected adults in Northwest Ethiopia: a multicentre case-control study2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 4, article id e009058Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The objective of this study was to identify determinants for tuberculosis (TB) among HIV-infected adults in Northwest Ethiopia.

    DESIGN: Case-control study.

    SETTING: Three hospitals and 10 health centres in Northwest Ethiopia.

    PARTICIPANTS: A total of 446 individuals consented to participate in the study (150 cases and 296 controls). Cases were HIV-infected adults diagnosed with active TB, and controls were HIV-infected adults without active TB.

    MAIN OUTCOME MEASURE: The link between TB and determinants was assessed using logistic regression. Determinants were categorised as sociodemographic, host-related, clinical and environmental.

    RESULTS: Smoking (adjusted OR (AOR) 5.47; 95% CI 2.26 to 13.22), presence of a TB patient in the family (AOR 2.66; 95% CI 1.25 to 5.66), alcohol consumption (AOR 2.49; 95% CI 1.29 to 4.80) and chewing khat (AOR 2.22; 95% CI 1.11 to 4.41) were independent determinants for increased occurrence of TB. Highly active antiretroviral therapy (HAART) (AOR 0.25; 95% CI 0.13 to 0.51), isoniazid preventive therapy (IPT) (AOR 0.22; 95% CI 0.11 to 0.41) and cotrimoxazole preventive therapy (AOR 0.32; 95% CI 0.19 to 0.55) had a protective effect against TB.

    CONCLUSIONS: HIV-infected adults with substance abuse (tobacco smoking, khat chewing and alcohol) should be prioritised for TB screening. This study reaffirmed that HAART and IPT are some of the best strategies for reducing TB occurrence in HIV-infected adults. These findings provide impetus to intensify tracing of TB household contacts.

  • 159.
    Alenius, Gerd-Marie
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Reumatology.
    A Clinical and Genetic Study of Psoriatic Arthritis2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Psoriatic arthritis (PsA) is an inflammatory joint disease associated with psoriasis. PsA has a heterogeneous pattern, expressed by different manifestations such as mild mono-oligoarthritis or very severe, erosive and destructive polyarthritis. Measurable inflammatory activity is not always prominent. The aetiology is unknown but genetic factors are believed to be of importance. The pattern of inheritance is proposed to be polygenic. The aim of this study was to estimate the prevalence of joint and axial manifestations, characterise the disease in relation to inflammatory and genetic markers, and to identify disease susceptibility gene(s) for PsA in patients from northern Sweden.

    All patients from the city of Umeå (n=276), selected from a community and hospital based psoriasis register (n=1737) at the Dept of Dermatology, were invited to a prevalence study. Two hundred-two patients were examined and 97 (48%) had inflammatory manifestations such as peripheral arthritis, axial disease, undifferentiated spondylarthropathy (uSpA) and enthesopathies. Of the 67 patients (33 %) with peripheral arthritis and/or axial disease, 30 were not previously diagnosed.

    The association of clinical manifestations and potential markers of aggressive joint disease with HLA associations were analysed in 88 patients with PsA. We were not able to confirm findings of other groups reporting strong association with several HLA-antigens. The prevalence of HLA-B17, B37 and B62 was increased compared with controls, but the strongest predictive factors among our patients for an aggressive disease, in a multiple logistic analysis, were polyarthritic disease and distal interphalangeal engagement.

    In order to investigate for disease susceptibility genes, five genetic loci were analysed with microsatellites and single nucleotide polymorphisms in an association study of 120 patients with PsA. There was a significant association with the TNFB locus on chromosome 6p but not with any other loci examined; 1q21 (PSORS4), 3q21 (PSORS5), 8q24 and CTLA4. When stratifying for the TNFB alleles the association was confined to allele 123. In a subgroup of patients who were HLA-typed (n=83), we were not able to verify linkage disequilibrium with the TNFB allele 123 and the HLA antigens; B17, B27, B37, B62 or Cw*0602.

    The presence of renal abnormalities was evaluated as a manifestation of systemic inflammation in 73 patients with PsA. Renal abnormalities defined as decreased creatinine-clearance (≤ mean - 2SD) and/or urinary albumin >25 mg/24 h was found in 23% of the patients. The predictive factors for renal abnormalities was inflammatory activity (ESR > 25 mm/h and/or CRP >15 mg/L) indicating a systemic effect in some of the patients.

    In conclusion, we found high prevalence of inflammatory manifestations in patients with psoriasis. There was no strong association between PsA and HLA antigens and predictive factors for aggressive disease were polyarthritic disease and DIP joint engagement. The TNFB locus was associated with PsA and there were no linkage disequilibrium with the HLA antigens B17, B27, B62 or Cw*0602. There were evidence for systemic effects as renal abnormalities in patients with PsA and measurable inflammatory activity.

  • 160.
    Alers, Margret
    et al.
    Unit Gender and Women’s Health, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands .
    Pepping, Tess
    Unit Gender and Women’s Health, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.
    Bor, Hans
    Unit Gender and Women’s Health, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.
    Verdonk, Petra
    Department of Medical Humanities, School of Medical Sciences, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands .
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lagro-Janssen, Antoine
    Unit Gender and Women’s Health, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.
    Speciality preferences in Dutch medical students influenced by their anticipation on family responsibilities2014In: Perspectives on Medical Eduction, ISSN 2212-277X, Vol. 3, no 6, p. 443-454Article in journal (Refereed)
    Abstract [en]

    Physician gender is associated with differences in the male-to-female ratio between specialities and with preferred working hours. We explored how graduating students’ sex or full-time or part-time preference influences their speciality choice, taking work-life issues into account. Graduating medical students at Radboud University Medical Centre, the Netherlands participated in a survey (2008–2012) on career considerations. Logistic regression tested the influence of sex or working hour preference on speciality choice and whether work-life issues mediate. Of the responding students (N = 1,050, response rate 83, 73.3 % women), men preferred full-time work, whereas women equally opted for part time. More men chose surgery, more women family medicine. A full-time preference was associated with a preference for surgery, internal medicine and neurology, a part-time preference with psychiatry and family medicine. Both male and female students anticipated that foremost the career of women will be negatively influenced by family life. A full-time preference was associated with an expectation of equality in career opportunities or with a less ambitious partner whose career would affect family life. This increased the likelihood of a choice for surgery and reduced the preference for family medicine among female students. Gender specifically plays an important role in female graduates’ speciality choice making, through considerations on career prospects and family responsibilities.

