Change search
Refine search result
180181182183184185 9101 - 9150 of 9241
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the 'Create feeds' function.
  • 9101. Zhang, Jiwen
    et al.
    Jin, Xia
    Zhu, Zhaoyin
    Huang, Li
    Liang, Shaojun
    Xu, Yuan
    Liao, Ruyan
    Zhou, Licheng
    Zhang, Yan
    Wilder-Smith, Annelies
    Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
    Early detection of Zika virus infection among travellers from areas of ongoing transmission in China2016In: Journal of Travel Medicine, ISSN 1195-1982, E-ISSN 1708-8305, Vol. 23, no 5, article id taw047Article in journal (Refereed)
    Abstract [en]

    Nine imported Zika virus (ZIKV) infections (four through temperature monitoring and epidemiological investigation at entry and five by active surveillance tracking of index case contacts during follow-up; from Venezuela [n = 5], Samoa [n = 3] and both Samoa and Fiji [n = 1]) were detected in mainland China from February 1 to 29, 2016. The minimal incubation period lasted 5.2 days, with mean lag time to diagnosis of 2.6 days. Diagnosis relied on positive real-time reverse transcriptase polymerase chain reaction for ZIKV RNA in serum (n = 7), urine (n = 4) or saliva (n = 3), respectively. All cases recovered rapidly without serious complications.

  • 9102. Zhang, Lei
    et al.
    Qiao, Qing
    Laatikainen, Tiina
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jousilahti, Pekka
    Onat, Altan
    Nilsson, Peter
    Tuomilehto, Jaakko
    The impact of dyslipidaemia on incidence of coronary heart disease in Finns and Swedes with different categories of glucose tolerance2011In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 91, no 3, p. 406-412Article in journal (Refereed)
    Abstract [en]

    Background: The association of dyslipidaemia with incidence of coronary heart disease (CHD) has not been well studied in people with different glucose categories.

    Methods: Data from six population-based prospective studies in Finland and Sweden, with 4818 men and 4269 women aged 25–89 years who were free of CHD and without a prior history of diabetes at baseline, were jointly analysed. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD incidence were estimated.

    Results: 457 participants developed CHD during follow-up of 10 years. The multivariate adjusted HRs (95% CIs) for CHD incidence were 1.39 (1.08–1.80), 0.57 (0.39–0.84), 1.21 (1.07–1.37), 1.56 (1.21–2.01) and 1.74 (1.34–2.26), respectively, corresponding to a one unit increase in Z-scores of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), non-HDL-C and TC to HDL ratio, in people with newly diagnosed diabetes. The prediction was also significant in non-diabetic population except for TG in individuals with normoglycaemia and TG and HDL-C in those with isolated IFG.

    Conclusion: Adverse lipid profiles were related to increased CHD incidence in normoglycaemic, fasting hyperglycaemic and diabetic individuals, but not in people with IGT. The findings may imply considering different management strategies in people with fasting or post-load hyperglycaemia.

  • 9103. Zhang, Ling-Ling
    et al.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Wang, Shu-Mei
    Injury related risk behaviour: a health belief model-based study of primary school students in a safe community in Shanghai2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 8, p. e70563-Article in journal (Refereed)
    Abstract [en]

    Aim

    To explore the relationship between Health belief model (HBM) and children and adolescents' unintentional injury risk behavior, to add some useful information for injury prevention.

    Methodology

    We investigated injury related health risk behavior and health belief status of students at primary schools grade 3 to 4, in a Safe Community, in Shanghai. Self-administered injury questionnaires were used to investigate risk behavior of students and HBM factors.

    Principal Findings

    The prevalence of risk behavior among students reported in this community was high. HBM scores showed differences between two groups of students classified by whether they had risk behavior or not. Self-efficacy was highly related with the status of socio-psychological behavior.

    Significance

    HBM has been widely used in explaining the disease-related behavior; however, it has been seldom used in injury-related behavior. The study demonstrated important relation of HBM to students' injury issues, and HBM could explain injury related behavior as well, especially for traffic injury-related behavior. When developing injury prevention strategies, we can take it into account.

  • 9104.
    Zhang, Linjie
    et al.
    Federal University of Rio Grande, Faculty of Medicine, Rio Grande, RS, Brazil.
    Prietsch, Silvio O. M.
    Federal University of Rio Grande, Faculty of Medicine, Rio Grande, RS, Brazil.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Halperin, Scott A.
    Halifax Dalhousie University, IWK Health Centre, Canadian Center for Vaccinology, Halifax, NS, Canada.
    Acellular vaccines for preventing whooping cough in children2014In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 9, article id CD001478Article, review/survey (Refereed)
    Abstract [en]

    Background Routine use of whole-cell pertussis (wP) vaccines was suspended in some countries in the 1970s and 1980s because of concerns about adverse effects. Following this action, there was a resurgence of whooping cough. Acellular pertussis (aP) vaccines, containing purified or recombinant Bordetella pertussis (B. pertussis) antigens, were developed in the hope that they would be as effective, but less reactogenic than the whole-cell vaccines. This is an update of a Cochrane review first published in 1999, and previously updated in 2012. In this update, we included no new studies. Objectives To assess the efficacy and safety of acellular pertussis vaccines in children and to compare them with the whole-cell vaccines. Search methods We searched CENTRAL (2013, Issue 12), MEDLINE (1950 to January week 2, 2014), EMBASE (1974 to January 2014), Biosis Previews (2009 to January 2014) and CINAHL (2009 to January 2014). Selection criteria We selected double-blind randomised efficacy and safety trials of aP vaccines in children up to six years old, with active follow-up of participants and laboratory verification of pertussis cases. Data collection and analysis Two review authors independently extracted data and assessed the risk of bias in the studies. Differences in trial design precluded a meta-analysis of the efficacy data. We pooled the safety data from individual trials using a random-effects meta-analysis model. Main results We included six efficacy trials with a total of 46,283 participants and 52 safety trials with a total of 136,541 participants. Most of the safety trials did not report the methods for random sequence generation, allocation concealment and blinding, which made it difficult to assess the risk of bias in the studies. The efficacy of multi-component (>= three) vaccines varied from 84% to 85% in preventing typical whooping cough (characterised by 21 or more consecutive days of paroxysmal cough with confirmation of B. pertussis infection by culture, appropriate serology or contact with a household member who has culture-confirmed pertussis), and from 71% to 78% in preventing mild pertussis disease (characterised by seven or more consecutive days of cough with confirmation of B. pertussis infection by culture or appropriate serology). In contrast, the efficacy of one-and two-component vaccines varied from 59% to 78% against typical whooping cough and from 41% to 58% against mild pertussis disease. Multi-component acellular vaccines are more effective than low-efficacy whole-cell vaccines, but may be less effective than the highest-efficacy whole-cell vaccines. Most systemic and local adverse events were significantly less common with aP vaccines than with wP vaccines for the primary series as well as for the booster dose. Authors' conclusions Multi-component (>= three) aP vaccines are effective in preventing whooping cough in children. Multi-component aP vaccines have higher efficacy than low-efficacy wP vaccines, but they may be less efficacious than the highest-efficacy wP vaccines. Acellular vaccines have fewer adverse effects than whole-cell vaccines for the primary series as well as for booster doses.

  • 9105.
    Zhang, Peng
    Blekinge Institute of Technology, School of Engineering, Department of Interaction and System Design.
    Multi-Agent Systems Supported Collaboration in Diabetic Healthcare2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis proposes a holistic and hierarchical architecture to Multi-agent System design, in order to resolve the collaboration problem in diabetic healthcare system. A diabetic healthcare system is a complex and social system in the case that it involves many actors and interrelations. Collaborations among various healthcare actors are vital to the quality of diabetic healthcare. The collaboration problem is manifested by the problems of accessibility and interoperability. To support the collaboration in diabetic healthcare as such a complex and social system, the MAS must have corresponding social entities and relationships. Therefore, it is assumed that theories explaining social activity can be applied to design of MAS. Activity Theory, specifically its holistic triangle model from Engström and hierarchy thinking, provides theoretical supports to the design of individual agent architecture and MAS coordination mechanism. It is argued that the holistic and hierarchical aspects should be designed in a MAS when applied to the healthcare setting. The diabetic healthcare system is analyzed on three levels based on the hierarchy thinking. The collaboration problem is analyzed and resolved via MAS coordination. Based on the holistic activity model in Activity Theory, Müller’s Vertical Layered Architecture is re-conceptualized in the Control Unit and Knowledge Base design. It is also argued that autonomy, adaptivity and persona should be especially focused when designing the interaction between an agent system and human users. This study has firstly identified some important social aspects and the technical feasibility of embedding those identified social aspects in agent architecture design. Secondly, a MAS was developed to illustrate how to apply the proposed architecture to design a MAS to resolve the collaboration problem in diabetic healthcare system. We have designed and implemented an agent system – IMAS (Integrated Multi-agent System) to validate the research questions and contributions. IMAS system provides real time monitoring, diabetic healthcare management and decision supports to the diabetic healthcare actors. A user assessment has been conducted to validate that the quality of the current diabetic healthcare system can be improved with the introduction of IMAS.

  • 9106.
    Zhang, Yin-Ping
    et al.
    Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China.
    Wei, Huan-Huan
    Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China.
    Wang, Wen
    Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China.
    Xia, Ru-Yi
    Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China.
    Zhou, Xiao-Ling
    Department of Orthopaedics, the 1st Attached Hospital, Xi’an Jiaotong University, Xi'an, People’s Republic of China.
    Porr, Caroline
    School of Nursing, Memorial University, St. John’s, Canada.
    Lammi, Mikko
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Cross-cultural adaptation and validation of the osteoporosis assessment questionnaire short version (OPAQ-SV) for Chinese osteoporotic fracture females2016In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 35, no 4, p. 1003-1010Article in journal (Refereed)
    Abstract [en]

    The Osteoporosis Assessment Questionnaire Short Version (OPAQ-SV) was cross-culturally adapted to measure health-related quality of life in Chinese osteoporotic fracture females and then validated in China for its psychometric properties. Cross-cultural adaptation, including translation of the original OPAQ-SV into Mandarin Chinese language, was performed according to published guidelines. Validation of the newly cross-culturally adapted OPAQ-SV was conducted by sampling 234 Chinese osteoporotic fracture females and also a control group of 235 Chinese osteoporotic females without fractures, producing robust content, construct, and discriminant validation results. Major categories of reliability were also met: the Cronbach alpha coefficient was 0.975, indicating good internal consistency; the test-retest reliability was 0.80; and principal component analysis resulted in a 6-factor structure explaining 75.847 % of the total variance. Further, the Comparative Fit Index result was 0.922 following the modified model confirmatory factor analysis, and the chi-squared test was 1.98. The root mean squared error of approximation was 0.078. Moreover, significant differences were revealed between females with fractures and those without fractures across all domains (p < 0.001). Overall, the newly cross-culturally adapted OPAQ-SV appears to possess adequate validity and reliability and may be utilized in clinical trials to assess the health-related quality of life in Chinese osteoporotic fracture females.

