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  • 701. Reims, Henrik M
    et al.
    Oparil, Suzanne
    Kjeldsen, Sverre E
    Devereux, Richard B
    Julius, Stevo
    Brady, William E
    Fyhrquist, Frej
    Ibsen, Hans
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Omvik, Per
    Wedel, Hans
    Beevers, Gareth
    de Faire, Ulf
    Kristianson, Krister
    Lederballe-Pedersen, Ole
    Nieminen, Markku S
    Dahlöf, Björn
    Losartan benefits over atenolol in non-smoking hypertensive patients with left ventricular hypertrophy: the LIFE study.2004In: Blood Press, ISSN 0803-7051, Vol. 13, no 6, p. 376-84Article in journal (Refereed)
  • 702.
    Reine, Ieva
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    From young to adult: health consequences of unemployment from a gender perspective2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background The point of departure in this thesis is that unemployment is a recognised determinant of health, which may vary between different ages and among men and women. Despite governmental policies to tackle unemployment and ease its effects on health, unemployment continues to bea growing public health problem.

    Aim The objective of the thesis was to analyse, from a gender perspective, the relationships between ill health and unemployment as well as other unstable labour market positions in the transition from youth to adulthood.

    The aim of each paper was: I. Does the association between ill health and unemployment differ between young people and adults? II. Is the transition from an unstable labour market position to permanent paid job health-protective? III. Is participation in labour market programmes related to mental health? IV. What is the association between ill health among men and women and how could it be analysed with a relational theory of gender?

    Methods The longitudinal study was carried out in Luleå - a medium-sized industrial town in the Northern Sweden. The cohort, consisting of all 1083 pupils (506 girls and 577 boys) aged 16 who attended the last year of compulsory school in 1981, was followed up at the ages of 16, 18, 21 and 30. The response rates were high e.g. 96.4% at 14 years follow-up. The cohort was followed with extensive and well-validated questionnaires. Multivariate logistic regression was used in all papers, while propensity score matchingwas used in Paper III.

    Results Paper I. Health effects of long-term unemployment differed between young people and adults. Long-term unemployment was more related to psychological ill health and smoking in young people than in adults. Paper II. The results indicated that after controlling for gender as well as for an indicator of health-related selection, possible confounders and mediators transition from an unstable labour market position to permanent employment could be health-promoting. Paper III. No association was found between participation in active labour market programmes and psychological symptoms. Due to methodological shortages the results have to be interpreted with caution. Adjustment for either all background selection variables or the propensity score in multivariate logistic regression showed similar associations suggesting that propensity score could be used to adjust for background selection variables. Paper IV. A strong association between unemployment and suboptimal self-rated health among women and high alcohol consumption among men was found and a theory of structural relations was used to discuss the gendered patterns for ill health.

    Conclusion The thesis indicated gendered patterns of relations between unemployment and the health outcomes, in the transition from youth to adulthood. The policy implications of my thesis are that full employment policies should be promoted to reduce the health inequalities associated with unemployment.

  • 703.
    Reine, Ieva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Novo, Mehmed
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Hammarström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Unemployment and ill health - a gender analysis: results from a 14-year follow-up of the Northern Swedish cohort2013In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 127, no 3, p. 214-222Article in journal (Refereed)
    Abstract [en]

    Objectives. To investigate the experience of suicidal expressions (death wishes, life weariness, ideation, plans and attempts) in young Swedish Sami, their attitudes toward suicide (ATTS), and experience of suicidal expressions and completed suicide in significant others and to compare with Swedes in general. Methods. A cross-sectional study comprising 516 Swedish Sami, 18-28 years of age together with an age and geographically matched reference group (n = 218). Parts of the ATTS questionnaire have been used to cover different aspects of the suicidal complex. Data were analysed with regard to gender, occupation, counties and experience of negative societal treatment due to Sami background. Results. Both young Sami and young Swedes reported suicidal ideation, life weariness, and death wishes in a high degree (30-50%), but it was more common among the Sami. Having had plans to commit suicide showed a significant gender difference only in the Sami. The prevalence of suicide attempts did not differ significantly between Sami and Swedes. Subgroups of the Sami reported a higher degree of suicidal behaviour, Sami women and reindeer herders reported a 3, 5-fold higher odds of suicide attempts and a 2-fold higher odds having had plans committing suicide. Sami living in Vasterbotten/Jamtland/Vasternorrland and Sami with experience of ethnicity related bad treatment 2-fold higher odds of suicidal plans compared to those living in other counties. Conclusion. An increased occurrence of suicidal ideation/death wishes/life weariness in young Sami compared to young majority Swedes was found, but not an increased prevalence of suicide attempts and positive attitudes together with an increased awareness to handle suicide problems could be a contributing factor. Severe circumstances and experience of ethnicity-related bad treatment seems to contribute to increased levels of suicidal plans and attempts in subgroups of Sami.

  • 704.
    Reine, Ieva
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Novo, Mehmed
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Does the association between ill health and unemployment differ between young people and adults?: results from a 14-year follow-up study with a focus on psychological health and smoking2004In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 118, no 5, p. 337-345Article in journal (Refereed)
    Abstract [en]

    Objectives. Research has given a comprehensive picture of the negative health consequences of unemployment without offering sufficient comparison between different age groups.

    The aim of this study was to analyse whether the associations between ill health, particularly poor psychological health and smoking, and unemployment differ between young and adult men and women.

    Study design. A 14-year follow-up study of graduates of compulsory school in an industrial town in northern Sweden was undertaken. The subjects were analysed at ages 16, 21 and 30 years. Complete data on the cohort were collected for 1044 individuals with the aid of a comprehensive questionnaire. The response rate was 96.4%.

    Methods. The main health measurements used in this study were poor psychological health and smoking, analysed by multivariate logistic regression.

    Results. After controlling for several background variables, associations between long-term unemployment and poor psychological health were found in young men and women, and adult men. Long-term unemployment was only associated with smoking inyoung people.

    Conclusions. The association between long-term unemployment and psychological health, as well as smoking, seemed to be stronger in young people than adults.

  • 705.
    Reine, Ieva
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Novo, Mehmed
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Does transition from an unstable labour market position to permanent employment protect mental health?: results from a 14-year follow-up of school-leavers2008In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 8, no 159Article in journal (Refereed)
    Abstract [en]

    Background: Having secure employment, in contrast to being unemployed, is regarded as an important determinant of health. Research and theories about the negative health consequences of unemployment indicated that transition from unemployment to a paid job could lead to improved health. The objective of this study was to test the hypothesis that obtaining permanent employment after being in an unstable labour market position protects mental health.

    Methods: A 14-year follow-up of all graduates from compulsory school in an industrial town in northern Sweden was performed at ages 16, 18, 21 and 30 years. Complete data on the cohort were collected for 1044 individuals with the aid of a comprehensive questionnaire. The response rate was 96.4%. The health measurement used in this study was the psychological symptoms analysed by multivariate logistic regression. Those who obtained permanent employment were the focus of the analysis. This group consisted of people who were in an unstable labour market position for a year or more between the ages of 25 and 29, and who had acquired a permanent job one year before and at the time of the investigation.

    Results: After controlling for gender as well as for an indicator of health-related selection, possible confounders and mediators, an association was found between the lower probability of psychological symptoms and obtaining permanent employment (OR = 0.35, 95% CI 0.19–0.63) as well as having permanent employment (OR = 0.22, 95% CI 0.10–0.51).

