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  • 8051.
    Westerling, Ragnar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Westin, Marcus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
      Analysis of the introduction of new health care interventions2011Report (Other academic)
  • 8052. Westerlund, Anna
    et al.
    Bellocco, Rino
    Sundström, Johan
    Adami, Hans-Olov
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Trolle Lagerros, Ylva
    Sleep characteristics and cardiovascular events in a large Swedish cohort2013In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 28, no 6, 463-473 p.Article in journal (Refereed)
    Abstract [en]

    Limited evidence suggests that the association between sleep duration and cardiovascular events is strongest in individuals who also report sleep disturbances. We investigated sleep duration and insomnia symptoms in relation to incident cardiovascular events in the Swedish National March Cohort comprising 41,192 adults. Habitual sleep duration and difficulty falling asleep, difficulty maintaining sleep, early morning awakening, and nonrestorative sleep were self-reported in 1997. During 13.2 years of follow-up, we identified 4,031 events (myocardial infarction, stroke, heart failure, or death from cardiovascular disease) in the Swedish National Patient Register and the Cause of Death Register. After adjustment for potential confounders, short sleep duration (≤5 h) was associated with slightly increased risks of overall cardiovascular events and, specifically, myocardial infarction: hazard ratio, HR (95 % confidence interval) 1.24 (1.06-1.44) and 1.42 (1.15-1.76), respectively. These HRs were attenuated as we included BMI, depressive symptoms and other relevant covariates in our analysis. Insomnia symptoms per se were unrelated to risk. However, in a joint analysis, there was some evidence that short sleepers who reported frequent insomnia symptoms had the highest HRs (1.26-1.39) of overall cardiovascular events. Short sleep or insomnia symptoms without the other conferred no increased risk. Our results suggest that symptoms of sleep disturbance should be taken into account when assessing the association between short sleep and cardiovascular disease.

  • 8053. Westerlund, Anna
    et al.
    Bottai, Matteo
    Adami, Hans-Olov
    Bellocco, Rino
    Nyrén, Olof
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Lagerros, Ylva Trolle
    Habitual sleep patterns and the distribution of body mass index: cross-sectional findings among Swedish men and women.2014In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 15, no 10, 1196-1203 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare distributions of body mass index (BMI) between individuals with different habitual sleep patterns.

    METHODS: We performed cross-sectional analyses of 40,197 Swedish adults (64% women), who reported sleep duration and quality, weight, height, and possible confounding factors in 1997. Using quantile regression, we estimated associations between sleep patterns and selected percentiles of the distribution of BMI.

    RESULTS: While the medians were similar, larger adjusted values of BMI were estimated in the upper part of the distribution among men and women with short sleep (≤5 h) compared with medium-length sleep (6-8 h). For example, in men, the 90th percentile of BMI was 0.80 kg/m(2) (95% confidence interval: 0.17-1.43 kg/m(2)) higher among short sleepers. In women, long sleepers (≥9 h) also showed larger values in the upper part of the BMI distribution; the 90th percentile was 1.23 kg/m(2) (0.42-2.04 kg/m(2)) higher than in medium-length sleepers. In male long sleepers, smaller values were estimated in the lower part of the BMI distribution; the 10th percentile was 0.84 kg/m(2) lower (0.35-1.32 kg/m(2)) than in medium-length sleepers. The 90th percentile of BMI in women with poor-quality compared with good-quality sleep was larger by 0.82 kg/m(2) (0.47-1.16 kg/m(2)); the 10th percentile was smaller by 0.17 kg/m(2) (0.02-0.32 kg/m(2)).

    CONCLUSIONS: Short, long or poor-quality sleepers showed larger, or smaller, values at the tails of the BMI distribution, but similar medians. Hence, unfavorable sleep patterns and BMI were associated only in a subset of this study population.

  • 8054.
    Westerlund, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Garvare, Rickard
    Nyström, Monica
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Parental support strengthened by the International Child Development Program: the implementation process2014Conference paper (Other academic)
  • 8055.
    Westerlund, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Garvare, Rickard
    Luleå tekniska universitet, Luleå, Sweden.
    Höög, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyström, Monica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The role of a change process facilitating function in relation to a large organizational development attempt in an healthcare organization.2014Conference paper (Other academic)
  • 8056.
    Westerlund, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Garvare, Rickard
    Nyström, Monica E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Managing the initiation and early implementation of health promotion interventions: a study of a parental support programme in primary care2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, 128-138 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mental health problems are increasing among children and adolescents worldwide, and parental support programmes have been suggested as one preventive intervention. However, the actual impact and low rates of adoption and sustainability of prevention programmes have proven to be a concern, and thus, further studies on their implementation are needed.

    AIM: This study focused on the initial implementation of the International Child Development Programme (ICDP) in primary care. The aim was to investigate the involved actors' views on factors likely to affect implementation and the strategies used to manage them.

    DESIGN: A case study design with a mixed-methods approach combining quantitative and qualitative data from questionnaires and interviews was used.

    METHODS: Eighty-two professionals at different positions in the involved organisations participated. Directed content analysis was used for analyses, focusing on perceived levels of importance and the manifestation of implementation factors.

    FINDINGS: Interviews and questionnaires provided descriptions of factors influencing the initial ICDP implementation. Uncertainty on how to manage important factors and vague change strategies was reported. Discrepancies in the perceived levels of importance versus manifestation were found regarding several factors, including hands-on support, time and resources, communication and information, a comprehensive plan of action, follow-ups, and external and internal collaborations. Manifested factors were a need for change, motivation and the ICDP's compatibility with existing norms, values and practices.

    CONCLUSIONS: Implementing a parental support programme in a complex setting will benefit from being preceded by a thorough examination of the intervention and the target context and the development of clear implementation strategies based on the results of that examination. This study provides insights into how and by whom knowledge on implementation is applied during the launch of a health promotion programme, and these insights might help increase the rate of adoption and the use of such programmes and thereby increase their effectiveness.

  • 8057. Westerlund, Anna
    et al.
    Trolle Lagerros, Ylva
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, The Netherlands; Karolinska Institutet, Sweden.
    Axelsson, John
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Relationships Between Questionnaire Ratings of Sleep Quality and Polysomnography in Healthy Adults2016In: Behavioural Sleep Medicine, ISSN 1540-2002, E-ISSN 1540-2010, Vol. 14, no 2, 185-199 p.Article in journal (Refereed)
    Abstract [en]

    This study aimed to examine the association between polysomnographic sleep and subjective habitual sleep quality and restoration from sleep. Thirty-one normal sleepers completed the Karolinska Sleep Questionnaire and multiple home polysomnography recordings (n = 2-5). Using linear regression, sleep quality and restoration were separately analyzed as functions of standard polysomnography parameters: sleep efficiency, total sleep time, sleep latency, stage 1 and 2 sleep, slow-wave sleep, rapid eye movement sleep, wake time after sleep onset, and awakenings (n), averaged across recordings. Stage 2 and slow-wave sleep predicted worse and better sleep quality, respectively. Also, slow-wave sleep predicted less subjective restoration, although adjustment for age attenuated this relation. Our findings lend some physiological validity to ratings of habitual sleep quality in normal sleepers. Data were less supportive of a physiological correlate of ratings of restoration from sleep.

  • 8058. Westerlund, Ellen
    et al.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Hög risk att insjukna i tyreotoxikos i norra Sverige: retrospektiv genomgång av journaler i Norrbotten för åren 2004–20052008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 45, 3196-3201 p.Article in journal (Refereed)
  • 8059.
    Westerlund, Hugo
    et al.
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden.
    Gustafsson, Per E.
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Theorell, Tores
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden.
    Janlert, Urban
    Umea Univ, Dept Publ Hlth & Clin Med Epidemiol & Publ Hlth, Umea, Sweden.
    Hammarström, Anne
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Social Adversity in Adolescence Increases the Physiological Vulnerability to Job Strain in Adulthood: A Prospective Population-Based Study2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 4, e35967Article in journal (Refereed)
    Abstract [en]

    Background: It has been argued that the association between job strain and health could be confounded by early life exposures, and studies have shown early adversity to increase individual vulnerability to later stress. We therefore investigated if early life exposure to adversity increases the individual's physiological vulnerability job strain in adulthood. Methodology/Principal Findings: In a population-based cohort (343 women and 330 men, 83% of the eligible participants), we examined the association between on the one hand exposure to adversity in adolescence, measured at age 16, and job strain measured at age 43, and on the other hand allostatic load at age 43. Adversity was operationalised as an index comprising residential mobility and crowding, parental loss, parental unemployment, and parental physical and mental illness (including substance abuse). Allostatic load summarised body fat, blood pressure, inflammatory markers, glucose, blood lipids, and cortisol regulation. There was an interaction between adversity in adolescence and job strain (B = 0.09, 95% CI 0.02 to 0.16 after adjustment for socioeconomic status), particularly psychological demands, indicating that job strain was associated with increased allostatic load only among participants with adversity in adolescence. Job strain was associated with lower allostatic load in men (beta = -0.20, 95% CI -0.35 to -0.06). Conclusions/Significance: Exposure to adversity in adolescence was associated with increased levels of biological stress among those reporting job strain in mid-life, indicating increased vulnerability to environmental stressors.