  • 9107. Zhao, Y.
    et al.
    Nicoll, Rachel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Diederichsen, A.
    Mickley, H.
    Ovrehus, K.
    Zamorano, P.
    Gueret, P.
    Schmermund, A.
    Maffei, E.
    Cademartiri, F.
    Budoff, M.
    Henein, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Coronary calcification and male gender predict significant stenosis in symptomatic patients in northern and southern Europe and the USA: A Euro-CCAD study2016In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645Article in journal (Refereed)
    Abstract [en]

    Background: Significant stenosis is the principal cause of stable angina but its predictors and their variation by geographical region are unclear.

    Methods and Results: From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 5515 symptomatic patients from northern Europe (Denmark, France, Germany), southern Europe (Italy, Spain) and USA. All had conventional cardiovascular risk factor assessment, angiography and CT scanning for coronary artery calcium (CAC) scoring. There were considerable differences in the patient characteristics between the groups, with the USA patients being younger and having more diet and lifestyle-related risk factors, although hypertension may have been better controlled than in Europe. USA patients had a two-fold increase in prevalence of significant stenosis and a three-fold increase in median CAC score. In all three groups, the log CAC score proved to be the strongest predictor of >50% stenosis followed by male gender. In the USA group there were no additional independently predictive risk factors, although in northern Europe obesity, hypertension, smoking and hypercholesterolaemia remained predictive, with all risk factors other than age and hypertension proving to be predictive in the southern Europe group. Without the CAC score as a variable, male gender followed by diabetes were the most important predictors in all three regions, with hypertension also proving predictive in northern Europe.

     Conclusion:  In symptomatic patients, the CAC score and male gender were the most important predictors of significant stenosis in symptomatic patients in northern and southern Europe and the USA.

  • 9108.
    Zhao, Zhuohui
    et al.
    Fudan Univ, Minist Educ, Key Lab Publ Hlth Safety, Sch Publ Hlth,Minist Hlth,Key Lab Hlth Technol As, Shanghai 200433, Peoples R China..
    Chen, Renjie
    Fudan Univ, Minist Educ, Key Lab Publ Hlth Safety, Sch Publ Hlth,Minist Hlth,Key Lab Hlth Technol As, Shanghai 200433, Peoples R China.;Fudan Univ, Shanghai Key Lab Atmospher Particle Pollut & Prev, Shanghai 200433, Peoples R China..
    Lin, Zhijing
    Fudan Univ, Minist Educ, Key Lab Publ Hlth Safety, Sch Publ Hlth,Minist Hlth,Key Lab Hlth Technol As, Shanghai 200433, Peoples R China..
    Cai, Jing
    Fudan Univ, Minist Educ, Key Lab Publ Hlth Safety, Sch Publ Hlth,Minist Hlth,Key Lab Hlth Technol As, Shanghai 200433, Peoples R China.;Fudan Univ, Shanghai Key Lab Atmospher Particle Pollut & Prev, Shanghai 200433, Peoples R China..
    Yang, Yingying
    Fudan Univ, Minist Educ, Key Lab Publ Hlth Safety, Sch Publ Hlth,Minist Hlth,Key Lab Hlth Technol As, Shanghai 200433, Peoples R China..
    Yang, Dandan
    Shanghai Key Lab Meteorol & Hlth, Shanghai, Peoples R China..
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Kan, Haidong
    Fudan Univ, Minist Educ, Key Lab Publ Hlth Safety, Sch Publ Hlth,Minist Hlth,Key Lab Hlth Technol As, Shanghai 200433, Peoples R China.;Fudan Univ, Shanghai Key Lab Atmospher Particle Pollut & Prev, Shanghai 200433, Peoples R China..
    Ambient carbon monoxide associated with alleviated respiratory inflammation in healthy young adults2016In: Environmental Pollution, ISSN 0269-7491, E-ISSN 1873-6424, Vol. 208, p. 294-298Article in journal (Refereed)
    Abstract [en]

    There is increasing controversy on whether acute exposure to ambient carbon monoxide (CO) is hazardous on respiratory health. We therefore performed a longitudinal panel study to evaluate the acute effects of ambient CO on fractional exhaled nitric oxide (FeNO), a well-established biomarker of airway inflammation. We completed 4-6 rounds of health examinations among 75 healthy young adults during April to June in 2013 in Shanghai, China. We applied the linear mixed-effect model to investigate the short-term associations between CO and FeNO. CO exposure during 2-72 h preceding health tests was significantly associated with decreased FeNO levels. For example, an interquartile range increase (0.3 mg/m(3)) of 2-h CO exposure corresponded to 10.6% decrease in FeNO. This association remained when controlling for the concomitant exposure to co-pollutants. This study provided support that short-term exposure to ambient CO might be related with reduced levels of FeNO, a biomarker of lower airway inflammation.

  • 9109. Zheng, Hou-Feng
    et al.
    Duncan, Emma
    Eriksson, Joel
    Bergström, Ulrica
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Yerges-Armstrong, Laura M.
    Leo, Paul J.
    Vandenput, Liesbeth
    Nicholson, Geoffrey
    Ladouceur, Martin
    Prince, Richard L.
    Leslie, William D.
    Eisman, John A.
    Goltzman, David
    Jones, Graeme
    Xiao, Yongjun
    Liu, Jeff
    Reid, Lanr
    Sambrook, Philip N.
    Dennison, Elaine M.
    Danoy, Patrick
    Wilson, Scott G.
    McCloskey, Eugene
    Eastell, Richard
    Spector, Tim
    Mitchell, Braxton D.
    Streeten, Elizabeth A.
    Brommage, Robert
    Lorentzon, Mattias
    Pettersson, Ulrika
    Brown, Matthew A.
    Ohlsson, Claes
    Richards, J. Brent
    WNT16 is associated with bone mineral density, osteoporotic fracture and bone strength: a large-scale meta-analysis of genomewide association studies2012In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 23, no Suppl 2, p. S402-S403Article in journal (Other academic)
  • 9110. Zheng, Hou-Feng
    et al.
    Forgetta, Vincenzo
    Hsu, Yi-Hsiang
    Estrada, Karol
    Rosello-Diez, Alberto
    Leo, Paul J.
    Dahia, Chitra L.
    Park-Min, Kyung Hyun
    Tobias, Jonathan H.
    Kooperberg, Charles
    Kleinman, Aaron
    Styrkarsdottir, Unnur
    Liu, Ching-Ti
    Uggla, Charlotta
    Evans, Daniel S.
    Nielson, Carrie M.
    Walter, Klaudia
    Pettersson-Kymmer, Ulrika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.
    McCarthy, Shane
    Eriksson, Joel
    Kwan, Tony
    Jhamai, Mila
    Trajanoska, Katerina
    Memari, Yasin
    Min, Josine
    Huang, Jie
    Danecek, Petr
    Wilmot, Beth
    Li, Rui
    Chou, Wen-Chi
    Mokry, Lauren E.
    Moayyeri, Alireza
    Claussnitzer, Melina
    Cheng, Chia-Ho
    Cheung, Warren
    Medina-Gomez, Carolina
    Ge, Bing
    Chen, Shu-Huang
    Choi, Kwangbom
    Oei, Ling
    Fraser, James
    Kraaij, Robert
    Hibbs, Matthew A.
    Gregson, Celia L.
    Paquette, Denis
    Hofman, Albert
    Wibom, Carl
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Tranah, Gregory J.
    Marshall, Mhairi
    Gardiner, Brooke B.
    Cremin, Katie
    Auer, Paul
    Hsu, Li
    Ring, Sue
    Tung, Joyce Y.
    Thorleifsson, Gudmar
    Enneman, Anke W.
    van Schoor, Natasja M.
    de Groot, Lisette C. P. G. M.
    van der Velde, Nathalie
    Melin, Beatrice
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Kemp, John P.
    Christiansen, Claus
    Sayers, Adrian
    Zhou, Yanhua
    Calderari, Sophie
    van Rooij, Jeroen
    Carlson, Chris
    Peters, Ulrike
    Berlivet, Soizik
    Dostie, Josee
    Uitterlinden, Andre G.
    Williams, Stephen R.
    Farber, Charles
    Grinberg, Daniel
    LaCroix, Andrea Z.
    Haessler, Jeff
    Chasman, Daniel I.
    Giulianini, Franco
    Rose, Lynda M.
    Ridker, Paul M.
    Eisman, John A.
    Nguyen, Tuan V.
    Center, Jacqueline R.
    Nogues, Xavier
    Garcia-Giralt, Natalia
    Launer, Lenore L.
    Gudnason, Vilmunder
    Mellstrom, Dan
    Vandenput, Liesbeth
    Amin, Najaf
    van Duijn, Cornelia M.
    Karlsson, Magnus K.
    Ljunggren, Osten
    Svensson, Olle
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Rousseau, Francois
    Giroux, Sylvie
    Bussiere, Johanne
    Arp, Pascal P.
    Koromani, Fjorda
    Prince, Richard L.
    Lewis, Joshua R.
    Langdahl, Bente L.
    Hermann, A. Pernille
    Jensen, Jens-Erik B.
    Kaptoge, Stephen
    Khaw, Kay-Tee
    Reeve, Jonathan
    Formosa, Melissa M.
    Xuereb-Anastasi, Angela
    Akesson, Kristina
    McGuigan, Fiona E.
    Garg, Gaurav
    Olmos, Jose M.
    Zarrabeitia, Maria T.
    Riancho, Jose A.
    Ralston, Stuart H.
    Alonso, Nerea
    Jiang, Xi
    Goltzman, David
    Pastinen, Tomi
    Grundberg, Elin
    Gauguier, Dominique
    Orwoll, Eric S.
    Karasik, David
    Davey-Smith, George
    Smith, Albert V.
    Siggeirsdottir, Kristin
    Harris, Tamara B.
    Zillikens, M. Carola
    van Meurs, Joyce B. J.
    Thorsteinsdottir, Unnur
    Maurano, Matthew T.
    Timpson, Nicholas J.
    Soranzo, Nicole
    Durbin, Richard
    Wilson, ScottG.
    Ntzani, Evangelia E.
    Brown, Matthew A.
    Stefansson, Kari
    Hinds, David A.
    Spector, Tim
    Cupples, L. Adrienne
    Ohlsson, Claes
    Greenwood, Celia M. T.
    Jackson, Rebecca D.
    Rowe, David W.
    Loomis, Cynthia A.
    Evans, David M.
    Ackert-Bicknell, Cheryl L.
    Joyner, Alexandra L.
    Duncan, Emma L.
    Kiel, Douglas P.
    Rivadeneira, Fernando
    Richards, J. Brent
    Whole-genome sequencing identifies EN1 as a determinant of bone density and fracture2015In: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 526, no 7571, p. 112-+Article in journal (Refereed)
    Abstract [en]