  • 161. Alexander, Anneli
    et al.
    Bergman, Patrick
    Hagströmer, Maria
    Sjöström, Michael
    IPAQ environmental module; Reliability testing2006In: Journal of Public Health, Vol. 14, no 2, p. 76-81Article in journal (Refereed)
  • 162. Alexander, Anneli
    et al.
    Bergman, Patrick
    Hagströmer, Maria
    Sjöström, Michael
    Metodprövning av IPAQs miljömodul2005In: Läkarstämman, Stockholm, 2005Conference paper (Refereed)
  • 163.
    Alexanderson, Kristina
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Leijon, Margareta
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingemar
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Rydh, Hillevi
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bjurulf, Per
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Epidemiology of sickness absence in a Swedish county in 1985, 1986 and 1987: A three year longitudinal study with focus on gender, age and occupation1994In: Scandinavian Journal of Social Medicine, ISSN 0300-8037, Vol. 22, no 1, p. 27-34Article in journal (Refereed)
    Abstract [en]

    In order to get a better epidemiological base for preventive intervention in the county of Östergötland, Sweden, a comprehensive study of sickness absence was done. During the years 1985, 1986 and 1987, all new periods of sick-leave exceeding seven days were registered with demographic variables. This information was related to data about the total population of Östergötland. Each year approx. 45,000 persons had approx. 61,000 sickness spells. These figures were stable over the years while the number of sick-leave days increased. Blue-collar occupations had the highest sick-leave rates and the female sick-leave rate was higher in general and much higher in most male-dominated occupations. The male rate was lower within female-dominated areas, except among secretaries and textile workers. Females in extremely male-dominated groups had the highest rates, while both male and female sick-leave rates were lower in more gender-integrated occupations.

  • 164.
    Alexandersson, Kristina
    et al.
    Karolinska Institutet.
    Lumikukka, Tuula
    Karolinska universitetssjukhuset, Huddinge.
    Tinghög, Petter
    Karolinska Institutet.
    Åkerlund, Kerstin
    Karolinska universitetssjukhuset, Solna.
    Att uppmärksamma barn till svårt sjuka patienter på en neurologisk klinik - utvärdering av implementering av rutiner och arbetssätt2017In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 4, p. 485-495Article in journal (Refereed)
    Abstract [sv]

    Barn till allvarligt somatiskt sjuka föräldrar löper en förhöjd risk för egen psykisk ohälsa. Här presenteras resultat från utvärderingen av implementering av rutiner och arbetssätt som syftade till att förbättra arbetet med att identifiera, informera samt stödja minderåriga barn till patienter på en neurologisk klinik. Fyra delstudier genomfördes. Resultaten indikerar att trots betydande insatser för att säkerställa att kliniken lever upp till sina lagstadgade uppgifter, fanns en stor förbättringspotential. Hela 80% av patienter med minderåriga barn hade inte fått information om sina barns rätt till stöd och 40% hade inte tillräckligt stöd för att utöva sin föräldraroll. Samtidigt noterades en tydlig ökning i andelen personal på kliniken som hade kunskap om sin skyldighet att erbjuda information, råd och stöd. 

  • 165.
    Alfadel, Anas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Social Activity and Health: Studying Elderly Adults’ Perspective upon Social Life and Health in Northern Sweden2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: The importance social activities plays in the elderly adults’ health was the focus of many different studies on social isolation and elderly adults. Yet, not so many studies tried to catch how socially active elderly adults think about the correlation between social life and health.

    Methods: A qualitative methodology with inductive approach has been carried out in this study. Data was collected under a one-hour long focus group discussion in which five informants from the study population participated in. Data was then analyzed using thematic analysis.

    Results: A variety of social activity for elderly adults is to be found in a small village in north Sweden. At the same time, the results show that elderly adults acknowledge the importance of social activity to health and show awareness about a well functioning social life. Nonetheless, two points emphasized a new meaning for the connection between social activity and health: food as a social activity, and, social activities keep mind alerted.

    Conclusion: There is to be a remarkable awareness in elderly adults living in north Sweden about the importance of social activity for health and that a variety in social activities is to be found even in small village in the north of Sweden.

  • 166.
    Alfakir, Firas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    “The thorny path towards future life!!”: International students’ experiences and feelings of stress: a qualitative study in Umeå2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Mental health among international students is one of the most important topics that have been studied in different countries worldwide, but none was done in Sweden. This thesis will explore both mental health problems with focus on stress among internationally mobile students in Umeå and the causes behind these problems. The general aim of this study will be to focus on exploring the experiences and feelings of these students in Umeå regarding culture shock, seasonal effect, social support network and academic stress.

    Methods: A qualitative methodology was used for this study. In depth semi-structured interviews were done with 4 international students in Umeå University from both genders who have spent at least six months in this city without returning to their original countries and these students were selected from four different continents. They were interviewed in regard to their experiences and feelings toward the main stressors that they can face when moving to a new city. The data was analyzed using thematic analysis which consists of both the deductive approach using the theory of stress and coping and the inductive approach where the researcher gave the data the opportunity to express itself freely.

    Results: This section includes the outcomes of the thematic analysis that was carried out. The first inductive approach of analysis revealed one main theme cultural balance and previous experience (globalization), which discloses the cultural diversity, distance and balance perceived by the internationally mobile students from the four different continents when they compare between their home culture and the Swedish culture. And how previous knowledge about the Swedish culture (globalization) can play a role in reducing the culture shock effect. The Second deductive approach of analysis was done by applying the Stress and Cognitive theory of stress and coping to the codes, which revealed two additional main themes. The first one is Stages of culture shock, which was analyzed using the emotions obtained by applying the theory. It shows the different stages experienced by the international students. The second one is coping strategies and individual differences, which shows the different coping mechanisms used by the students from the four different continents.

    Conclusion: leaving your home to study abroad can be a stressful experience even if you have previous knowledge about the new country, which can result in developing some mental health problems. Seasonal differences in particular are one of the most difficult things for international students to deal with, especially in Umeå where winter can be long and dark. Culture shock, on the other hand, can be another stressful situation, where you need to understand its different dimensions like cultural distance, balance and differences. Also culture shock stages, and its related emotion and coping mechanisms should be studied well to be able to find solutions for it. Social support network and how it interacts with students’ mental health should also be taken into account when leaving your people back-home. Of course study performance should not be neglected also when we need to study mental health problems as studying is the first reason why international students wanted to travel. After exploring all these aspects in particular implications for practice can be implemented to reduce the effect of the negative side of moving to a new country.

  • 167.
    Alfonso-Sanchez, José L
    et al.
    Department of Preventive Medicine and Public Health, University of Valencia.
    Mackenbach, Johan
    Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands .
    Hoffman, Rasmus
    Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands .
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Alfonso-Landet, Gema
    Department of Preventive Medicine and Public Health, University of Valencia..
    Evidence on the Association between Socioeconomic Resources and Amenable Mortality2017In: International Journal of Health Sciences and Research, Vol. 7(4), p. 370-379Article in journal (Refereed)
  • 168.
    Alfonsson, Sven
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Replacing the term “binge eating” with “loss of control over eating” affects eating disorder screening in clinical care2015In: Obesity Research and Clinical Practice, ISSN 1871-403X, E-ISSN 1878-0318, Vol. 9, no 5, p. 531-532Article in journal (Refereed)
    Abstract [en]

    Having episodes of binge eating is central to the binge eating disorder (BED) and bulimia nervosa (BN) diagnoses but may be difficult to assess accurately through self-report instruments and estimates of prevalence varies [1,2]. Some researchers have reported lower levels of binge eating in clinical interviews where interviewers may use follow up questions and correct misunderstandings, compared with self-report questionnaires [3]. Another reason for mixed results may be the negative stigma of binge eating behaviours and thus the embarrassment of admitting having binge eating episodes [4,5].