    Conclusion: Our findings suggest that transition from an unstable labour market position topermanent employment could be health-promoting, even after controlling for possible confounders and mediators, as well as for an indicator of health-related selection. However, as there are few studies in the field, there is a need for more longitudinal studies in order to further analyse the relationship and to examine possible explanations. The policy implication of our study is that the transformation of unstable labour market positions into permanent employment could contribute to better public health.

  • 706.
    Reine, Ieva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Novo, Mehmed
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Is participation in labour market programmes related to mental health?: results from a 14-year follow-up of the Northern Swedish cohort2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 1, p. 26-34Article in journal (Refereed)
    Abstract [en]

    Aims: There is a lack of empirical studies assessing the possible impact of active labour market programmes (ALMP) on health. The aim of this study was to analyze whether participation in ALMP, in contrast to being unemployed and not participating in ALMP (UNALMP), was related to mental health at different ages.

    Methods: The study was carried out in a medium-sized industrial town in the north of Sweden. The cohort, consisting of all 1,083 pupils who attended or should have attended the last year of compulsory school in 1981, was followed up at the ages of 16, 18, 21 and 30. Data on 381 individuals at age 21, and 281 at age 30 were used in the study. The main health measurement was psychological symptoms among participants of ALMP in contrast to UNALMP at ages 21 and 30, and was analyzed by propensity score matching method (PSM) and multivariate logistic regression.

    Results: Generally, ALMP had higher scores of psychological symptoms than UNALMP. Nevertheless, participation in ALMP was not related to mental health. Due to methodological shortages our results have to be interpreted with caution. Adjustment for either all background selection variables or the propensity score in multivariate logistic regression showed similar associations, suggesting that propensity score could be used to adjust for background selection variables.

    Conclusions: There is a need for more well-designed studies, using a theoretical framework, within the field, that are based on larger samples.

  • 707.
    Renström, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Payne, Felicity
    Metabolic Disease Group, The Wellcome Trust Sanger Institute, Cambridge CB10 1SA, UK.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Brito, Ema C
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Barroso, Ines
    Metabolic Disease Group, The Wellcome Trust Sanger Institute, Cambridge CB10 1SA, UK.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Franks, Paul W
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Replication and extension of genome-wide association study results for obesity in 4,923 adults from Northern Sweden.2009In: Human Molecular Genetics, ISSN 0964-6906, E-ISSN 1460-2083, Vol. 18, no 8, p. 1489-1496Article in journal (Refereed)
    Abstract [en]

    Recent genome-wide association studies (GWAS) have identified multiple risk loci for common obesity (FTO, MC4R, TMEM18, GNPDA2, SH2B1, KCTD15, MTCH2, NEGR1, and PCSK1). Here we extend those studies by examining associations with adiposity and type 2 diabetes in Swedish adults. The nine single nucleotide polymorphisms (SNPs) were genotyped in 3,885 non-diabetic and 1,038 diabetic individuals with available measures of height, weight and BMI. Adipose mass and distribution was objectively assessed using dual energy X-ray absorptiometry (DEXA) in a sub-group of non-diabetics (n=2,206). In models with adipose mass traits, BMI or obesity as outcomes, the most strongly associated SNP was FTO rs1121980 (P<0.001). Five other SNPs (SH2B1 rs7498665, MTCH2 rs4752856, MC4R rs17782313, NEGR1 rs2815752, and GNPDA2 rs10938397) were significantly associated with obesity. To summarize the overall genetic burden, a weighted risk score comprising a subset of SNPs was constructed; those in the top quintile of the score were heavier (+2.6kg) and had more total (+2.4kg), gynoid (+191g), and abdominal (+136g) adipose tissue than those in the lowest quintile (all P<0.001). The genetic burden score significantly increased diabetes risk, with those in the highest quintile (n=193/594 cases/controls) being at 1.55-fold (95% CI: 1.21-1.99; P<0.0001) greater risk of type 2 diabetes than those in the lowest quintile (n=130/655 cases/controls). In summary, we have statistically replicated six of the previously associated obese-risk loci and our results suggest that the weight-inducing effects of these variants are explained largely by increased adipose accumulation.

  • 708.
    Rexvid, Devin
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Blom, Björn
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Evertsson, Lars
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Socialarbetares och allmänläkares (icke-) användning av kunskap i risksamhället2011Conference paper (Other academic)
    Abstract [sv]

    Bakgrund: Dagens samhälle beskrivs ofta som ett risksamhälle. Karaktäristiskt för risksamhället är ökad komplexitet, eskalerande osäkerhet och minskat eller brutet förtroende för professioners kompetens och förmåga att handskas med den ökande komplexiteten och osäkerheten. Närmare bestämt handlar det urholkade förtroendet för professioner om ett ifrågasättande av deras definitionsmakt, autonomi och diskretion. Idag är det i hög grad kraven på riskreduceringstekniker, exempelvis evidensbaserad praktik och standardiserade riskbedömningsinstrument, som står för kontroverserna om professionsutövningens natur, villkor och utmaningar.

    Syfte: Att undersöka hur risk påverkar (icke-)användning av kunskap i professionell praktik i socialt arbete och allmänmedicin, samt att belysa hur de två professionerna förhåller sig till riskteknologins imperativ.

    Metod: Studien är ett utsnitt ur en större systematisk litteraturöversikt över socialarbetares och allmänläkares (icke-)användning av kunskap i praktiken. Föreliggande paper bygger på knappt hälften av de 100 referee-granskade artiklar som översikten inbegriper. 

    Resultat: I studien framkommer bl.a. att det finns mer forskning om allmänläkares oföljsamhet gentemot riskreduceringstekniker, om osäkerhet och komplexitet samt hantering av dessa faktorer, om mer användning av informella än standardiserade osäkerhets- och komplexitetsreduceringsteknologier, jämfört med dito forskning i socialt arbete. Ett annat resultat är att forskning i socialt arbete sätter socialarbetares risktagande i relation till deras bristande kunskap medan forskning om allmänläkare relaterar det till deras icke-användning av riskreduceringstekniker.

    Konklusion: En preliminär slutsats är att skillnaderna mellan socialt arbete och allmänmedicin är så pass stora – även om människovård är en gemensam nämnare – att det inte automatiskt går att överföra principer och modeller mellan dem.

  • 709. Ridderstedt, Frida
    et al.
    Widerström, Micael
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology. Unit of Communicable Disease Control and Prevention – Östersund.
    Lindh, Johan
    Lilja, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Unit of Clinical Research Center – Östersund.
    Sick leave due to diarrhea caused by contamination of drinking water supply with Cryptosporidium hominis in Sweden: a retrospective study2018In: Journal of Water and Health, ISSN 1477-8920, E-ISSN 1996-7829, Vol. 16, no 5, p. 704-710Article in journal (Refereed)
    Abstract [en]

    We investigated sick leave from work, studies, preschool, and kindergarten occurring between 1 November 2010 and 31 January 2011 and associated with a waterborne outbreak of diarrhea caused by Cryptosporidium hominis in late November 2010 in Östersund, Sweden with 45.2% of 60,000 residents being symptomatic. A questionnaire defining acute watery diarrhoea and/or ≥3 diarrhea episodes/day as cryptosporidiosis was sent to 1,508 residents in late January 2011 (response rate 69.2%). Among adults aged 18–60 years, 24.0% took sick leave for a mean of 4.6 (SD ± 4.0) days due to cryptosporidiosis, and an additional 10.6% were absent from work a mean of 4.0 (±2.2) days to care for symptomatic children. Among children (aged ≤17 years), 35.0% stayed home sick from kindergarten/preschool or school/university for a mean of 5.2 (±3.8) days resulting in 5.1 (±4.4) days of absence from work per sick child shared between parents/guardians. The estimated total number of sick leave days was 50,000 for adults and 20,700 for children, with an estimated direct cost of €7 million for employers. The potential impact on society of sick leave caused by waterborne diseases must be considered in decisions regarding the quality of drinking water.