    The extent to which low-frequency (minor allele frequency (MAF) between 1-5%) and rare (MAF <= 1%) variants contribute to complex traits and disease in the general population is mainly unknown. Bone mineral density (BMD) is highly heritable, a major predictor of osteoporotic fractures, and has been previously associated with common genetic variants(1-8), as well as rare, population specific, coding variants(9). Here we identify novel non-coding genetic variants with large effects on BMD (n(total) = 53,236) and fracture (n(total) = 508,253) in individuals of European ancestry from the general population. Associations for BMD were derived from whole-genome sequencing (n = 2,882 from UK10K (ref. 10); a population-based genome sequencing consortium), whole-exome sequencing (n = 3,549), deep imputation of genotyped samples using a combined UK10K/1000 Genomes reference panel (n = 26,534), and de novo replication genotyping (n = 20,271). We identified a low-frequency non-coding variant near a novel locus, EN1, with an effect size fourfold larger than the mean of previously reported common variants for lumbar spine BMD8 (rs11692564(T), MAF51.6%, replication effect size510.20 s.d., P-meta = 2 x 10(-14)), which was also associated with a decreased risk of fracture (odds ratio = 0.85; P = 2 x 10(-11); ncases = 98,742 and ncontrols = 409,511). Using an En1cre/flox mouse model, we observed that conditional loss of En1 results in low bone mass, probably as a consequence of high bone turnover. We also identified a novel low frequency non-coding variant with large effects on BMD near WNT16 (rs148771817(T), MAF = 1.2%, replication effect size +10.41 s.d., P-meta = 1 x 10(-11)). In general, there was an excess of association signals arising from deleterious coding and conserved non-coding variants. These findings provide evidence that low-frequency non-coding variants have large effects on BMD and fracture, thereby providing rationale for whole-genome sequencing and improved imputation reference panels to study the genetic architecture of complex traits and disease in the general population.

  • 9111. Zheng, Hou-Feng
    et al.
    Tobias, Jon H
    Duncan, Emma
    Evans, David M
    Eriksson, Joel
    Paternoster, Lavinia
    Yerges-Armstrong, Laura M
    Lehtimäki, Terho
    Bergström, Ulrica
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Kähönen, Mika
    Leo, Paul J
    Raitakari, Olli
    Laaksonen, Marika
    Nicholson, Geoffrey C
    Viikari, Jorma
    Ladouceur, Martin
    Lyytikäinen, Leo-Pekka
    Medina-Gomez, Carolina
    Rivadeneira, Fernando
    Prince, Richard L
    Sievanen, Harri
    Leslie, William D
    Mellström, Dan
    Eisman, John A
    Movérare-Skrtic, Sofia
    Goltzman, David
    Hanley, David A
    Jones, Graeme
    St Pourcain, Beate
    Xiao, Yongjun
    Timpson, Nicholas J
    Smith, George Davey
    Reid, Ian R
    Ring, Susan M
    Sambrook, Philip N
    Karlsson, Magnus
    Dennison, Elaine M
    Kemp, John P
    Danoy, Patrick
    Sayers, Adrian
    Wilson, Scott G
    Nethander, Maria
    McCloskey, Eugene
    Vandenput, Liesbeth
    Eastell, Richard
    Liu, Jeff
    Spector, Tim
    Mitchell, Braxton D
    Streeten, Elizabeth A
    Brommage, Robert
    Pettersson-Kymmer, Ulrika
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Brown, Matthew A
    Ohlsson, Claes
    Richards, J Brent
    Lorentzon, Mattias
    WNT16 influences bone mineral density, Cortical bone thickness, bone strength, and Osteoporotic fracture risk2012In: PLoS genetics, ISSN 1553-7404, Vol. 8, no 7, p. e1002745-Article in journal (Refereed)
    Abstract [en]

    We aimed to identify genetic variants associated with cortical bone thickness (CBT) and bone mineral density (BMD) by performing two separate genome-wide association study (GWAS) meta-analyses for CBT in 3 cohorts comprising 5,878 European subjects and for BMD in 5 cohorts comprising 5,672 individuals. We then assessed selected single-nucleotide polymorphisms (SNPs) for osteoporotic fracture in 2,023 cases and 3,740 controls. Association with CBT and forearm BMD was tested for ∼2.5 million SNPs in each cohort separately, and results were meta-analyzed using fixed effect meta-analysis. We identified a missense SNP (Thr>Ile; rs2707466) located in the WNT16 gene (7q31), associated with CBT (effect size of -0.11 standard deviations [SD] per C allele, P = 6.2×10(-9)). This SNP, as well as another nonsynonymous SNP rs2908004 (Gly>Arg), also had genome-wide significant association with forearm BMD (-0.14 SD per C allele, P = 2.3×10(-12), and -0.16 SD per G allele, P = 1.2×10(-15), respectively). Four genome-wide significant SNPs arising from BMD meta-analysis were tested for association with forearm fracture. SNP rs7776725 in FAM3C, a gene adjacent to WNT16, was associated with a genome-wide significant increased risk of forearm fracture (OR = 1.33, P = 7.3×10(-9)), with genome-wide suggestive signals from the two missense variants in WNT16 (rs2908004: OR = 1.22, P = 4.9×10(-6) and rs2707466: OR = 1.22, P = 7.2×10(-6)). We next generated a homozygous mouse with targeted disruption of Wnt16. Female Wnt16(-/-) mice had 27% (P<0.001) thinner cortical bones at the femur midshaft, and bone strength measures were reduced between 43%-61% (6.5×10(-13)<P<5.9×10(-4)) at both femur and tibia, compared with their wild-type littermates. Natural variation in humans and targeted disruption in mice demonstrate that WNT16 is an important determinant of CBT, BMD, bone strength, and risk of fracture.

  • 9112. Zheng, Yi Wu
    et al.
    Lai, Xu Xin
    Zhao, De Yu
    Zhang, Chun Qing
    Chen, Jian Jun
    Zhang, Luo
    Wei, Qing Yu
    Chen, Shi
    Liu, En Mei
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Gjesing, Birgitte
    Zhong, Nan Shan
    Spangfort, D Michael
    Indoor Allergen Levels and Household Distributions in Nine Cities Across China2015In: Biomedical and environmental sciences, ISSN 0895-3988, E-ISSN 2214-0190, Vol. 28, no 10, p. 709-717Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Chinese allergic subjects have high levels of sensitization to house dust mite (HDM) and other indoor allergens. This study quantifies common indoor allergen levels in Chinese households.

    METHODS: Dust samples were collected from nine cities. Major allergens Der p 1 and Der f 1 from Dermatophagoides pteronyssinus and D. farinae, and specific antigens of Blomia tropicalis, Tyrophagus putrescentiae, Acarus siro, and cockroach species Blattella germanica and Periplaneta americana were measured by ELISA.

    RESULTS: HDM allergens were found in dust samples from bedding in 95% of the Chinese households. The median levels varied from <0.006 to 9.2 µg/g of dust, depending on the city. The percentages of households having HDM allergen levels associated with the risk of developing allergy sensitization and asthma were 65% and 25%, respectively. Specific antigens of the storage mite and cockroach were only found in samples from the southern and tropical regions of China. Levels of mite allergens were generally higher in samples from bedding compared to samples from the living room, even for storage mites, whereas levels of cockroach antigens were higher in the living room samples.

    CONCLUSION: HDM allergens are present in bedding dust samples from most Chinese households. Cities in southern and central China have relatively high levels of HDM major allergens compared to cities in northern and western China. Antigens of storage mites and cockroaches are not as common as HDM allergens.

  • 9113. Zhong, Jia
    et al.
    Karlsson, Oskar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences. Center for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden.
    Wang, Guan
    Li, Jun
    Guo, Yichen
    Lin, Xinyi
    Zemplenyi, Michele
    Sanchez-Guerra, Marco
    Trevisi, Letizia
    Urch, Bruce
    Speck, Mary
    Liang, Liming
    Coull, Brent A
    Koutrakis, Petros
    Silverman, Frances
    Gold, Diane R
    Wu, Tangchun
    Baccarelli, Andrea A
    B vitamins attenuate the epigenetic effects of ambient fine particles in a pilot human intervention trial2017In: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 114, no 13, p. 3503-3508Article in journal (Refereed)
    Abstract [en]

    Acute exposure to fine particle (PM2.5) induces DNA methylation changes implicated in inflammation and oxidative stress. We conducted a crossover trial to determine whether B-vitamin supplementation averts such changes. Ten healthy adults blindly received a 2-h, controlled-exposure experiment to sham under placebo, PM2.5 (250 μg/m(3)) under placebo, and PM2.5 (250 μg/m(3)) under B-vitamin supplementation (2.5 mg/d folic acid, 50 mg/d vitamin B6, and 1 mg/d vitamin B12), respectively. We profiled epigenome-wide methylation before and after each experiment using the Infinium HumanMethylation450 BeadChip in peripheral CD4(+) T-helper cells. PM2.5 induced methylation changes in genes involved in mitochondrial oxidative energy metabolism. B-vitamin supplementation prevented these changes. Likewise, PM2.5 depleted 11.1% [95% confidence interval (CI), 0.4%, 21.7%; P = 0.04] of mitochondrial DNA content compared with sham, and B-vitamin supplementation attenuated the PM2.5 effect by 102% (Pinteraction = 0.01). Our study indicates that individual-level prevention may be used to complement regulations and control potential mechanistic pathways underlying the adverse PM2.5 effects, with possible significant public health benefit in areas with frequent PM2.5 peaks.