  • 169.
    Alfredsson, Elin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Kulturella aktiviteters betydelse för äldres känsla av sammanhang: En enkätundersökning på två äldreboenden i Mellansverige2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective: The purpose of this study was to investigate whether there was any association between participation in cultural activities and sense of coherence among seniors living in two nursing homes.

    Methods: A questionnaire based on Antonovskys SOC-13-questionaire was used, with added self-formulated questions including gender, age, level of physical function and participation in cultural activities. The questionnaire was distributed to 76 people 65 years and older without dementia at two nursing homes in central Sweden and 40 respondents answered the questionnaire. The material was processed and analyzed in the statistic computer program SPSS, where descriptive statistics were prepared and a chi-square analysis and logistic regression analysis was performed.

    Results: No statistically significant relationship between participation in cultural activities and sense of coherence could be seen. However, there was a correlation between the level of function and SOC scores. The lower level of function, i.e. the more help the respondent needed in everyday life, the lower sense of coherence.

    Conclusion: Functional level seems to have greater impact on an individual's sense of coherence than participation in cultural activities in the given study population.

  • 170.
    Alfredsson, Lars
    et al.
    lars.alfredsson@imm.ki.se.
    Hammar, Niklas
    Fransson, Eleanor
    de Faire, Ulf
    Hallqvist, Johan
    Knutsson, Anders
    Nilsson, Tohr
    Theorell, Törres
    Westerholm, Peter
    Job strain and major risk factors for coronary heart disease.: Baseline results from the WOLF Study2002In: Scandinavian Journal of Work, Environment & Health, ISSN 0355-3140, Vol. 28, no 4, p. 238-248Article in journal (Refereed)
    Abstract [en]

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

  • 171.
    Alfredsson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jeghannathan, Bhoomikumar
    Attitudes towards mental health and the integration of mental health services into primary health care: a cross-sectional survey among health-care workers in Lvea Em District, Cambodia2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1331579Article in journal (Refereed)
    Abstract [en]

    Background: Cambodia is a country where the resources for treating mental health disorders are far from sufficient. One strategy to narrow the treatment gap is to integrate mental health into primary health care (PHC). Understanding the knowledge and attitudes towards mental health integration that health-care workers have is important for assessing the challenges and opportunities when planning a potential integration project. Objective: The aim of this study was to assess these basic conditions in Lvea Em District, Cambodia. Design: A structured self-reporting questionnaire regarding attitudes and knowledge about mental health and its integration into PHC was collected from 75 health-care workers in Lvea Em District, Cambodia in October 2015. Firstly, descriptive analyses were carried out, and secondly, linear regression analyses to assess the relationship between attitudes and socio-demographic variables were conducted. Results: There was clear support towards integrating mental health services into PHC among these participants as 81.3% were interested in personally delivering mental health care at their units. Respondents who reported having received some kind of mental health-care training tended to have a more positive attitude towards mentally ill people (p = 0.005) and those who thought there was a high need for mental health care had a more favourable attitude towards the integration of mental health services (p = 0.007). Conclusions: The most important finding from this survey was the willingness and the acceptance of the need for integration of mental health care. This enhances the feasibility of integrating mental health services at the PHC level. Improving the competence of mental health care in these settings will likely help to reduce the treatment gap for mental, neurological and substance use disorders in Cambodia.

  • 172.
    Alfredsson, Pontus
    et al.
    University of Skövde, School of Health and Education.
    Hildorzon, Julia
    University of Skövde, School of Health and Education.
    Att främja fysisk aktivitet hos gravida kvinnor2014Independent thesis Basic level (university diploma), 5 credits / 7,5 HE creditsStudent thesis
    Abstract [en]

    Background: There is a gradual percentage increase in pregnant women who are overweight or obese in the west hemisphere. In Sweden, nearly 40 percent of those women are overweight and 10 percent are obese. One third of them are physically inactive which makes the research within public health highly relevant. Aim: To promote physical activity amongst pregnant women. Method: Ten research articles on the topic were reviewed to achieve a deeper understanding. By summarizing the most important and relevant points brought up in each article, a conclusion was formed. Those points where then categorized into three themes, which turned the study into a type of literature. Results: There are many factors that impact the pregnant women’s physical activity. These factors can be triggered by the actual pregnancy, such as symptoms causing the body to change. Location and environment is seen as important to help the promotion, such as social support and access to activities close to home. Effective interventions are diet and exercise consultations and measurable goals by using pedometers. Conclusion: The conclusion of this study was that several factors promoting pregnant women’s physical activity. Pregnant women are likely to follow the prenatal cares advice and therefore can interventions designed with the promoting factors integrated to prenatal care to achieve goals of public health.

  • 173. Alfvén, Tobias
    et al.
    Axelson, Henrik
    Lindstrand, Ann
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Persson, Lars-Ake
    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).
    Dödligheten minskar, men fortfarande dör 7 miljoner barn varje år2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 1-2, p. 28-30Article in journal (Other academic)
    Abstract [sv]

    Millenniemål 4 lyder: »Barnadödligheten under de fem första levnadsåren ska minska med två tredjedelar till 2015 jämfört med år 1990«.

    Barnadödligheten minskar i ­stora delar av världen, men inte i tillräckligt snabb takt för att uppnå målet. Den skiljer sig också kraftigt mellan länder och mellan olika grupper inom länderna.

    Sex dödsorsaker står för mer än 90 procent av alla dödsfall före 5 års ålder: neonatal mortalitet, lunginflammation, diarré, ­malaria, mässling och HIV/aids. ­Undernäring beräknas vara ­delorsak till cirka en tredjedel av dessa dödsfall.

    Vi har kunskap och metoder att med kostnadseffektiva lösningar reducera barnadödligheten med två tredjedelar. Fortsatt inter­nationellt samarbete, utökade ­resurser samt lokal, nationell po­litisk vilja krävs för att lyckas.