  • 710.
    Risberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    “I am solely a professional – neutral and genderless”: on gender bias and gender awareness in the medical profession2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: During the last decades research has reported seemingly unjustified differences between how women and men are perceived as patients, medical students and physicians. Most studies have been performed outside Scandinavia. The overall aim of this thesis is to illustrate, analyse and discuss aspects of gender bias and gender awareness in clinical medicine, medical research and medical education, all in a Swedish setting.

    Material and methods: Physicians’ ways of reasoning and reflecting on different professional arenas were investigated from a gender perspective in three cross-sectional studies: A. Written answers from a national examination for 289 Swedish interns where the examinees were allocated to suggest management of a common health problem - irritable bowel syndrome - in either a male or a female paper-patient with identical case descriptions. B. Assessments from 682 physicians, in structured assessment forms, of the scientific quality of two fictive research abstracts - one with a quantitative and one with a qualitative design – where authorship was assigned to either a woman or a man. C. Answers from 303 physician teachers to a questionnaire where they, on scales, assessed the importance of gender in different professional relationships and also gave open-ended comments.

    Most analyses were quantitative, using chi2-tests and multivariate logistic regression as statistical methods. Differences were discussed in relation to gender theory. Qualitative method, by way of open and selective coding, was used to explore the open-ended answers in the questionnaire and to create codes from the written answers in the national exam.

    Results: A. There were differences in outcome for male and female cases in history taking and in proposed diagnoses, investigations and treatment, e.g. more questions about and tests for alcohol were suggested for men and more tests for thyroid function for women. Both men and women physicians contributed to the gender bias but showed different patterns. B. The quantitative abstract was judged the same regardless of the gender of the assessor or author. The qualitative abstract was not ranked as scientific as the quantitative, but as more accurate, trustworthy, relevant and interesting with a female author especially by women assessors. C. Men physicians, especially in the surgical group, expressed low awareness of gender compared to women physicians. The qualitative analysis rendered a picture of how the physicians perceive ‘gender’, problems they connect with gender and their attitudes to gender issues. Some important concepts identified were ‘inequity’, ‘difference’, ‘delicate situations’, and ‘resistance’. To get an overview and better understanding of various expressions of gender bias, a theoretical model was developed, on the basis of the findings in the qualitative analysis. The main findings of the thesis are discussed in relation to this model where equity/inequity and sameness/difference are important points of departure.

    Conclusions: The findings of gendered outcome in the national exam call attention to ‘knowledge-mediated gender bias’, a phenomenon implying that once knowledge of gender differences in a condition has been established this might cause gender biased assessments of individual patients in the clinical situation. Gender appears to affect scientific evaluations. This has implications for situations where research is assessed and interpreted: in medical tutoring, research guidance, peer reviewing, and in forming evaluation committees for research funding. Physician teachers seem little aware of gender as an area of competence and knowledge and tend to connect gender issues with women. Depending on how ‘difference’ and ‘equity’ are apprehended various forms of resistance to gender emerge, each with plausible bias risks. Educational programmes for faculty members, encouraging continuous reflections on gender attitudes and supporting male participation, are suggested. Besides providing a more comprehensive understanding of patients and their health problems, increased gender awareness among physicians might improve the working climate and help reduce the gendered division of labour in the medical profession.

  • 711.
    Risberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    ["I'm just a civil servant--neutral and sexless". About the resistance against the gender perspective and the risk of gender bias in medicine]2005In: Lakartidningen, ISSN 0023-7205, Vol. 102, no 40, p. 2852-4Article in journal (Other academic)
  • 712.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Johansson, Eva
    Gender awareness among physicians--the effect of specialty and gender. A study of teachers at a Swedish medical school.2003In: BMC Med Educ, ISSN 1472-6920, Vol. 3, p. 8-Article in journal (Refereed)
  • 713.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gender perspective in medicine: a vital part of medical scientific rationality. A useful model for comprehending structures and hierarchies within medical science.2006In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, no 4, p. 20-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: During the past few decades, research has reported gender bias in various areas of clinical and academic medicine. To prevent such bias, a gender perspective in medicine has been requested, but difficulties and resistance have been reported from implementation attempts. Our study aimed at analysing this resistance in relation to what is considered good medical research.

    METHOD: We used a theoretical model, based on scientific competition, to understand the structures of scientific medicine and how they might influence the resistance to a gender perspective in medicine. The model was originally introduced to discuss how pluralism improves rationality in the social sciences.

    RESULTS: The model provided a way to conceptualise different fields of research in medicine: basic research, applied research, medical philosophy, and 'empowering' research. It clarified how various research approaches within medicine relate to each other, and how they differ and compete. It also indicated why there might be conflicts between them: basic and applied research performed within the biomedical framework have higher status than gender research and other research approaches that are performed within divergent research paradigms.

    CONCLUSION: This hierarchy within medical research contributes to the resistance to a gender perspective, causing gender bias and making medical scientific rationality suboptimal. We recommend that the theoretical model can be applied in a wider medical context when different and hierarchically arranged research traditions are in conflict. In this way, the model might contribute to shape a medical community where scientific pluralism is acknowledged to enlarge, not to disturb, the scientific rationality of medicine.

  • 714.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gender awareness among physicians - the effect of speciality and gender: A study of teachers at a Swedish medical school2003In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 3, no 8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: An important goal for medical education today is professional development including gender equality and awareness of gender issues. Are medical teachers prepared for this task? We investigated gender awareness among physician teachers, expressed as their attitudes towards the role of gender in professional relationships, and how it varied with physician gender and specialty. We discuss how this might be related to the gender climate and sex segregation in different specialties. METHOD: Questionnaires were sent to all 468 specialists in the clinical departments and in family medicine, who were engaged in educating medical students at a Swedish university. They were asked to rate, on visual analogue scales, the importance of physician and patient gender in consultation, of preceptor and student gender in clinical tutoring and of physician gender in other professional encounters. Differences between family physicians, surgical, and non-surgical hospital doctors, and between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. RESULTS: The response rate was 65 %. There were differences between specialty groups in all investigated areas mainly due to disparities among men. The odds for a male family physician to assess gender important were three times higher, and for a male non-surgical doctor two times higher when compared to a male surgical doctor. Female teachers assessed gender important to a higher degree than men. Among women there were no significant differences between specialty groups. CONCLUSIONS: There was an interaction between physician teachers' gender and specialty as to whether they identified gender as important in professional relationships. Male physicians, especially from the surgical group, assessed gender important to a significantly lower degree than female physicians. Physicians' degree of gender awareness may, as one of many factors, affect working climate and the distribution of women and men in different specialties. Therefore, to improve working climate and reduce segregation we suggest efforts to increase gender awareness among physicians, for example educational programs where continuous reflections about gender attitudes are encouraged.