  • 8060. Westerlund, Hugo
    et al.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Theorell, Tores
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Social Adversity in Adolescence Increases the Physiological Vulnerability to Job Strain in Adulthood: A Prospective Population-Based Study2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 4, e35967- p.Article in journal (Refereed)
    Abstract [en]

    Background: It has been argued that the association between job strain and health could be confounded by early life exposures, and studies have shown early adversity to increase individual vulnerability to later stress. We therefore investigated if early life exposure to adversity increases the individual's physiological vulnerability job strain in adulthood. Methodology/Principal Findings: In a population-based cohort (343 women and 330 men, 83% of the eligible participants), we examined the association between on the one hand exposure to adversity in adolescence, measured at age 16, and job strain measured at age 43, and on the other hand allostatic load at age 43. Adversity was operationalised as an index comprising residential mobility and crowding, parental loss, parental unemployment, and parental physical and mental illness (including substance abuse). Allostatic load summarised body fat, blood pressure, inflammatory markers, glucose, blood lipids, and cortisol regulation. There was an interaction between adversity in adolescence and job strain (B = 0.09, 95% CI 0.02 to 0.16 after adjustment for socioeconomic status), particularly psychological demands, indicating that job strain was associated with increased allostatic load only among participants with adversity in adolescence. Job strain was associated with lower allostatic load in men (beta = -0.20, 95% CI -0.35 to -0.06). Conclusions/Significance: Exposure to adversity in adolescence was associated with increased levels of biological stress among those reporting job strain in mid-life, indicating increased vulnerability to environmental stressors.

  • 8061. Westerlund, Hugo
    et al.
    Gustafsson, Per E
    Umeå universitet, Allmänmedicin.
    Theorell, Töres
    Janlert, Urban
    Umeå universitet, Epidemiologi och global hälsa.
    Hammarström, Anne
    Umeå universitet, Allmänmedicin.
    Parental academic involvement in adolescence, academic achievement over the life course and allostatic load in middle age: a prospective population-based cohort study2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 6, 508-513 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parental involvement in their children's studies, particularly in terms of academic socialisation, has been shown to predict academic achievement, and is thus a candidate modifiable factor influencing life course socioeconomic circumstances. Socioeconomic disadvantage is thought to impact on health over the life course partly by allostatic load, that is, cumulative biological risk. We sought to elucidate the role of parental involvement at age 16 on the life course development of allostatic load.

    METHODS: In a population-based cohort (365 women and 352 men, 67% of the eligible participants), we examined the association between parental involvement in their offspring's studies, measured by teacher and pupil ratings at age 16 and an allostatic load index summarising 12 physiological risk markers at age 43. Mediation through life course academic and occupational achievement was assessed by entering school grades, adult educational achievement and socioeconomic position at age 43 in a linear regression analysis in a stepwise manner and testing for mediation.

    RESULTS: Parental interest in their offspring's studies during the last year of compulsory school-rather than the parent's social class or availability of practical academic support-was found to predict adult allostatic load (β=-0.12, 95% CI -0.20 to -0.05). Further adjustments indicated that academic achievement over the life course mediated a large part of the effect of parental interest on allostatic load.

    CONCLUSIONS: Parental interest in their offspring's studies may have protective effects by decreasing the likelihood of a chain of risk involving low academic achievement, low socioeconomic position and high accumulated physiological stress.

  • 8062.
    Westerlund, Hugo
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Gustafsson, Per E
    Umeå Univ, Dept Publ Hlth & Clin Med, Umeå.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Janlert, Urban
    Umeå Univ, Dept Publ Hlth & Clin Med, Umeå.
    Hammarström, Anne
    Umeå Univ, Dept Publ Hlth & Clin Med, Umeå.
    Parental academic involvement in adolescence, academic achievement over the life course and allostatic load in middle age: a prospective population-based cohort study.2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 76, no 6, 508-513 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parental involvement in their children's studies, particularly in terms of academic socialisation, has been shown to predict academic achievement, and is thus a candidate modifiable factor influencing life course socioeconomic circumstances. Socioeconomic disadvantage is thought to impact on health over the life course partly by allostatic load, that is, cumulative biological risk. We sought to elucidate the role of parental involvement at age 16 on the life course development of allostatic load. METHODS: In a population-based cohort (365 women and 352 men, 67% of the eligible participants), we examined the association between parental involvement in their offspring's studies, measured by teacher and pupil ratings at age 16 and an allostatic load index summarising 12 physiological risk markers at age 43. Mediation through life course academic and occupational achievement was assessed by entering school grades, adult educational achievement and socioeconomic position at age 43 in a linear regression analysis in a stepwise manner and testing for mediation. RESULTS: Parental interest in their offspring's studies during the last year of compulsory school-rather than the parent's social class or availability of practical academic support-was found to predict adult allostatic load (β=-0.12, 95% CI -0.20 to -0.05). Further adjustments indicated that academic achievement over the life course mediated a large part of the effect of parental interest on allostatic load. CONCLUSIONS: Parental interest in their offspring's studies may have protective effects by decreasing the likelihood of a chain of risk involving low academic achievement, low socioeconomic position and high accumulated physiological stress.

  • 8063. Westerlund, Hugo
    et al.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Theorell, Töres
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Parental academic involvement in adolescence, academic achievement over the life course and allostatic load in middle age: a prospective population-based cohort study2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 6, 508-513 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parental involvement in their children's studies, particularly in terms of academic socialisation, has been shown to predict academic achievement, and is thus a candidate modifiable factor influencing life course socioeconomic circumstances. Socioeconomic disadvantage is thought to impact on health over the life course partly by allostatic load, that is, cumulative biological risk. We sought to elucidate the role of parental involvement at age 16 on the life course development of allostatic load.

    METHODS: In a population-based cohort (365 women and 352 men, 67% of the eligible participants), we examined the association between parental involvement in their offspring's studies, measured by teacher and pupil ratings at age 16 and an allostatic load index summarising 12 physiological risk markers at age 43. Mediation through life course academic and occupational achievement was assessed by entering school grades, adult educational achievement and socioeconomic position at age 43 in a linear regression analysis in a stepwise manner and testing for mediation.

    RESULTS: Parental interest in their offspring's studies during the last year of compulsory school-rather than the parent's social class or availability of practical academic support-was found to predict adult allostatic load (β=-0.12, 95% CI -0.20 to -0.05). Further adjustments indicated that academic achievement over the life course mediated a large part of the effect of parental interest on allostatic load.

    CONCLUSIONS: Parental interest in their offspring's studies may have protective effects by decreasing the likelihood of a chain of risk involving low academic achievement, low socioeconomic position and high accumulated physiological stress.

  • 8064.
    Westerlund, Hugo
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Gustafsson, Per E.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Janlert, Urban
    Hammarström, Anne
    Social Adversity in Adolescence Increases the Physiological Vulnerability to Job Strain in Adulthood: A Prospective Population-Based Study2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 4, e35967Article in journal (Refereed)
    Abstract [en]

    Background: It has been argued that the association between job strain and health could be confounded by early life exposures, and studies have shown early adversity to increase individual vulnerability to later stress. We therefore investigated if early life exposure to adversity increases the individual's physiological vulnerability job strain in adulthood. Methodology/Principal Findings: In a population-based cohort (343 women and 330 men, 83% of the eligible participants), we examined the association between on the one hand exposure to adversity in adolescence, measured at age 16, and job strain measured at age 43, and on the other hand allostatic load at age 43. Adversity was operationalised as an index comprising residential mobility and crowding, parental loss, parental unemployment, and parental physical and mental illness (including substance abuse). Allostatic load summarised body fat, blood pressure, inflammatory markers, glucose, blood lipids, and cortisol regulation. There was an interaction between adversity in adolescence and job strain (B = 0.09, 95% CI 0.02 to 0.16 after adjustment for socioeconomic status), particularly psychological demands, indicating that job strain was associated with increased allostatic load only among participants with adversity in adolescence. Job strain was associated with lower allostatic load in men (beta = -0.20, 95% CI -0.35 to -0.06). Conclusions/Significance: Exposure to adversity in adolescence was associated with increased levels of biological stress among those reporting job strain in mid-life, indicating increased vulnerability to environmental stressors.

  • 8065.
    Westerlund, Hugo
    et al.
    Stockholm, Sweden .
    Rajaleid, Kristiina
    Stockholm, Sweden .
    Virtanen, Pekka
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin. Tampere, Finland .
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Nummi, Tapio
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin. Tampere, Finland .
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Parental academic involvement in adolescence as predictor of mental health trajectories over the life course: a prospective population-based cohort study.2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, 653- p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mental health problems are rising, especially among younger people, indicating a need to identify determinants of the development of mental health over the life course. Parental involvement in their children's studies, particularly in terms of academic socialisation, has been shown to predict better mental health in adulthood, as well as other more favourable health outcomes, but no study published so far has examined its impact on trajectories of mental health. We therefore sought to elucidate the role of parental involvement at age 16 on the life course development of internalised mental health symptoms.

    METHODS: In a population-based cohort (452 women and 488 men, 87 % of the eligible participants), we examined the association between parental involvement in their offspring's studies, measured by teacher and pupil ratings at age 16, and an index of internalised mental health symptoms at the ages of 16, 18, 21, 30, and 43. Using latent class trajectory analysis, 5 different trajectories were derived from these indices: Very low stable (least symptoms), Low stable, Increasing, Moderate stable, and High decreasing (most symptoms). Multinomial logistic regression was used to regress trajectory membership on the parental involvement variables.