  • 174.
    Algotson, S.
    et al.
    Allebarnsratten, Stockholm, Sweden; Sch Hosp Culinary Arts & Meal Sci, Univ Örebro, Örebro, Sweden.
    Öström, Åsa
    Örebro University, School of Humanities, Education and Social Sciences.
    Sapere-taste lessons in Swedish pre-schools2010In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 20, no Suppl. 1, p. 106-106Article in journal (Other academic)
  • 175.
    Ali, DK
    et al.
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Dalal, Koustuv
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Yousefzade-Chabok, S
    Trauma Research Center, Guilan University of Medical Science, Rasht, Iran.
    Jansson, B
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Mohammadi, R
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Costs related to drowning and near drowning in northern Iran (Guilan province)2011In: Ocean and Coastal Management, ISSN 0964-5691, E-ISSN 1873-524X, Vol. 54, no 3, p. 250-255Article in journal (Refereed)
    Abstract [en]

    In Iran and many other low- and middle-income countries, few  studies have been carried out in order to assess which cost analysis methods should be  undertaken at the household and community level in relation to incidences of drowning. In this study, we have attempted to develop a model for  estimating the impact of the economic burden that drowning and near drowning events incur for victims’ families in the Guilan province in the north of  Iran by  using an  incidence approach. During the financial year of March 2007 to 2008,  the following cost-related aspects of  drowning episodes were evaluated: (note: main cost elements were income adjusted by family and years) medical costs, productivity loss  costs and death costs. A total of 137 drowning fatalities and 104 near drowning incidents were recorded. Males in the age  span of  10e29  years constitute a  majority of  the epidemiology and economy data. When the number of variables included in cost analysis was expanded, the estimated burden of economic duress increased dramatically; however, drowning cost for  one drowned victim was equivalent to 17  times the country’s  gross domestic product(GDP) per capital. Identification of  injured person-based costs in  this study will  enable development of  more effective prevention programs and provide indicators of  other costs related to drowning episodes such as  property damage and the impact of  these accidents on community services and the public health care system.

  • 176. Ali, Mohammed
    et al.
    Asefaw, Teklehaimanot
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Beyene, Hagos
    Pedersen, F Karup
    Helping northern Ethiopian communities reduce childhood mortality: population-based intervention trial2005In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 83, no 1, p. 27-33Article in journal (Refereed)
  • 177.
    Ali, Mona
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, Department of Caring and Public Health Sciences.
    Make Every Mother Count: Maternal mortality in Malawi, India and United Kingdom2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective: The aim of this thesis is to examine and compare the maternal mortality in three different countries; Malawi, India and United Kingdom, as well as highlighting the attributing factors and preventive steps that would reduce the maternal mortality in these countries. Methods and material: The studied design that was chosen is an ecological study which means to study the relationship between aggregated health data and exposing factors, for example a geographical area and time period. The reason of choosing this study can be seen in the relationship and the factors that contribute to maternal mortality in Malawi, India and the United Kingdom. In order to attain the objective of the thesis a variety of sources were utilized to find data, statistics and scientific articles concerning maternal mortality in all three countries.Results and conclusion: Maternal mortality is the highest in Malawi and India, while it is very low in the United Kingdom when compared with these two countries. The result shows among other things that the maternal mortality is mainly caused by direct causes both in Malawi and India and in the United Kingdom the maternal mortality is mainly from indirect causes. It is also shown that the maternal mortality in these countries have been changed over the years. It is also shown that preventive steps such as family planning, skilled attendance, obstetric emergency care and antenatal care can significantly reduce the maternal mortality rate.

  • 178. Ali, Tazeen S
    et al.
    Asad, Nargis
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Krantz, Gunilla
    Intimate partner violence in urban Pakistan: prevalence, frequency, and risk factors2011In: International journal of women's health, ISSN 1179-1411, Vol. 3, p. 105-15Article in journal (Refereed)
    Abstract [en]

    Background: Intimate partner violence (IPV) is an important public health issue with severe adverse consequences. Population-based data on IPV from Muslim societies are scarce, and Pakistan is no exception. This study was conducted among women residing in urban Karachi, to estimate the prevalence and frequency of different forms of IPV and their associations with sociodemographic factors.

    Methods: This cross-sectional community-based study was conducted using a structured questionnaire developed by the World Health Organisation for research on violence. Community midwives conducted face-to-face interviews with 759 married women aged 25–60 years.

    Results: Self-reported past-year and lifetime prevalence of physical violence was 56.3 and 57.6%, respectively; the corresponding figures for sexual violence were 53.4% and 54.5%, and for psychological abuse were 81.8% and 83.6%. Violent incidents were mostly reported to have occurred on more than three occasions during the lifetime. Risk factors for physical violence related mainly to the husband, his low educational attainment, unskilled worker status, and five or more family members living in one household. For sexual violence, the risk factors were the respondent’s low educational attainment, low socioeconomic status of the family, and five or more family members in one household. For psychological violence, the risk factors were the husband being an unskilled worker and low socioeconomic status of the family.

    Conclusion: Repeated violence perpetrated by a husband towards his wife is an extremely common phenomenon in Karachi, Pakistan. Indifference to this type of violence against women stems from the attitude that IPV is a private matter, usually considered a justifiable response to misbehavior on the part of the wife. These findings point to serious violations of women’s rights and require the immediate attention of health professionals and policymakers.

  • 179. Ali, Tazeen S
    et al.
    Krantz, Gunilla
    Gul, Raisa
    Asad, Nargis
    Johansson, Eva
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Gender roles and their influence on life prospects for women in urban Karachi, Pakistan: a qualitative study2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, p. 7448-Article in journal (Refereed)
    Abstract [en]

    Background: Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women’s and men’s life prospects.

    Objective: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men’s and women’s life circumstances.

    Design: Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied.

    Findings: Two major themes emerged during analysis: ‘Reiteration of gender roles’ and ‘Agents of change’. The first theme included perceptions of traditional gender roles and how these preserve women’s subordination. The power gradient, with men holding a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation.

    Conclusions: This study reveals serious gender inequalities and human rights violations against women in the Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. Women routinely faced serious restrictions and limitations of autonomy. However, attainment of higher levels of education especially not only for women but also for men was viewed as an agent towards change. Furthermore, mass media was perceived as having a positive role to play in supporting women’s empowerment.

  • 180. Ali, Tazeen S
    et al.
    Krantz, Gunilla
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Violence permeating daily life: a qualitative study investigating perspectives on violence among women in Karachi, Pakistan2012In: International Journal of Women's Health, ISSN 1179-1411, E-ISSN 1179-1411, Vol. 4, p. 577-585Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study explored how married women perceive situations which create family conflicts and lead to different forms of violence in urban Pakistan. In addition, it examines perceptions of consequences of violence, their adverse health effects, and how women resist violence within marital life.

    METHODS: Five focus group discussions were conducted with 28 women in Karachi. Purposive sampling, aiming for variety in age, employment status, education, and socioeconomic status, was employed. The focus group discussions were conducted in Urdu and translated into English. Manifest and latent content analysis were applied.

    RESULTS: One major theme emerged during the analysis, ie, family violence through the eyes of females. This theme was subdivided into three main categories. The first category, ie, situations provoking violence and their manifestations, elaborates on circumstances that provoke violence and situations that sustain violence. The second category, ie, actions and reactions to exposure to violence, describes consequences of ongoing violence within the family, including those that result in suicidal thoughts and actions. The final category, ie, resisting violence, describes how violence is avoided through women's awareness and actions.