  • 715.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, EE
    Westman, G
    Hamberg, K
    "I would like to think that we are all human beings and can understand each other.”: Qualitative analysis of attitudes towards gender issues among physician teachersManuscript (preprint) (Other academic)
  • 716.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    A theoretical model for analysing gender bias in medicine2009In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 8, p. 28-Article in journal (Refereed)
    Abstract [en]

    During the last decades research has reported unmotivated differences in the treatment of women and men in various areas of clinical and academic medicine. There is an ongoing discussion on how to avoid such gender bias. We developed a three-step-theoretical model to understand how gender bias in medicine can occur and be understood. In this paper we present the model and discuss its usefulness in the efforts to avoid gender bias. In the model gender bias is analysed in relation to assumptions concerning difference/sameness and equity/inequity between women and men. Our model illustrates that gender bias in medicine can arise from assuming sameness and/or equity between women and men when there are genuine differences to consider in biology and disease, as well as in life conditions and experiences. However, gender bias can also arise from assuming differences when there are none, when and if dichotomous stereotypes about women and men are understood as valid. This conceptual thinking can be useful for discussing and avoiding gender bias in clinical work, medical education, career opportunities and documents such as research programs and health care policies. Too meet the various forms of gender bias, different facts and measures are needed. Knowledge about biological differences between women and men will not reduce bias caused by gendered stereotypes or by unawareness of health problems and discrimination associated with gender inequity. Such bias reflects unawareness of gendered attitudes and will not change by facts only. We suggest consciousness-rising activities and continuous reflections on gender attitudes among students, teachers, researchers and decision-makers.

  • 717.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    "Important...but of low status": male education leaders´ views on gender in medicine2011In: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, Vol. 45, no 6, p. 613-624Article in journal (Refereed)
    Abstract [en]

    Objectives The implementation of and communication about matters associated with gender in medical education have been predominantly perceived as women's issues. This study aimed to explore attitudes towards and experiences of gender-related issues among key male members of faculties of medicine.

    Methods We conducted semi-structured interviews with 20 male education leaders from the six medical schools in Sweden. The interviews were analysed qualitatively using a modified grounded theory approach.

    Results The core category -'important... but of low status'- reflects ambivalent attitudes towards gender-related issues in medicine among male education leaders. All informants were able to articulate why gender matters. As doctors, they saw gender as a determinant of health and, as bystanders, they had witnessed inequalities and the wasting of women's competence. However, they had doubts about gender-related issues and found them to be overemphasised. Gender education was seen as a threat to medical school curricula as a consequence of the time and space it requires. Gender-related issues were considered to be unscientifically presented, to mostly concern women's issues and to tend to involve 'male bashing' (i.e. gender issues were often labelled as ideological and political). Interviewees asked for facts and knowledge, but questioned specific lessons and gender theory. Experiences of structural constraints, such as prejudice, hierarchies and homosociality, were presented, making gender education difficult and downgrading it.

    Conclusions The results indicate that male faculty leaders embrace the importance of gender-related issues, but do not necessarily recognise or defend their impact on an area of significant knowledge and competence in medicine. To change this and to engage more men in gender education, faculty measures are needed to counteract prejudice and to upgrade the time allocation, merits and status of gender implementation work. Based on our findings, we present and discuss possible ways to interest more men and to improve gender education in medicine.

  • 718.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Centre for Gender Excellence, research programme Challenging Gender, Umeå University, Umeå, SE-90187, Sweden.
    Westman, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Centre for Gender Excellence, research programme Challenging Gender, Umeå University, Umeå, SE-90187, Sweden.
    Attitudes toward and experiences of gender issues among physician teachers: a survey study conducted at a university teaching hospital in Sweden2008In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 8, article id 10Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Gender issues are important to address during medical education, however research about the implementation of gender in medical curricula reports that there are obstacles. The aim of this study was to explore physician teachers' attitudes to gender issues.

    METHODS: As part of a questionnaire, physician teachers at Umeå University in Sweden were given open-ended questions about explanations for and asked to write examples why they found gender important or not. The 1 469 comments from the 243 respondents (78 women, 165 men) were analyzed by way of content analysis. The proportion of comments made by men and women in each category was compared.

    RESULTS: We found three themes in our analysis: Understandings of gender, problems connected with gender and approaches to gender. Gender was associated with differences between women and men regarding behaviour and disease, as well as with inequality of life conditions. Problems connected with gender included: delicate situations involving investigations of intimate body parts or sexual attraction, different expectations on male and female physicians and students, and difficulty fully understanding the experience of people of the opposite sex. The three approaches to gender that appeared in the comments were: 1) avoidance, implying that the importance of gender in professional relationships was recognized but minimized by comparing gender with aspects, such as personality and neutrality; 2) simplification, implying that gender related problems were easy to address, or already solved; and 3) awareness, implying that the respondent was interested in gender issues or had some insights in research about gender. Only a few individuals described gender as an area of competence and knowledge. There were comments from men and women in all categories, but there were differences in the relative weight for some categories. For example, recognizing gender inequities was more pronounced in the comments from women and avoidance more common in comments from men.

    CONCLUSION: The surveyed physician teachers gave many examples of gender-related problems in medical work and education, but comments describing gender as an area of competence and knowledge were few. Approaches to gender characterized by avoidance and simplification suggest that faculty development programs on gender need to address and reflect on attitudes as well as knowledge.

  • 719.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Westman, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gender in medicine - an issue for women only? A survey of physician teachers' gender attitudes.2003In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 2, no 1, p. 10-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: During the last decades research has disclosed gender differences and gender bias in different fields of academic and clinical medicine. Consequently, a gender perspective has been asked for in medical curricula and medical education. However, in reports about implementation attempts, difficulties and reluctance have been described. Since teachers are key persons when introducing new issues we surveyed physician teachers' attitudes towards the importance of gender in professional relations. We also analyzed if gender of the physician is related to these attitudes. METHOD: Questionnaires were sent to all 468 senior physicians (29 % women), at the clinical departments and in family medicine, engaged in educating medical students at a Swedish university. They were asked to rate, on five visual analogue scales, the importance of physician and patient gender in consultation, of physician and student gender in clinical tutoring, and of physician gender in other professional encounters. Differences between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. RESULTS: The response rate was 65 %. The physicians rated gender more important in consultation than in clinical tutoring. There were significant differences between women and men in all investigated areas also when adjusting for speciality, age, academic degree and years in the profession. A higher proportion of women than men assessed gender as important in professional relationships. Those who assessed very low were all men while both men and women were represented among those with high ratings. CONCLUSIONS: To implement a gender perspective in medical education it is necessary that both male and female teachers participate and embrace gender aspects as important. To facilitate implementation and to convince those who are indifferent, this study indicates that special efforts are needed to motivate men. We suggest that men with an interest in gender issues should be involved in this work. Further research is needed to find out how such male-oriented endeavours should be outlined.