  • 9114.
    Zhu, Jijia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The Risk Factors of Depression among older people in China2012Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 9115.
    Zhu, Ying
    et al.
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Dalal, Koustuv
    Department of Medical and Health Sciences, Center for Medical Technology, Assessment and Division of Social Medicine and Public Health Sciences, Linköping University, Linköping, Sw.
    Childhood exposure to domestic violence and attitude towards wife beating in adult life: a study of men in India.2010In: Journal of Biosocial Science, ISSN 0021-9320, E-ISSN 1469-7599, Vol. 42, no 2, p. 255-69Article in journal (Refereed)
    Abstract [en]

    This study examined men's justification of wife beating in relation to their perceived rights and autonomy using a nationally representative sample of 18,047 men in India with childhood exposure to parental violence. Five reasons for wife beating justification, four items of men's perceived rights, and five items of household autonomy were analysed using chi2 test and logistic regression. Among 18,047 participants, 67% justified wife beating. Low education, economic stress and being unmarried were generally more associated with justifying wife beating for all five reasons. Wife's refusal of sex and husband's final say on household autonomy are risk factors. Joint autonomy on household decision making and wife's autonomy on managing her own earnings are protective factors. Perceived relationship rights and autonomy are highly predictive of wife-beating justification for the men who have been exposed to parental violence during childhood. The study has significant implications for public health planners and education strategies.

  • 9116.
    Ziaei, Reza
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Mohammadi, Reza
    Karolinska institutet.
    Dastgiri, Saeed
    Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
    Viitasara, Eija
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Asl Rahimi, Vahab
    Unit for Adolescence Health, Province Health Center, Tabriz, Iran.
    Jeddi, Abolfazl
    Unit for Adolescence Health, Province Health Center, Tabriz, Iran.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The Prevalence, Attitudes, and Correlates of Waterpipe Smoking Among High School Students in Iran: a Cross-Sectional Study2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no 6, p. 686-696Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of the present study was to determine the correlates of waterpipe (WP) smoking among 15–17-year-old high school students in Iran.

    Method

    Data were collected using the Global Youth Tobacco Survey (GYTS), a self-administrated questionnaire distributed to a representative sample of high school students aged 15–17 in the city of Tabriz. Current WP smoking was defined as past 30-day use, and ever WP smoking was defined as at least one or two lifetime puffs. Differences in WP use, knowledge, and attitudes were analyzed using chi-square and Fisher exact tests. Binary logistic regression estimated the association between relevant independent variables (e.g., age) and the dependent variables (current/ever WP smoking).

    Results

    Of 1517 students, 21.6 % (95 % confidence interval [CI] = 19.5, 23.8) were ever WP smokers, and 9.7 % (95 % CI = 8.2, 11.2) were current WP smokers. Of current WP smokers, 40.3 % have stated that they want to stop smoking now. Moreover, 14.1 % of non-WP smokers reported that they might enjoy smoking WP. Of current WP smokers, 49.0 % have smoked at cafés. Additionally, 95.3 % of current WP smokers reported that their age did not prevent them from being served a WP. Studying in high school third grade (adjusted odds ratios (AORs) = 1.70; 95 % CI [1.10, 2.63]), experience of cigarette smoking (AORs = 1.57; 95 % CI [1.12, 2.20]), and being prepared to accept a WP offered by close friends (AORs = 3.31; 95 % CI [2.17, 5.04]) were independently associated with ever WP smoking, and accepting a WP offered by close friends (AORs = 4.36; 95 % CI [2.69, 7.07]) and gender (female) (AORs = 0.45; 95 % CI [0.30, 0.70] were independently associated with current WP smoking.

    Conclusion

    Prevalence of current and ever WP smoking is high in Tabriz. There is an urgent need to design interventions in order to increase students’ and their parents’ awareness regarding the harmfulness of WP, and to establish legal measures to restrict adolescents’ access to WPs and tobacco in society.

  • 9117.
    Ziaei, Shirin
    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).
    Women’s status and child nutrition: Findings from community studies in Bangladesh and Nicaragua2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The importance of women’s status for child nutrition has recently been recognized. However, pathways through which women’s status can affect their caretaking practices and child nutrition have not been fully determined. The aim of this thesis was to evaluate associations between aspects of women’s status – including exposure to domestic violence and level of autonomy and social support – with their level of stress, feeding practices and child nutritional status in two different cultural settings: Bangladesh and Nicaragua.

    Data were acquired from population-based studies. For Study I we used data from the Bangladesh 2007 Demographic and Health Survey, and Study II was embedded in the 2009 Health and Demographic Surveillance System conducted in Los Cuatro Santos, rural Nicaragua. Studies III and IV were part of the MINIMat study, conducted in rural Bangladesh. In-person interviews were conducted and validated questionnaires were used in each of the studies. Anthropometric characteristics of the children were recorded based on standardized World Health Organization techniques.

    In Bangladesh, we found women with lifetime experience of domestic violence to be more likely to report emotional distress during pregnancy, cease exclusive breastfeeding before 6 months and have a stunted child. Further, we found a negative association between experience of domestic violence and duration of excusive breastfeeding to be mitigated with breastfeeding counseling. In Nicaragua, a lower level of maternal autonomy was associated with more appropriate breastfeeding practices such as higher odds of exclusive breastfeeding and longer continuation of breastfeeding. Further, a maternal lower level of social support was associated with better child nutritional status.

    In conclusion, this investigation showed that different dimensions of women’s status were associated with their feeding practices and child nutritional status and also revealed that the strength and direction of these associations may vary by the child’s age, setting and other contextual factors. These findings suggest that women’s status might have an important public health impact on child health and its role should be considered in programs and policies aiming to improve child health and nutrition.

  • 9118. Ziaei, Shirin
    et al.
    Contreras, Mariela
    Blandón, Elmer Zelaya
    Persson, Lars-Åke
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Ekström, Eva-Charlotte
    Women's autonomy and social support and their associations with infant and young child feeding and nutritional status: community-based survey in rural Nicaragua2015In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, no 11, p. 1979-1990Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the associations of women's autonomy and social support with infant and young child feeding practices (including consumption of highly processed snacks and sugar-sweetened beverages) and nutritional status in rural Nicaragua. Design: Cross-sectional study. Feeding practices and children's nutritional status were evaluated according to the WHO guidelines complemented with information on highly processed snacks and sugar-sweetened beverages. Women's autonomy was assessed by a seventeen-item questionnaire covering dimensions of financial independence, household-, child-, reproductive and health-related decision making and freedom of movement. Women's social support was determined using the Duke-UNC Functional Social Support Questionnaire. The scores attained were categorized into tertiles. Setting: Los Cuatro Santos area, rural Nicaragua. Subjects: A total of 1371 children 0-35 months of age. Results: Children of women with the lowest autonomy were more likely to be exclusively breast-fed and continue to be breast-fed, while children of women with middle level of autonomy had better complementary feeding practices. Children of women with the lowest social support were more likely to consume highly processed snacks and/or sugar-sweetened beverages but also be taller. Conclusions: While lower levels of autonomy and social support were independently associated with some favourable feeding and nutrition outcomes, this may not indicate a causal relationship but rather that these factors reflect other matters of importance for child care.

  • 9119.
    Ziaei, Shirin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Contreras, Mariela
    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).
    Zelaya Blandón, Elmer
    Asociación para el Desarrollo Económico y Social de El Espino (APRODESE).
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Hjern, Anders
    Centre for Health Equity Studies, Karolinska Institutet/Stockholm University.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Women´s autonomy and social support and their associations with infant and young child feeding and nutritional status: community-based survey in rural Nicaragua2015In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, no 11, p. 1979-1990Article in journal (Refereed)
    Abstract [en]

    Objective

    To evaluate the associations of women’s autonomy and social support with infant and young child feeding practices (including consumption of highly processed snacks and sugar-sweetened beverages) and nutritional status in rural Nicaragua.

    Design

    Cross-sectional study. Feeding practices and children’s nutritional status were evaluated according to the WHO guidelines complemented with information on highly processed snacks and sugar-sweetened beverages. Women’s autonomy was assessed by a seventeen-item questionnaire covering dimensions of financial independence, household-, child-, reproductive and health-related decision making and freedom of movement. Women’s social support was determined using the Duke-UNC Functional Social Support Questionnaire. The scores attained were categorized into tertiles.

    Setting

    Los Cuatro Santos area, rural Nicaragua.

    Subjects

    A total of 1371 children 0–35 months of age.

    Results

    Children of women with the lowest autonomy were more likely to be exclusively breast-fed and continue to be breast-fed, while children of women with middle level of autonomy had better complementary feeding practices. Children of women with the lowest social support were more likely to consume highly processed snacks and/or sugar-sweetened beverages but also be taller.

    Conclusions

    While lower levels of autonomy and social support were independently associated with some favourable feeding and nutrition outcomes, this may not indicate a causal relationship but rather that these factors reflect other matters of importance for child care.

  • 9120. ziaei, shirin
    et al.
    Frith, Amy Lynn
    Ekström, Eva-Charlotte
    Naved, Ruchira Tabassum
    Experiencing lifetime domestic violence: associations with mental health and stress among pregnant women in rural Bangladesh: The MINIMat randomized trialArticle in journal (Other academic)
  • 9121. ziaei, shirin
    et al.
    Frith, Amy Lynn
    Ekström, Eva-Charlotte
    Naved, Ruchira Tabassum
    Experiencing lifetime domestic violence: associations with mental health and stress among pregnant women in rural Bangladesh.: The MINIMat randomized trialArticle in journal (Other academic)
  • 9122.
    Ziaei, Shirin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Frith, Amy Lynn
    thaca Coll, Sch Hlth Sci & Human Performance, Ithaca, NY 14850 USA.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Naved, Ruchira Tabassum
    Int Ctr Diarrhoeal Dis Res ICDDR B, Dhaka, Bangladesh.
    Experiencing Lifetime Domestic Violence: Associations with Mental Health and Stress among Pregnant Women in Rural Bangladesh: The MINIMat Randomized Trial2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 12, article id e0168103Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experience of domestic violence has negative mental health consequences for women. The association of cumulative and specific forms of domestic violence, particularly emotional violence and controlling behavior, with common mental disorders and stress has rarely been studied in pregnant women. The aim of this study is to evaluate associations of specific and multiple forms of lifetime domestic violence and controlling behavior with distress and cortisol level during pregnancy in rural Bangladeshi women.

    METHODS AND FINDINGS: In this observational sub-study of larger MINIMat trial, 3504 pregnant women were interviewed using a shortened Conflict Tactic Scale about their lifetime experience of domestic violence including physical, sexual, emotional domestic violence and controlling behavior. Women's levels of emotional distress were assessed using the self-reported questionnaire (SRQ-20) developed by WHO, and levels of morning salivary cortisol were measured in a subsample (n = 1300) of women during week 28-32 of pregnancy. Regression analyses were used to estimate the associations of lifetime physical, sexual, emotional domestic violence and controlling behavior with levels of distress and cortisol during pregnancy. The prevalence of lifetime domestic violence was 57% and emotional distress was 35% in these pregnant women. All forms of domestic violence were associated with higher levels of emotional distress. Women who experienced either emotional violence or controlling behavior had the highest levels of emotional distress. There was a dose-response relationship between cumulative number of the different forms of domestic violence and women's levels of emotional distress. There was no association between women's experience of domestic violence and level of morning salivary cortisol.