    CONCLUSION: The current study highlights how female victims of abuse are trapped in a society where violence from a partner and family members is viewed as acceptable, where divorce is unavailable to the majority, and where societal support of women is limited. There is an urgent need to raise the subject of violence against women and tackle this human rights problem at all levels of society by targeting the individual, family, community, and societal levels concurrently.

  • 181. Ali, Tazeen S
    et al.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Krantz, Gunilla
    Intimate partner violence and mental health effects: a population-based study among married women in Karachi, Pakistan2013In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 20, no 1, p. 131-139Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Intimate partner violence (IPV) is recognized all over the world for its association with mental health problems in women. In Pakistan, such violence occurs commonly, but detailed information on mental health effects is scarce. The purpose of this study is to focused on married couples in urban Karachi to investigate mental health effects associated with physical, sexual and psychological violence perpetrated by husbands towards wives. Disclosure rates and health care-seeking behaviour were also investigated. METHOD: This cross-sectional study involved 759 women between the ages of 25 and 60 years, selected using a multi-stage random sampling technique. The women were interviewed by trained community midwives using a structured questionnaire. RESULTS: In the total population of women, mental symptoms were prevalent. Women subjected to any form of violence reported, however, considerably poorer mental health than unexposed women. A statistically significant difference for almost all of the studied health parameters persisted even after controlling for socio-demographic factors. The strongest associations were found for suicidal thoughts and physical violence (OR 4.41; 3.18-6.12), sexual abuse (OR 4.39; 3.17-6.07) and psychological abuse (OR 5.17; 3.28-8.15). The interviews revealed that only 27% of the women subjected to violence had disclosed this to anyone, in most cases to their parents. CONCLUSION: The findings in this study highlight that the violence women have to face contributes to the development of multiple forms of psychological stress and serious mental health problems. Women's restrictive life circumstances seriously hamper women's empowerment. Reliable health surveillance system and health care services are needed to serve abused women. Policy initiatives focused on IPV and gender inequality in Pakistan should be initiated.

  • 182. Al-Janabi, Hareth
    et al.
    Flynn, Terry N
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Coast, Joanna
    Development of a self-report measure of capability wellbeing for adults: the ICECAP-A.2012In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 21, no 1, p. 167-76Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The benefits of health and social care are not confined to patient health alone and therefore broader measures of wellbeing may be useful for economic evaluation. This paper reports the development of a simple measure of capability wellbeing for adults (ICECAP-A).

    METHODS: In-depth, informant-led, interviews to identify the attributes of capability wellbeing were conducted with 36 adults in the UK. Eighteen semi-structured, repeat interviews were carried out to develop a capability-based descriptive system for the measure. Informants were purposively selected to ensure variation in socio-economic status, age, sex, ethnicity and health. Data analysis was carried out inductively and iteratively alongside interviews, and findings were used to shape the questions in later interviews.

    RESULTS: Five over-arching attributes of capability wellbeing were identified for the measure: "stability", "attachment", "achievement", "autonomy" and "enjoyment". One item, with four response categories, was developed for each attribute for the ICECAP-A descriptive system.

    CONCLUSIONS: The ICECAP-A capability measure represents a departure from traditional health economics outcome measures, by treating health status as an influence over broader attributes of capability wellbeing. Further work is required to value and validate the attributes and test the sensitivity of the ICECAP-A to healthcare interventions.

  • 183. Alkema, Leontine
    et al.
    Chou, Doris
    Hogan, Daniel
    Zhang, Sanqian
    Moller, Ann-Beth
    Gemmill, Alison
    Fat, Doris Ma
    Boerma, Ties
    Temmerman, Marleen
    Mathers, Colin
    Say, Lale
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. University of the Witwatersrand, Johannesburg, South Africa.
    Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 387, no 10017, p. 462-474Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030.

    METHODS: We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources.

    RESULTS: We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100,000 livebirths (80% UI 359-427) in 1990, to 216 (207-249) in 2015, corresponding to a relative decline of 43·9% (34·0-48·7), with 303,000 (291,000-349,000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0-3·1) in the Caribbean to 5·0% (4·0-6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100,000 livebirths (11-14) for high-income regions to 546 (511-652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%.

    INTERPRETATION: Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country-specific SDG targets are ambitious for most high mortality countries, countries that made a concerted effort to reduce maternal mortality between 2000 and 2010 provide inspiration and guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths.

    FUNDING: National University of Singapore, National Institute of Child Health and Human Development, USAID, and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

  • 184. All, Rainar
    et al.
    Harrami, Omar
    Postgård, Ulrika
    Strömgren, Mattias
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Olyckor, riskanalyser och säkerhetsarbete: Några olika perspektiv inom Räddningsverket2006Other (Other (popular science, discussion, etc.))
    Abstract [sv]

    Sammanfattning

    Syftet med denna kartläggning har varit att ge en nulägesbild över hur riskanalyser, riskbedömningar och riskvärderingar sker i Räddningsverkets arbete med skydd mot olyckor. Ett syfte har också varit att beskriva de olika strategier för säkerhetsarbete som tillämpas i myndigheten.



    Kartläggningen har utförts genom gruppintervjuer under perioden oktober 2004 mars 2005 och har följts upp med hjälp av två seminarier i november 2005. Analysgruppen har bestått av medarbetare vid Räddningsverkets sekretariat för forskning och analys.

    Resultaten visar bland annat att:

    - verkets arbete utgår från en kompott av olyckor, skador och händelser, var och en med sin egen logik baserad på tradition, lagstiftning och politisk inriktning

    - arbetet bedrivs utifrån en mångfald av strategier som i många fall inte är produkten av genomtänkta analyser och medvetna val

    - verkets olika roller behöver närmare analyseras och kopplas till tydligare

    strategier och metoder för arbetet med skydd mot olyckor

    - säkerhetsarbete och riskhantering är inte synonyma begrepp i myndigheten

    - det saknas myndighetsgemensamma begreppsdefinitioner inom det kartlagda

    området

    - det råder en brist i myndigheten på djupare diskussioner och reflektioner kring värdegrunder och principer för riskvärdering.



    Rapporten behandlar många olika frågor som på olika sätt är relevanta för Räddningsverkets arbete på kort och lång sikt. I rapporten ges ett tiotal förslag till fortsatt arbete. Några förslag är att:

    - utarbeta en begreppspolicy för myndigheten

    - utarbeta information till privatpersoner som lagenliga skyldigheter inom det olycksförebyggande området

    - satsa på kompetensutveckling internt

    - starta ett utvecklingsarbete inom riskvärdering

    - utveckla analysförmåga för framtidens olycksrisk

    - starta en idéverkstad för framtida säkerhetsarbete



    Kartläggningen ska ligga till grund för fortsatt utvecklingsarbete inom Räddningsverket. Delar av materialet kan också komma att utgöra underlag för

    utveckling av läromedel för verkets utbildningsverksamhet. Rapporten utgör också en möjlig källa för fortsatt forskning och analys inom området

  • 185.
    Allard, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Virology.
    Enteric adenovirus type 41: genome organization and specific detection procedures1992Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Enteric adenoviruses (EAd) types 40 and 41 (Ad40 and Ad41) representing subgenus F, are primary pathogens of children being second only to rotaviruses as the most important cause of infantile diarrhea.