  • 720.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    News from the Nordic countries2011In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 29, no 1, p. 2-3Article in journal (Other academic)
  • 721.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    What is the mechanism behind the association between autoantibodies against GAD65 and high body mass index?2004In: J Intern Med, ISSN 0954-6820, Vol. 256, no 3, p. 262-3; author reply 264Article in journal (Other academic)
  • 722.
    Rolandsson, Olov
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Daka, B
    Lernmark, A
    Concordance between three radio binding assays for GAD65Ab in an adult type 2 diabetes population.2007In: Acta Diabetologica, ISSN 0940-5429, E-ISSN 1432-5233, Vol. 44, no suppl 1, p. S43-S43Article in journal (Refereed)
  • 723.
    Rolandsson, Olov
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hampe, Christiane S.
    Sharp, Stephen J.
    Ardanaz, Eva
    Boeing, Heiner
    Fagherazzi, Guy
    Mancini, Francesca Romana
    Nilsson, Peter M.
    Overvad, Kim
    Chirlaque, Maria-Dolores
    Dorronsoro, Miren
    Gunter, Marc J.
    Kaaks, Rudolf
    Key, Timothy J.
    Khaw, Kay-Tee
    Krogh, Vittorio
    Kuehn, Tilman
    Palli, Domenico
    Panico, Salvatore
    Sacerdote, Carlotta
    Sanchez, Maria-Jose
    Severi, Gianluca
    Spijkerman, Annemieke M. W.
    Tumino, Rosario
    van der Schouw, Yvonne T.
    Riboli, Elio
    Forouhi, Nita G.
    Langenberg, Claudia
    Wareham, Nicholas J.
    Autoimmunity plays a role in the onset of diabetes after 40 years of age2019In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428Article in journal (Refereed)
    Abstract [en]

    Aims/hypothesis: Type 1 and type 2 diabetes differ with respect to pathophysiological factors such as beta cell function, insulin resistance and phenotypic appearance, but there may be overlap between the two forms of diabetes. However, there are relatively few prospective studies that have characterised the relationship between autoimmunity and incident diabetes. We investigated associations of antibodies against the 65 kDa isoform of GAD (GAD65) with type 1 diabetes and type 2 diabetes genetic risk scores and incident diabetes in adults in European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct, a case-cohort study nested in the EPIC cohort.

    Methods: GAD65 antibodies were analysed in EPIC participants (over 40 years of age and free of known diabetes at baseline) by radioligand binding assay in a random subcohort (n = 15,802) and in incident diabetes cases (n = 11,981). Type 1 diabetes and type 2 diabetes genetic risk scores were calculated. Associations between GAD65 antibodies and incident diabetes were estimated using Prentice-weighted Cox regression.

    Results: GAD65 antibody positivity at baseline was associated with development of diabetes during a median follow-up time of 10.9 years (HR for GAD65 antibody positive vs negative 1.78; 95% CI 1.43, 2.20) after adjustment for sex, centre, physical activity, smoking status and education. The genetic risk score for type 1 diabetes but not type 2 diabetes was associated with GAD65 antibody positivity in both the subcohort (OR per SD genetic risk 1.24; 95% CI 1.03, 1.50) and incident cases (OR 1.97; 95% CI 1.72, 2.26) after adjusting for age and sex. The risk of incident diabetes in those in the top tertile of the type 1 diabetes genetic risk score who were also GAD65 antibody positive was 3.23 (95% CI 2.10, 4.97) compared with all other individuals, suggesting that 1.8% of incident diabetes in adults was attributable to this combination of risk factors.

    Conclusions/interpretation: Our study indicates that incident diabetes in adults has an element of autoimmune aetiology. Thus, there might be a reason to re-evaluate the present subclassification of diabetes in adulthood.

  • 724.
    Rolandsson, Olov
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hampe, Christiane S
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Radtke, Jared
    Langenberg, Claudia
    Wareham, Nicholas
    Prevalence and Regional Distribution of Autoantibodies Against GAD65Ab in a European Population Without Diabetes: The EPIC-InterAct Study2015In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 38, no 8, p. E114-E115Article in journal (Refereed)
  • 725.
    Rolandsson, Olov
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Hasselström, Jan
    Oien, Rut
    Säwe, Juliette
    [Peripheral arterial disease in primary health care. Occurrence and care]2006In: Lakartidningen, ISSN 0023-7205, Vol. 103, no 37, p. 2645-6, 2648Article in journal (Refereed)
  • 726.
    Rolandsson, Olov
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Marklund, Stefan L
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Ågren, Åsa
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Hägg, Erik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Hemoglobin A1c can be analyzed in blood kept frozen at -80 degrees C and is not commonly affected by hemolysis in the general population.2004In: Metabolism, ISSN 0026-0495, Vol. 53, no 11, p. 1496-9Article in journal (Refereed)
  • 727.
    Rolandsson, Olov
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Svensson, Maria
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    How to diagnose and classify diabetes in primary health care: Lessons learned from the Diabetes Register in Northern Sweden (DiabNorth)2012In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 30, no 2, p. 81-87Article in journal (Refereed)
    Abstract [en]

    Objective. The objective was to create a diabetes register and to evaluate the validity of the clinical diabetes diagnosis and its classification. Design. The diabetes register was created by linkage of databases in primary and secondary care, the pharmaceutical database, and ongoing population-based health surveys in the county. Diagnosis and classification were validated by specialists in diabetology or general practitioners with special competence in diabetology. Analysis of autoantibodies associated with type 1 diabetes was used for classification. Setting. Primary and secondary health care in the county of V sterbotten, Sweden. Patients. Patients with diabetes (median age at diagnosis 56 years, inter quartile range 50-60 years) who had participated in the V sterbotten Intervention Programme (VIP) and accepted participation in a diabetes register. Results. Of all individuals with diabetes in VIP, 70% accepted to participate in the register. The register included 3256 (M/F 1894/1362) diabetes patients. The vast majority (95%) had data confirming the diabetes diagnoses according to WHO recommendations. Unspecified diabetes was the most common (54.6%) classification by the general practitioners. After assessment by specialists and analysis of autoantibodies the majority were classified as type 2 diabetes (76.8%). Type 1 diabetes was the second largest group (7.2%), including a sub-group of patients with latent autoimmune diabetes (4.8%). Conclusion. It was concluded that it is feasible to create a diabetes register based on information in medical records in general practice. However, special attention should be paid to the validity of the diabetes diagnosis and its classification.