    CONCLUSION: Including emotional violence and controlling behavior as major types of violence in future research and health interventions is warranted. Furthermore, the extent of the negative impacts of domestic violence on pregnant women, multiple forms of violence and their cumulative effects need to be investigated.

  • 9123.
    Ziaei, Shirin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Rahman, Anisur
    ICDDR B, Dhaka, Bangladesh.
    Raqib, Rubhana
    ICDDR B, Dhaka, Bangladesh.
    Lönnerdal, Bo
    Univ Calif Davis, Dept Nutr, Davis, CA 95616 USA.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    A Prenatal Multiple Micronutrient Supplement Produces Higher Maternal Vitamin B-12 Concentrations and Similar Folate, Ferritin, and Zinc Concentrations as the Standard 60-mg Iron Plus 400-μg Folic Acid Supplement in Rural Bangladeshi Women.2016In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 146, no 12, p. 2520-2529Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The effects of prenatal food and micronutrient supplementation on maternal micronutrient status are not well known.

    OBJECTIVE: We compared the efficacy and effectiveness of 3 different micronutrient supplements on maternal micronutrient status when combined with food supplementation.

    METHODS: In the MINIMat (Maternal and Infant Nutrition Intervention, Matlab) trial in Bangladesh, 4436 pregnant women were randomly assigned to daily intake of 3 types of micronutrient capsules: 30 mg Fe and 400 μg folic acid (Fe30F), 60 mg Fe and 400 μg folic acid (Fe60F), or multiple micronutrient supplements (MMNs) combined with early (week 9 of pregnancy) or usual (week 20 of pregnancy) food supplementation in a 2 by 3 factorial design. Plasma concentrations of vitamin B-12, folate, ferritin, and zinc were analyzed before the start of micronutrient supplementation (week 14) and at week 30 of pregnancy in 641 randomly selected women. An electronic monitoring device was used to measure the number of capsules taken. The effectiveness of food and micronutrient regimens as well as efficacy per capsule in maternal micronutrient status were analyzed by ANOVA and general linear models.

    RESULTS: At week 30 of pregnancy, women in the MMN group had higher geometric mean concentrations of vitamin B-12 than women in the Fe60F group (119 compared with 101 pmol/L, respectively); no other differences in effectiveness of micronutrient and food regimens were observed. A dose-response relation between the number of capsules taken and concentrations of folate and ferritin was observed for all micronutrient supplements. Fe30F had lower efficacy per capsule in increasing ferritin concentrations within the first tertile of capsule intake than did Fe60F and MMNs. Because ferritin reached a plateau for all types of micronutrient supplements, there was no difference between the regimens in their effectiveness.

    CONCLUSION: Compared with Fe60F, MMNs produced higher maternal vitamin B-12 and similar ferritin and folate concentrations in Bangladeshi women. The MINIMat trial was registered at isrctn.org as ISRCTN16581394.

  • 9124.
    Zidar, Maria Norfjord
    et al.
    Malardalen Univ, Sch Hlth Care & Social Welf, Div Publ Hlth Sci, SE-72123 Vasteras, Sweden..
    Larm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Malardalen Univ, Sch Hlth Care & Social Welf, Div Publ Hlth Sci, SE-72123 Vasteras, Sweden..
    Tillgren, Per
    Malardalen Univ, Sch Hlth Care & Social Welf, Div Publ Hlth Sci, SE-72123 Vasteras, Sweden..
    Akhavan, Sharareh
    Malardalen Univ, Sch Hlth Care & Social Welf, Div Publ Hlth Sci, SE-72123 Vasteras, Sweden..
    Non-attendance of mammographic screening: the roles of age and municipality in a population-based Swedish sample2015In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 14, article id 157Article in journal (Refereed)
    Abstract [en]

    Background: Inequality in health and health care is increasing in Sweden. Contributing to widening gaps are various factors that can be assessed by determinants, such as age, educational level, occupation, living area and country of birth. A health care service that can be used as an indicator of health inequality in Sweden is mammographic screening. The non-attendance rate is between 13 and 31 %, while the average is about 20 %. This study aims to shed light on three associations: between municipality and non-attendance, between age and non-attendance, and the interaction of municipality of residence and age in relation to non-attendance. Methods: The study is based on data from the register that identifies attenders and non-attenders of mammographic screening in a Swedish county, namely the Radiological Information System (RIS). Further, in order to provide a socio-demographic profile of the county's municipalities, aggregated data for women in the age range 40-74 in 2012 were retrieved from Statistics Sweden (SCB), the Public Health Agency of Sweden, the National Board of Health and Welfare, and the Swedish Social Insurance Agency. The sample consisted of 52,541 women. Analysis conducted of the individual data were multivariate logistic regressions, and pairwise chi-square tests. Results: The results show that age and municipality of residence associated with non-attendance of mammographic screening. Municipality of residence has a greater impact on non-attendance among women in the age group 70 to 74. For most of the age categories there were differences between the municipalities in regard to non-attendance to mammographic screening. Conclusions: Age and municipality of residence affect attendance of mammographic screening. Since there is one sole and pre-selected mammographic screening facility in the county, distance to the screening facility may serve as one explanation to non-attendance which is a determinant of inequity. From an equity perspective, lack of equal access to health and health care influences facility utilization.

  • 9125.
    Ziegert, Kristina
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Livet i skuggan av dialys: beskrivning av anhörigas vardag ; tema: välfärd och välbefinnande2007In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 84, no 3, p. 239-246Article in journal (Refereed)
  • 9126.
    Ziegert, Kristina
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI). Department of Medicine, Central Hospital Halmstad, S-301 85 Halmstad, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI). Department of Medicine, Linköping University, Linköping, Sweden .
    Conceptions of life situation among next-of-kin of haemodialysis patients2001In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 9, no 4, p. 231-239Article in journal (Refereed)
    Abstract [en]

    The presence of renal disease in a family is a strain on both the patient and the next-of-kin, affecting their life situations. Surprisingly, few studies dealing with the ways that the next-of-kin experience their situation are available. The aim of this study was to describe how the next-of-kin of haemodialysis patients conceive their life situation. Data were collected by interviewing 12 people who live with someone with dialysis-treated renal disease and analysed according to a qualitative method inspired by the phenomenographic approach. Six description categories of how the subjects construed their life situation emerged: a feeling of confinement; a feeling of social isolation; a feeling that the way of life has changed; a feeling of security in life; a feeling of a threatening future; and promoting health. The next-of-kin generally expressed a large degree of commitment to and concern for the sick person. In spite of their life situation having been dramatically changed, the next-of-kin described an ability to adapt. With the help of society the feelings of confinement and social isolation can be dispersed, enabling the next-of-kin to promote the health of the sick person. A suggestion for further research is to study what adaptation strategies next-of-kin use in their life situation.

  • 9127.
    Ziegert, Kristina
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Högstedt, Benkt
    Dept. of Development and Research, Central Hospital, Halmstad, Sweden .
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Lidell, Evy
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Time distribution factors of hospital and home care among chronic haemodialysis patients2004In: EDTNA-ERCA journal, ISSN 1019-083X, Vol. 30, no 1, p. 19-22Article in journal (Refereed)
    Abstract [en]

    Today, many studies are available that focus on haemodialysis; however studies on the time distribution factor involved are lacking. It is therefore important to study the distribution of time, taking into account outpatient care, inpatient care and home care. The aim of the study was to chart over a five-year period, the time distribution factors of hospital care and home care among chronic haemodialysis patients. The design of the study was descriptive, and the data material was drawn from a patient register (N = 61). The data analysis was performed by means of both descriptive and inferential statistics.

  • 9128.
    Zineldin, Mosad
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Patient self-efficacy and health2016Conference paper (Refereed)
    Abstract [en]

    How patients cope with and manage their chronic condition when not under direct medical supervision makes a difference in their quality of life, their health, and their utilization of the healthcare system—and such self-efficacy and self-management can be both time-consuming and complex.

    The concept of self-efficacy is receiving increasing recognition as a predictor of health behavior change and maintenance. The purpose of this speech is to facilitate a clearer understanding of both the concept and its relevance for health behaviour, practice, healthcare quality, patient safety and quality of life in general. A patient who believes in being able to produce a desired effect can conduct a more active and self-determined life course. Health specific self-efficacy is a person’s optimistic self-belief about being capable to resist temptations and to adopt a healthy lifestyle. A co-creating Health program enables clinicians and patients to make their interactions and healthcare institutions/system as productive as possible.

  • 9129.
    Zineldin, Mosad
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Management and Economics.
    Camgoz Akdag, Hatice
    Kadir Has University, Management Department,Istanbul-Turkey.
    Quality of Health Care and Patient Satisfaction: An exploratory investigation of the 5Qs model in Turkey2009Conference paper (Refereed)
    Abstract [en]

    The aim is to examine the major factors affecting patients’ perception of cumulative summation. Secondly, empirically to examine the major factors affecting perception of the cumulative satisfaction to address the question whether patients in Istanbul evaluate quality of health care to be similarly or differently than the Kazakhstani, Egyptian and Jordanian patients.

    A questionnaire was distributed to people who are or were patient once in Istanbul hospitals. The questionnaire contains a total of 39 items (attributes) of newly developed five quality dimensions (5Qs). A total of 1107 complete and usable questionnaires were received. Frequency distribution, factor analysis and reliability analysis is used for analysing the data collected.

    The first three factors that are the biggest concern for people being treated in hospitals in Turkey these are: the quality of infrastructure; the quality of atmosphere, and quality of object. The specific attributes, which were perceived as concerns, were similar with all other three countries results. A cure to improve the quality for health-care services can be an application of total relationship management and the 5Qs model together with customer orientation strategy.

    The result can be used by the hospitals to reengineer and redesign creatively their quality management processes and the future direction of their more effective health-care quality strategies.

    In this research a study is described involving a new instrument and a new method, which assure a reasonable level of relevance, validity and reliability, while being explicitly change-oriented. This study argues that a patient's satisfaction is a cumulative construct, summing satisfaction with five different qualities (5Qs) of the hospital: quality of object, processes, infrastructure, interaction, and atmosphere.