    RESULTS: Teacher-rated parental interest in their offspring's studies during the last year of compulsory school was associated with a lower risk of entering the Moderate stable (OR = 0.54; 95 % CI 0.30 to 0.98) and High decreasing (OR = 0.41; 0.18 to 0.91) trajectories, compared with the Low stable, also after adjustment for sex, parental social class and mental health, family unemployment and own school grades. Both these associations were present only in children with grades above the national average. Student-rated availability of assistance with homework was associated with a higher chance of entering the Very low stable trajectory in the whole sample (OR = 1.24; 1.07 to 1.43), in men (OR = 1.25; 1.05 to 1.48) and in those with above average grades (OR = 1.39; 1.13 to 1.72), and with a lower risk of entering the Moderate stable in women (OR = 0.74; 0.55 to 0.99), also after the same adjustments.

    CONCLUSIONS: Parental involvement in their offspring's studies may buffer against poor mental health in adolescence which may track into adulthood.

  • 8066. Westerlund, Jessica
    et al.
    Graff, Pål
    Bryngelsson, Ing-Liss
    Westberg, Håkan
    Eriksson, Kåre
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Löfstedt, Håkan
    Occupational exposure to trichloramine and trihalomethanes in Swedish indoor swimming pools: evaluation of personal and stationary monitoring2015In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 59, no 8, 1074-1084 p.Article in journal (Refereed)
    Abstract [en]

    Introduction: Chlorination is a method commonly used to keep indoor swimming pool water free from pathogens. However, chlorination of swimming pools produces several potentially hazardous by-products as the chlorine reacts with nitrogen containing organic matter. Up till now, exposure assessments in indoor swimming pools have relied on stationary measurements at the poolside, used as a proxy for personal exposure. However, measurements at fixed locations are known to differ from personal exposure. Methods: Eight public swimming pool facilities in four Swedish cities were included in this survey. Personal and stationary sampling was performed during day or evening shift. Samplers were placed at different fixed positions around the pool facilities, at similar to 1.5 m above the floor level and 0-1 m from the poolside. In total, 52 personal and 110 stationary samples of trichloramine and 51 personal and 109 stationary samples of trihalomethanes, were collected. Results: The average concentration of trichloramine for personal sampling was 71 µg m-3, ranging from 1 to 240 µg m-3 and for stationary samples 179 µg m-3, ranging from 1 to 640 µg m-3. The air concentrations of chloroform were well below the occupational exposure limit (OEL). For the linear regression analysis and prediction of personal exposure to trichloramine from stationary sampling, only data from personal that spent > 50% of their workday in the pool area were included. The linear regression analysis showed a correlation coefficient (r2) of 0.693 and a significant regression coefficient β of 0.621; (95% CI = 0.329-0.912, P = 0.001). Conclusion: The trichloramine exposure levels determined in this study were well below the recommended air concentration level of 500 µg m-3; a WHO reference value based on stationary sampling. Our regression data suggest a relation between personal exposure and area sampling of 1:2, implying an OEL of 250 µg m-3 based on personal sampling.

  • 8067.
    Westerlund, Jessica
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Graff, Pål
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology.
    Eriksson, Kåre
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Löfstedt, Håkan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Occupational Exposure to Trichloramine and Trihalomethanes in Swedish Indoor Swimming Pools: Evaluation of Personal and Stationary Monitoring2015In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 59, no 8, 1074-1084 p.Article in journal (Refereed)
    Abstract [en]

    Introduction: Chlorination is a method commonly used to keep indoor swimming pool water free from pathogens. However, chlorination of swimming pools produces several potentially hazardous by-products as the chlorine reacts with nitrogen containing organic matter. Up till now, exposure assessments in indoor swimming pools have relied on stationary measurements at the poolside, used as a proxy for personal exposure. However, measurements at fixed locations are known to differ from personal exposure.

    Methods: Eight public swimming pool facilities in four Swedish cities were included in this survey. Personal and stationary sampling was performed during day or evening shift. Samplers were placed at different fixed positions around the pool facilities, at similar to 1.5 m above the floor level and 0-1 m from the poolside. In total, 52 personal and 110 stationary samples of trichloramine and 51 personal and 109 stationary samples of trihalomethanes, were collected.

    Results: The average concentration of trichloramine for personal sampling was 71 mu g m(-3), ranging from 1 to 240 mu g m(-3) and for stationary samples 179 mu g m(-3), ranging from 1 to 640 mu g m(-3). The air concentrations of chloroform were well below the occupational exposure limit (OEL). For the linear regression analysis and prediction of personal exposure to trichloramine from stationary sampling, only data from personal that spent > 50% of their workday in the pool area were included. The linear regression analysis showed a correlation coefficient (r (2)) of 0.693 and a significant regression coefficient beta of 0.621; (95% CI = 0.329-0.912, P = 0.001).

    Conclusion: The trichloramine exposure levels determined in this study were well below the recommended air concentration level of 500 mu g m(-3); a WHO reference value based on stationary sampling. Our regression data suggest a relation between personal exposure and area sampling of 1:2, implying an OEL of 250 mu g m(-3) based on personal sampling.

  • 8068.
    Westerlund, Michael
    et al.
    Stockholm University, Faculty of Humanities, Department of Journalism, Media and Communication (JMK).
    Wasserman, Danuta
    Nationell prevention av självmord och psykisk ohälsa (NASP), Karolinska institutet.
    Självmordsprevention i skolor i Sverige - hur ser det ut idag?2003In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 80, no 5, 462-473 p.Article in journal (Refereed)
    Abstract [sv]

    Studien visar att beredskapen i svenska skolor är låg när det gäller att upptäcka och hjälpa elever som befinner sig i allvarlig psykisk och social nöd och därmed riskerar att utföra självmordshandlingar. Trots att en stor andel av rektorerna uppger att de har personlig erfarenhet av elever som begått självmord eller utfört självmordsförsök saknar majoriteten av skolorna skriftliga planer, förebyggande program och utbildning av personal i självmordspreventiva åtgärder. Inget i resultaten pekar heller mot några större förändringar i positiv riktning inom en nära framtid.

  • 8069.
    Westgren, N
    et al.
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Hultling, C
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Levi, Richard
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Seiger, A
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Westgren, M
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Sexuality in women with traumatic spinal cord injury.1997In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 76, no 10, 977-983 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sexuality in spinal cord injured women has largely been neglected. One reason may be the male dominance amongst traumatically spinal cord injured individuals. The purpose of this study is to elucidate sexual issues in women with spinal cord injuries.

    METHODS: Survey of near-total prevalence population in the greater Stockholm area. Structured interview, based on a standardized questionnaire. Self-rating scales for evaluation of the importance of sexual activity before and after injury and for defining and rating the medical problem most significantly interfering with sexual activity. Marital status and/or partnership pre- and post-injury and information on sexual matters provided after injury were evaluated in detail. Out of a total 65 women, 62 participated in the study.

    RESULT: Women with complete and incomplete cervical lesions rated the importance of sexual activity significantly lower after, as compared to before, spinal cord injury. No significant differences were found in women with lower-level lesions. Urinary leakage, spasticity and positioning problems were the medical problems most significantly interfering with partner-related sexual activity. Only six women had received information on sexual matters before discharge from hospital. None of the partners had received such information.

    CONCLUSION: The women's neurological status affect their ability to adapt sexually after injury. Medical problems commonly interfere with sexuality and should be identified and treated. No adverse impact of spinal cord injury on marital status could be confirmed. Sexual counseling has yet to become an integral part of rehabilitation.

  • 8070.
    Westgren, Ninni
    et al.
    Spinalis SCI Research Unit, Karolinska Hospital and Department of Clinical Neuroscience and Family Medicine,Karolinska Institute, Stockholm, Sweden .
    Levi, Richard
    Spinalis SCI Research Unit, Karolinska Hospital and Department of Clinical Neuroscience and Family Medicine,Karolinska Institute, Stockholm, Sweden .
    Sexuality After Injury: Interviews with Women After Traumatic Spinal Cord Injury1999In: Sexuality and disability, ISSN 0146-1044, E-ISSN 1573-6717, Vol. 7, no 4, 309-319 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to illuminate sexual experiences in women after traumatic spinal cord injury (SCI), including psychological, physical and social barriers that will have to be overcome to resume a sexually active life with a partner. Interviews with eight women were performed. The women were 20–43 years old, previously healthy, with experience of stable heterosexual relationships both before and after SCI. The interviews covered three main areas: 1. The first sexual contact after injury: expectations, concerns, outcome; 2. Communication with partner on sexual matters, before and after injury; and 3. Sexual activity after injury: limitations, compensatory strategies. In addition, advice from the women to newly injured and rehabilitation staff/counselors was requested. Results suggest a strong influence of pre-injury sexual behaviour on post-injury sexual adaptation. A positive attitude towards sexuality and good communicative skills seem to be of particular importance for a favourable outcome of sexual rehabilitation. Even under such circumstances, however, SCI as a rule leads to significant loss of sexual ability. A realistic approach is therefore recommended in counseling, taking the mourning of loss of function into consideration, and allowing the patients to express their grief. Thus, sexual rehabilitation programs need to address a dynamic process of mourning and coping, rather than merely teaching skills for having sexual intercourse after SCI.

  • 8071.
    Westin, M
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Åhs, A
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Persson, KB
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Westerling, R
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Hälsa och vårdutnyttjande 2001.2002In: Socialmedicinsk rapportserieArticle in journal (Other academic)
  • 8072.
    Westin, Marcus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Sundelin, Claes
    Westerling, Ragnar
    Single parent characteristics and children's mental healthArticle in journal (Refereed)
  • 8073.
    Westin, Marcus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Swedish parental characteristics and children's mental health2010Article in journal (Refereed)
  • 8074.
    Westin, Niklas
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Petré, Jonas
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Ensam, nedstämd och rastlös: En studie om komorbiditet och hälsotillstånd hos hjälpsökande spelberoende2008Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte och frågeställningar

    Syftet med studien är att undersöka skillnader i hälsa mellan hjälpsökande spelberoende personer och den vuxna populationen i Sverige.

    1. Har hjälpsökande spelberoende sämre upplevd hälsa än den övriga befolkningen?
    2. Är hjälpsökande spelberoende mer rastlösa eller stressade än den övriga befolkningen?
    3. Kan komorbiditet konstateras hos hjälpsökande spelberoende?

    Metod

    En stödförening för spelberoende kontaktades och enkäter delades ut och samlades in under två möten. Totalt svarade 31 personer på enkäten. Resultaten jämfördes med data från undersökningen LIV 2000 för att se eventuella skillnader mot en population som mer motsvarar befolkningen i Sverige. I de fall en skillnad upptäcktes togs hänsyn till andra faktorer som kunde påverka resultatet.

    Resultat

    Inga skillnader i smärta, värk, upplevd fysisk och psykisk hälsa förekom. Hjälpsökande spelberoende upplevde oftare sömnproblem. De kände sig oftare rastlösa, ensamma och nedstämda jämfört med befolkningen i stort. En större andel av de hjälpsökande spelberoende var rökare eller snusare. Hjälpsökande spelberoende var mindre nöjda med sin totala livssituation. Dock upplevde de i högre grad kunna påverka sin livssituation.

    Slutsats

    Det finns vissa skillnader i hälsotillstånd mellan hjälpsökande spelberoende och befolkningen i stort. Resultaten är inte heltäckande och vidare forskning behövs för att undersöka om hälsoskillnaderna påverkar behandlingen av spelberoende.

  • 8075.
    Westling, Linnéa
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Tänk på Figuren, konferera i naturen!: Hur en konferensanläggning kan påverka gästernas hälsa.2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte och frågeställningar: Syftet med denna uppsats var att undersöka hur konferensanläggningen, Finnhamns Arkipelag, skulle kunna arbeta med hälsoaktiviteter för sina gäster med framförallt naturen som redskap.

    - Hur påverkar naturen konferensgästernas hälsa?

    - Hur arbetar redan hälsonischade konferensanläggningar?

    - Hur kan naturen användas inom hälsoarbetet på konferensanläggningar?

    - Vad kan utvecklas på Finnhamns konferensanläggning?

    Metod: Forskningen är avsedd att kartlägga behov, önskemål, erfarenhet och åsikter kring ämnet och slutsatsen drogs att den kvalitativa metoden, intervjuer, var mest lämpad för att kunna besvara frågeställningarna. Data har samlats in via fyra intervjuer, två ansikte mot ansikte och två via telefon utefter respondentens önskemål. Respondenterna har erfarenhet och kompetens inom området samt arbetar med friskvård eller är konferensansvariga på anläggningarna De jobbar med aktiviteter och hälsa för deras konferensgäster och har alla sett de positiva resultaten av vistelse i naturen.

    Resultat: Resultaten visar att naturen har återuppbyggande och en rad andra positiva effekter på konferensgäster som har aktiviteter utomhus. De nischade konferensanläggningarna har en mängd aktiviteter och är flexibla utefter önskemål. De menar att gästerna får mer energi och blir mer mottagliga för information efter en aktivitet. Utomhus erbjuds allt från stavgång till hinderbanor och inomhus kan bland annat yoga och massage erbjudas. Finnhamn har många möjligheter att utveckla och nischa sig mot hälsoaktiviter. Finnhamn är omgivet av liknande natur som de redan nischade konferensanläggningarna och kan även se de positiva effekterna av att erbjuda aktiviteter som inte är alltför tidskrävande.

    Slutsats: Slutsatsen är att stor vikt måste läggas vid att påpeka för företaget som bokar konferens, hur viktigt hälsa och naturvistelse är och hur det påverkar deras medarbetare. Informationen som ges under konferensen kan påverka gästen och leda till kunskap som kan förbättra deras hälsa även i framtiden.

  • 8076.
    Westman, Anders
    Örebro University, School of Health and Medical Sciences.
    Musculoskeletal pain in primary health care: a biopsychosocial perspective for assessment and  treatment2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Long-term musculoskeletal pain is a large public health problem with serious consequences for both the individual and society. Psychosocial factors have been shown to be good predictors of long-term disability and play an important role in the transition from acute to chronic pain. Early identification and intervention of those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering. The overall aim of this thesis was to assess a biopsychosocial approach to the assessment and management of musculoskeletal pain patients in primary health care.

    To this end, biopsychosocial assessment and treatment methods were tested in two different populations of primary care patients suffering pain. Results indicated that improvements in quality of life and work capacity one year after early multimodal rehabilitation were basically maintained after five years. The most salient prognostic factors determining return to work were educational level and the individual’s perceived health (Study I). Psychosocial factors as measured by the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) were related to disability and perceived health three years after treatment for non-acute pain problems (Study II). The experimental group in the controlled multimodal pain rehabilitation programme had lower health care utilization and a reduced risk of using large amounts of medication after three years compared with the participants in the control group. However, there were no significant differences between the groups on variables such as work capacity, function, catastrophizing and pain (Study III). Distinct profiles of catastrophizing, fear-avoidance beliefs, and distress were extracted and meaningfully related to future sick leave and dysfunction (Study IV).

    Our findings provide support for the biopsychosocial model and highlight the importance of psychosocial factors in long-term outcome. The results underscore the need for early identification of patients at risk. Further, multimodal treatment that covers not only biological but also psychosocial factors seems to be a key to successful treatment, and ideally this intervention should be matched to the patients' needs.

  • 8077.
    Westman, Anton
    et al.
    Umeå University.
    Sjöling, Mats
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Lindberg, Ann
    Swedish University of Agricultural Sciences.
    Björnstig, Ulf
    Umeå University.
    The SKYNET data: demography and injury reporting in Swedish skydiving2010Conference paper (Refereed)
    Abstract [en]

    The Swedish Parachute Association (SFF) national registry of skydiving injuries is one of the few trauma databases available for research on sport parachuting. The usefulness of this compulsory reporting system may benefit from a description of its base population and an evaluation of its sensitivity and specificity. METHODS: Cross-sectional analysis based on data collected through a web-based questionnaire (SKYNET), from all persons renewing a Swedish skydiving license 2008 (n=1049). Sensitivity was measured as the proportion of injury events fulfilling the reporting criterion (injury event requiring care of a physician) that were actually reported, by comparing the injury events reported to the SFF during the skydiving seasons 2006 and 2007 with the injury events retrospectively reported to the web-based questionnaire for the same time period. Specificity was measured as the proportion of false positives in relation to the defined reporting criterion for the same time period. Self-stated bone fractures, shoulder dislocations and cruciate ligament injuries were labeled as non-minor injuries. Factors affecting the likelihood of reporting were evaluated using logistic regression. RESULTS: The response rate was 100%. The overall sensitivity of the reporting system 2006/2007 was 0.37 (95% confidence interval (CI) 0.24-0.51). With self-stated non-minor injuries as the target for reporting, the sensitivity was 0.67 (95% CI 0.43-0.85). No significant effect on reporting was found for gender, age, license level, years in the sport, total number of jumps or club affiliation. The specificity was 0.91 (95% CI 0.83-0.95). Descriptive statistics of the Swedish skydiving population show several gender differences. CONCLUSIONS: The low sensitivity will yield false low incidence calculations, but as there is no evidence for differential underreporting, risk comparisons related to the candidate predictor variables appear reasonably valid. The false positive reporting warrants assortment of incoming data and a clarification of the reporting criteria. Attitudes to reporting may be of value to study, to understand the drivers and constraints for achieving a more complete notification of skydiving injuries.