  • 728.
    Rolandsson, Olov
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Palmer, JP
    Latent autoimmune diabetes in adults (LADA) is dead: long live autoimmune diabetes!2010In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 53, no 7, p. 1250-1253Article in journal (Refereed)
  • 729.
    Rolandsson, Olov
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Risborg, M
    Rasmark, S
    Distal symmetric polyneuropathy is uncommon in impaired glucose tolerance.2008In: 67th Annual Meeting of the American-Diabetes-AssociationJune 06-10, 2008, San Francisco, 2008Conference paper (Other academic)
  • 730.
    Rolandsson, Olov
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Risborg, O
    Rasmark, S
    Distal symmetric polyneuropathy is uncommon in impaired glucose tolerance.: Conference Information: 67th Annual Meeting of the American-Diabetes-Association2008In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 57, no suppl 1, p. A224-A224Article in journal (Refereed)
  • 731. Romaguera, D.
    et al.
    Norat, T.
    Wark, P. A.
    Vergnaud, A. C.
    Schulze, M. B.
    van Woudenbergh, G. J.
    Drogan, D.
    Amiano, P.
    Molina-Montes, E.
    Sanchez, M. J.
    Balkau, B.
    Barricarte, A.
    Beulens, J. W. J.
    Clavel-Chapelon, F.
    Crispim, S. P.
    Fagherazzi, G.
    Franks, P. W.
    Grote, V. A.
    Huybrechts, I.
    Kaaks, R.
    Key, T. J.
    Khaw, K. T.
    Nilsson, P.
    Overvad, K.
    Palli, D.
    Panico, S.
    Quiros, J. R.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sacerdote, C.
    Sieri, S.
    Slimani, N.
    Spijkerman, A. M. W.
    Tjonneland, A.
    Tormo, M. J.
    Tumino, R.
    van den Berg, S. W.
    Wermeling, P. R.
    Zamora-Ros, R.
    Feskens, E. J. M.
    Langenberg, C.
    Sharp, S. J.
    Forouhi, N. G.
    Riboli, E.
    Wareham, N. J.
    Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct2013In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 56, no 7, p. 1520-1530Article in journal (Refereed)
    Abstract [en]

    Consumption of sugar-sweetened beverages has been shown, largely in American populations, to increase type 2 diabetes incidence. We aimed to evaluate the association of consumption of sweet beverages (juices and nectars, sugar-sweetened soft drinks and artificially sweetened soft drinks) with type 2 diabetes incidence in European adults. We established a case-cohort study including 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants selected from eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. After exclusions, the final sample size included 11,684 incident cases and a subcohort of 15,374 participants. Cox proportional hazards regression models (modified for the case-cohort design) and random-effects meta-analyses were used to estimate the association between sweet beverage consumption (obtained from validated dietary questionnaires) and type 2 diabetes incidence. In adjusted models, one 336 g (12 oz) daily increment in sugar-sweetened and artificially sweetened soft drink consumption was associated with HRs for type 2 diabetes of 1.22 (95% CI 1.09, 1.38) and 1.52 (95% CI 1.26, 1.83), respectively. After further adjustment for energy intake and BMI, the association of sugar-sweetened soft drinks with type 2 diabetes persisted (HR 1.18, 95% CI 1.06, 1.32), but the association of artificially sweetened soft drinks became statistically not significant (HR 1.11, 95% CI 0.95, 1.31). Juice and nectar consumption was not associated with type 2 diabetes incidence. This study corroborates the association between increased incidence of type 2 diabetes and high consumption of sugar-sweetened soft drinks in European adults.

  • 732.
    Rosendahl, Erik
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Yifter-Lindgren, Elinor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Håglin, Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nyberg, Lars
    High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living: a randomised controlled trial2006In: Australian Journal of Physiotherapy, ISSN 0004-9514, Vol. 52, no 2, p. 105-113Article in journal (Refereed)
    Abstract [en]

    The aims of this randomised controlled trial were to determine if a high-intensity functional exercise program improves balance, gait ability, and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training. One hundred and ninety-one older persons dependent in activities of daily living, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ? 10 participated. They were randomised to a high-intensity functional exercise program or a control activity, which included 29 sessions over 3 months, as well as to protein-enriched energy supplement or placebo. Berg Balance Scale, self-paced and maximum gait speed, and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA, using the intention-to-treat principle. At three months, the exercise group had improved significantly in self-paced gait speed compared with the control group (mean difference 0.04 m/s, p = 0.02). At six months, there were significant improvements favouring the exercise group for Berg Balance Scale (1.9 points, p = 0.05), self-paced gait speed (0.05 m/s, p = 0.009), and lower-limb strength (10.8 kg, p = 0.03). No interaction effects were seen between the exercise and nutrition interventions. In conclusion, a high-intensity functional exercise program has positive long-term effects in balance, gait ability, and lower-limb strength for older persons dependent in activities of daily living. An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training.

  • 733.
    Ruge, Toralph
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Recruiting high-risk individuals to a diabetes prevention program: how hard can it be?2007In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 30, no 7, p. e61-Article in journal (Refereed)
  • 734. Ruwald, Anne Christine H.
    et al.
    Westergaard, Bo
    Sehestedt, Thomas
    Kjeldsen, Sverre E.
    Lindholm, Lars H.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wachtell, Kristian
    Devereux, Richard B.
    Ibsen, Hans
    Nieminen, Markku S.
    Dahlof, Bjorn
    Olsen, Michael H.
    Losartan versus atenolol-based antihypertensive treatment reduces cardiovascular events especially well in elderly patients: the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study2012In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 30, no 6, p. 1252-1259Article in journal (Refereed)
    Abstract [en]

    Background: The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study has previously demonstrated a beneficial effect of losartan compared to atenolol-based antihypertensive treatment in patients with essential hypertension and left-ventricular hypertrophy (LVH). However, patient age often influences the choice of antihypertensive drugs. Therefore, we investigated the influence of age on the effects of losartan versus atenolol-based antihypertensive treatment. Methods: A total of 9193 hypertensive patients with LVH aged 45-83 years were followed for a mean of 4.8 years. Blood pressure, high-density lipoprotein cholesterol (HDL-C), Sokolow-Lyon voltage, Cornell voltage-duration product and urine albumin-creatinine ratio (UACR) were measured yearly throughout the study. Patients were divided into two age groups according to the median age of 67 years and the effects of losartan versus atenolol-based antihypertensive treatment on the primary composite endpoint (CEP) consisting of cardiovascular death, nonfatal stroke or nonfatal myocardial infarction were investigated. Results: The beneficial effect of losartan versus atenolol-based treatment was greater in the group of patients older than 67 years [hazard ratio 0.79 (0.69-0.91), P=0.001] compared to the group of patients younger than 67 years [hazard ratio 1.03 (0.82-1.28), P=0809], P=0.045 for interaction. The beneficial effects of losartan versus atenolol-based antihypertensive treatment on pulse pressure, HDL-C, UACR, and Cornell and Sokolow-Lyon voltage were not more pronounced in patients older than 67 years compared to patients younger than 67 years. All five risk factors considered as time-varying covariates predicted CEP independently (P<0.01) with the exception of pulse pressure (P=0.37) and the interaction between age and treatment on outcome remained significant (P=0.042). Conclusions: We showed a greater beneficial effect of losartan versus atenolol-based antihypertensive treatment in the group of patients older than 67 years compared to the group of patients younger than 67 years. This difference was not explained by a more pronounced effect of losartan-based treatment on any of the cardiovascular risk factors demonstrated to have independent prognostic importance.

  • 735.
    Rönnqvist, Hanna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    "Eventually, I end up quiet": Experiences of inclusion and participation in medical school- interviews with students belonging to cultural minorities2016Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 736. Sacerdote, Carlotta
    et al.
    Ricceri, Fulvio
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Baldi, Ileana
    Chirlaque, Maria-Dolores
    Feskens, Edith
    Bendinelli, Benedetta
    Ardanaz, Eva
    Arriola, Larraitz
    Balkau, Beverley
    Bergmann, Manuela
    Beulens, Joline W. J.
    Boeing, Heiner
    Clavel-Chapelon, Francoise
    Crowe, Francesca
    de Lauzon-Guillain, Blandine
    Forouhi, Nita
    Franks, Paul W.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gallo, Valentina
    Gonzalez, Carlos
    Halkjaer, Jytte
    Illner, Anne-Kathrin
    Kaaks, Rudolf
    Key, Timothy
    Khaw, Kay-Tee
    Navarro, Carmen
    Nilsson, Peter M.
    Dalton, Susanne Oksbjerg
    Overvad, Kim
    Pala, Valeria
    Palli, Domenico
    Panico, Salvatore
    Polidoro, Silvia
    Ramon Quiros, J.
    Romieu, Isabelle
    Sanchez, Maria-Jose
    Slimani, Nadia
    Sluijs, Ivonne
    Spijkerman, Annemieke
    Teucher, Birgit
    Tjonneland, Anne
    Tumino, Rosario
    van der A, Daphne
    Vergnaud, Anne-Claire
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sharp, Stephen
    Langenberg, Claudia
    Riboli, Elio
    Vineis, Paolo
    Wareham, Nicholas
    Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-InterAct study2012In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, no 4, p. 1162-1173Article in journal (Refereed)
    Abstract [en]

    Background Type 2 diabetes mellitus ( T2DM) is one of the most common chronic diseases worldwide. In high- income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship.

    Method We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340 234, 3.99 million person-years of follow-up). A random sub-cohort of 16 835 individuals and a total of 12 403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed.

    Results Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women).

    Conclusion This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI.

  • 737. Salander, Per
    et al.
    Bergenheim, A T
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Henriksson, Roger
    Pathways from symptoms to medical care: a descriptive study of symptom development and obstacles to early diagnosis in brain tumour patients.1999In: Fam Pract, ISSN 0263-2136, Vol. 16, no 2, p. 143-8Article in journal (Refereed)
  • 738.
    Salander, Pär
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Why "spirituality" instead of "the humanistic side of medicine"?2014In: Academic Medicine, ISSN 1040-2446, E-ISSN 1938-808X, Vol. 89, no 11, p. 1430-1430Article in journal (Other academic)
  • 739.
    Salander, Pär
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Why 'spirituality' instead of 'the humanistic side of medicine'?2014In: Academic Medicine, ISSN 1040-2446, E-ISSN 1938-808X, Vol. 89, no 11, p. 1430-Article in journal (Refereed)
    Abstract [en]

    To the Editor: In a recent commentary, Puchalski et al1 describe the developing field of "spirituality” and its expansion into health professions education. However, we question whether this promotion really reflects an improvement.

    1 Puchalski CM, Blatt B, Kogan M, Butler A. Spirituality and health: The development of a field. Acad Med. 2014;89:10–16.

  • 740.
    Salander, Pär
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Why 'spirituality' instead of 'the humanistic side of medicine'?2014In: Academic Medicine, ISSN 1040-2446, E-ISSN 1938-808X, Vol. 89, no 11, p. 1430-Article in journal (Refereed)
  • 741.
    Salander, Pär
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Lilliehorn, Sara
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Kero, Anneli
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    The impact of breast cancer on living an everyday life 4.5-5 years post-diagnosis: a qualitative prospective study of 39 women2011In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 50, no 3, p. 399-407Article in journal (Refereed)
    Abstract [en]

    Background. The survival of women with breast cancer has improved. There are many studies available describing different aspects of how the illness and its treatment affect the women. Usually these studies are cross-sectional and focus on assessments of a sample of women at a single point in time during post-treatment. These studies are important but of limited value if we are interested in understanding more about breast cancer in a life context. The present study is a contribution.

    Methods. A consecutive sample of 39 women was followed up by means of repeated thematic interviews about how they lived their lives, from the end of radiation therapy to a point four years later, i.e. 4.5–5 years post diagnosis.

    Results. Four different groups of women emerged. Largely, the first group evaluated the cancer initiated transformation of their lives in a positive way. The breast cancer helped them depart from a career treadmill or to positive interpersonal experiences. In the second group the cancer and its treatment seemed to pass without marked traces. The cancer made a difference for the third group, but both in positive and negative ways. A different life perspective or improved relationships were weighted against troublesome side effects from treatment. Finally, in the fourth group a bodily decline due to side effects and other health problems was predominant and this obstructed their chances of living a good life.

    Discussion. The narratives showed that being diseased by breast cancer has different impacts depending on how the woman lives her life – it is very much a matter of transition in a life context. The results are furthermore discussed in relation to adaptation and coping theory.

  • 742.
    Samuelsson, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hedenmalm, Karin
    Persson, Ingemar
    Mortality from venous thromboembolism in young Swedish women and its relation to pregnancy and use of oral contraceptives: an approach to specifying rates2005In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 20, no 6, p. 509-516Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pregnancy and use of combined oral contraceptives (COCs) are major risk factors for venous thromboembolism (VTE) in young women and we wanted to obtain accurate VTE mortality data overall, by age, associated with the use of COCs and pregnancy. METHODS: From the Swedish Cause of Death Register (CDR) we identified women aged 15-44 with VTE as underlying or contributory cause of death during the period 1990-1999. We scrutinized medical records and included verified VTE cases without active cancer or terminal disease. Pregnancy statistics and COC utilization data were obtained from national databases. RESULTS: Of the 120 cases included, 9 (8%) were associated with pregnancy and 28 (23%) with current COC use. The overall refined VTE mortality rate in current COC users was 7.5[4.7; 10.3] per million user-years and the corresponding pregnancy-related rate was 8.9[4.1;17.0] per million pregnancy years, rates increasing with age. For ages 15-24, the rate was significantly higher in current COC users than in non-pregnant women not using COCs: 6.0[3.1; 10.5] per million user-years vs. 0.3[0.0; 1.2] per million woman years. Underlying cause mortality data included 82% of VTE deaths associated with COCs, and 56% of maternal deaths had a pregnancy-related code. CONCLUSION: Mortality figures from VTE associated with the use of COCs and pregnancy were similar. COC use had an important impact on the total VTE mortality in the youngest age group. Standard mortality statistics do not allow accurate monitoring of VTE mortality in young women due to missing data, misdiagnoses and coding rules.

  • 743.
    Samuelsson, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hellgren, Margareta
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Pregnancy-related deaths due to pulmonary embolism in Sweden.2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, Vol. 86, no 4, p. 435-43Article in journal (Refereed)
  • 744.
    Samuelsson, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Groth, Katarina
    medicinkliniken och Brunflo Hälsocentral, Jämtlands läns landsting.
    Hedenmalm, Karin
    Läkemedelsverket, Uppsala.
    Ung kvinna med p-ring drabbad av armtrombos: möjligt samband med mutation i protrombingenen2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 1-2, p. 32-34Article in journal (Other academic)
    Abstract [en]

    We report a case of axillary vein thrombosis in a young woman. The only identified risk factors included heterozygosity for the prothrombin 20210A variant, heavy lifting, and use of NuvaRing, a novel form of combined hormonal contraception. Thrombosis of the upper extremity veins is a rare condition that is often associated with specific local risk factors such as the presence of a central venous catheter, strenuous muscular effort or upper limb trauma. Recent research has also shown an association to traditional risk factors for venous thromboembolism (VTE) including coagulation abnormalities, surgery, immobilization, use of hormonal contraception and a family history of VTE. It is important to be aware of the rare occurrence of VTE associated with combined hormonal contraception. There is no evidence that vaginal administration is associated with a lower risk of VTE. Four cases of VTE with NuvaRing have hitherto been reported to the Swedish Medical Products Agency accounting for a reported incidence of 5,3 (95% CI 1,4-13,5) cases per 10 000 women years of use.

  • 745.
    Samuelsson, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hägg, Staffan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology.
    Incidence of venous thromboembolism in young Swedish women and possibly preventable cases among combined oral contraceptive users2004In: Acta Obstetricia et Gynecologica Scandinavica, Supplement, ISSN 0300-8835, Vol. 83, no 7, p. 674-681Article in journal (Refereed)
    Abstract [en]

    Background. We wanted to study the incidence of venous thromboembolism (VTE), acquired risk factors of VTE and preventable cases among users of combined oral contraceptives (COCs).

    Methods. All women aged 15–44 years, (n = 24 373) living in the county of Jämtland, Sweden, between 1991 and 2000, constituted the study base in a retrospective case-reference study. Women with VTE were identified through hospital registers and interviewed by telephone. The utilization of COCs according to age was obtained from a prospective prescription database, and data from national health databases were used.

    Results. Of 88 women with first-time VTE, 43 (49%) were COC users and 13 (15%) were pregnant. All women had at least one known risk factor, and 51 (58%) women had combinations of risk factors. The total incidence rate of VTE per 100 000 women-years for all women were 36 (29–44), for nonusers 19 (12–25) for women using third generation COCs 115 (67–184), for women using other COCs 60 (37–83), and for women during pregnancy and postpartum 103 (55–177). Of the total 244 000 women-years represented, COC users constituted 24%, pregnant women 5%, and women with other acquired risk factors 5%. The corresponding incidence rates after excluding VTE cases with other acquired risk factors were 10 (6–14), 1.2 (0.14–4.4), 64 (29–121), 27 (13–48), and 59 (24–121), per 100 000 women-years. In 11 (26%) of the COC-related VTE cases, there were relative contraindications for use of COCs or lack of thromboprophylaxis in relation to surgery.

    Conclusion. We found a very low incidence of idiopathic VTE among young non-OC users. The incidence of VTE during pregnancy was only slightly higher than during COC use. It was considered that a significant part of COC-related VTE might have been avoided.

  • 746.
    Samuelsson, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Nyström, Emma
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Söderstrom, L.
    TREATMENT FOR STRESS URINARY INCONTINENCE WITH THE SUPPORT OF A MOBILE APPLICATION IS EFFECTIVE WHEN IMPLEMENTED FOR FREE USE2016In: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 35, no S4, p. S92-S94Article in journal (Other academic)
  • 747. Samuelsson, Åsa
    et al.
    Houkes, Inge
    Verdonk, Petra
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Types of employment and their associations with work characteristics and health in Swedish women and men2012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 2, p. 183-190Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate whether type of employment was related to work characteristics and health status at age 42 adjusted for health status at age 30 and whether gender moderates the associations.

    Methods: Questionnaire data was used from a 27-year follow-up study of school-leavers carried out in Lulea in the north of Sweden (response rate 94%). The study population consisted of 877 (47.8% women) working respondents. Data were analysed by means of t-tests, ANOVAs, and multiple linear regression analyses.

    Results: Men were more often self-employed, while more women had temporary types of employment. Moreover, men reported more control over work and less emotional exhaustion than women. Compared to permanently employed, self-employed (men and women) perceived more control over work and better health status (p<0.01). Self-employed men also reported more demands and social support (p<0.05). People in temporary types of employment, however, reported less job control, as well as lower health status (only men) (p<0.01). Poor self-reported health and emotional exhaustion were significantly (p<0.05) associated with poor work characteristics (more demands, lower job control, and lower support).

    Conclusions: No direct associations between type of employment and health were found for women and men. However we find indications of an influence of type of employment on work and thereupon health, with job control playing an important role.

  • 748.
    San Sebastian, Miguel
    et al.
    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.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Socioeconomic inequalities in functional somatic symptoms by social and material conditions at four life course periods in Sweden: a decomposition analysis2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 8, p. 1-10, article id e006581Article in journal (Refereed)
    Abstract [en]

    Objective: Socioeconomic inequalities in health are deemed a worldwide public health problem, but current research is lacking on key points including determinants of socioeconomic differences in health, and not the least variations of these determinants over the life course. Using a 26-year prospective Swedish community-based cohort, we aim at decomposing socioeconomic inequalities in functional somatic symptoms by social and material life circumstances, at 4 periods of the life course. Design: Repeated cross-sectional study. Setting: Participants came from the Northern Swedish Cohort (n= 1001), who completed questionnaires about occupational class, social and material living conditions, and symptoms at ages 16, 21, 30 and 42. Socioeconomic inequalities were estimated and decomposed using the Blinder-Oaxaca decomposition analysis. Results: Inequalities in symptoms between blue-collar and white-collar socioeconomic groups increased along the life course in the sample. In the decomposition analysis, a high proportion of the gap between socioeconomic groups could be explained by social and material living conditions at ages 16 (84% explained), 30 (45%) and 42 (68%), but not at age 21. Specific social (parental illness at age 16 and violence at ages 30 and 42) and material (parental unemployment at age 16, and own unemployment and financial strain at ages 30 and 42) factors contributed jointly to the health gaps. Conclusions: Socioeconomic inequalities in functional somatic symptoms increased along the life course in this Swedish cohort. A considerable portion of the social gaps in health was explained by concurrent social and material conditions, and the importance of specific adversities was dependent on the life course stage. Our findings suggest that socioeconomic inequalities in functional somatic symptoms may be reduced by addressing both social and material living conditions of disadvantaged families, and also that the life course stage needs to be taken into consideration.

  • 749.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    More than 1 out of 100 will have myocardial infarction and stroke because of enalapril--effect of drug package inserts?2006In: Läkartidningen, Vol. 103, no 8, p. 564-567Article in journal (Refereed)
  • 750.
    Sandström, Herbert
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wahlin, A
    Congenital dyserythropoietic anemia type III.2000In: Haematologica, ISSN 0390-6078, E-ISSN 1592-8721, Vol. 85, no 7, p. 753-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Congenital dyserythropoietic anemia type III (CDA-III) is a group of very rare disorders characterized by similar bone marrow morphology. The clinical picture is characterized by hemolytic anemia and dramatic bone marrow changes dominated by active erythropoiesis with big multinucleated erythroblasts. The aim of this review is to describe the clinical manifestations, laboratory findings, and management CDA-III.

    EVIDENCE AND INFORMATION SOURCES: The present review critically examines relevant articles and abstracts published in journals covered by the Science Citation Index and Medline. The authors have performed several studies on CDA-III.

    STATE OF ART AND PERSPECTIVES: The clinical and laboratory manifestations of CDA-III indicate that the gene responsible for it, which has been mapped to chromosome 15q22, is expressed not only in erythroblasts during mitosis but also in B-cells, and in cells of the retina. Preliminary results indicate genetic and phenotypic similarities between a Swedish and an American family, both with an autosomally dominant inherited form of CDA-III. It is possible that the genetic lesion is identical in these families, but the different phenotypes and modes of inheritance reported among some other cases of CDA-III are probably the results of other genetic lesions. At present, the function of the gene responsible for the Swedish (V sterbotten) variant of CDA-III (CDAN3) is unknown and it is an important goal to characterize and clone this gene in order to study its function.

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