  • 9130. Zoeller, R. Thomas
    et al.
    Bergman, Ake
    Becher, Georg
    Bjerregaard, Poul
    Bornman, Riana
    Brandt, Ingvar
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Organismal Biology, Environmental toxicology.
    Iguchi, Taisen
    Jobling, Susan
    Kidd, Karen A.
    Kortenkamp, Andreas
    Skakkebaek, Niels E.
    Toppari, Jorma
    Vandenberg, Laura N.
    A path forward in the debate over health impacts of endocrine disrupting chemicals2014In: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 13, p. 118-Article in journal (Refereed)
    Abstract [en]

    Several recent publications reflect debate on the issue of "endocrine disrupting chemicals" (EDCs), indicating that two seemingly mutually exclusive perspectives are being articulated separately and independently. Considering this, a group of scientists with expertise in basic science, medicine and risk assessment reviewed the various aspects of the debate to identify the most significant areas of dispute and to propose a path forward. We identified four areas of debate. The first is about the definitions for terms such as "endocrine disrupting chemical", "adverse effects", and "endocrine system". The second is focused on elements of hormone action including "potency", "endpoints", "timing", "dose" and "thresholds". The third addresses the information needed to establish sufficient evidence of harm. Finally, the fourth focuses on the need to develop and the characteristics of transparent, systematic methods to review the EDC literature. Herein we identify areas of general consensus and propose resolutions for these four areas that would allow the field to move beyond the current and, in our opinion, ineffective debate.

  • 9131.
    Zugna, Daniela
    et al.
    Canc Epidemiol Unit, Centrr Rieferimento Epidemiol & Prevenz Oncol Piemon, Turin, Italy; Univ Turin, Turin, Italy.
    Richiardi, Lorenzo
    Canc Epidemiol Unit, Centrr Rieferimento Epidemiol & Prevenz Oncol Piemon, Turin, Italy; Univ Turin, Turin, Italy.
    Stephansson, Olof
    Clin Epidemiol Unit, Dept Med, Karolinska Inst, Stockholm, Sweden.
    Cnattingius, Sven
    Clin Epidemiol Unit, Dept Med, Karolinska Inst, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Clin Epidemiol Unit, Dept Med, Karolinska Inst, Stockholm, Sweden; Dept Pediat, Örebro University Hospital, Örebro, Sweden; Coll Med, Dept Med & Immunol, Div Gastroenterol & Hepatol, Mayo Clin, Rochester MN, USA.
    Mortality Rate in Children Born to Mothers and Fathers With Celiac Disease: A Nationwide Cohort Study2013In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 177, no 12, p. 1348-1355Article in journal (Refereed)
    Abstract [en]

    Celiac disease (CD) is associated with increased mortality rate and adverse pregnancy outcome, but little is known about offspring mortality rate. In this nationwide retrospective cohort study, we identified persons whose biopsy-verified CD was diagnosed in Sweden in 19692008. We compared mortality rates in children born to mothers with and without CD (n 16,121 vs. n 61,782) and children born to fathers with and without CD (n 9,289 vs. n 32,984). Median age of offspring at end of follow-up was 28.7 (range, 16.739.7) years. We also examined mortality rates in children born to mothers with undiagnosed CD (later CD diagnosis; n 12,919) and diagnosed CD (n 3,202) to determine if intrauterine exposures associated with CD could affect offspring mortality rate. We estimated hazard ratios for death by using Cox regression. Death rates were independent of maternal CD (60 deaths per 100,000 person-years in children of mothers with CD, vs. 54 in controls) and paternal CD (53 deaths per 100,000 person-years in children of fathers with CD, vs. 53 in controls). Corresponding adjusted hazard ratios were 1.09 (95 confidence interval: 0.95, 1.26) for maternal CD and 1.02 (95 confidence interval: 0.85, 1.23) for paternal CD. Death rates were similar in children born to mothers with undiagnosed CD and in children whose mothers had diagnosed CD during pregnancy. Parental CD does not seem to influence mortality rate in offspring, which suggests that neither genetic influences of CD nor intrauterine conditions have adverse effects on offspring mortality rate.

  • 9132. Zulu, Joseph M
    et al.
    Michelo, Charles
    Msoni, Carol
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Byskov, Jens
    Blystad, Astrid
    Increased fairness in priority setting processes within the health sector: the case of Kapiri-Mposhi District, Zambia2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, p. 75-Article in journal (Refereed)
    Abstract [en]

    Background: The challenge of priority setting (PS) in health care within contexts of severe resource limitations has continued to receive attention. Accountability for Reasonableness (AFR) has emerged as a useful framework to guide the implementation of PS processes. In 2006, the AFR approach to enhance legitimate and fair PS was introduced by researchers and decision makers within the health sector in the EU funded research project entitled 'Response to Accountable priority setting for Trust in health systems' (REACT). The project aimed to strengthen fairness and accountability in the PS processes of health systems at district level in Zambia, Tanzania and Kenya. This paper focuses on local perceptions and practices of fair PS (baseline study) as well as at the evolution of such perceptions and practices in PS following an AFR based intervention (evaluation study), carried out at district level in Kapiri-Mposhi District in Zambia. Methods: Data was collected using in depth interviews (IDIs), focus group discussions (FGDs) and review of documents from national to district level. The study population for this paper consisted of health related stakeholders employed in the district administration, in non-governmental organizations (NGO) and in health facilities. Results: During the baseline study, concepts of legitimacy and fairness in PS processes were found to be grounded in local values of equity and impartiality. Government and other organizational strategies strongly supported devolution of PS and decision making procedures. However, important gaps were identified in terms of experiences of stakeholder involvement and fairness in PS processes in practice. The evaluation study revealed that a transformation of the views and methods regarding fairness in PS processes was ongoing in the study district, which was partly attributed to the AFR based intervention. Conclusions: The study findings suggest that increased attention was given to fairness in PS processes at district level. The changes were linked to a number of simultaneous factors among them the concepts introduced by the present project with its emphasis on fairness and enhanced participation. A responsive leadership that was increasingly accountable to its operational staff and communities emerged as one of the key elements in driving the processes forward.

  • 9133.
    Zulu, Joseph Mumba
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Michelo, Charles
    Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
    Innovation in health service delivery: integrating community health assistants into the health system at district level in Zambia2015In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, p. 38-Article in journal (Refereed)
    Abstract [en]

    Background: To address the huge human resources for health gap in Zambia, the Ministry of Health launched the National Community Health Assistant Strategy in 2010. The strategy aims to integrate community-based health workers into the health system by creating a new group of workers, called community health assistants (CHAs). However, literature suggests that the integration process of national community-based health worker programmes into health systems has not been optimal. Conceptually informed by the diffusion of innovations theory, this paper qualitatively aimed to explore the factors that shaped the acceptability and adoption of CHAs into the health system at district level in Zambia during the pilot phase. Methods: Data gathered through review of documents, 6 focus group discussions with community leaders, and 12 key informant interviews with CHA trainers, supervisors and members of the District Health Management Team were analysed using thematic analysis. Results: The perceived relative advantage of CHAs over existing community-based health workers in terms of their quality of training and scope of responsibilities, and the perceived compatibility of CHAs with existing groups of health workers and community healthcare expectations positively facilitated the integration process. However, limited integration of CHAs in the district health governance system hindered effective programme trialability, simplicity and observability at district level. Specific challenges at this level included a limited information flow and sense of programme ownership, and insufficient documentation of outcomes. The district also had difficulties in responding to emergent challenges such as delayed or non-payment of CHA incentives, as well as inadequate supervision and involvement of CHAs in the health posts where they are supposed to be working. Furthermore, failure of the health system to secure regular drug supplies affected health service delivery and acceptability of CHA services at community level. Conclusion: The study has demonstrated that implementation of policy guidelines for integrating community-based health workers in the health system may not automatically guarantee successful integration at the local or district level, at least at the start of the process. The study reiterates the need for fully integrating such innovations into the district health governance system if they are to be effective.

  • 9134.
    Zulu, Joseph Mumba
    et al.
    Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia .
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Michelo, Charles
    Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia .
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Developing the national community health assistant strategy in Zambia: a policy analysis2013In: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 11, p. 24-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In 2010, the Ministry of Health in Zambia developed the National Community Health Assistant strategy, aiming to integrate community health workers (CHWs) into national health plans by creating a new group of workers, called community health assistants (CHAs). The aim of the paper is to analyse the CHA policy development process and the factors that influenced its evolution and content. A policy analysis approach was used to analyse the policy reform process.

    METHODOLOGY: Data were gathered through review of documents, participant observation and key informant interviews with CHA strategic team members in Lusaka district, and senior officials at the district level in Kapiri Mposhi district where some CHAs have been deployed.

    RESULTS: The strategy was developed in order to address the human resources for health shortage and the challenges facing the community-based health workforce in Zambia. However, some actors within the strategic team were more influential than others in informing the policy agenda, determining the process, and shaping the content. These actors negotiated with professional/statutory bodies and health unions on the need to develop the new cadre which resulted in compromises that enabled the policy process to move forward. International agencies also indirectly influenced the course as well as the content of the strategy. Some actors classified the process as both insufficiently consultative and rushed. Due to limited consultation, it was suggested that the policy content did not adequately address key policy content issues such as management of staff attrition, general professional development, and progression matters. Analysis of the process also showed that the strategy might create a new group of workers whose mandate is unclear to the existing group of health workers.

    CONCLUSIONS: This paper highlights the complex nature of policy-making processes for integrating CHWs into the health system. It reiterates the need for recognising the fact that actors' power or position in the political hierarchy may, more than their knowledge and understanding of the issue, play a disproportionate role in shaping the process as well as content of health policy reform.

  • 9135.
    Zulu, Joseph Mumba
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Michelo, Charles
    Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hope and despair: community health assistants' experiences of working in a rural district in Zambia2014In: Human Resources for Health, ISSN 1478-4491, E-ISSN 1478-4491, Vol. 12, no 1, article id 30Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In order to address the challenges facing the community-based health workforce in Zambia, the Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called community health assistants (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work.

    METHODS: A phenomenological approach was used to examine CHAs' experiences. Data collected through in-depth interviews with 12 CHAs in Kapiri Mposhi district and observations were analysed using a thematic analysis approach.

    RESULTS: Personal characteristics such as previous experience and knowledge, passion to serve the community and a desire to improve skills motivated people to become CHAs. Health systems characteristics such as an inclusive work culture in some health posts motivated CHAs to work. Conversely, a non-inclusive work culture created a social structure which constrained CHAs' ability to learn, to be innovative and to effectively conduct their duties. Further, limited supervision, misconceptions about CHA roles, poor prioritisation of CHA tasks by some supervisors, as well as non- and irregular payment of incentives also adversely affected CHAs' ability to work effectively. In addition, negative feedback from some colleagues at the health posts affected CHA's self-confidence and professional outlook. In the community, respect and support provided to CHAs by community members instilled a sense of recognition, appreciation and belonging in CHAs which inspired them to work. On the other hand, limited drug supplies and support from other community-based health workers due to their exclusion from the government payroll inhibited CHAs' ability to deliver services.