  • 8078.
    Westman, Anton
    et al.
    Umeå Universitet, Institutionen för Kirurgisk och perioperativ vetenskap, Umeå Universitet.
    Sjöling, Mats
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Lindberg, Ann
    Svenska Lantbruks Universitetet, Uppsala.
    Björnstig, Ulf
    Umeå Universitet, Institutionen för Kirurgisk och perioperativ vetenskap, Umeå Universitet.
    The SKYNET data: Demography and injury reporting in Swedish skydiving2010In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 42, no 2, 778-783 p.Article in journal (Refereed)
    Abstract [en]

    Background: The Swedish Parachute Association (SFF) national registry of skydiving injuries is one of the few trauma databases available for research on sport parachuting. The usefulness of this compulsory reporting system may benefit from a description of its base population and an evaluation of its sensitivity and specificity. Methods: Cross-sectional analysis based on data collected through a web-based questionnaire (SKYNET), from all persons renewing a Swedish skydiving license 2008(n=1049). Sensitivity was measured as the proportion of injury events fulfilling the reporting criterion(injury event requiring care of a physician) that were actually reported, by comparing the injury events reported to the SFF during the skydiving seasons 2006 and 2007 with the injury events retrospectively reported to the webbased questionnaire for the same time period. Specificity was measured as the proportion of false positives in relation to the defined reporting criterion for the same time period. Self-stated bone fractures, shoulder dislocations and cruciate ligament injuries were labeled as non-minor injuries. Factors affecting the likelihood of reporting were evaluated using logistic regression. Results: The response rate was 100%. The overall sensitivity of the reporting system 2006/2007 was 0.37(95% confidence interval(CI) 0.24-0.51). With self-stated non-minor injuries as the target for reporting, the sensitivity was 0.67(95% CI 0.43-46 0.85). No significant effect on reporting was found for gender, age, license level, years in the sport, total number of jumps or club affiliation. The specificity was 0.91(95% CI 0.83-0.95). Descriptive statistics of the Swedish skydiving population show several gender differences. Conclusions: The low sensitivity will  yield false low incidence calculations, but as there is no evidence for differential underreporting, risk comparisons related to the candidate predictor variables appear reasonably valid. The false positive reporting warrants assortment of incoming data and a clarification of the reporting criteria. Attitudes to reporting may be of value to study, to understand the drivers and constraints for achieving a more complete notification of skydiving injuries.

  • 8079.
    Westman, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Planning primary health care provision: assessment of development work at a health centre1986Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    At the Primary Health Care Centre in Vännäs (VPHCC), northern Sweden, a development work was implemented in 1976-1980. The overall purpose was to enhance primary health care planning. In trying to improve health care delivery cooperation with community members was initiated and some organizational changes like a new appointment system, a new medical record and local care programs for some common diseases were introduced. Official statistics were also used for comparative purposes.

    The aims of the work were postulated (increased accessibility, higher continuity, more equitable distribution and enhanced cooperation) and suitable methods were designed. From postal surveys, chartreviews and administrative data (from hospitals, out-patient clinics and health centres) figures and information were collected.

    Accessibility was studied by waiting room time which was reduced and continuity, analyzed with a new concept - visit based provider continuity - was improved. The question of equitable distribution was studied by the consultation rates at different out-patient clinics. It seemed as if the local development work changed the patterns of utilization but some important issues were not decisively answered.

    Repeated postal surveys reflected the question of equitable distribution and the cooperation between the VPHCC and the community members. Positive responses were recorded in aspects like telephone accessibility and health care information. In a tracer study of diabetes the quality of care was studied. The local care program was actually implemented in the daily practice but the question of care quality needs further penetration.

    Within the frames of the development work new methods in the health care planning were introduced. Our work started from the prerequisits of the VPHCC and other health centres might find other ways of planning for care provision. On a general level, however, the structure of our work - defining aims, means and evaluation methods - can be used by others.

  • 8080.
    Westman, Jolin
    University of Skövde, School of Health and Education.
    Skiftarbetes inverkan på sjuksköterskors hälsa: En litteraturstudie2016Independent thesis Basic level (university diploma), 5 credits / 7,5 HE creditsStudent thesis
    Abstract [en]

    Introduction Shift work affects the circadian rhythm. Working night shift can, for instance, result in a disrupted circadian rhythm, which can have adverse effects on health. Nurses are a particularly vulnerable group in health care since they often work shifts.

     

    Purpose The purpose of this study was to explore how nurses are affected by shift work and what effects of shift work can have on nurses' health.

     

    Method The work was carried out as a literature review with a systematic approach, in which 10 scientific articles were selected from the databases; Academic Search Elite, CINAHL and MEDLINE. The articles were examined, analyzed, results were summarized and conclusions were drawn.

     

    Results Many nurses, often regardless of the type of shift work they have, suffer from insomnia, fatigue and gastrointestinal problems. Short rest between shifts and workload is mentioned in several articles as cause to the problems.

     

    Discussion Short rest between shifts can be a major contributing factor to the problems, circadian rhythm and shift work itself may not affect health as much as short rest and too little time for recovery in between shifts.

  • 8081. Wettergren, Björn
    et al.
    Blennow, Margareta
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Söder, Olle
    Ludvigsson, Jonas F.
    Child Health Systems in Sweden2016In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 177, S187-S202 p.Article in journal (Refereed)
    Abstract [en]

    On a national level, several factors are responsible for Sweden's leading position in achieving the excellent health of children because Sweden has experienced a long history of peace and success in establishing a parliamentary democracy throughout the 20th century. Among the different sectors of society, Sweden has been able to focus on prevention and health promotion. The Swedish health care system is publicly financed based on local taxation. Pediatricians working in secondary and tertiary care are employed by the public sector, whereas family physicians are employed by both the private and public sectors. The pediatric departments at county and university levels provide a high quality of inpatient care for neonates and children. The county hospital pediatric departments typically include one neonatal ward and one ward for older children. Subspecialization exists even at the county level, and there is close cooperation between the county level and subspecialist units at the university level. Within the primary care sector, most children receive care from family physicians. The majority of family physicians have completed 3 months of pediatrics in their basic training program. In the more densely populated areas there are also pediatric ambulatory care centers working mostly with referrals from the family physicians. Preventive care is carried out at midwife-led maternity health centers, nurse-led Child Health Centers, and nurse-led school health care settings and reach almost everyone (99%). All health care for children and adolescents is free of charge up to 18 years of age.

  • 8082. Wettermark, B
    et al.
    Brandt, L
    Kieler, H
    Bodén, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Centre for pharmacoepidemiology, Karolinska Institutet.
    Pregabalin is increasingly prescribed for neuropathic pain, generalised anxiety disorder and epilepsy but many patients discontinue treatment2014In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 68, no 1, 104-110 p.Article in journal (Refereed)
    Abstract [en]

    AIM: To assess prescribing patterns, sociodemographic characteristics and previous disease history in patients receiving pregabalin.

    METHODS: An observational study using register data on dispensed drugs and recorded diagnoses for all patients in Stockholm, Sweden, who filled at least one prescription of pregabalin between July 2005 and December 2009. Analyses focused on prevalence, incidence, diagnosis patterns, prior dispensing of other analgesics/psychotropics and persistence to treatment over time.

    RESULT: A total of 18,626 patients (mean age 55 years, 63% women) were initiated on treatment between July 2006 and December 2009. Approved indications were recorded in hospital and/or primary care within 1 year prior to the first dispensing for 40% of the patients (epilepsy 1.3%, neuropathic pain 35.5% and generalised anxiety disorder (GAD) 3.6%). Antidepressants were used by 55%, opioids by 49% and sedatives by 48% prior to initiation of pregabalin. One-third (34%) only purchased one prescription and the proportion purchasing pregabalin 1 year after initiation was 42.1% for epilepsy, 36.3% for GAD, 21.5% for neuropathic pain and 25.6% for those without any of the included diagnoses.

    CONCLUSION: Pregabalin was mainly used as a second-line drug for the treatment of GAD or neuropathic pain and to a lesser extent as add-on therapy in epilepsy. However, a large proportion of all patients only purchased one prescription and the persistence declined rapidly over time. The issue of potential off-label prescribing or poor registration of diagnoses should also be noted as a high proportion had been prescribed the drug without a record of any of the approved indications.

  • 8083.
    Wey, Daniela
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. São Paulo University, Brazil; Faculdades Metropolitanas Unidas, Brazil.
    Garefelt, Johanna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Fischer, Frida M.
    Moreno, Claudia R.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. São Paulo University, Brazil.
    Lowden, Arne
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Individual differences in the sleep/wake cycle of Arctic flexitime workers2016In: Chronobiology International, ISSN 0742-0528, E-ISSN 1525-6073, Vol. 33, no 10, 1422-1432 p.Article in journal (Refereed)
    Abstract [en]

    Daytime workers tend to have shorter sleep duration and earlier sleep onset during work days than on days off. Large individual differences in sleep onset and sleep duration may be observed on work days, but work usually synchronizes sleep offset to a similar time. The present study describes individual differences in sleep behaviour of 48 daytime workers (25 men, aged 20-58 years) from an iron ore mine in Northern Sweden. The aim of the study was to determine whether differences in sleep patterns during work days were associated with the outcomes of sleepiness and sleep complaints. Cluster analysis was used to group workers into two categories of sleep onset and sleep duration. The "Late Sleep Onset" cluster comprised workers who slept 1.30 h later than the "Early Sleep Onset" cluster (p < 0.0001 for all weekdays). The "Long Sleep Duration" cluster slept 1.10 h longer than the "Short Sleep Duration" cluster (p < 0.0002 for work nights). The "Late Sleep Onset" cluster reported less refreshing sleep (p < 0.01) and had lower sufficient sleep scores (p < 0.01) than the "Early Sleep Onset" cluster. The "Short Sleep Duration" cluster also reported lower scores for sufficient sleep (p < 0.04) than the "Long Sleep Duration" cluster. For combined characteristics (phase and duration), workers with a late phase and short sleep duration reported greater sleep debt and sleepiness than workers with an early phase and short sleep duration (p < 0.02). Work schedule and commuting time modulate both sleep phase and sleep duration independently. Workers, classified as having an intermediate sleep phase preference, can organize their sleep time in order to minimize sleep debt and sleepiness symptoms. Individual differences in sleep phase and duration should be considered when promoting well-being at work even among groups with similar sleep needs. In order to minimize sleep debt and sleepiness symptoms, successful sleep behaviour could be promoted involving extend use of flexitime arrangement (i.e. later starting times) and reduce use of alarm clocks.

  • 8084.
    Wiberg, Anna
    Halmstad University, School of Social and Health Sciences (HOS).
    Stressrelaterad ohälsa hos föräldralösabarn och ungdomar i länder utanför Europa2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: There are 143 million orphans and adolescentsaround the world today. They have lost an important protection in their lives. The protection a genetic parent is expected to provide is the best for the child or adolescent to survive.Purpose:The purpose of this study was to illuminate factors thattrigger stress-related illness among orphans in countries outside Europe.Method:This paper is performed as a literature study and it isbased upon 12 scientific articles.Results:A total of three themes are presented which were; Care,witnessed violence and the feeling of powerlessness. Common to the three themes is that they showed how the situation and health is of orphaned children and adolescents. Stress occurred for example at times when they had witnessed a serious incident which changed their life situation.They experienced negative attitudes from society which made it difficult for the orphaned children and adolescents to have a normal life.Implication:This knowledge can be used to create a supportiveenvironment for the children and adolescents. More information to guardians and concerned organizations about health promotion is also an appropriate measure. 

  • 8085.
    Wiberger, Maja
    et al.
    Univ Gothenburg, Dept Publ Hlth Epidemiol & Community Med, SE-40530 Gothenburg, Sweden.
    Eiben, Gabriele
    Univ Gothenburg, Dept Publ Hlth Epidemiol & Community Med, SE-40530 Gothenburg, Sweden.
    Lisner, Lauren
    Univ Gothenburg, Dept Publ Hlth Epidemiol & Community Med, SE-40530 Gothenburg, Sweden.
    Mehlig, Kirsten
    Univ Gothenburg, Dept Publ Hlth Epidemiol & Community Med, SE-40530 Gothenburg, Sweden.
    Papoutsou, Stalo
    Res & Educ Inst Child Hlth, Strovolos, Cyprus.
    Hunsberger, Monica
    Univ Gothenburg, Dept Publ Hlth Epidemiol & Community Med, SE-40530 Gothenburg, Sweden.
    Children consuming milk cereal drink are at increased risk for overweight: The IDEFICS Sweden study, on behalf of the IDEFICS Consortium2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 6, 518-524 p.Article in journal (Refereed)
    Abstract [en]

    Aims: The aims of this study were to characterize milk cereal drink (MCD) consumption among Swedish children and to investigate the association between MCD and overweight in a longitudinally followed cohort of children over 2 years of age. Methods: In the Swedish cohort from IDEFICS (Identification and prevention of Dietary-and lifestyle-induced health EFfects In Children and infantS) we examined early feeding practices and weight status when children were aged 2-9 years (2007/2008) and at 2-year follow-up. Weight and height were measured at both time points in 1077 children. Characteristics of MCD consumers were explored with logistic regression. Body mass index (BMI) z-scores at both time points and weight status at follow-up were regressed on explanatory factors using mixed linear and logistic regression, respectively. Results: Nearly 69% of children had consumed MCD. The MCD consumers were more likely than never-consumers to have two native Swedish parents, parents with less than 2 years of post-secondary education, and a shorter period of breastfeeding. MCD consumers had a higher BMI z-score at follow-up compared with baseline (difference in BMI z-score=0.12, 95% confidence interval (CI)= 0.07, 0.17), while the average BMI z-score in non-consumers remained stable over time (0.00, 95% CI= -0.07, 0.07). MCD consumers were nearly five times more likely than non-consumers to become overweight during the follow-up (odds ratio (OR)= 4.78, 95% CI= 1.68, 13.59), independent of breastfeeding. Conclusions: MCD was consumed by the majority of children in this study. MCD consumption is associated with an increased risk for overweight and less exposure to breastfeeding. Our findings motivate future research aimed at investigating how MCD should be recommended.

  • 8086. Wiberg-Itzel, Eva
    et al.
    Pembe, Andrea B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Järnbert-Pettersson, Hans
    Norman, Margareta
    Wihlbäck, Anna-Carin
    Hoesli, Irene
    Todesco Bernasconi, Monya
    Azria, Elie
    Åkerud, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lactate in Amniotic Fluid: Predictor of Labor Outcome in Oxytocin-Augmented Primiparas' Deliveries2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 10, e0161546Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: One of the major complications related to delivery is labor dystocia, or an arrested labor progress. Many dystocic deliveries end vaginally after administration of oxytocin, but a large numbers of women with labor dystocia will undergo a long and unsafe parturition. As a result of the exertion required in labor, the uterus produces lactate. The uterine production of lactate is mirrored by the level of lactate in amniotic fluid (AFL).

    OBJECTIVES: To evaluate whether the level of AFL, analysed in a sample of amniotic fluid collected vaginally at arrested labor when oxytocin was needed, could predict labor outcome in nulliparous deliveries.

    METHODS: A prospective multicentre study including 3000 healthy primiparous women all with a singleton pregnancy, gestational age 37 to 42 weeks and no maternal /fetal chronic and/or pregnancy-related conditions. A spontaneous onset of labor, regular contractions and cervical dilation ≥ 3 cm were required before the women were invited to take part in the study.

    RESULTS: AFL, analysed within 30 minutes before augmentation, provides information about delivery outcome. Sensitivity for an acute cesarean section according to high (≥10.1mmol/l) or low (< 10.1mmol/l) AFL values was 39.0% (95% CI; 27-50), specificity 90.3% (95% CI; 87-93) PPV 37.3% (95% CI; 27-48) and NPV was 91.0% (95% CI; 88-93). The overall percentage of correct predictions of delivery outcome when the AFL level was used was 83.7%. Deliveries with a high AFL-level correlated with delivery time >12h (p = 0.04), post-partum fever (>38°C, p = 0.01) and post-partum haemorrhage >1.5L (p = 0.04).

    CONCLUSION: The AFL is a good predictor of delivery outcome in arrested nulliparous deliveries. Low levels of AFL may support the decision to continue a prolonged vaginal labor by augmentation with oxytocin. A high level of AFL correlates with operative interventions and post-partum complications.

  • 8087.
    Wickström, Anne
    et al.
    Umeå University, Sweden.
    Fagerström, Maria
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Rehabilitation Center.
    Wickström, Lucas
    Linköping University, Department of Computer and Information Science. Linköping University, Faculty of Science & Engineering.
    Granasen, Gabriel
    Umeå University, Sweden.
    Dahle, Charlotte
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Vrethem, Magnus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Sundstrom, Peter
    Umeå University, Sweden.
    The impact of adjusted work conditions and disease-modifying drugs on work ability in multiple sclerosis2017In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, no 8, 1137-1147 p.Article in journal (Refereed)
    Abstract [en]

    Background: Multiple sclerosis (MS) is a neurological disorder that causes significantly reduced ability to work, and the Expanded Disability Status Scale (EDSS) is one of the main predictors for reduced work ability. Objectives: To investigate how work requirements, flexible work conditions and disease-modifying drugs (DMDs) influence the work ability in relation to different EDSS grades in two MS populations. Methods: Work ability was studied in two MS populations: one in the southern and one in the northern part of Sweden, both demographically similar. In the latter population, more active work-promoting interventions have been practised and second-generation DMDs have been widely used from the onset of disease for several years. Results: The proportion of MS patients who participated in the workforce or studied was significantly higher in the northern compared with the southern population (pamp;lt;0.001). The employees in the northern population had significantly lower requirements, greater adapted work conditions and were able to work more hours per week. Higher EDSS was associated with lower reduction in number of worked hours per week in the northern population (p=0.042). Conclusion: Our data indicated that treatment strategy and adjusted work conditions have impact on work ability in MS.

  • 8088.
    Wickström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Fagerström, Maria
    Wickström, Lucas
    Granåsen, Gabriel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Dahle, Charlotte
    Vrethem, Magnus
    Sundström, Peter
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    The impact of adjusted work conditions and disease-modifying drugs on work ability in multiple sclerosis2017In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, no 8, 1137-1147 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Multiple sclerosis (MS) is a neurological disorder that causes significantly reduced ability to work, and the Expanded Disability Status Scale (EDSS) is one of the main predictors for reduced work ability.

    OBJECTIVES: To investigate how work requirements, flexible work conditions and disease-modifying drugs (DMDs) influence the work ability in relation to different EDSS grades in two MS populations.

    METHODS: Work ability was studied in two MS populations: one in the southern and one in the northern part of Sweden, both demographically similar. In the latter population, more active work-promoting interventions have been practised and second-generation DMDs have been widely used from the onset of disease for several years.

    RESULTS: The proportion of MS patients who participated in the workforce or studied was significantly higher in the northern compared with the southern population (p < 0.001). The employees in the northern population had significantly lower requirements, greater adapted work conditions and were able to work more hours per week. Higher EDSS was associated with lower reduction in number of worked hours per week in the northern population (p = 0.042).

    CONCLUSION: Our data indicated that treatment strategy and adjusted work conditions have impact on work ability in MS.

  • 8089.
    Wickström, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Höglund, Berit
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lundgren, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Increased risk for mental illness, injuries, and violence in children born to mothers with intellectual disability: A register study in Sweden during 1999-20122017In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 65, 124-131 p.Article in journal (Refereed)
    Abstract [en]

    Several studies have demonstrated that mothers with intellectual disability (ID) have a higher prevalence of mental health illness, lower socio-economic status, and a higher risk of alcohol and drug use compared to mothers without ID. The children of mothers with ID are over-represented in child protection and legal proceedings but are generally a less studied group than the mothers. The aim of this study was to investigate if children born to mothers with ID had an increased risk of being diagnosed with mental illness, injuries, and violence compared with children of mothers without ID. The study comprised a population based cohort of children born in Sweden between 1999 and 2005. Data were collected from the Medical Birth Register and linked with two other national registers; ICD-10 codes were used for medical diagnoses, including ID. The children were followed from birth to seven years of age. In total, 478,577 children were included, of whom 2749 were born to mothers with ID. Children of mothers with ID were at a greater risk of having mental health problems (adjusted odds ratio (OR)= 2.02; 95% confidence interval (CI) = 1.74-2.35) and ID (OR = 4.14; CI = 2.95-5.82) in early childhood. They had an increased risk for injuries due to falls (OR = 1.15; CI 1.04-1.27). The largest risk related to trauma was violence and child abuse (OR =3.11; CI = 1.89-5.12). In conclusion, children of mothers with ID had an increased risk for injuries, violence, and child abuse. We therefore suggest that parents with ID should receive evidence based support so that their children receive the best care and protection. (C) 2017 The Author(s). Published by Elsevier Ltd.

  • 8090.
    Widenfalk Ehlin, Evelyn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Habiliteringspersonals erfarenheter av att arbeta med habiliteringsplaner för personer med funktionshinder-En kvalitativ intervjustudie2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: The Swedish County Council is under the Health Care Act required to establish habilitation plans regarding decided interventions for people with disabilities. This plan is an important implement in habilitation services in order to ensure equitable care, participation and influence in the treatment of people with disabilities.  The purpose and goals of the intervention are documented in the plan, which is created together with the person with a disability.

    Purpose: The aim of this study was to describe the professional’s perceptions and experiences of working with, establishing and evaluating habilitation plans. In short, the purpose was to study how habilitation plans are used in the daily work with people with disabilities.

    Method: This is a descriptive qualitative interview study where a total of 16 interviews were analyzed by qualitative content analysis.

    Results: The analysis yielded four categories containing a total of 14 subcategories: the informants experiences difficulties in goal setting, setting goals that could be evaluated and meaningful during time. The study shows that due to lack of knowledge about how a habilitation plan could be updated, many of the efforts were not connected to the existing habilitation plan. Forms and templates that were available were not clinically anchored, meaning that different approaches were applied. The results also show a lack of clear guidelines and procedures about how a habilitation plan should be reported to colleagues. In the habilitation process the professional needed to clarify the working process with the habilitation plans for the person with disabilities and their relatives.  The participation for the person with disabilities was described to confound with the person cognitive ability and relatives impact. To create conditions for participation, the professional used image support when needed. The work from the habilitation plan gave structure and clarity but was also an administrative burden because the purpose of the plan was unclear. Conclusion:

    This study shows that there are difficulties in the process of developing habilitation plans and difficulties in making the habilitation plan an effective instrument in the daily work. Several areas in need of development were identified: clear guidelines on how to update habilitation plans, templates and forms should be compatible with each other and clear guidelines for reporting the plan to colleagues. Also, involving habilitation plans in the daily work is a challenge that remains to be met.

  • 8091.
    Widerström, Mathilda
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Utmattningssyndrom bland högskolestudenter: En intervjustudie2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective: The aim of this study is to increase understanding how chronic fatigue syndrome affects university students' lifes.

    Method: The study used a qualitative method where five interviews were conducted on college students aged 19-25 years, which at some time during their life had chronic fatigue syndrome. The data was processed through content analysis.

    Results: The results showed that chronic fatigue syndrome affected students’ life situation. They needed treatment and were on sick-leave during certain periods and had problems with memory, concentration and focus.

    Conclusion: Symptoms of chronic fatigue syndrome can manifest in terms of headaches, stomach pain, weight loss, weight gain and insomnia. The factors that influence if a college student develops fatigue syndrome is a heavy workload from work and studies, high demands and no time for recovery. However further research is needed on the relationship between being a student and chronic fatigue syndrome to clarify causal factors.

  • 8092.
    Widerström, Micael
    et al.
    Umeå University, Umeå, Sweden.
    Schonning, Caroline
    Public Health Agency of Sweden, Solna, Sweden.
    Lilja, Mikael
    Umeå University, Umeå, Sweden.
    Lebbad, Marianne
    Public Health Agency of Sweden, Solna, Sweden.
    Ljung, Thomas
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Allestam, Gorel
    Public Health Agency of Sweden, Solna, Sweden.
    Ferm, Martin
    Umeå University, Umeå, Sweden.
    Björkholm, Britta
    Public Health Agency of Sweden, Solna, Sweden.
    Hansen, Anette
    Public Health Agency of Sweden, Solna, Sweden.
    Hiltula, Jan I.
    Östersund Municipality, Östersund, Sweden.
    Långmark, Jonas
    Public Health Agency of Sweden, Solna, Sweden .
    Löfdahl, Margareta
    Public Health Agency of Sweden, Solna, Sweden .
    Omberg, Maria
    Jämtland County Council, Östersund, Sweden .
    Reutenwall, Christina
    Public Health Agency of Sweden, Solna, Sweden .
    Samuelsson, Eva
    Umeå University, Umeå, Sweden .
    Widgren, Katarina
    Public Health Agency of Sweden, Solna, Sweden .
    Wallensten, Anders
    Public Health Agency of Sweden, Solna, Sweden .
    Lindh, Johan
    Public Health Agency of Sweden, Solna, Sweden .
    Large Outbreak of Cryptosporidium hominis Infection Transmitted through the Public Water Supply, Sweden2014In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 20, no 4, 581-589 p.Article in journal (Refereed)
    Abstract [en]

    In November 2010, approximate to 27,000 (approximate to 45%) inhabitants of Ostersund, Sweden, were affected by a waterborne outbreak of cryptosporidiosis. The outbreak was characterized by a rapid onset and high attack rate, especially among young and middle-aged persons. Young age, number of infected family members, amount of water consumed daily, and gluten intolerance were identified as risk factors for acquiring cryptosporidiosis. Also, chronic intestinal disease and young age were significantly associated with prolonged diarrhea. Identification of Ctyptosporidium hominis subtype lbA10G2 in human and environmental samples and consistently low numbers of oocysts in drinking water confirmed insufficient reduction of parasites by the municipal water treatment plant. The current outbreak shows that use of inadequate microbial barriers at water treatment plants can have serious consequences for public health. This risk can be minimized by optimizing control of raw water quality and employing multiple barriers that remove or inactivate all groups of pathogens.

  • 8093.
    Widfeldt, Marie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Hälsoinspiratörer på arbetsplatsen - en undersökning om chefens inställning2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

     

     

     

     

    ABSTRACT

    Widfeldt, M. (2011). Health motivators in the workplace – a study on the manager’s attitude. Public Health Science C: Theory and method with application and examination paper. Faculty of Health and Working Life: University of Gävle.

    Within the Swedish Post office, health promotion is actively being carried out. In order to reach out with health promotion to all employees, health motivators have an important role. In order to succeed in achieving good results from this work, managers’ attitudes are seen as an important prerequisite. The purpose of this study was to investigate the attitudes to health motivators among managers in the Swedish Post office. The study was based on a qualitative design and involved 16 managers, of whom eight managers worked with health motivators and eight managers did not. The collected interviews were analyzed using a content analysis and the results showed that managers had a positive attitude towards working with health motivators. Managers with health motivators noticed positive effects in the form of healthier employees, reduced absenteeism, and an improved working environment. Managers without health motivators noted time constraints and lack of interest among employees as the main reasons for not working with them. In conclusion, this study has shown that managers have a positive attitude towards working with health motivators, but that the time and the interests among employees are required to work in this way.

    Key words:

    health motivator, managers, attitudes, effects

  • 8094. Wiebert, P.
    et al.
    Svartengren, M.
    Lindberg, Magnus
    Örebro University, School of Health and Medical Sciences.
    Hemmingsson, T.
    Lundberg, I.
    Nise, G.
    Mortality, morbidity and occupational exposure to airway-irritating agents among men with a respiratory diagnosis in adolescence2008In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 65, no 2, 120-125 p.Article in journal (Other academic)
    Abstract [en]

    Objectives: To examine the influence of an airway diagnosis in adolescence on future health and occupation in Swedish men.

    Methods: Data were collected from the linkage of four Swedish national registers: the Military Service Conscription Register, the Population and Housing Censuses, the Inpatient Care Register and the National Cause of Death Register. A job-exposure matrix for airway-irritating substances was developed for application on the conscription cohort. The cohort included 49 321 Swedish men born 1949–51. Three groups—(1) healthy, (2) asthmatics (mild and severe asthma) and (3) subjects with allergic rhinitis without concurrent asthma—were identified at conscription and analysed for mortality, in-patient care and strategies for choice of occupation with emphasis on airway-irritating job exposure. Analyses were adjusted for smoking and childhood socioeconomic position.

    Results: The prevalence of total asthma was 1.8%, severe asthma 0.45% and allergic rhinitis 2.7%. Mortality for all causes was significantly higher in total asthma, hazard ratio (HR) 1.49 (95% CI 1.00 to 2.23), and lower in allergic rhinitis, HR 0.52 (95% CI 0.30 to 0.91). Asthma was a risk factor for inpatient care while allergic rhinitis was associated with less in-patient care (odds ratio (OR) for total asthma 1.16 (95% CI 1.00 to 1.34), severe asthma 1.38 (95% CI 1.04 to 1.85), allergic rhinitis 0.92 (95% CI 0.82 to 1.03)). Those with asthma tended to avoid jobs with a high probability for airway-irritating exposure (OR 0.88, 95% CI 0.71 to 1.09), but not to the same extent as subjects with allergic rhinitis (OR 0.58, 95% CI 0.47 to 0.70) (ORs from 1990).

    Conclusion: Subjects with asthma did not change their exposure situation to the same extent as subjects with allergic rhinitis. Further, asthmatics had an increased risk for morbidity and mortality compared to healthy subjects and subjects with allergic rhinitis.

  • 8095. Wiedmann, Silke
    et al.
    Hillmann, Steffi
    Abilleira, Sonia
    Dennis, Martin
    Hermanek, Peter
    Niewada, Maciej
    Norrving, Bo
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Rudd, Anthony G.
    Wolfe, Charles D. A.
    Heuschmann, Peter U.
    Variations in Acute Hospital Stroke Care and Factors Influencing Adherence to Quality Indicators in 6 European Audits2015In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 46, no 2, 579-581 p.Article in journal (Refereed)
    Abstract [en]

    Background and Purpose-We compared compliance with standards of acute stroke care between 6 European audits and identified factors associated with delivery of appropriate care. Methods-Data were derived from stroke audits in Germany, Poland, Scotland, Catalonia, Sweden, and England/Wales/Northern-Ireland participating within the European Implementation Score (EIS) collaboration. Associations between demographic and clinical characteristics with adherence to predefined quality indicators were investigated by hierarchical logistic regression analyses. Results-In 2007/2008 data from 329 122 patients with stroke were documented. Substantial variations in adherence to quality indicators were found; older age was associated with a lower probability of receiving thrombolytic therapy, anticoagulant therapy, or stroke unit treatment and a higher probability of being tested for dysphagia. Women were less likely to receive anticoagulant or antiplatelet therapy or stroke unit treatment. No major weekend effect was found. Conclusions-Detected variations in performance of acute stroke services were found. Differences in adherence to quality indicators might indicate population subgroups with specific needs for improving care delivery.

  • 8096. Wierup, Ia
    et al.
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Wandell, Per
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Ärnlov, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Borne, Yan
    Low anthropometric measures and mortality-results from the Malmo Diet and Cancer Study2015In: Annals of Medicine, ISSN 0785-3890, E-ISSN 1365-2060, Vol. 47, no 4, 325-331 p.Article in journal (Refereed)
    Abstract [en]

    Aim. To study the association between anthropometric measures: body mass index (BMI), percent body fat, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), waist-to-hip-to-height ratio (WHHR), and A Body Shape Index (ABSI); to see if individuals in the lowest 5 percentiles for these measures have an increased risk of mortality. Methods. A population-based prospective cohort study ( 10,304 men and 16,549 women), the Malmo Diet and Cancer study (MDC), aged 45-73 years. Results. During a mean follow-up of 14 +/- 3 years, 2,224 men and 1,983 women died. There was a significant increased mortality risk after adjustments for potential confounders in the group with the 5% lowest BMI ( referent 25%-75%); hazard ratios (HR) with 95% confidence intervals were 1.33 (1.10-1.61) for women and 1.27 (1.07-1.52) for men. A similar significant increased mortality risk was seen with the 5% lowest percent body fat, HR 1.31 (1.07-1.60) for women and 1.25 (1.04-1.50) for men. Women with an ABSI in the lowest 5 percentiles had a lower mortality risk HR 0.64 (0.48-0.85). Conclusion. These results imply that BMI or percent body fat could be used to identify lean individuals at increased mortality risk.

  • 8097.
    Wiesiollek, Kathrin
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Naturupplevelse och psykisk hälsa: Hur påverkar naturupplevelser människor med stress- och utmattningssymtom2013Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Stress-related diseases in Sweden have doubled since 1997. Even longterm sickness related tostress has increased over the last decade. In future there is a need of alternative methods todecrease the amount of people being affected to gain a better population health. Natureassisted therapy (NAT) was shown to be a successful method as part of the therapy of stressand burnout likewise was nature an important factor to prevent people from mentaldisorders. The aim of this study was to analyse the latest research concearning nature and itshealth effects with focus on stress and burnout patients in order to plan health promotingactivities outdoors for these patients. Questions included in the study were what impact natureexperiences have apart from medical and psychotherapeutic methods and how natureexperiences do affect stress and burnout patients. The results show that viewing landscapes,rest activities in boreal environment (especially broad-leaved and pine forest), closeness towater and bright wide surroundings have positive effects on people with stress. There is theevidence that certain nature qualities can serve as resources for recovery from stress. Theycan also reduce the risk for gaining mental health. Nature experience is evoking a relaxingmechanism through the activation of the parasympathetic nerve system. For a longtermeffect affected patients do not only need to be shown meaningful activities outdoors but alsohas nature and outdoor activities to become a part of people’s everyday life.

  • 8098.
    Wieslander, Gunilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Ocular symptoms, tear film stability, nasal patency, and biomarkers in nasal lavage in indoor painters in relation to emissions from water-based paint2010In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 83, no 7, 733-741 p.Article in journal (Refereed)
    Abstract [en]

    Despite the decreased use of solvent-based paint (SBP) and increased use of water-based paints (WBP) with possible risk for microbial growth, few health studies are available. The aim was to study the symptoms and ocular and nasal biomarkers in house painters in relation to paint use and personal exposure to volatile organic compounds (VOC) and microbial VOC (MVOC) during indoor painting with WBP. All house painters from three major companies and unexposed controls (janitors from one company) were invited, 94% (N = 31) and 95% (N = 20) of non-asthmatics participated, respectively. Tear film break-up time (BUT), nasal patency by acoustic rhinometry, and biomarkers in nasal lavage (NAL) were measured at work, and a doctor's administered questionnaire was answered. Personal sampling (8 h) of formaldehyde, VOC, and MVOC was performed in 17 house painters using WBP. House painters had increase in ocular symptoms, decreased BUT, and increased NAL-lysozyme, when compared to controls. Painters reporting mucosal irritation from WBP had less nasal patency and higher NAL-myeloperoxidase (NAL-MPO). A large proportion of the VOC consisted of propylenglycol, diglycol ethers, and Texanol. There was an association between 8-h exposure to propylene glycol and NAL-eosinophilic cationic protein (NAL-ECP), 2-phenoxyethanol levels and reduced BUT, sum of aliphatic glycol ethers and increased NAL-MPO. Increased levels of 1-octen-3-ol, one MVOC, were related to reduced nasal patency and increase in NAL-MPO. House painters may have a risk for adverse physiological reactions in the ocular and nasal mucosa. A minority of painters susceptible to WBP can react with neutrophilic nasal inflammation. Different chemicals in the paint could cause either neutrophilic or eosinophilic inflammation, or reduced tear film stability. In addition, house painters are exposed to MVOC which may affect the nasal mucosa.

  • 8099.
    Wihlborg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Strokepatienters upplevelser av egenhälsa och stöd från sjukvården: en kvalitativ studie2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 8100.
    Wihlborg, Elin
    et al.
    Linköping University, Department of Management and Engineering, Political Science. Linköping University, Faculty of Arts and Sciences.
    Norstedt, Anna
    Linköping University.
    New ways and actors when diplomacy goes digital: The e-Diplomacy Campaign “Midwives4All2017In: Proceedings of the 50th Hawaii International Conference on System Sciences, 2017, Waikoloa: University of Hawaii , 2017, 2438-2447 p.Conference paper (Refereed)
    Abstract [en]

    This article focuses on Midwives4All, an e-diplomacy campaign launched by the Swedish MFA in 2015. The campaign aims to spread knowledge about the benefits of midwives and evidence-based midwifery. Within the campaign, the Swedish MFA, and in particular its Communications Department (UD-KOM), combines e-diplomacy and networking and the campaign has become one key activity within the Swedish feminist foreign policy. It is organizing diplomacy in new ways that regards both choices of channels and the networking with inter- and nongovernmental organizations. The limited impacts of the campaign are seen as consequences of the peripheral status of the issue and the lack of systematic structures for e-diplomacy so far. In spite of this the case indicates that e-diplomacy has the potential to raise and empower both new actor groups and new issues on the diplomatic agenda.

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