    The EAds differ from all other adenoviruses in their inability to grow in most conventional established cell lines and have been suggested to be deficient in some early gene functions since they could be complemented by Ad 5 early regions EIA and E1B. In order to search for differences that could explain its characteristic growth restriction, the early regions EIA and E1B of Ad41 (strain D389) were sequenced, analysed and compared with the corresponding regions of Adl2, Ad7, Ad2, and Ad4. As revealed by the analysis of Ad2, three major mRNAs of 9S, 12S and 13S are generated from region EIA. The EIA region of Ad41 encodes two mRNAs corresponding to the 12S and 13S mRNAs. Only the 13S mRNA is transcribed at detectable levels. This mRNA can be translated into a 251 aa putative protein that contains the three highly conserved domains found in all other human adenoviruses and shown to be responsible for many important regulatory functions during infection.

    The E1B region of Ad41 encodes three transcripts that correspond to 22S, 14S and 9S mRNA of Ad2. No equivalent to the 13S mRNA of Ad2 E1B is found. In addition the Ad41 14S mRNA exhibits an additional exon of 23 bp created by a donor and an acceptor splice sites not desribed for other adenovirus E1B sequences.

    Due to their growth restriction in conventional cultures, rapid diagnostic procedures developed for the enteric adenovirus infections have mainly been aimed at the detection of viral antigens or nucleic acids. This thesis also describes several procedures developed for the general detection of adenoviruses and specific detection of the enteric types in stools specimens. General and specific hybridization assays were developed by use of two BamHI clones obtained from the EIA region of Ad41. One- and two-step PCR procedures were also developed for the general detection of adenoviruses using primers corresponding to highly conserved sequences within the hexon gene. Subgenus F specific one- and two-step PCRs were developed by using primers located in the Ad41 E1B region.

    The one-step PCR systems were tested and validated against isolation in tissue culture, DNA restriction enzyme analysis and a commercial latex agglutination test in the study of 60 specimens obtained from children with rotavirus negative diarrhea. The asymptomatic fecal excretion of adenoviruses was evaluated by two-step PCR amplifications on samples from 50 healthy children, 50 healthy adults, and 50 adults suffering from diarrhea.

    Finally, a simplified procedure for detection, discrimination and typing of EAd was also designed by combining the one-step PCR amplification of the hexon region with the restriction of the 300 bp product.

  • 186. Allen, Elizabeth Palchik
    et al.
    Muhwezi, Wilson Winstons
    Henriksson, Dorcus Kiwanuka
    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. Karolinska Institutet, Sweden..
    Mbonye, Anthony Kabanza
    Health facility management and access: a qualitative analysis of challenges to seeking healthcare for children under five in Uganda2017In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 32, no 7, p. 934-942Article in journal (Refereed)
    Abstract [en]

    While several studies have documented the various barriers that caretakers of children under five routinely confront when seeking healthcare in Uganda, few have sought to capture the ways in which caretakers themselves prioritize their own barriers to seeking services. To that end, we asked focus groups of caretakers to list their five greatest challenges to seeking care on behalf of children under five. Using qualitative content analysis, we grouped responses according to four categories: (1) geographical access barriers; (2) facility supplies, staffing, and infrastructural barriers; (3) facility management and administration barriers (e.g. health worker professionalism, absenteeism and customer care); and (4) household barriers related to financial circumstances, domestic conflicts with male partners and a stated lack of knowledge about health-related issues. Among all focus groups, caretakers mentioned supplies, staffing and infrastructure barriers most often and facility management and administration barriers the least. Caretakers living furthest from public facilities (8-10 km) more commonly mentioned geographical barriers to care and barriers related to financial and other personal circumstances. Caretakers who lived closest to health facilities mentioned facility management and administration barriers twice as often as those who lived further away. While targeting managerial barriers is vitally important-and increasingly popular among national planners and donors-it should be done while recognizing that alleviating such barriers may have a more muted effect on caretakers who are geographically harder to reach - and by extension, those whose children have an increased risk of mortality. In light of calls for greater equity in child survival programming - and given the limited resource envelopes that policymakers often have at their disposal - attention to the barriers considered most vital among caretakers in different settings should be weighed.

  • 187.
    Allwell-Brown, Gbemisola
    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).
    Individual and household-level determinants of malaria infection in under-5 children from north-west and southern Nigeria: A cross-sectional comparative study based on the 2015 Nigeria Malaria Indicator Survey2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction

    Nigeria has the highest malaria burden worldwide. The 2010 and 2015 Nigeria Malaria Indicator Surveys (NMIS) suggest an improvement in malaria indicators, with the North West zone lagging behind. This study aimed to identify the individual and household-level malaria determinants in north-west and southern Nigeria, using Rapid Diagnostic Testing (RDT) and microscopy for malaria diagnosis.

    Methods

    Data on 3,358 children aged 6-59 months from north-west and southern Nigeria from the 2015 NMIS was used. The two populations were compared using chi-square tests, and logistic regression analysis was done for determinants of malaria infection, based on RDT and microscopic malaria test results.

    Results

    Malaria prevalence by RDT in the north-west and south was 55.8% and 29.2%, respectively (37.0% and 14.9%, respectively by microscopy). In both populations, a higher age, positive RDT in an additional household member and rural residence increased the odds of malaria infection; while higher education of the head of household and greater household wealth lowered the odds of malaria infection. Household clustering of RDT-positive cases appeared to be stronger in the south compared to the north-west. There were no statistically significant differences between the results using RDT or microscopy.

    Conclusion

    Irrespective of the diagnostic tool used, malaria determinants were similar in north-west and southern Nigeria. However, poorer social circumstances were observed in the north-west, and may account for the delayed progress in malaria control in the region. There may be a need to intensify malaria control efforts, particularly in the north-west, while awaiting socio-economic development.

     

  • 188.
    Alm Stävlid, Sofia
    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).
    A cross-sectional study on depression, anxiety, and perfectionism in students at Uppsala University and patients at Uppsala University hospital2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction Mental illness is one of the largest causes of disability worldwide and it is becoming more prevalent among adolescents. The aim of this thesis was to compare the levels of anxiety and depressive symptoms among students at Uppsala University in relation to patients at the psychiatric department of Uppsala University Hospital, and to see if there was a possible correlation between anxiety and depression and higher levels of perfectionism.

    Methods Students at Uppsala University and patients at Uppsala University hospital participated in the student group and the clinical group of the study (n=93 and n=109 respectively). Data on anxiety and depressive symptoms, and perfectionism traits were collected with questionnaires and analyzed. Linear regression analysis was performed to determine the relationship between perfectionism and anxiety and depression. Independent t-test was used to examine the difference of means between the student group and the clinical group.

    Results The clinical group had a significantly higher mean score in the anxiety and depression scale The same trend could also be seen for all sub scales; anxiety, depression, and perfectionism There was a significant positive association between perfectionism and anxiety and depression.

    Conclusion There was a significant difference in levels of anxiety and depression for the students compared to patients, and a positive association between perfectionism and anxiety and depression. Furthermore, half of the students in the study had scores that would qualify them for psychiatric treatment. This research highlights the need for further research on the mental health of students in Uppsala and Sweden.

  • 189.
    Alm, Susanne
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Future orientation climate in the school class: Relations to adolescent delinquency, heavy alcohol use, and internalizing problem2016In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 70, p. 324-331Article in journal (Refereed)
    Abstract [en]

    It is well known, based on previous research, that adolescents' thoughts and feelings about their future are related to the risk of delinquency, alcohol use as well as health. However, other well-known facts are that adolescents' actions are substantially shaped in interaction with peers and that, during adolescence, individuals spend a considerable amount of the day at school, in interaction with classmates. Despite this, there is an almost complete lack of studies exploring to what extent the school climate, as measured by thoughts and feelings about the future, can influence individual adolescents. The aim of the current study is to investigate whether the future orientation (FO) climate, measured at the school class level, is related to delinquency, alcohol use and internalizing problems at the individual level, among a sample of Swedish students 14–15 years of age. The data used come from the Swedish part of the Youth in Europe (YES!) study, which is part of the larger project Children of Immigrants - Longitudinal Survey in Four European Countries (CILS4EU). In the present paper, we use data from the first wave, collected among 8th grade students in 2010/11 (n = 4119–4364). The method used was multilevel modeling (linear probability models (LPM) and linear regression analysis). The results showed that, in school classes where a high proportion of students had a positive future orientation, the risk of heavy alcohol use at the individual level was lower, also after adjusting for individual FO and for individual- and class-level socioeconomic conditions. A similar, but not statistically significant, tendency was found for delinquency. In addition, having a high proportion of students with a positive FO in a school class was associated with fewer internalizing problems, also after controlling for individual FO and socioeconomic conditions at the individual and school class level. We conclude that the surrounding school class, in terms of its general future orientation climate, may play a role for individual outcomes in the form of problem behaviors and mental health.

  • 190.
    Alm, Susanne
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The gendered mirror on the wall: Satisfaction with physical appearance and its relationship to global self-esteem and psychosomatic complaints among adolescent boys and girls2017In: Young - Nordic Journal of Youth Research, ISSN 1103-3088, E-ISSN 1741-3222, Vol. 26, no 5, p. 1-17Article in journal (Refereed)
    Abstract [en]

    The study investigated gender differences in satisfaction with physical appearance as a domain-specific aspect of self-esteem, and its association with global self-esteem and psychosomatic complaints. The data used was from the Stockholm School Survey, conducted among ninth grade students (15–16 years), with pooled information from six cross-sectional surveys in 2004–2014 (n = 32,117). Girls reported lower satisfaction with their appearance than boys. Satisfaction with appearance was more strongly associated with global self-esteem among girls, while the association with psychosomatic complaints was similar for both genders. There was a tendency towards a decline in satisfaction with appearance at the end of the study period for both genders, albeit more strong for girls. We conclude that satisfaction with appearance may contribute to our understanding of poor mental well-being among adolescent girls.

  • 191.
    Almberg, Mica
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Är yoga hälsa?: En hälsoanalys av yoga enligt YogaSutras2007Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpStudent thesis
    Abstract [sv]

    Syfte och frågeställningar

    Syftet är att undersöka yoga och dess förhållande till hälsa ur ett fysiskt, psykiskt och själsligt perspektiv.

    Frågeställningarna är:

    - Hur beskrivs vägen mot tillståndet yoga enligt YogaSutras utifrån ett fysiskt, psykiskt och själsligt perspektiv?

    - Hur beskrivs tillståndet yoga enligt YogaSutras utifrån ett fysiskt, psykiskt och själsligt perspektiv?

    - På vilket sätt förhåller sig yoga enligt YogaSutras till hälsa utifrån ett fysiskt, psykiskt och själsligt perspektiv?

    Metod

    Metoden består av en textanalys ur en innehållsaspekt. Boken som används heter YogaSutras är skriven på sanskrit och översatt till engelska. Texten har bearbetats genom meningskoncentration och kategoriseras utifrån perspektiven fysiskt, psykiskt och själsligt, som en del utav det övergripande begreppet hälsa. Resultaten har sedan analyserat med stöd av Katie Erikssons hälsoteori.

    Resultat

    Resultatet visar att YogaSutras beskriver olika metoder och tekniker som individen kan utföra på vägen mot det slutgiltiga tillståndet yoga. Dessa innefattar fysiska, psyksiska och själsliga perspektiv. De tre perspektiven sker också i samverkan av varandra. I det slutgiltiga tillståndet yoga är de tre perspektiven integrerade. Detta överstämmer väl med Erikssons definition av hälsobegreppet.

    Slutsats

    Det står det klart att det finns minst ett förhållande mellan yoga och hälsa, vilket är att yoga bidrar till hälsa hos individen. Detta får även stöd av presenterad forskning. Det slutgiltiga tillståndet yoga kan även anses vara jämförbart med det optimala hälsotillståndet, eftersom tillstånden överensstämmer med varandra.

  • 192. Almond, Douglas
    et al.
    Edlund, Lena
    Joffe, Michael
    Palme, Mårten
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    An adaptive significance of morning sickness? Trivers-Willard and Hyperemesis Gravidarum2016In: Economics and Human Biology, ISSN 1570-677X, E-ISSN 1873-6130, Vol. 21, p. 167-171Article in journal (Refereed)
    Abstract [en]

    Nausea during pregnancy, with or without vomiting, is a common early indication of pregnancy in humans. The severe form, Hyperemesis Gravidarum (HG), can be fatal. The aetiology of HG is unknown. We propose that HG may be a proximate mechanism for the Trivers-Willard (T-W) evolutionary hypothesis that mothers in poor condition should favor daughters. Using Swedish linked registry data, 1987-2005, we analyze all pregnancies that resulted in an HG admission and/or a live birth, 1.65 million pregnancies in all. Consistent with the T-W hypothesis, we find that: (i) HG is associated with poor maternal condition as proxied by low education; (ii) HG in the first two months of pregnancy is associated with a 7% point increase in live girl births; and (iii) HG affected pregnancies have a 34-percent average rate of inferred pregnancy loss, higher among less educated women.

  • 193.
    Almquist B., Ylva
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Högnäs, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Only the lonely? All-cause mortality among children without siblings and children without friends2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background: In childhood, relations with siblings and friends lie at the core of social interaction. Lacking either type of relationship may reflect lower levels of social support. While social support is known to be negatively associated with premature death, there are still no long-term follow-ups of mortality risks among children without siblings (‘only-children’) and children without friends (‘lonely-children’). The aim of the present study was therefore to examine and compare all-cause mortality in these two groups.