    CONCLUSIONS: Programmes aimed at integrating community-based health workers into health systems should adequately consider multiple incentives, effective management, supervision and support from the district. These should be tailored towards enhancing the individual, health system and community characteristics that positively impact work motivation at the local level if such programmes are to effectively contribute towards improved primary healthcare.

  • 9136.
    Zulu, Joseph Mumba
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Public Health, School of Medicine, University of Zambia, P.O. Box 50110, Lusaka, Zambia.
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Michelo, Charles
    Univ Zambia, Sch Med, Dept Publ Hlth, Lusaka, Zambia.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Integrating national community-based health worker programmes into health systems: a systematic review identifying lessons learned from low-and middle-income countries2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, no 1, article id 987Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite the development of national community-based health worker (CBHW) programmes in several low- and middle-income countries, their integration into health systems has not been optimal. Studies have been conducted to investigate the factors influencing the integration processes, but systematic reviews to provide a more comprehensive understanding are lacking.

    METHODS: We conducted a systematic review of published research to understand factors that may influence the integration of national CBHW programmes into health systems in low- and middle-income countries. To be included in the study, CBHW programmes should have been developed by the government and have standardised training, supervision and incentive structures. A conceptual framework on the integration of health innovations into health systems guided the review. We identified 3410 records, of which 36 were finally selected, and on which an analysis was conducted concerning the themes and pathways associated with different factors that may influence the integration process.

    RESULTS: Four programmes from Brazil, Ethiopia, India and Pakistan met the inclusion criteria. Different aspects of each of these programmes were integrated in different ways into their respective health systems. Factors that facilitated the integration process included the magnitude of countries' human resources for health problems and the associated discourses about how to address these problems; the perceived relative advantage of national CBHWs with regard to delivering health services over training and retaining highly skilled health workers; and the participation of some politicians and community members in programme processes, with the result that they viewed the programmes as legitimate, credible and relevant. Finally, integration of programmes within the existing health systems enhanced programme compatibility with the health systems' governance, financing and training functions. Factors that inhibited the integration process included a rapid scale-up process; resistance from other health workers; discrimination of CBHWs based on social, gender and economic status; ineffective incentive structures; inadequate infrastructure and supplies; and hierarchical and parallel communication structures.

    CONCLUSIONS: CBHW programmes should design their scale-up strategy differently based on current contextual factors. Further, adoption of a stepwise approach to the scale-up and integration process may positively shape the integration process of CBHW programmes into health systems.

  • 9137.
    Zvar Hurtig, Robert
    Mälardalen University, School of Health, Care and Social Welfare.
    Mäns erfarenheter och värderingar av fetma och fetmakirurgi: En intervjustudie i Västmanlands län2011Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Fetma är en medicinsk diagnos och många av kroppens biologiska funktioner är i obalans med ökad risk för följdtillstånd. För att motverka ohälsan är viktminskning ofta det enda alternativet. Fetmakirurgi är en hållbar viktminskningsmetod, vanligast är gastric bypass, med snabba långsiktiga effekter på följdtillstånd. I riket, liksom i Västmanlands län opereras en övervägande majoritet kvinnor. Varför män i Västmanland opereras i lägre utsträckning än kvinnor är okänt.

    Syfte: Studiens syfte var att erhålla och analysera mäns värderingar och drivkrafter bakom fetmakirurgi. Målet var även att studera mäns subjektiva uppfattningar av västerländska kroppsideal och dess roll bakom beslutet till fetmakirurgi, samt deras förväntningar av det kirurgiska ingreppet.

    Metod: Informanterna rekryterades genom Överviktigas riksförbund i Västmanland. Urvalet bestod av fem män i åldern 40-49 år som samtliga intervjuades om subjektiva erfarenheter av och attityder till fetma och fetmakirurgi. Intervjuerna utfördes med hjälp av ett intervjuschema och en tematisk tankekarta baserade på Hälsouppfattningsmodellen.

    Resultat: Den övergripande drivkraften bakom beslutet var männens hälsa och välbefinnande. Att orka jobba och vara aktiv med familj och vänner beskrevs även som avgörande. Rådande kroppsideal eftersträvades inte. Enligt männen var fetmakirurgi resultatet av insiktsprocesser och ett tillräckligt socialt stöd; fler bör se fetmakirurgi som en hållbar viktminskningsmetod

  • 9138.
    Zyczynski, T.
    et al.
    Bristol Myers Squibb Co, Princeton, NJ USA..
    Khoury, J.
    Emory Univ, Winship Canc Inst, Atlanta, GA 30322 USA..
    Goldberg, S.
    John Theurer Canc Ctr, Hackensack, NJ USA..
    Mauro, M.
    Mem Sloan Kettering Canc Ctr, 1275 York Ave, New York, NY 10021 USA..
    Michallet, M.
    Ctr Hosp Lyon Sud, Pierre Benite, France..
    Paquette, R.
    UCLA Med Ctr, Los Angeles, CA USA..
    Foreman, A.
    ICON Clin Res, San Francisco, CA USA..
    Subar, M.
    Bristol Myers Squibb Co, Princeton, NJ USA..
    Turner, M.
    ICON Clin Res, San Francisco, CA USA..
    Daumont, Manley M.
    Bristol Myers Squibb Co, Paris, France..
    Hehlmann, R.
    Heidelberg Univ, Mannheim, Germany..
    Simonsson, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
    Imatinib Discontinuation And Tki Switching Patterns In The Retrospective And Prospective Cohorts In Simplicity, A Study Of Chronic-Phase Chronic Myeloid Leukemia (Cp-Cml) Patients (Pts) In Routine Clinical Practice2016In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 19, no 7, p. A894-A895Article in journal (Refereed)
  • 9139.
    Äijö, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Hälsosammare snabbmat – upplevda möjligheter och problem bland restauranger: En intervjuundersökning ur snabbmatsrestaurangers perspektiv2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Over the past 30 years the incidence of overweight and obesity has increased. Obesity is a risk factor for many diseases, for instance type 2 Diabetes, cardiovascular diseases, many types of cancer and musculoskeletal diseases. That ready available food today is so accessible can be a reason for the public health problems of overweight and obesity.

    Objective: The aim was to study what possibilities and barriers there are for fast-food restaurants to sell healthy food.

    Methods: Information was collected by seven telephone interviews and two respondents answered by e-mail. Nine persons that were in charge of the menu at different fast-food restaurant chains in Sweden participated in the study.

    Results: To have a large variety was considered to be a problem for selling healthy food, also because the sale of it was low in some of the fast-food chains. Some of the informants did not find any problems with selling healthy food and it was regarded as an opportunity to get more consumers.

    Conclusion: The demand for healthier food has increased, and the offer and sales of it has also escalated. Nevertheless traditional fast food is selling well and that is why most restaurants focus on that range of food rather than offering their costumers healthier options in their menu.

  • 9140.
    Ängeby, Karin
    et al.
    Women’s Department, Central Hospital, Karlstad, Sweden.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Inland Norway Univ Appl Sci, Fac Publ Hlth, Dept Nursing, Elverum, Norway.
    Hildingsson, Ingegerd
    Department of Health Sciences, Mid Sweden University, Sundsvall, .
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Prevalence of Prolonged Latent Phase and Labor Outcome: Review of Birth Records in a Swedish Population2018In: Journal of midwifery & women's health, ISSN 1526-9523, E-ISSN 1542-2011, Vol. 63, no 1, p. 33-44, article id JMWH12704Article in journal (Refereed)
    Abstract [en]

    The prevalence of a prolonged latent phase of labor has been described as ranging from 5% to 6.5% in previous research. The aim of this study was to describe the prevalence of the prolonged latent phase of 18 hours or more, based on women's report, in women intending vaginal birth and who had spontaneous onset of labor. An additional aim was to compare the incidence of obstetric interventions, and the labor and neonatal outcomes in women with and without a prolonged latent phase.

    METHODS:

    A descriptive and comparative study was performed in a mid-sized hospital in western Sweden. The sample consisted of 1343 birth records of women who intended vaginal births and who had spontaneous onset of labor at 37 or more weeks' gestation during a one-year period (2013-2014). Background characteristics, obstetric interventions, and labor and neonatal outcomes were compared between women with latent phases lasting less than 18 hours and 18 hours or more, based on women's self-report. Odds ratios with 95% confidence intervals were calculated for the different exposure variables.

    A prolonged latent phase lasting 18 hours or more occurred in 23% of all births analyzed (n = 1343). A prolonged latent phase was more common among nulliparous women (29.2%) but also common for multiparous women (17%). Nulliparous and multiparous women who experienced a prolonged latent phase were more often exposed to amniotomy during latent phase. For nulliparous women, the adjusted odds ratio (aOR) was 11.57 (95% confidence interval [CI], 5.25-25.51) and for multiparous women the aOR was 18.73 (95% CI, 9.06-38.69). Similarly, amniotomy during active phase was more common for both nulliparous and multiparous women who experienced a prolonged latent phase (aOR, 4.05; 95% CI, 2.53-6.47 and aOR, 3.93; 95% CI, 2.43-6.37, respectively). Women with latent phases of 18 hours or more, more often experienced augmentation of labor during all phases, especially during latent phase. For nulliparous women, the aOR was 10.13 (95% CI, 2.82-36.39) and for multiparous women, aOR was11.9 (95% CI, 3.69-38.71). A prolonged latent phase was associated with more instrumental vaginal births for multiparas (aOR, 2.58; 95% CI, 1.27-5.26) and emergency cesarean regardless of parity (nulliparous women: aOR, 3.21; 95% CI, 1.08-9.50 and multiparous women: aOR, 3.93; 95% CI, 1.67-9.26).

    Based on women's self-report, the prevalence of a prolonged latent phase in women at term who planned a vaginal birth and had spontaneous onset of labor was higher than previously reported. Women with a prolonged latent phase were more likely to receive obstetric interventions. Assisted vaginal birth was more common for nulliparous women with prolonged latent phase and emergency cesarean occurred more frequently for both nulliparous women and multiparous women with a prolonged latent phase.

  • 9141.
    Ärnlöv, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 20132015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 9995, p. 743-800Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.

    METHODS: Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries.

    FINDINGS: Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013.

    INTERPRETATION: Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.

    FUNDING: Bill & Melinda Gates Foundation.