    Methods: Cox regression analysis was based on a Stockholm cohort born in 1953 (n = 15,117). Individuals were identified as only-children if there were no records of siblings before age 18. Derived from sociometric data collected at age 13, lonely-children were defined as not being nominated by classmates as one of three best friends. The follow-up of all-cause mortality covered ages 20-56.

    Results: Both only-children and lonely-children had increased risks of premature mortality. When adjusted for a wide range of family-related and individual factors, the risk ratio for only-children increased in strength whereas the risk ratio for lonely-children was reduced. The former finding may be explained by suppressor effects: for example, both only-children and those whose parents had alcohol problems had higher mortality risks but only-children were less likely to have parents with alcohol problems. The latter finding was primarily due to adjustment for scholastic ability.

    Conclusions: It is concluded that while only-children and lonely-children have similar risks of all-cause mortality, the processes leading up to premature death appear to be rather different. Yet, interventions targeted at improving social learning experiences may be beneficial for both groups.

    Key messages:

    • Only-children have higher risks of premature mortality but the mechanisms remain unclear.

    • Lonely-children are at risk of premature mortality primarily due to poorer scholastic ability.

  • 194.
    Almquist B., Ylva
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Landstedt, Evelina
    Hammarström, Anne
    Associations between social support and depressive symptoms: social causation or social selection – or both?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 1, p. 84-89Article in journal (Refereed)
    Abstract [en]

    Background: Numerous studies have demonstrated an association between social support and health, almost regardless of how social support and health have been conceptualised or measured. Even so, the issue of causality has not yet been sufficiently addressed. This issue is particularly challenging for mental health problems such as depressive symptoms. The aim of the present study is to longitudinally assess structural and functional aspects of social support in relation to depressive symptoms in men and women, through a series of competing causal models that, in contrast to many other statistical methods, allow for bi-directional effects. Methods: Questionnaire data from the Northern Swedish Cohort (n = 1001) were utilised for the years 1995 (age 30) and 2007 (age 42). Associations were analysed by means of gender-specific structural equation modelling, with structural and functional support modelled separately. Results: Both structural and functional support were associated with depressive symptoms at ages 30 and 42, for men and women alike. A higher level of support, particularly functional support, was associated with a decrease in depressive symptoms over time among men. Among women, there were bi-directional effects of social support and depressive symptoms over time. Conclusion: Concerning social support and health, the social causation hypothesis seems relevant for men whereas, for women, the associations appear to be more complex. We conclude that preventive and health promoting work may need to consider that the presence of depressive symptoms in itself impedes on women’s capability to increase their levels of social support.

  • 195.
    Almquist, Ylva B
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hälsosamt samspel i skolan - långsiktiga effekter2014In: På väg in : ungdomars liv och försörjning: Rapport från forskarseminariet i Umeå 15–16 januari 2014, Stockholm: Försäkringskassan , 2014, , p. 73-82p. 73-82Chapter in book (Other academic)
  • 196.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hälsosamt samspel i skolan2012In: Framtider, ISSN 0281-0492, no 3, p. 12-15Article in journal (Other academic)
  • 197.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Skolan som social arena och elevers psykiska ohälsa2012In: Den orättvisa hälsan: Om socioekonomiska skillnader i hälsa och livslängd / [ed] Mikael Rostila, Susanna Toivanen, Stockholm: Liber, 2012Chapter in book (Other academic)
  • 198.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Childhood friendships and the clustering of adverse circumstances in adulthood - a longitudinal study of a Stockholm cohort2013In: Longitudinal and life course studies, ISSN 1124-9064, E-ISSN 1757-9597, Vol. 4, no 3, p. 180-195Article in journal (Refereed)
    Abstract [en]

    Friendships constitute a central feature of childhood, yet little is known about the developmental significance extending beyond childhood and adolescence. The aim of the present study was therefore to investigate the association between childhood friendships and adult outcomes. Since many outcomes in adulthood go hand in hand, the outcome pattern as a whole was targeted. Based on a longitudinal data material consisting of more than 14,000 individuals born in Stockholm in 1953, a cluster analysis of adult circumstances (1992-2007) was first conducted. Second, the association between three indicators of childhood friendships (1966) and the outcome profiles was analysed by means of multinomial regression analysis. The results indicated that children who lacked leisure time friends and a best friend in the school class had increased risks of ending up in the more adverse clusters as adults, whereas the opposite association was found for those who reported being solitary. The effect of childhood friendships was rather consistent across both single and multiple problems, suggesting that the disadvantages of being without friends in childhood do not accumulate over the life course to any large extent. Generally, the results were the same for males and females. It is concluded that childhood friendships are important for adverse circumstances in adulthood, for both genders. As far as the long-lasting effects of children's friendships involve varying access to social support, school-based interventions should compensate for the scarcity of support following the lack of childhood friends.

  • 199.
    Almquist, Ylva B.
    et al.
    Stockholm Univ, Karolinska Inst, Stockholm, Sweden..
    Landstedt, E.
    Stockholm Univ, Karolinska Inst, Umea, Sweden..
    Jackisch, J.
    Stockholm Univ, Karolinska Inst, Stockholm, Sweden..
    Rajaleid, K.
    Stockholm Univ, Karolinska Inst, Stockholm, Sweden..
    Westerlund, H.
    Stockholm Univ, Karolinska Inst, Stockholm, Sweden..
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Growing through asphalt: What counteracts the long-term negative health impact of youth adversity?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27Article in journal (Other academic)
  • 200.
    Almquist, Ylva B
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Landstedt, E.
    Jackisch, Josephine
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hammarström, A.
    Growing through asphalt: What counteracts the long-term negative health impact of youth adversity?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background

    Adversity in the family of origin tends to translate into poor health development. Yet, the fact that this is not the always the case has been seen an indicator of resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status.

    Methods

    The study was based on the Northern Swedish Cohort born in 1965 (n = 1,001). Measures of social and material adversity, health, and protective factors related to school, peers, and spare time, were derived from questionnaires distributed to the cohort members and their teachers at age 16. Self-rated health was measured at age 43. The main associations were examined by means of ordinal regression analysis, with the role of the protective factors being assessed through interaction analysis.

    Results

    Social and material adversity in youth was associated with poorer self-rated health in midlife among males and females alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time – particularly in terms of being seen as having good educational and work prospects, as well as a high-quality spare time – appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health.

    Conclusions

    There are several factors outside the context of the family that seemingly have the potential to buffer against the negative health consequences stemming from having experienced a disadvantaged upbringing. Initiatives targeted at increasing academic motivation and commitment as well as social capital and relationships in youth, may here be of particular relevance.

    Key messages:

    • While the experience of disadvantageous living conditions in adolescence tends to translate into poor health development across the life course, this is not always the case.

    • Advantages related to school, peers, and spare time have the potential of counteracting the negative health impact of an adverse family context.

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