  • 9142.
    Ärnlöv, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Ruge, Toralph
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Serum endostatin and risk of mortality in the elderly: findings from 2 community-based cohorts2013In: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 33, no 11, p. 2689-2695Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    Experimental data imply that endostatin, a proteolytically cleaved fragment of collagen XVIII, could be involved in the development of cardiovascular disease and cancer. Prospective data concerning the relation between circulating endostatin and mortality are lacking. Accordingly, we aimed to study associations between circulating endostatin and mortality risk.

    APPROACH AND RESULTS:

    Serum endostatin was analyzed in 2 community-based cohorts: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; women 50%, n=931; mean age, 70 years; median follow-up, 7.9 years) and the Uppsala Longitudinal Study of Adult Men (ULSAM; n=748; mean age, 77 years; median follow-up, 9.7 years). During follow-up, 90 participants died in PIVUS (1.28/100 person-years at risk), and 417 participants died in ULSAM (6.7/100 person-years at risk). In multivariable Cox regression models adjusted for age and established cardiovascular risk factors, 1 SD higher ln(serum endostatin level) was associated with a hazard ratio of mortality of 1.39 and 95% confidence interval, 1.26 to 1.53, on average in both cohorts. In the ULSAM cohort, serum endostatin was also associated with cardiovascular mortality (177 deaths; hazard ratio per SD of ln[endostatin] 1.45, 95% confidence interval [1.25-1.71]) and cancer mortality (115 deaths; hazard ratio per SD of ln[endostatin] 1.35, 95% confidence interval [1.10-1.66]).

    CONCLUSIONS:

    High serum endostatin was associated with increased mortality risk in 2 independent community-based cohorts of the elderly. Our observational data support the importance of extracellular matrix remodeling in the underlying pathophysiology of cardiovascular disease and cancer.

  • 9143.
    Åberg, Anna Cristina
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Elderly Care Recipients' perceptions of Activity-Related Life Space - A Qualitative Study2007In: International Association of Gerontology and Geriatrics VI European Congress. St Petersburg, Russia, July 2007, 2007Conference paper (Other academic)
  • 9144.
    Åberg, Anna Cristina
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Frykberg, Gunilla
    Hirschfeld, Helga
    Gait initiation from sitting in a 93 year old woman with “fear of falling” - a single case pilot study2006In: JEGM 06: The 1st Joint ESMAC – GCMAS Meeting. Amsterdam, Holland, September 2006, 2006Conference paper (Other academic)
  • 9145.
    Åberg Yngwe, Monica
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The family's economic resources and adolescents' health complaints - do adolescents' own economic resources matter? 2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 1, p. 24-29Article in journal (Refereed)
    Abstract [en]

    Background: The present study focuses on the relevance of economic resources to psychological and psychosomatic health complaints during adolescence. It explores the link between the family's and the adolescent's economic resources and investigates whether or not differences in health complaints by the family's financial situation can be explained by adolescents' own economic resources. Methods: Drawing on data from two Swedish surveys on living conditions during adolescence (in the age group 10-18 years) conducted in 2002-03, logistic regressions were used to assess the associations between adolescents' own and household economic resources on two measures of health complaints. Results: The association between family economic hardship (i.e. lack of cash margin) and adolescents' health complaints largely disappeared when controlling for adolescents' own economic resources. Three measures of own absolute and relative economic resources were used. Out of these, the ability (or not) to buy things that others have was connected with both psychological [Odds ratio (OR) 2.16, 95% confidence interval (95% CI) 1.6-2.9] and psychosomatic complaints (OR 1.67, 95% CI 1.3-2.1), irrespective of age and gender. The importance of lacking a personal cash margin or not being able to join friends seemed to differ between age groups and genders. Conclusions: The importance of different aspects of economic resources seems to vary across age groups and gender. However, not being able to buy things that others have was clearly associated with health complaints irrespective of age and gender. Family economic hardship was associated with adolescents' health complaints, and this association was largely explained by adolescents' own economic resources.

  • 9146.
    Åhlin, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    The perception of TrT among its implementers: Evaluating the implementation process of Teaching Recovery Techniques among implementers in an intervention targeting unaccompanied refugee minors in Uppsala, Sweden. 2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    This thesis looks at how involved implementers of the Teaching Recovery Techniques-project in Uppsala, Sweden have experienced the project. Teaching Recovery Techniques is originally a group-based intervention created for use in disaster areas. This intervention has the aim to give self-help to unaccompanied refugee minors with post-traumatic stress symptoms in Uppsala and two neighbouring municipalities, by using non-psychiatric personnel to teach stress-mitigation. This is a pilot project as Teaching Recovery techniques have never been used in this type of setting before. To investigate the opinions of the involved personnel, qualitative interviews with roughly half of the group leader have been made. These have been analysed using manifest content analysis.

        The thesis found that while many are happy with the project, it has required unexpectedly high workload as well as suffered from unclear responsibility delegations and lacking communication, primarily in the start of the project. However, due to strong motivation from involved implementers and adaptability from employers, these issues have been overcome to a great degree. Lesson for further TrT-projects targeting unaccompanied minors should put extra effort in planning and defining the roles of involved actors as well as include arenas for horizontal communication between group leaders.

  • 9147.
    Åhlin, Erik
    Södertörn University, School of Natural Sciences, Technology and Environmental Studies.
    Tuberculosis care in Stockholm: An organizational analysis based on staff perception2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    In an increasingly more interconnected world, the importance of epidemiology in public and international health is rapidly increasing. Tuberculosis is one of the diseases that contributes to this, as its lengthy incubation time and annual high mortality count makes it one of the toughest bacteria for the medical community to combat. Sweden is today a low-endemic region but still suffers a number of cases each year. The majority of these infections have occurred abroad.

    This qualitative study aims evaluate the Swedish healthcare systems organizational structure in relation to the treating and tracking of tuberculosis. Key personnel from several different units working with diagnosing, treating and tracking of tuberculosis have been interviewed about their perception regarding the organizational structure. The data have been analyzed through H. Mintzbergs theoretical framework regarding organizational structure. The analysis shows that the current system can be described as an Adhocracy. The organization is highly capable of handling adjustment and producing unique and complex outputs in the form of individualized treatment plans and disease tracking efforts. However, the system is highly dependent on internal communication and has great difficulty in up-scaling and expanding. The study shows that the current system would be challenged by a sharp increase in tuberculosis-cases in Stockholm.

  • 9148.
    Åhlin, Julia K.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Jansson-Fröjmark, Markus
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Job demands, control and social support as predictors of trajectories of depressive symptoms2018In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 235, p. 535-543Article in journal (Refereed)
    Abstract [en]

    Background: Job demands, job control and social support have been associated with depressive symptoms. However, it is unknown how these work characteristics are associated with different trajectories of depressive symptoms, which this study aimed to examine. Methods: We included 6679 subjects in the Swedish Longitudinal Occupational Survey of Health (SLOSH), who completed biennial questionnaires in 2006-2016. Group-based trajectory models identified groups with similar development of depressive symptoms. Multinomial logistic regression estimated associations between baseline demands, control, social support and trajectories of depressive symptoms. Results: We identified six depression trajectories with varying severity and stability across four measurements. High job demands and low social support, but not low control, were associated with higher probability of belonging to subsequent trajectories with higher symptom level compared to very low symptom level. Adjusted risk ratios ranged from 1.26, 95% CI = 1.06-1.51 (low symptom trajectory) to 2.51, 95% CI = 1.43-4.41 (persistent severe symptom trajectory). Results also indicated that onset of high demands, low control and low social support increases depressive symptoms over time. Limitations: The results were based on self-reported data and all individuals did not have complete data in all waves. Conclusions: The results indicated that especially perceptions of high job demands and low social support are associated with higher or increasing levels of depressive symptoms over time. This support the supposition that high job demands, and low social support may have long-term consequences for depressive symptoms and that interventions targeting job demands and social support may contribute to a more favourable course of depression.

  • 9149.
    Åhlin, Julia K.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Griep, Yannick
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Trajectories of job demands and control: risk for subsequent symptoms of major depression in the nationally representative Swedish Longitudinal Occupational Survey of Health (SLOSH)2018In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 91, no 3, p. 263-272Article in journal (Refereed)
    Abstract [en]

    Purpose

    Depression is a global health concern. High job demands, low job control, and the combination (high strain) are associated with depression. However, few longitudinal studies have investigated changed or repeated exposure to demands and control related to depression. We investigated how trajectories of exposure to job demands and control jointly influence subsequent depression.

    Methods

    We included 7949 subjects from the Swedish Longitudinal Occupational Survey of Health, who completed questionnaires of perceived job demands and control, and depressive symptoms from 2006 to 2014. None of them were depressed between 2006 and 2012. Univariate and joint group-based trajectory models identified groups with similar development of demands and control across 2006–2012. Logistic regression estimated the risk for symptoms of major depression in 2014 according to joint trajectory groups.

    Results

    The joint trajectory model included seven groups, all with fairly stable levels of demands and control over time. Subjects in the high strain and active (high demands and high control) trajectories were significantly more likely to have subsequent major depressive symptoms compared to those having low strain, controlling for demographic covariates (OR 2.15; 95% Cl 1.24–3.74 and OR 2.04; 95% CI 1.23–3.40, respectively). The associations did not remain statistically significant after adjusting for previous depressive symptoms in addition to demographic covariates.

    Conclusions

    The results indicate that the levels of job demands and control were relatively unchanged across 6 years and suggest that long-term exposure to a high strain or active job may be associated with increased risk for subsequent depression.

  • 9150.
    Åhlström, Jonas
    Mälardalen University, School of Health, Care and Social Welfare.
    Studenter och stress: En enkätstudie om självupplevd stress bland studenter på Mälardalens högskola2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Stress and stress related diseases is a problem in today’s society and those most affected by it are young people. The stress is also unequal as women are more affected than men. For students stress can be a factor that affects their performance in school negatively. The aim of the study was to investigate for perceived stress among students at Mälardalen University and analyze gender and study program differences. The study had a quantitative approach and was conducted thru a cross-sectional study. The study was answered by 72 questionnaires that were completed by students from four study programs at Mälardalen University. The data of the study was analyzed by chi-2-tests in the data program SPSS. The result of the study gave an account of the perceived stress among the students who reported to perceive some stress, but it was neither high nor low. The results showed gender- and study program-differences that were not statistically significant. However the differences among study programs could be traced to the gender differences as three out of four programs were male or female dominated. The conclusions of the study are that the students have some perceived stress and that there are some differences in perceived stress for gender and study programs that are not statistically significant.

180181182183184185 9101 - 9150 of 9241
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf