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  • 9101.
    Wijnhoven, T M A
    et al.
    Noncommunicable Diseases and Health Promotion, World Health Organization Regional Office for Europe, Copenhagen Ø, Denmark.
    van Raaij, J M A
    Centre for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
    Spinelli, A
    National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
    Rito, A I
    Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge IP, Lisbon, Portugal.
    Hovengen, R
    Department of Health Statistics, National Institute of Public Health, Oslo, Norway.
    Kunesova, M
    Obesity Unit, Institute of Endocrinology, Prague, Czech Republic.
    Starc, G
    Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.
    Rutter, H
    National Obesity Observatory, Oxford, UK.
    Sjöberg, A
    Department of Public Health and Community Medicine, Public Health Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Petrauskiene, A
    Academy of Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    O'Dwyer, U
    Department of Health and Children, Dublin, Ireland.
    Petrova, S
    Department of Food and Nutrition, National Centre of Public Health and Analysis, Sofia, Bulgaria.
    Farrugia Sant'angelo, V
    Primary Health Care Department, Floriana, Malta.
    Wauters, M
    Flemish Agency for Care and Health, Flemish Ministry of Welfare, Public Health and Family, Brussels, Belgium.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Rubana, I-M
    Public Health Agency, Riga, Latvia.
    Breda, J
    Noncommunicable Diseases and Health Promotion, World Health Organization Regional Office for Europe, Copenhagen Ø, Denmark.
    WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6-9-year-old children2013In: Pediatric Obesity, ISSN 2047-6302, E-ISSN 2047-6310, Vol. 8, no 2, p. 79-97Article in journal (Refereed)
    Abstract [en]

    UNLABELLED: What is already known about this subject Overweight and obesity prevalence estimates among children based on International Obesity Task Force definitions are substantially lower than estimates based on World Health Organization definitions. Presence of a north-south gradient with the highest level of overweight found in southern European countries. Intercountry comparisons of overweight and obesity in primary-school children in Europe based on measured data lack a similar data collection protocol. What this study adds Unique dataset on overweight and obesity based on measured weights and heights in 6-9-year-old children from 12 European countries using a harmonized surveillance methodology. Because of the use of a consistent data collection protocol, it is possible to perform valid multiple comparisons between countries. It demonstrates wide variations in overweight and obesity prevalence estimates among primary-school children between European countries and regions.

    BACKGROUND: Nutritional surveillance in school-age children, using measured weight and height, is not common in the European Region of the World Health Organization (WHO). The WHO Regional Office for Europe has therefore initiated the WHO European Childhood Obesity Surveillance Initiative.

    OBJECTIVE: To present the anthropometric results of data collected in 2007/2008 and to investigate whether there exist differences across countries and between the sexes.

    METHODS: Weight and height were measured in 6-9-year-old children in 12 countries. Prevalence of overweight, obesity, stunting, thinness and underweight as well as mean Z-scores of anthropometric indices of height, weight and body mass index were calculated.

    RESULTS: A total of 168 832 children were included in the analyses and a school participation rate of more than 95% was obtained in 8 out of 12 countries. Stunting, underweight and thinness were rarely prevalent. However, 19.3-49.0% of boys and 18.4-42.5% of girls were overweight (including obesity and based on the 2007 WHO growth reference).The prevalence of obesity ranged from 6.0 to 26.6% among boys and from 4.6 to 17.3% among girls. Multi-country comparisons suggest the presence of a north-south gradient with the highest level of overweight found in southern European countries.

    CONCLUSIONS: Overweight among 6-9-year-old children is a serious public health concern and its variation across the European Region highly depends on the country. Comparable monitoring of child growth is possible across Europe and should be emphasized in national policies and implemented as part of action plans.

  • 9102.
    Wijnhoven, T M A
    et al.
    Noncommunicable Diseases and Health Promotion, World Health Organization Regional Office for Europe, Copenhagen Ø, Denmark.
    van Raaij, J M A
    Centre for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
    Spinelli, A
    National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
    Rito, A I
    Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge IP, Lisbon, Portugal.
    Hovengen, R
    Department of Health Statistics, National Institute of Public Health, Oslo, Norway.
    Kunesova, M
    Obesity Unit, Institute of Endocrinology, Prague, Czech Republic.
    Starc, G
    Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.
    Rutter, H
    National Obesity Observatory, Oxford, UK.
    Sjöberg, A
    Department of Public Health and Community Medicine, Public Health Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Petrauskiene, A
    Academy of Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    O'Dwyer, U
    Department of Health and Children, Dublin, Ireland.
    Petrova, S
    Department of Food and Nutrition, National Centre of Public Health and Analysis, Sofia, Bulgaria.
    Farrugia Sant'angelo, V
    Primary Health Care Department, Floriana, Malta.
    Wauters, M
    Flemish Agency for Care and Health, Flemish Ministry of Welfare, Public Health and Family, Brussels, Belgium.
    Yngve, Agneta
    Örebro University, School of Hospitality, Culinary Arts & Meal Science. Depart- ment of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden; Department of Health, Nutrition and Management, Oslo and Akershus University College, Oslo, Norway.
    Rubana, I-M
    Public Health Agency, Riga, Latvia.
    Breda, J
    Noncommunicable Diseases and Health Promotion, World Health Organization Regional Office for Europe, Copenhagen Ø, Denmark.
    WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6-9-year-old children2013In: Pediatric obesity, ISSN 2047-6310, Vol. 8, no 2, p. 79-97Article in journal (Refereed)
    Abstract [en]

    UNLABELLED: What is already known about this subject Overweight and obesity prevalence estimates among children based on International Obesity Task Force definitions are substantially lower than estimates based on World Health Organization definitions. Presence of a north-south gradient with the highest level of overweight found in southern European countries. Intercountry comparisons of overweight and obesity in primary-school children in Europe based on measured data lack a similar data collection protocol. What this study adds Unique dataset on overweight and obesity based on measured weights and heights in 6-9-year-old children from 12 European countries using a harmonized surveillance methodology. Because of the use of a consistent data collection protocol, it is possible to perform valid multiple comparisons between countries. It demonstrates wide variations in overweight and obesity prevalence estimates among primary-school children between European countries and regions.

    BACKGROUND: Nutritional surveillance in school-age children, using measured weight and height, is not common in the European Region of the World Health Organization (WHO). The WHO Regional Office for Europe has therefore initiated the WHO European Childhood Obesity Surveillance Initiative.

    OBJECTIVE: To present the anthropometric results of data collected in 2007/2008 and to investigate whether there exist differences across countries and between the sexes.

    METHODS: Weight and height were measured in 6-9-year-old children in 12 countries. Prevalence of overweight, obesity, stunting, thinness and underweight as well as mean Z-scores of anthropometric indices of height, weight and body mass index were calculated.

    RESULTS: A total of 168 832 children were included in the analyses and a school participation rate of more than 95% was obtained in 8 out of 12 countries. Stunting, underweight and thinness were rarely prevalent. However, 19.3-49.0% of boys and 18.4-42.5% of girls were overweight (including obesity and based on the 2007 WHO growth reference).The prevalence of obesity ranged from 6.0 to 26.6% among boys and from 4.6 to 17.3% among girls. Multi-country comparisons suggest the presence of a north-south gradient with the highest level of overweight found in southern European countries.

    CONCLUSIONS: Overweight among 6-9-year-old children is a serious public health concern and its variation across the European Region highly depends on the country. Comparable monitoring of child growth is possible across Europe and should be emphasized in national policies and implemented as part of action plans.

  • 9103.
    Wijnhoven, Trudy M. A.
    et al.
    Division of Noncommunicable Diseases and Promoting Health through the Life-Course,WHO Regional Office for Europe, UNCity, Copenhagen,Denmark.
    van Raaij, Joop M. A.
    Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, P.O. Bilthoven, Netherlands; Division of Human Nutrition,Wageningen University, Wageningen, Netherlands.
    Spinelli, Angela
    National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Lissner, Lauren
    Section for Epidemiology and Social Medicine, Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Spiroski, Igor
    Department of Physiology and Monitoring of Nutrition, Institute of Public Health, Skopje, Macedonia.
    Sant'Angelo, Victoria Farrugia
    Primary Child Health, Floriana Health Centre, Floriana, Malta.
    Pérez-Farinós, Napoleón
    Spanish Agency for Consumer Affairs, Food Safety and Nutrition, Madrid, Spain.
    Martos, Éva
    National Institute of Pharmacy and Nutrition, Budapest, Hungary.
    Heinen, Mirjam
    National Nutrition Surveillance Centre, School of Public Health, Physiotherapy & Population Science, University College Dublin, Belfield, Dublin, Ireland.
    Kunešová, Marie
    Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic.
    Rito, Ana I.
    Instituto Nacional de Saúde Dr. Ricardo Jorge, IP, Lisbon, Portugal.
    Hovengen, Ragnhild
    Department of Health Statistics, Norwegian Institute of Public Health, Oslo, Norway.
    Starc, Gregor
    Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.
    Duleva, Vesselka
    Department of Food and Nutrition, National Center of Public Health and Analyses, Sofia, Bulgaria.
    Pudule, Iveta
    Centre for Disease Prevention and Control, Riga, Latvia.
    Petrauskiene, Ausra
    Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Braeckevelt, Lien
    Flemish Agency for Care and Health, Flemish Ministry ofWelfare, Public Health and Family, Koning Albert II-Laan 35, Brussels, Belgium.
    Hassapidou, Maria
    Department of Nutrition and Dietetics, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece.
    Breda, João
    Division of Noncommunicable Diseases and Promoting Health through the Life-Course,WHO Regional Office for Europe, UNCity, Copenhagen,Denmark.
    van't Veer, Pieter
    Division of Human Nutrition,Wageningen University, Wageningen, Netherlands.
    WHO European Childhood Obesity Surveillance Initiative: Impact of type of clothing worn during anthropometric measurements and timing of the survey on weight and body mass index outcome measures in 6-9-year-old children2016In: Epidemiology Research International, ISSN 2090-2972, E-ISSN 2090-2980, article id 5130317Article in journal (Refereed)
    Abstract [en]

    Background: The World Health Organization European Childhood Obesity Surveillance Initiative (COSI) conducted examinations in 6–9-year-old children from 16 countries in the first two rounds of data collection. Allowing participating countries to adhere to their local legal requirements or adapt to other circumstances required developing a flexible protocol for anthropometric procedures.

    Objectives: (1) Review intercountry variation in types of clothing worn by children during weight and height measurements, clothes weight adjustments applied, timing of the survey, and duration of data collection; (2) assess the impact of the observed variation in these practices on the children’s weight or body mass index (BMI) outcome measures.

    Results: The relative difference between countries’ unadjusted and clothes-adjusted prevalence estimates for overweight was 0.3–11.5%; this figure was 1.4–33.3% for BMI-for-age Z-score values. Monthly fluctuations in mean BMI-for-age Z-score values did not show a systematic seasonal effect. The majority of the monthly BMI-for-age Z-score values did not differ statistically within a country; only 1–3 monthly values were statistically different within some countries.

    Conclusions: The findings of the present study suggest that the built-in flexibility in the COSI protocol concerning the data collection practices addressed in the paper can be kept and thus do not necessitate a revision of the COSI protocol.

  • 9104.
    Wijnhoven, Trudy M. A.
    et al.
    Division of Noncommunicable Diseases and Promoting Health through the Life-Course,WHO Regional Office for Europe, UNCity, Copenhagen,Denmark.
    van Raaij, Joop M. A.
    Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands; Division of Human Nutrition,Wageningen University, Wageningen, Netherlands.
    Spinelli, Angela
    National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
    Yngve, Agneta
    Örebro University, School of Hospitality, Culinary Arts & Meal Science.
    Lissner, Lauren
    Section for Epidemiology and Social Medicine, Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Spiroski, Igor
    Department of Physiology and Monitoring of Nutrition, Institute of Public Health, Skopje, Macedonia.
    Sant'Angelo, Victoria Farrugia
    Primary Child Health, Floriana Health Centre, Floriana, Malta.
    Pérez-Farinós, Napoleón
    Food Safety and Nutrition, Spanish Agency for Consumer Affairs, Madrid, Spain.
    Martos, Éva
    National Institute of Pharmacy and Nutrition, Budapest, Hungary.
    Heinen, Mirjam
    National Nutrition Surveillance Centre, School of Public Health, Physiotherapy & Population Science, University College Dublin, Belfield, Dublin, Ireland.
    Kunešová, Marie
    Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic.
    Rito, Ana I.
    Instituto Nacional de Saúde Dr. Ricardo Jorge, IP, Lisbon, Portugal.
    Hovengen, Ragnhild
    Department of Health Statistics, Norwegian Institute of Public Health, Oslo, Norway.
    Starc, Gregor
    Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.
    Duleva, Vesselka
    Department of Food and Nutrition, National Center of Public Health and Analyses, Sofia, Bulgaria.
    Pudule, Iveta
    Centre for Disease Prevention and Control, Riga, Latvia.
    Petrauskiene, Ausra
    Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Braeckevelt, Lien
    Public Health and Family, Flemish Agency for Care and Health, Brussels, Belgium.
    Hassapidou, Maria
    Department of Nutrition and Dietetics, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece.
    Breda, João
    Division of Noncommunicable Diseases and Promoting Health through the Life-Course,WHO Regional Office for Europe, UNCity, Copenhagen,Denmark.
    van't Veer, Pieter
    Division of Human Nutrition,Wageningen University, Wageningen, Netherlands.
    WHO European Childhood Obesity Surveillance Initiative: Impact of type of clothing worn during anthropometric measurements and timing of the survey on weight and body mass index outcome measures in 6-9-year-old children2016In: Epidemiology Research International, ISSN 2090-2972, E-ISSN 2090-2980, article id 5130317Article in journal (Refereed)
    Abstract [en]

    Background: The World Health Organization European Childhood Obesity Surveillance Initiative (COSI) conducted examinations in 6–9-year-old children from 16 countries in the first two rounds of data collection. Allowing participating countries to adhere to their local legal requirements or adapt to other circumstances required developing a flexible protocol for anthropometric procedures.

    Objectives: (1) Review intercountry variation in types of clothing worn by children during weight and height measurements, clothes weight adjustments applied, timing of the survey, and duration of data collection; (2) assess the impact of the observed variation in these practices on the children’s weight or body mass index (BMI) outcome measures.

    Results: The relative difference between countries’ unadjusted and clothes-adjusted prevalence estimates for overweight was 0.3–11.5%; this figure was 1.4–33.3% for BMI-for-age Z-score values. Monthly fluctuations in mean BMI-for-age Z-score values did not show a systematic seasonal effect. The majority of the monthly BMI-for-age Z-score values did not differ statistically within a country; only 1–3 monthly values were statistically different within some countries.

    Conclusions: The findings of the present study suggest that the built-in flexibility in the COSI protocol concerning the data collection practices addressed in the paper can be kept and thus do not necessitate a revision of the COSI protocol.

  • 9105.
    Wijnhoven, Trudy Ma
    et al.
    Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, UN City, Copenhagen, Denmark.
    van Raaij, Joop Ma
    Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
    Yngve, Agneta
    Örebro University, School of Hospitality, Culinary Arts & Meal Science.
    Sjöberg, Agneta
    Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Kunešová, Marie
    Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic.
    Duleva, Vesselka
    Department of Food and Nutrition, National Center of Public Health and Analyses, Sofia, Bulgaria.
    Petrauskiene, Ausra
    Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Rito, Ana I
    National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal.
    Breda, João
    Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, UN City, Copenhagen, Denmark.
    WHO European Childhood Obesity Surveillance Initiative: health-risk behaviours on nutrition and physical activity in 6-9-year-old schoolchildren2015In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, no 17, p. 3108-3124Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess to what extent eight behavioural health risks related to breakfast and food consumption and five behavioural health risks related to physical activity, screen time and sleep duration are present among schoolchildren, and to examine whether health-risk behaviours are associated with obesity.

    DESIGN: Cross-sectional design as part of the WHO European Childhood Obesity Surveillance Initiative (school year 2007/2008). Children's behavioural data were reported by their parents and children's weight and height measured by trained fieldworkers. Descriptive statistics and logistic regression analyses were performed.

    SETTING: Primary schools in Bulgaria, Lithuania, Portugal and Sweden; paediatric clinics in the Czech Republic.

    SUBJECTS: Nationally representative samples of 6-9-year-olds (n 15 643).

    RESULTS: All thirteen risk behaviours differed statistically significantly across countries. Highest prevalence estimates of risk behaviours were observed in Bulgaria and lowest in Sweden. Not having breakfast daily and spending screen time ≥2 h/d were clearly positively associated with obesity. The same was true for eating 'foods like pizza, French fries, hamburgers, sausages or meat pies' >3 d/week and playing outside <1 h/d. Surprisingly, other individual unhealthy eating or less favourable physical activity behaviours showed either no or significant negative associations with obesity. A combination of multiple less favourable physical activity behaviours showed positive associations with obesity, whereas multiple unhealthy eating behaviours combined did not lead to higher odds of obesity.

    CONCLUSIONS: Despite a categorization based on international health recommendations, individual associations of the thirteen health-risk behaviours with obesity were not consistent, whereas presence of multiple physical activity-related risk behaviours was clearly associated with higher odds of obesity.

  • 9106.
    Wijnhoven, Trudy Ma
    et al.
    Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, UN City, Copenhagen, Denmark.
    van Raaij, Joop Ma
    Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Sjöberg, Agneta
    Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Kunešová, Marie
    Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic.
    Duleva, Vesselka
    Department of Food and Nutrition, National Center of Public Health and Analyses, Sofia, Bulgaria.
    Petrauskiene, Ausra
    Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Rito, Ana I
    National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal.
    Breda, João
    Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, UN City, Copenhagen, Denmark.
    WHO European Childhood Obesity Surveillance Initiative: health-risk behaviours on nutrition and physical activity in 6-9-year-old schoolchildren2015In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, no 17, p. 3108-3124Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess to what extent eight behavioural health risks related to breakfast and food consumption and five behavioural health risks related to physical activity, screen time and sleep duration are present among schoolchildren, and to examine whether health-risk behaviours are associated with obesity.

    DESIGN: Cross-sectional design as part of the WHO European Childhood Obesity Surveillance Initiative (school year 2007/2008). Children's behavioural data were reported by their parents and children's weight and height measured by trained fieldworkers. Descriptive statistics and logistic regression analyses were performed.

    SETTING: Primary schools in Bulgaria, Lithuania, Portugal and Sweden; paediatric clinics in the Czech Republic.

    SUBJECTS: Nationally representative samples of 6-9-year-olds (n 15 643).

    RESULTS: All thirteen risk behaviours differed statistically significantly across countries. Highest prevalence estimates of risk behaviours were observed in Bulgaria and lowest in Sweden. Not having breakfast daily and spending screen time ≥2 h/d were clearly positively associated with obesity. The same was true for eating 'foods like pizza, French fries, hamburgers, sausages or meat pies' >3 d/week and playing outside <1 h/d. Surprisingly, other individual unhealthy eating or less favourable physical activity behaviours showed either no or significant negative associations with obesity. A combination of multiple less favourable physical activity behaviours showed positive associations with obesity, whereas multiple unhealthy eating behaviours combined did not lead to higher odds of obesity.

    CONCLUSIONS: Despite a categorization based on international health recommendations, individual associations of the thirteen health-risk behaviours with obesity were not consistent, whereas presence of multiple physical activity-related risk behaviours was clearly associated with higher odds of obesity.

  • 9107. Wiklund, Fredrik
    et al.
    Trolle Lageros, Ylva
    Chang, Ellen
    Bälter, Katarina
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences.
    Adami, Hans-Olov
    Grönberg, Henrik
    Lifetime total physical activity and prostate cancer risk: a population-based case-control study in Sweden2008In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 23, no 11, p. 739-746Article in journal (Refereed)
    Abstract [en]

    The etiologic role of physical activity in prostate cancer development is unclear. We assessed the association between lifetime total physical activity and prostate cancer risk in a Swedish population-based case–control study comprising 1,449 incident prostate cancer cases and 1,118 unaffected population controls. Information regarding physical activity was obtained via a self-administered questionnaire assessing occupational, household, and recreational activity separately at various ages throughout an individual’s lifetime. Clinical data (TNM-classification, Gleason sum and PSA) was obtained from linkage to the National Prostate Cancer Registry. Overall, we observed no association between lifetime total physical activity and prostate cancer risk (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 0.77–1.41 for ≥49.7 vs. <41.9 metabolic equivalent-hours per day). There was a significantly increased risk of prostate cancer in the most active men compared with the least active men in household (OR = 1.44, 95% CI = 1.08–1.92) and recreational physical activity (OR = 1.56, 95% CI = 1.16–2.10). Comparing the most active with the least active men, total physical activity was not associated with either localized disease (OR = 0.95, 95% CI = 0.67–1.34) or advanced disease (OR = 1.19, 95% CI = 0.83–1.71). These findings do not support the hypothesis that physical activity uniformly protects against prostate cancer development.

  • 9108.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Close to the edge: discursive, gendered and embodied stress in modern youth2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Adolescent subjective health and mental problems have become a public health concern not only in Sweden but worldwide. The overall aim of this thesis is to deepen and widen the understanding of young peoples’ subjective health, psychosomatic and stress-related problems. A special focus is put on experienced stress among adolescent girls and young women. The study setting is one youth health centre, and three upper secondary schools in Umeå, a university town in northern Sweden. The research design combines qualitative and quantitative methods with the main focus on qualitative methods. An interdisciplinary theoretical synthesis is utilised, primarily based on bio-psycho-social, phenomenological, and social constructionist approaches.

    The three qualitative papers (I-III) are based on the same sample of 40 young women who had sought help at the youth health centre because of their stress-related problems. Paper I explores the stressors experienced by the young women, whereas Paper II explores the lived experiences of stress. Paper III examines the young women’s experiences of living in a violent partner relationship as young teenagers, and how this has affected their lives and health over time. Paper IV investigates perceived stress and subjective health complaints among older adolescents in upper secondary school.

     

    Methods Data was derived from: a) a qualitative interview study with 40 adolescent girls and young women, aged between 16–25 years, who had sought help at the youth health centre for stress problems. Qualitative content analysis was used in combination with discourse-orientated analysis (Paper I); a phenomenological approach (Paper II), and narrative method (Paper III); b) a school-based survey with a sample of 16–18-year-old boys and girls (n=1027), in upper secondary school, grades 1 and 2, from different educational programs at three schools. Perceived stress, self-rated health, subjective health complaints, anxiety, and depression, were measured with a questionnaire including a set of instruments. Statistical analyses were descriptive and analytical.

     

    Results Paper I identified multiple stressors of modernity, gender orders and youth. Contextual factors, including social constructions and practices of gender, played an important role for the stress experienced by these young women. The results revealed that multiple and intersecting stressors and demands connected to essential life spheres, contributed not only to experiences of distress but also to feelings of constraint. Moreover, the roles of excessive taking of responsibility and failing adult support were revealed.

    Paper II illuminated multidimensional lived and embodied experiences of distress. ‘Living close to the edge’ emerged as the common theme running through all of the interviews and captured the young women’s sometimes unbearable situations. The theme contains dimensions of physical, emotional, cognitive, social, and existential distress, as well as dimensions of distrust and disempowerment.

    Paper III examined two Swedish adolescent girls’ experiences of living in a violent relationship as teenagers, and how this has affected their lives and health over time. The analysis revealed violation, stress, trauma, coping, and agency during adolescence and the transition into adulthood.

    Paper IV showed a high level of perceived stress, and subjective health and stress complaints among boys and girls. High pressure and excessive demands from school were experienced by a majority of boys and girls. Perceived stress was correlated with subjective health and stress complaints and anxiety. There was a clear gender difference: two to three times as many girls than boys reported subjective health complaints, e.g. headaches, tiredness and sleeping difficulties, musculoskeletal pain, sadness and anxiety.

     

    Conclusion Several issues of relevance to public health were raised throughout the thesis. According to the interview results, the young women face multiple and intersecting stressors of modernity, gender orders and being young, which correspond to their multidimensional experiences of ‘living close to the edge’. Their experiences of stress are multidimensional, and include physical, emotional, cognitive, social and existential dimensions. Findings from the qualitative study were also mirrored in the findings from the larger group of adolescents in the school survey, where a high proportion of older adolescents, particularly girls, reported perceptions of stress. Moreover, perceived stress correlated to a variety of subjective health complaints and anxiety. The results can be understood and explained from a variety of perspectives. The experience of ‘managing alone’ indicated perceptions of inadequate social support. The overall results indicated a risk of more negative health development, particularly among adolescent girls and young women. Stressors of modernity, gender orders and youth were prominent. The continuation and normalisation of oppression and violence are also discussed as a severe gendered stressor in young women’s lives. This calls for a broad contextualised and gender-sensitive approach to young people’s stress and health problems. In conclusion, the age and gender gap in adolescent health needs to be further explored, and processes of distress, distrust and disempowerment have to be taken more seriously.

  • 9109.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    ”He wrecked me”: Young men’s violence as a severe form of doing gendered ill-health in Swedish teenage girls2008In: 10th International Interdisciplinary Congress of women, Mundos De Mujeres/ Women’s Worlds. Madrid, Spanien, July, 2008. / [ed] Bárbara de Braganza, 12 - 3º D - 28004 Madrid, SpainPh.: + 34 91 310 43 76 - Fax: + 34 91 319 57 46e-mail: mmww08@unicongress.com, 2008Conference paper (Refereed)
  • 9110.
    Wiklund, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stress hos unga - samband med ångest, hälsobesvär och genus2013In: BestPractice - Psykiatri/Neurologi. Yrkesdialog mellan specialister, Vol. 4, no 14, p. 7-11Article in journal (Other academic)
  • 9111.
    Wiklund, Maria
    et al.
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden; Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Social Medicine, Umeå University, Umeå, Sweden.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Fysioterapi.
    Stålnacke, Britt-Marie
    Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
    Hammarström, Anne
    Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Social Medicine, Umeå University, Umeå, Sweden.
    Lehti, Arja
    Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Department of Clinical Sciences, Professional Development, Umeå University, Umeå, Sweden.
    Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31542Article in journal (Refereed)
    Abstract [en]

    Background: Long-term musculoskeletal pain is common, particularly among women. Pain conditions are a concern in primary health care, and people with severe and complex pain are referred to specialty health care. There is gender bias in access, counselling, assessment, and treatment of long-term pain.

    Objective: This study explores patient accounts and perceptions about important (social) factors for accessing specialised pain rehabilitation from gender and intersectional equality perspectives. We aimed to identify potential biases and inequalities in accessing rehabilitation resources at a specialised rehabilitation clinic.

    Design: Individual semi-structured interviews were conducted with 10 adults after an assessment or completion of a specialised rehabilitation programme in northern Sweden. Qualitative content analysis was used to explore patients’ perceptions of important factors for accessing rehabilitation.

    Results: One main theme was formulated as Access to rehab – not a given. Three categories of perceived inequality were demonstrated: power of gender, power of social status, and power of diagnosis. Participants perceived rehabilitation as a resource that is not equally available, but dependent on factors such as gender, socio-economic status, ability to work, ethnicity, or age, and more subtle aspects of social status and habitus (e.g. appearance, fitness, and weight). The character of diagnosis received (medical versus psychiatric or social) was also noted.

    Conclusions: It is crucial that professionals are aware of how potential inequalities related to gender, social status, and diagnosis, and their intersections, can be created, perceived, and have influence on the processes of assessment and treatment. Reduction of social determinants of health and biases remain important within global, national, and local contexts.

  • 9112.
    Wiklund, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, article id 31542Article in journal (Refereed)
    Abstract [en]

    Background: Long-term musculoskeletal pain is common, particularly among women. Pain conditions are a concern in primary health care, and people with severe and complex pain are referred to specialty health care. There is gender bias in access, counselling, assessment, and treatment of long-term pain.

    Objective: This study explores patient accounts and perceptions about important (social) factors for accessing specialised pain rehabilitation from gender and intersectional equality perspectives. We aimed to identify potential biases and inequalities in accessing rehabilitation resources at a specialised rehabilitation clinic.

    Design: Individual semi-structured interviews were conducted with 10 adults after an assessment or completion of a specialised rehabilitation programme in northern Sweden. Qualitative content analysis was used to explore patients’ perceptions of important factors for accessing rehabilitation.

    Results: One main theme was formulated as Access to rehab – not a given. Three categories of perceived inequality were demonstrated: power of gender, power of social status, and power of diagnosis. Participants perceived rehabilitation as a resource that is not equally available, but dependent on factors such as gender, socio-economic status, ability to work, ethnicity, or age, and more subtle aspects of social status and habitus (e.g. appearance, fitness, and weight). The character of diagnosis received (medical versus psychiatric or social) was also noted.

    Conclusions: It is crucial that professionals are aware of how potential inequalities related to gender, social status, and diagnosis, and their intersections, can be created, perceived, and have influence on the processes of assessment and treatment. Reduction of social determinants of health and biases remain important within global, national, and local contexts.

  • 9113.
    Wiklund, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Malmgren-Olsson, Eva-Britt
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Öhman, Ann
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bergström, Erik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Fjellman Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Subjective health complaints in older adolescents are related to perceived stress, anxiety and gender: a cross-sectional school study in Northern Sweden2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 993Article in journal (Refereed)
    Abstract [en]

    Purpose: Adolescent subjective health has become a public health concern in Sweden and worldwide. The purpose of this study is to investigate perceived stress and subjective health complaints among older adolescents.

    Methods: Data were derived from a school-based survey with a sample consisting of 16–18 year olds (n=1027), boys and girls, in high school grades 1 and 2, from different educational programs in three public high schools within a university municipality in northern Sweden. Perceived stress, self-rated health, subjective health complaints, anxiety, and depression, were measured with a questionnaire including a set of instruments.

    Results: A large proportion of both girls and boys reported health complaints and perceived stress. There was a clear gender difference; girls reported two to three-fold higher proportions of subjective health complaints such as headache, tiredness and sleeping difficulties, musculoskeletal pain, as well as sadness and anxiety. Pressure and demands correlated strongly with psychosomatic symptoms (r=0.71) and anxiety (r=0.71).

    Conclusions: The results indicate that subjective health complaints are prevalent during adolescence, especially in girls, and furthermore that perceived stress and demands may be important explanatory factors. Future studies should pay attention to the balance between gender-related demands, perceived control and social support, particularly in the school environment, in order to prevent negative strain and stress-related ill-health. The gender gap in adolescent health needs to be further explored.

  • 9114.
    Wiklund, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Bengs, Carita
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Malmgren-Olsson, Eva-Britt
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Living close to the edge: embodied dimensions of distress during emerging adulthood2014In: SAGE Open, ISSN 2158-2440, E-ISSN 2158-2440, Vol. 2, no 4, p. 1-17Article in journal (Refereed)
    Abstract [en]

    Although self-reported stress-related problems are common among Swedish adolescent girls and young women, few qualitative studies have been made of young people’s own understandings and descriptions of their situation. The aim of our present study, therefore, is to explore and analyze the lived experiences of stress among adolescent girls and young women who had sought help at a youth health center. Interviews were conducted with 40 girls and young women, aged 16-25 years. The interviews were analyzed by qualitative content analysis. “Living close to the edge” is interpreted as the common theme running through all of the interviews and represents the participants’ sometimes unbearable situations. The theme contains dimensions of physical, emotional, cognitive, social, and existential distress, as well as dimensions of distrust and disempowerment. Findings highlight the importance of addressing these dimensions in youth health interventions. The importance of contextualizing young women’s distress is furthermore emphasized.

  • 9115.
    Wiklund, Mats
    et al.
    Trafikanalys.
    Simonsson, Lennart
    Swedish National Road and Transport Research Institute.
    Forsman, Åsa
    Swedish National Road and Transport Research Institute, Traffic and road users, Traffic safety, society and road-user.
    Traffic safety and economic fluctuation: long-term and short-term analyses and a literature survey2012Report (Other academic)
    Abstract [en]

    In studies of traffic safety is it important to have good knowledge of both internal and external factors. Examples of the former are driver behaviour and the roads’ safety standard, while examples of the latter are the demographic structure and the economic situation. This report includes a survey of methods used by previous researchers comprising which variables they used as indicators of the state of the market. It was concluded that unemployment was the most common economic variable, where an increase in unemployment indicates a decrease in the number of killed road users. The same result was found when a time series analysis was performed on Swedish data. It was also shown that part of the reduction in the number of fatalities in Sweden during a recession was explained by young drivers’ reducing their car use. There is, however, still a remaining effect of unemployment that cannot be explained by young drivers car use. One theory is that the state of the market affects the road users´ travel patterns. Data collected from fatal accident reports during the recession in December 2008-March 2009, were compared to the same period in 2005/2006, 2006/2007 and 2007/2008 during which period the economy was stronger. The only significant difference was that the number of fatalities and number of fatal accidents were higher during periods of economic growth. No significant difference was found with respect to, among others, accident type, time of day, age or gender distribution.

  • 9116.
    Wiklund, Peder
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Adipose tissue, the skeleton and cardiovascular disease2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Cardiovascular disease (CVD) is the leading cause of death in the Western World, although the incidence of myocardial infarction (MI) has declined over the last decades. However, obesity, which is one of the most important risk factors for CVD, is increasingly common. Osteoporosis is also on the rise because of an aging population. Based on considerable overlap in the prevalence of CVD and osteoporosis, a shared etiology has been proposed. Furthermore, the possibility of interplay between the skeleton and adipose tissue has received increasing attention the last few years with the discovery that leptin can influence bone metabolism and that osteocalcin can influence adipose tissue.

    A main aim of this thesis was to investigate the effects of fat mass distribution and bone mineral density on the risk of MI. Using dual-energy x-ray absorptiometry (DEXA) we measured 592 men and women for regional fat mass in study I. In study II this was expanded to include 3258 men and women. In study III 6872 men and women had their bone mineral density measured in the total hip and femoral neck using DEXA. We found that a fat mass distribution with a higher proportion of abdominal fat mass was associated with both an adverse risk factor profile and an increased risk of MI. In contrast, a higher gynoid fat mass distribution was associated with a more favorable risk factor profile and a decreased risk of MI, highlighting the different properties of abdominal and gynoid fat depots (study I-II). In study III, we investigated the association of bone mineral density and risk factors shared between CVD and osteoporosis, and risk of MI. We found that lower bone mineral density was associated with hypertension, and also tended to be associated to other CVD risk factors. Low bone mineral density was associated with an increased risk of MI in both men and women, apparently independently of the risk factors studied (study III).

    In study IV, we investigated 50 healthy, young men to determine if a high-impact loading intervention in the form of a series of jumps would lead to changes in glucose and lipid metabolism. We found that the intervention group had significantly lowered serum glucose levels compared to the control group. Changes in all metabolic parameters favored the intervention group with an increase in lipolysis from baseline and a decrease in cholesterol.

    In summary, the proportion of abdominal and gynoid fat mass displayed contrasting associations to both CVD risk factors and MI risk. Abdominal fat mass was associated with a higher risk while a high proportion of gynoid fat mass was associated with a lower risk. Bone mineral density displayed an inverse association with MI risk, seemingly independently of CVD risk factors, suggesting other explanations to a shared pathogenesis. Finally, high impact loading on the skeleton in young, healthy men decreased serum glucose levels and tended to improve other metabolic parameters, suggesting that the skeleton can affect energy metabolism.

  • 9117.
    Wiklund, Peder
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Low bone mineral density is associated with increased risk for myocardial infarction in men and women2012In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 23, no 3, p. 963-970Article in journal (Refereed)
    Abstract [en]

    Summary The association between bone mineral density (BMD) and myocardial infarction (MI) was investigated in 6872 men and women. For both men and women lower BMD in the femoral neck and hip was associated with increased risk of MI largely independent of smoking, hypertension, hypertriglyceridemia and diabetes.

    Purpose The relationship between bone mineral density (BMD) and cardiovascular disease isn’t completely understood. The objective of this prospective study was to investigate the risk of myocardial infarction (MI) in relation to bone mineral density and to determine if cardiovascular risk factors could explain this association.

    Methods Dual X-ray absorptiometry (DEXA) was performed in 5490 women and 1382 men to determine total hip and femoral neck bone mineral density (BMD, g/cm²) and estimate femoral neck volumetric BMD (vBMD, g/cm³) . During a mean follow-up time of 5.7 years 117 women and 79 men suffered an initial MI.

    Results After adjustment for age and BMI, lower BMD of the femoral neck and total hip was associated with increased risk of MI for both women (hazard ratio (HR)=1.33, 95% confidence interval (CI): 1.08-1.66 per standard deviation (SD) decrease in femoral neck BMD) and men (HR=1.74, 95% CI: 1.34-2.28 per SD decrease in total hip BMD). After additional adjustment for smoking, hypertension, hypertriglyceridemia and diabetes the associations were slightly attenuated in men (HR=1.42-1.88 in the age and BMI-adjusted model versus 1.33-1.77 in the fully adjusted model) while similar attenuations were seen in women (HR=1.06-1.25 versus 1.05-1.22).

    Conclusion Lower BMD was associated with an increase in MI risk for both men and women. Women had consistently lower HRs compared to men in all models. Adjusting for smoking, hypertension, hypertriglyceridemia and diabetes did not distinctively weaken these associations.

  • 9118.
    Wiklund, Peder
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Toss, Fredrik
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Franks, Paul W
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Abdominal and gynoid fat mass are associated with cardiovascular risk factors in men and women2008In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 93, no 11, p. 4360-4366Article in journal (Refereed)
    Abstract [en]

    CONTEXT: Abdominal obesity is an established risk factor for cardiovascular disease (CVD). However, the correlation of dual-energy x-ray absorptiometry (DEXA) measurements of regional fat mass with CVD risk factors has not been completely investigated.

    OBJECTIVE: The aim of this study was to investigate the association of estimated regional fat mass, measured with DEXA and CVD risk factors.

    DESIGN, SETTING, AND PARTICIPANTS: This was a cross-sectional study of 175 men and 417 women. DEXA measurements of regional fat mass were performed on all subjects, who subsequently participated in a community intervention program.

    MAIN OUTCOME MEASURES: Outcome measures included impaired glucose tolerance, hypercholesterolemia, hypertriglyceridemia, and hypertension. RESULTS: We began by assessing the associations of the adipose measures with the cardiovascular outcomes. After adjustment for confounders, a sd unit increase in abdominal fat mass was the strongest predictor of most cardiovascular variables in men [odds ratio (OR)=2.63-3.37; P<0.05], whereas the ratio of abdominal to gynoid fat mass was the strongest predictor in women (OR=1.48-2.19; P<0.05). Gynoid fat mass was positively associated with impaired glucose tolerance, hypertriglyceridemia, and hypertension in men (OR=2.07-2.15; P<0.05), whereas the ratio of gynoid to total fat mass showed a negative association with hypertriglyceridemia and hypertension (OR=0.42-0.62; P<0.005).

    CONCLUSIONS: Abdominal fat mass is strongly independently associated with CVD risk factors in the present study. In contrast, gynoid fat mass was positively associated, whereas the ratio of gynoid to total fat mass was negatively associated with risk factors for CVD.

  • 9119.
    Wiklund, Susanne
    et al.
    Stockholms läns landsting, Karolinska institutet.
    Fagerberg, Ingegerd
    Ersta Sköndal University College, Department of Health Care Sciences.
    Örtqvist, Åke
    Karolinska institutet, Stockholms läns landsting.
    Broliden, Kristina
    Karolinska institutet.
    Tammelin, Ann
    Stockholms läns landsting, Karolinska institutet.
    Acquisition of extended spectrum β-lactamases during travel abroad: A qualitative study among Swedish travellers examining their knowledge, risk assessment, and behaviour2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, p. 32378-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Travel to foreign countries involves the risk of becoming a carrier of antibiotic-resistant bacteria, especially when the destination is a country with a high prevalence of this type of bacteria.

    AIM AND METHODS: The aim of this study was to learn about the knowledge of antibiotic resistance, and the behaviour and risk-taking among travellers, who had become carriers of extended spectrum beta-lactamases (ESBL)-producing bacteria during travel to a high-prevalence country. A modified version of grounded theory was used to analyse 15 open interviews.

    RESULTS: The analysis resulted in a core category: A need for knowledge to avoid risk-taking. Before the journey, the participants did not perceive there to be any risk of becoming a carrier of antibiotic- resistant bacteria. The low level of knowledge of antibiotic-resistant bacteria and transmission routes influenced their behaviour and risk-taking during their journey, resulting in them exposing themselves to risk situations. After their trip, the majority did not believe that their personal risk behaviour could have caused them to become carriers of ESBL.

    CONCLUSION: The participants' lack of knowledge of antibiotic-resistant bacteria resulted in unconscious risk-taking during their journey, which may have resulted in becoming carriers of ESBL-producing bacteria.

  • 9120.
    Wiklund, Susanne
    et al.
    Stockholms läns landsting, Karolinska institutet.
    Fagerberg, Ingegerd
    Ersta Sköndal University College, Department of Health Care Sciences. Karolinska institutet.
    Örtqvist, Åke
    Karolinska institutet, Stockholms läns landsting.
    Broliden, Kristina
    Karolinska institutet.
    Tammelin, Ann
    Karolinska institutet.
    Staff experiences of caring for patients with extended-spectrum β-lactamase–producing bacteria: A qualitative study2015In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 43, no 12, p. 1302-1309Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients who become carriers of antibiotic-resistant bacteria are sometimes stigmatized by health professionals. Staff members' fears of becoming infected could affect their willingness to care for these patients.

    METHODS:The purpose of this study was to increase the knowledge of what it means for staff in acute care settings and nursing homes to care for patients with extended-spectrum β-lactamase (ESBL)-producing bacteria. Assistant nurses, registered nurses, and physicians from acute care settings and nursing homes were interviewed. A modified version of Grounded Theory was used for the analysis.

    RESULTS:The analysis resulted in the core category "to operate as an expert in a chaotic environment" in acute care settings. Despite a lack of resources, hospital staff try to provide the best possible care for patients with ESBL. The analysis of the interviews in the nursing homes resulted in the core category "the employee who, despite uncertainty, provides good care." Despite some fear, and a lack of knowledge, the study participants tried to provide the residents with good care.

    CONCLUSION: Staff in acute care settings and nursing homes must have adequate knowledge and reasonable working conditions to be able to provide high-quality care for patients and residents who are ESBL carriers.

  • 9121.
    Wiklund, Susanne
    et al.
    Stockholms läns landsting, Karolinska institutet.
    Fagerberg, Ingegerd
    Ersta Sköndal University College, Department of Health Care Sciences.
    Örtqvist, Åke
    Karolinska institutet, Stockholms läns landsting.
    Vading, Malin
    Karolinska institutet.
    Giske, Göran
    Karolinska institutet.
    Broliden, Kristina
    Karolinska institutet.
    Tammelin, Ann
    Stockholms läns landsting, Karolinska institutet.
    Knowledge and understanding of antibiotic resistance and the risk of becoming a carrier when travelling abroad: A qualitative study of Swedish travelers.2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 3, p. 302-308Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Increasing globalisation, with the migration of people, animals and food across national borders increases the risk of the spread of antibiotic-resistant bacteria. To avoid becoming a carrier of antibiotic-resistant bacteria when travelling, knowledge about antibiotic resistance is important.

    MATERIALS AND METHODS: We aimed to describe the knowledge and understanding of antibiotic-resistant bacteria, and of the risk for becoming a carrier of such bacteria, among Swedish travellers before their travel to high-risk areas. A questionnaire with three open-ended questions was distributed to 100 individuals before departure.

    RESULTS: The travellers' answers were analysed using content analysis, resulting in the theme 'To be an insecure traveller who takes control over one's own journey'. Our results showed that the travellers were aware of what the term 'antimicrobial resistance' meant, but did not understand its real significance, nor the consequences for the individual nor for society. They also distanced themselves from the problem. Few thought that their travel would entail a risk of becoming a carrier of resistant bacteria. The lack of knowledge caused an uncertainty among the travellers, whom tried to master the situation by using coping strategies. They proposed a number of measures to prevent carriership. The measures were general and primarily aimed at avoiding illness abroad, particularly acute gastro-intestinal infection.

    CONCLUSIONS: In health care and vaccination clinics, there is a need for improved information for persons intending to travel to high-risk areas, both about the risks of contracting antibiotic-resistant bacteria and about effective preventive measures.

  • 9122.
    Wikman, Sofia
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Criminology.
    Unga mår allt sämre - eller?: Kunskapsöversikt om ungas psykiska hälsa i Sverige 20182018Report (Other academic)
  • 9123.
    Wikman, Sofia
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Criminology.
    Unga mår allt sämre - eller? Kunskapsöversikt om ungas psykiska hälsa i Sverige 2018: Kortversion2018Report (Other academic)
  • 9124. Wikstrom, G.
    et al.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Olofsson, Mona
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stalhammar, J.
    Bergman, G. J.
    Tornblom, M.
    Wintzell, V.
    Balas, B.
    Corda, S.
    Lindmark, Karl
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Suboptimal dosing of common heart failure treatments in newly diagnosed patients with heart failure: a retrospective population-based cohort study in Sweden2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no Suppl: 1, p. 54-54Article in journal (Refereed)
  • 9125. Wikstrom, G.
    et al.
    Lindmark, K.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Olofsson, M.
    Stalhammar, J.
    Bergman, G. J.
    Tornblom, M.
    Wintzell, V.
    Wirta, S. Bruce
    Balas, B.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Drug treatment patterns in patients newly diagnosed with heart failure: a retrospective population-based cohort study in Sweden2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no Supplement: 1, p. 55-55, article id Meeting Abstract: P286Article in journal (Refereed)
  • 9126.
    Wikström, Erika
    et al.
    Boendeverksamheten, Social resursförvaltning, City of Gothenburg, Gothenburg, Sweden.
    Eriksson, Eva-Maria
    Boendeverksamheten, Social resursförvaltning, City of Gothenburg, Gothenburg, Sweden.
    Lindroth, Malin
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Sexual and reproductive health and rights (SRHR) education with homeless people in Sweden2018In: Sex Education: Sexuality, Society and Learning, ISSN 1468-1811, E-ISSN 1472-0825, p. 1-15Article in journal (Refereed)
    Abstract [en]

    This paper describes the implementation of an educational intervention to enhance sexual health among homeless people by including sexual and reproductive health and rights (SRHR) as a part of social work provision with this group. Adult service users in different forms of temporary accommodation were provided with the opportunity to participate in three group sessions. Seventeen sessions, six with women and eleven with men, took place at six different housing facilities in Gothenburg. The intervention implementation process (which involved preparation, creation, realisation and evaluation) is described, and factors of importance are identified. Service users appreciated the opportunity to receive information and discuss sexual health, rights and norms. The success of the work may be related to the fact that the project was anchored both in social services and among service users, constantly adjusted, and delivered using a respectful approach. Social work organisations and professionals have an important role to play in acknowledging and promoting service users? sexual health and rights, especially among disadvantaged and socially excluded groups including homeless people.

  • 9127. Wikström, Ewa
    et al.
    Arman, Rebecka
    Dellve, Lotta
    University of Borås, School of Health Science.
    Vad gör chefer med sin tid och hur kan tid och engagemang hanteras på2013In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. Tema Ledarskap, no 6, p. 830-837Article in journal (Refereed)
    Abstract [sv]

    En studie om chefers tidsanvändning har genomförts med syftet att undersöka hur man kan understödja mer hållbar tidsanvändning och hållbart engagemang. Chefer hade många korta aktiviteter och många möten men kommunicerade sällan med sin egen chef på tu man hand. Arbetet präglades av ständiga förhandlingar, prioriteringar och omprioriteringar. Om chefer inte har enskild tid för att kommunicera med sin överordnade får det konsekvenser avseende att kunna göra välavvägda och acceptabla prioriteringar och i förlängningen för legitimiteten i ledarskapet. Vården och dess chefer har mycket att vinna på att utveckla kommunikationen om vardagsarbetetes dilemman. Utifrån våra resultat har ett studiematerial utvecklats som syftar till att stödja chefer och ledningsgrupper i det vardagliga arbetet avseende hållbart ledarskap, chefskap och tidsanvändning

  • 9128. Wikström, Ewa
    et al.
    Dellve, Lotta
    Tengelin, Ellinor
    Arman, Rebecka
    Chefers tidsanvändning och stress i sjukvården2011Book (Other academic)
  • 9129. Wikström, Ewa
    et al.
    Dellve, Lotta
    Sahlgrenska akademin, Göteborgs universitet.
    Tengelin, Ellinor
    Arman, Rebecka
    Chefers tidsanvändning och stress i sjukvården2011Report (Other academic)
  • 9130.
    Wilder-Smith, Annelies
    Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore and Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
    Dengue in international travelers: quo vadis?2013In: Journal of Travel Medicine, ISSN 1195-1982, E-ISSN 1708-8305, Vol. 20, no 6, p. 341-343Article in journal (Refereed)
  • 9131.
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    DengueTools: innovative strategies and tools for the prevention and control of dengue2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 36-36Article in journal (Other academic)
    Abstract [en]

    With estimated 390 million infections annually and 2.5 billion people at risk, dengue is a major emerging disease threat and an escalating public health problem worldwide. Effective vector control remains elusive, and surveillance in dengue endemic countries remains suboptimal at best. We lack understanding of individual or combined roles of viral, entomological, ecological, environmental and climate factors that influence dengue transmission dynamics and their respective outbreak predictive capability and the most cost-effective approach for surveillance and early warning systems. To address those gaps we have set up a comprehensive, early warning, laboratory-based sentinel disease surveillance system in Sri Lanka that has predictive capability for epidemic dengue. Furthermore, children are the most vulnerable group for dengue. We desperately need simple, cost-effective and scalable control strategies to protect children from dengue. Our DengueTools consortium hypothesized that insecticide treated school uniforms may be a target for school-based intervention to reduce the incidence of dengue in school children. We will report on our preliminary results. Lastly, DengueTools examines gaps in understanding the risk of introduction of dengue to non-infected areas, including Europe. We currently have insufficient data on the magnitude and trends of importation and virus evolution over time and by geographic origin. We also only have a poor understanding of vector density, preferred breeding sites, and vectorial capacity of Aedes in temperate climates that are needed for predictive models under changing climate conditions. We will collect clinical and virological data in travellers returning to Europe from dengue endemic countries, explore the effectiveness of vector control programs against Aedes albopictus in Southern France, and develop predictive risk models and maps the the introduction and establishment of dengue in Europe under different future climate scenarios in Europe. DengueTools is a global consortium of 14 partners, funded by the European commission 7th framework. We have 12 work packages around 3 main research areas.

    Disclosure: Principal Investigator of DengueTools. No other conflict of interests since January 2011.

  • 9132.
    Wilder-Smith, Annelies
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The elusive global burden of dengue2016In: Lancet. Infectious diseases (Print), ISSN 1473-3099, E-ISSN 1474-4457, Vol. 16, no 6, p. 629-631Article in journal (Other academic)
  • 9133.
    Wilder-Smith, Annelies
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Heidelberg Univ, Sch Med, Inst Publ Hlth, Heidelberg, Germany.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Olanratmanee, Phanthip
    Maskhao, Pongsri
    Sringernyuang, Luechai
    Logan, James G.
    Lindsay, Steve W.
    Banks, Sarah
    Gubler, Duane
    Louis, Valerie R.
    Tozan, Yesim
    Kittayapong, Pattamaporn
    The impact of insecticide-treated school uniforms on dengue infections in school-aged children: study protocol for a randomised controlled trial in Thailand2012In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 13, article id 212Article in journal (Refereed)
    Abstract [en]

    Background: There is an urgent need to protect children against dengue since this age group is particularly sensitive to the disease. Since dengue vectors are active mainly during the day, a potential target for control should be schools where children spend a considerable amount of their day. School uniforms are the cultural norm in most developing countries, worn throughout the day. We hypothesise that insecticide-treated school uniforms will reduce the incidence of dengue infection in school-aged children. Our objective is to determine the impact of impregnated school uniforms on dengue incidence.

    Methods: A randomised controlled trial will be conducted in eastern Thailand in a group of schools with approximately 2,000 students aged 7-18 years. Pre-fabricated school uniforms will be commercially treated to ensure consistent, high-quality insecticide impregnation with permethrin. A double-blind, randomised, crossover trial at the school level will cover two dengue transmission seasons.

    Discussion: Practical issues and plans concerning intervention implementation, evaluation, analysing and interpreting the data, and possible policy implications arising from the trial are discussed.

  • 9134.
    Wilder-Smith, Annelies
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Chang, Chui Rhong
    Leong, Wei Yee
    Zika in travellers 1947-2017: a systematic review.2018In: Journal of Travel Medicine, ISSN 1195-1982, E-ISSN 1708-8305, Vol. 25, no 1Article in journal (Refereed)
    Abstract [en]

    Introduction: Travellers contributed substantially to the rapid spread of Zika virus (ZIKV). They act as sentinel and may unmask ongoing ZIKV transmission in countries where outbreaks have not yet been reported. Our objectives were to (i) describe the burden of ZIKV infections in international travellers over time; (ii) estimate the proportion of birth defects as a result of maternal ZIKV infection in travellers; (iii) track the extent of sexual transmission; (iv) summarize ZIKV infections in returning travellers as reported by the GeoSentinel network; and (v) identify countries without reports on local ZIKV transmission where travellers served as sentinel.

    Methods: We performed a systematic review from 1947 to April 2017 on travel-associated ZIKV infections. We also compared published reports on autochthonous ZIKV transmission in Asia with published reports on exportations from travellers in Asia.

    Results: Of 314 papers that fit the inclusion criteria, 61 were eligible for final analysis. There was an exponential increase in the number of reported ZIKV infected travellers from the years 2013 to 2016, which declined in 2017. Amongst pregnant women with ZIKV infection, (5%) resulted in a fetus or infant with ZIKV-associated birth defects. An estimated 1% of the total number of ZIKV cases reported in the USA and Europe were acquired through sexual transmission. Through the GeoSentinel network, five countries (Indonesia, Philippines, Thailand, Vietnam, Cameroon) were identified as sentinel markers where ZIKV was exported despite the absence of reported local transmission.

    Conclusions: Mobility patterns and travel volumes can help to identify the most likely origin of importation, and also in predicting further propagation. Studies on pregnant returning travellers have contributed to a better understanding of the risk estimates of congenital Zika syndrome/microcephaly as a result of maternal ZIKV infection, and the relative contribution of sexual transmisison.

  • 9135.
    Wilder-Smith, Annelies
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore ; Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
    Cohn, Emily
    Lloyd, David C.
    Tozan, Yesim
    Brownstein, John S.
    Internet-based media coverage on dengue in Sri Lanka between 2007 and 20152016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, p. 1-5, article id 31620Article in journal (Refereed)
    Abstract [en]

    Background: Internet-based media coverage to explore the extent of awareness of a disease and perceived severity of an outbreak at a national level can be used for early outbreak detection. Dengue has emerged as a major public health problem in Sri Lanka since 2009. Objective: To compare Internet references to dengue in Sri Lana with references to other diseases (malaria and influenza) in Sri Lanka and to compare Internet references to dengue in Sri Lanka with notified cases of dengue in Sri Lanka. Design: We examined Internet-based news media articles on dengue queried from Health Map for Sri Lanka, for the period January 2007 to November 2015. For comparative purposes, we compared hits on dengue with hits on influenza and malaria. Results: There were 565 hits on dengue between 2007 and 2015, with a rapid rise in 2009 and followed by a rising trend ever since. These hits were highly correlated with the national epidemiological trend of dengue. The volume of digital media coverage of dengue was much higher than of influenza and malaria. Conclusions: Dengue in Sri Lanka is receiving increasing media attention. Our findings underpin previous claims that digital media reports reflect national epidemiological trends, both in annual trends and inter-annual seasonal variation, thus acting as proxy biosurveillance to provide early warning and situation awareness of emerging infectious diseases.

  • 9136. Wilder-Smith, Annelies
    et al.
    Leong, Wei-Yee
    Lopez, Luis Fernandez
    Amaku, Marcos
    Quam, Mikkel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Khan, Kamran
    Massad, Eduardo
    Potential for international spread of wild poliovirus via travelers2015In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 13, article id 133Article in journal (Refereed)
    Abstract [en]

    Background: The endgame of polio eradication is hampered by the international spread of poliovirus via travelers. In response to ongoing importations of poliovirus into polio-free countries, on 5 May 2014, WHO's Director-General declared the international spread of wild poliovirus a public health emergency of international concern. Our objective was to develop a mathematical model to estimate the international spread of polio infections. Methods: Our model took into account polio endemicity in polio-infected countries, population size, polio immunization coverage rates, infectious period, the asymptomatic-to-symptomatic ratio, and also the probability of a traveler being infectious at the time of travel. We applied our model to three scenarios: (1) number of exportations of both symptomatic and asymptomatic polio infections out of currently polio-infected countries, (2) the risk of spread of poliovirus to Saudi Arabia via Hajj pilgrims, and (3) the importation risk of poliovirus into India. Results: Our model estimated 665 polio exportations (>99 % of which were asymptomatic) from nine polio-infected countries in 2014, of which 78.3 % originated from Pakistan. Our model also estimated 21 importations of poliovirus into Saudi Arabia via Hajj pilgrims and 20 poliovirus infections imported to India in the same year. Conclusion: The extent of importations of asymptomatic and symptomatic polio infections is substantial. For countries that are vulnerable to polio outbreaks due to poor national polio immunization coverage rates, our newly developed model may help guide policy-makers to decide whether imposing an entry requirement in terms of proof of vaccination against polio would be justified.

  • 9137.
    Wilder-Smith, Annelies
    et al.
    National University of Singapore, Department of Medicine, Singapore.
    Lover, A
    Kittayapong, P
    Burnham, G
    Hypothesis: Impregnated school uniforms reduce the incidence of dengue infections in school children2011In: Medical Hypotheses, ISSN 0306-9877, E-ISSN 1532-2777, Vol. 76, no 6, p. 861-862Article in journal (Refereed)
    Abstract [en]

    Dengue infection causes a significant economic, social and medical burden in affected populations in over 100 countries in the tropics and sub-tropics. Current dengue control efforts have generally focused on vector control but have not shown major impact. School-aged children are especially vulnerable to infection, due to sustained human-vector-human transmission in the close proximity environments of schools. Infection in children has a higher rate of complications, including dengue hemorrhagic fever and shock syndromes, than infections in adults. There is an urgent need for integrated and complementary population-based strategies to protect vulnerable children. We hypothesize that insecticide-treated school uniforms will reduce the incidence of dengue in school-aged children. The hypothesis would need to be tested in a community based randomized trial. If proven to be true, insecticide-treated school uniforms would be a cost-effective and scalable community based strategy to reduce the burden of dengue in children.

  • 9138. Wilder-Smith, Annelies
    et al.
    Massad, Eduardo
    Age specific differences in efficacy and safety for the CYD-tetravalent dengue vaccine2016In: Expert Review of Vaccines, ISSN 1476-0584, E-ISSN 1744-8395, Vol. 15, no 4, p. 437-441Article in journal (Refereed)
    Abstract [en]

    CYD-TDV is the first dengue vaccine to have completed Phase 3 efficacy trials. Efficacy was consistently higher in those aged 9 and above for all variables studied: efficacy against virologically confirmed dengue of any severity and serotype, serotype specific efficacy, efficacy dependent on baseline seropositivity, efficacy against hospitalizations and efficacy against severe disease. Because of the higher efficacy and the absence of a safety signal, the age group with the best benefit of the use of CYD-TDV is individuals aged 9 and above - the age group for which licensure is now being sought.

  • 9139.
    Wilder-Smith, Annelies
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Preet, Raman
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Renhorn, Karl-Erik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ximenes, R. A.
    Rodrigues, L. C.
    Solomon, T.
    Neyts, J.
    Lambrechts, L.
    Willison, H.
    Peeling, R.
    Falconar, A. K.
    Precioso, A. R.
    Logan, J.
    Lang, T.
    Endtz, H. P.
    Erasmus, M. C.
    Massad, E.
    ZikaPLAN: Zika Preparedness Latin American Network2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1398485Article in journal (Refereed)
    Abstract [en]

    The ongoing Zika virus (ZIKV) outbreak in Latin America, the Caribbean, and the Pacific Islands has underlined the need for a coordinated research network across the whole region that can respond rapidly to address the current knowledge gaps in Zika and enhance research preparedness beyond Zika. The European Union under its Horizon 2020 Research and Innovation Programme awarded three research consortia to respond to this need. Here we present the ZikaPLAN (Zika Preparedness Latin American Network) consortium. ZikaPLAN combines the strengths of 25 partners in Latin America, North America, Africa, Asia, and various centers in Europe. We will conduct clinical studies to estimate the risk and further define the full spectrum and risk factors of congenital Zika virus syndrome (including neurodevelopmental milestones in the first 3 years of life), delineate neurological complications associated with ZIKV due to direct neuroinvasion and immune-mediated responses in older children and adults, and strengthen surveillance for birth defects and Guillain-Barré Syndrome. Laboratory-based research to unravel neurotropism and investigate the role of sexual transmission, determinants of severe disease, and viral fitness will underpin the clinical studies. Social messaging and engagement with affected communities, as well as development of wearable repellent technologies against Aedes mosquitoes will enhance the impact. Burden of disease studies, data-driven vector control, and vaccine modeling as well as risk assessments on geographic spread of ZIKV will form the foundation for evidence-informed policies. While addressing the research gaps around ZIKV, we will engage in capacity building in laboratory and clinical research, collaborate with existing and new networks to share knowledge, and work with international organizations to tackle regulatory and other bottlenecks and refine research priorities. In this way, we can leverage the ZIKV response toward building a long-term emerging infectious diseases response capacity in the region to address future challenges.

  • 9140.
    Wilder-Smith, Annelies
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Renhorn, Karl-Erik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Tissera, Hasitha
    Abu Bakar, Sazaly
    Alphey, Luke
    Kittayapong, Pattamaporn
    Lindsay, Steve
    Logan, James
    Hatz, Christoph
    Reiter, Paul
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Louis, Valerie R.
    Tozan, Yesim
    Massad, Eduardo
    Tenorio, Antonio
    Lagneau, Christophe
    L'Ambert, Gregory
    Brooks, David
    Wegerdt, Johannah
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gubler, Duane
    DengueTools: innovative tools and strategies for the surveillance and control of dengue2012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 17273-Article in journal (Refereed)
    Abstract [en]

    Dengue fever is a mosquito-borne viral disease estimated to cause about 230 million infections worldwide every year, of which 25,000 are fatal. Global incidence has risen rapidly in recent decades with some 3.6 billion people, over half of the world's population, now at risk, mainly in urban centres of the tropics and subtropics. Demographic and societal changes, in particular urbanization, globalization, and increased international travel, are major contributors to the rise in incidence and geographic expansion of dengue infections. Major research gaps continue to hamper the control of dengue. The European Commission launched a call under the 7th Framework Programme with the title of 'Comprehensive control of Dengue fever under changing climatic conditions'. Fourteen partners from several countries in Europe, Asia, and South America formed a consortium named 'DengueTools' to respond to the call to achieve better diagnosis, surveillance, prevention, and predictive models and improve our understanding of the spread of dengue to previously uninfected regions (including Europe) in the context of globalization and climate change. The consortium comprises 12 work packages to address a set of research questions in three areas: Research area 1: Develop a comprehensive early warning and surveillance system that has predictive capability for epidemic dengue and benefits from novel tools for laboratory diagnosis and vector monitoring. Research area 2: Develop novel strategies to prevent dengue in children. Research area 3: Understand and predict the risk of global spread of dengue, in particular the risk of introduction and establishment in Europe, within the context of parameters of vectorial capacity, global mobility, and climate change. In this paper, we report on the rationale and specific study objectives of 'DengueTools'. DengueTools is funded under the Health theme of the Seventh Framework Programme of the European Community, Grant Agreement Number: 282589 Dengue Tools.

  • 9141.
    Wilder-Smith, Annelies
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sessions, O.
    Massad, E.
    Khan, K.
    The dengue outbreak in Madeira 2012: exploring the origins2013Conference paper (Other academic)
  • 9142.
    Wilder-Smith, Annelies
    et al.
    Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Institute of Public Health, University of Heidelberg, Germany.
    Vannice, Kirsten S.
    Hombach, Joachim
    Farrar, Jeremy
    Nolan, Terry
    Population Perspectives and World Health Organization Recommendations for CYD-TDV Dengue Vaccine2016In: Journal of Infectious Diseases, ISSN 0022-1899, E-ISSN 1537-6613, Vol. 214, no 12, p. 1796-1799Article in journal (Refereed)
  • 9143. Wilder-Smith, Annelies
    et al.
    Yoon, In-Kyu
    Edging closer towards the goal of a dengue vaccine2016In: Expert Review of Vaccines, ISSN 1476-0584, E-ISSN 1744-8395, Vol. 15, no 4, p. 33-35Article in journal (Refereed)
  • 9144. Wilkinson, Claire
    et al.
    Laslett, Anne-Marie
    Ferris, Jason
    Livingston, Michael
    Mugavin, Janette
    Room, Robin
    Centre for Alcohol Policy Research, Turning Point, Eastern Health, and Centre for Health and Society, Melbourne School of Population and Global Health, University of Melbourne, Australien.
    Callinan, Sarah
    The range and magnitude of alcohol's harm to others study: study methodology and measurement challenges2014In: Australasian epidemiologist, ISSN 1327-8835, Vol. 21, no 2, p. 12-16Article in journal (Refereed)
    Abstract [en]

    ‘The Range and Magnitude of Alcohol’s Harm to Others’, or ‘Harm to Others Study’ (HTO Study) for short, is an Australian study conducted collaboratively with researchers in New Zealand. The project studied the effects of alcohol on people other than the drinker using survey, registry and qualitative interview methodologies. The study commenced in 2008. This paper describes the methodologies as well as discusses some of the challenges in measuring alcohol’s harm to others. The HTO Study is the first comprehensive study of alcohol’s harm to others. The project has contributed a different perspective to the measurement of alcohol-related harms and contributed to policy discussions.

  • 9145. Willers, Carl
    et al.
    Iderberg, Hanna
    Axelsen, Mette
    Dahlström, Tobias
    Julin, Bettina
    Leksell, Janeth
    Lindberg, Agneta
    Lindgren, Peter
    Muth, Karin Loostrom
    Svensson, Ann-Marie
    Lilja, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 6, article id e0199170Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic status, origin or demographic attributes shall not determine the quality of healthcare delivery, according to e.g. United Nations and European Union rules. Health equity has been defined as the absence of systematic disparities and unwarranted differences between groups defined by differences in social advantages. A study was performed to investigate whether this was applicable to type 1 diabetes mellitus (T1D) care in a setting with universal, tax-funded healthcare. Methods: This retrospective registry-study was based on patient-level data from individuals diagnosed with T1D during 2010-2011 (n = 16,367) in any of seven Swedish county councils (covering -65% of the Swedish population). Health equity in T1D care was analysed through multivariate regression analyses on absolute HbA1c level at one-year follow-up, one-year change in estimated glomerular filtration rate (eGFR) and one-year change in cardiovascular risk score, using selected sociodemographic dimensions as case-mix factors. Results: Higher educational level was consistently associated with lower levels of HbA1c, and so was being married. Never married was associated with worse eGFR development, and lower educational level was associated with higher cardiovascular risk. Women had higher HbA1c levels than men, and glucose control was significantly worse in patients below the age of 25. Conclusion: Patients' sociodemographic profile was strongly associated with absolute levels of risk factor control in T1 D, but also with an increased annual deterioration in eGFR. Whether these systematic differences stem from patient-related problems or healthcare organisational shortcomings is a matter for further research. The results, though, highlight the need for intensified diabetes management education and secondary prevention directed towards T1D patients, taking sociodemographic characteristics into account.

  • 9146.
    Willers, Carl
    et al.
    Ivbar Inst, Stockholm, Sweden;Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden.
    Iderberg, Hanna
    Karolinska Inst, Med Management Ctr, Stockholm, Sweden;Ivbar Inst, Stockholm, Sweden.
    Axelsen, Mette
    Univ Gothenburg, Dept Internal Med, Inst Med, Gothenburg, Sweden.
    Dahlström, Tobias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Julin, Bettina
    Ivbar Inst, Stockholm, Sweden.
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Dalarna Univ, Sch Educ Hlth & Social Studies, Dalarna, Sweden.
    Lindberg, Agneta
    Hassleholm Hosp, Hassleholm, Sweden.
    Lindgren, Peter
    Karolinska Inst, Med Management Ctr, Stockholm, Sweden;Swedish Inst Hlth Econ, Lund, Sweden.
    Muth, Karin Loostrom
    Alingsas Hosp, Dept Internal Med, Alingsas, Sweden.
    Svensson, Ann-Marie
    Swedish Natl Diabet Register, Vastra Gotalandsreg, Gothenburg, Sweden.
    Lilja, Mikael
    Umea Univ, Dept Publ Hlth & Clin Med, Unit Res Educ & Dev, Ostersund Hosp, Umea, Sweden.
    Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 6, article id e0199170Article in journal (Refereed)
    Abstract [en]

    Background Socioeconomic status, origin or demographic attributes shall not determine the quality of healthcare delivery, according to e.g. United Nations and European Union rules. Health equity has been defined as the absence of systematic disparities and unwarranted differences between groups defined by differences in social advantages. A study was performed to investigate whether this was applicable to type 1 diabetes mellitus (T1D) care in a setting with universal, tax-funded healthcare. Methods This retrospective registry-study was based on patient-level data from individuals diagnosed with T1D during 2010-2011 (n = 16,367) in any of seven Swedish county councils (covering -65% of the Swedish population). Health equity in T1D care was analysed through multivariate regression analyses on absolute HbA1c level at one-year follow-up, one-year change in estimated glomerular filtration rate (eGFR) and one-year change in cardiovascular risk score, using selected sociodemographic dimensions as case-mix factors. Results Higher educational level was consistently associated with lower levels of HbA1c, and so was being married. Never married was associated with worse eGFR development, and lower educational level was associated with higher cardiovascular risk. Women had higher HbA1c levels than men, and glucose control was significantly worse in patients below the age of 25. Conclusion Patients' sociodemographic profile was strongly associated with absolute levels of risk factor control in T1 D, but also with an increased annual deterioration in eGFR. Whether these systematic differences stem from patient-related problems or healthcare organisational shortcomings is a matter for further research. The results, though, highlight the need for intensified diabetes management education and secondary prevention directed towards T1D patients, taking sociodemographic characteristics into account.

  • 9147. Willers, Carl
    et al.
    Lekander, Ingrid
    Ekstrand, Elisabeth
    Lilja, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Pessah-Rasmussen, Hélène
    Sunnerhagen, Katharina S.
    von Euler, Mia
    Sex as predictor for achieved health outcomes and received care in ischemic stroke and intracerebral hemorrhage: a register-based study2018In: Biology of Sex Differences, ISSN 2042-6410, Vol. 9, article id 11Article in journal (Refereed)
    Abstract [en]

    Background: Differences in stroke care and health outcomes between men and women are debated. The objective of this study was to explore the relationship between patients' sex and post-stroke health outcomes and received care in a Swedish setting.

    Methods: Patients with a registered diagnosis of acute intracerebral hemorrhage (ICH) or ischemic stroke (IS) within regional administrative systems (ICD-10 codes I61* or I63*) and the Swedish Stroke Register during 2010-2011 were included and followed for 1 year. Data linkage to multiple other data sources on individual level was performed. Adjustments were performed for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity in multivariate regression analyses of health outcomes and received care. Health outcomes (e.g., survival, functioning, satisfaction) and received care measures (regional and municipal resources and processes) were studied.

    Results: Study population: 13,775 women and 13,916 men. After case-mix adjustments for the above factors, we found women to have higher 1-year survival rates after both IS (ORfemale = 1.17, p < 0.001) and ICH (ORfemale = 1.65, p < 0.001). Initial inpatient stay at hospital was, however, shorter for women βfemale, IS = -0.05, p < 0.001; βfemale, ICH = -0.08, p < 0.005). For IS, good function (mRS <= 2) was more common in men (ORfemale = 0.86, p < 0.001) who also received more inpatient care during the first year βfemale = -0.05, p < 0.001).

    Conclusions: A lower proportion of women had good functioning, a difference that remained in IS after adjustments for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity. The amount of received hospital care was lower for women after adjustments. Whether shorter hospital stay results in lower function or is a consequence of lower function cannot be elucidated. One-year survival was higher in men when no adjustments were made but lower after adjustments. This likely reflects that women were older at time of stroke, had more severe strokes, and more disability pre-stroke-factors that make a direct comparison between the sexes intricate.

  • 9148. Williams, Jill
    et al.
    Ibisomi, Latifat
    Sartorius, Benn
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Collinson, Mark
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Tollman, Stephen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Garenne, Michel
    Convergence in fertility of South Africans and Mozambicans in rural South Africa, 1993-20092013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, no 1, p. 20-26Article in journal (Refereed)
    Abstract [en]

    Background: Although there are significant numbers of people displaced by war in Africa, very little is known about long-term changes in the fertility of refugees. Refugees of the Mozambican civil war (1977-1992) settled in many neighbouring countries, including South Africa. A large number of Mozambican refugees settled within the Agincourt sub-district, underpinned by a Health and Socio-demographic Surveillance Site (AHDSS), established in 1992, and have remained there. The AHDSS data provide a unique opportunity to study changes in fertility over time and the role that the fertility of self-settled refugee populations plays in the overall fertility level of the host community, a highly relevant factor in many areas of sub-Saharan Africa.

    Objectives: To examine the change in fertility of former Mozambican self-settled refugees over a period of 16 years and to compare the overall fertility and fertility patterns of Mozambicans to host South Africans.

    Methods: Prospective data from the AHDSS on births from 1993 to 2009 were used to compare fertility trends and patterns and to examine socio-economic factors that may be associated with fertility change.

    Results: There has been a sharp decline in fertility in the Mozambican population and convergence in fertility patterns of Mozambican and local South African women. The convergence of fertility patterns coincides with a convergence in other socio-economic factors.

    Conclusion: The fertility of Mozambicans has decreased significantly and Mozambicans are adopting the childbearing patterns of South African women. The decline in Mozambican fertility has occurred alongside socio-economic gains. There remains, however, high unemployment and endemic poverty in the area and fertility is not likely to decrease further without increased delivery of family planning to adolescents and increased education and job opportunities for women.

  • 9149. Williams, Michael A.
    et al.
    Malm, Jan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Eklund, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Horton, Nicholas J.
    Voss, Susan E.
    Distortion Product Otoacoustic Emissions and Intracranial Pressure During CSF Infusion Testing2016In: Aerospace medicine and human performance, ISSN 2375-6314, Vol. 87, no 10, p. 844-851Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A noninvasive method to monitor changes in intracranial pressure (ICP) is required for astronauts on long-duration spaceflight who are at risk of developing the Visual Impairment/Intracranial Pressure syndrome that has some, but not all of the features of idiopathic intracranial hypertension. We assessed the validity of distortion product otoacoustic emissions (DPOAEs) to detect changes in ICP. METHODS: Subjects were eight patients undergoing medically necessary diagnostic cerebrospinal fluid (CSF) infusion testing for hydrocephalus. DPOAE measurements were obtained with an FDA-approved system at baseline and six controlled ICP levels in similar to 3 mmHg increments in random order, with a range from 10.8 +/- 2.9 mmHg (SD) at baseline to 32.3 +/- 4.1 mmHg (SD) at level 6. RESULTS: For f2 frequencies between 800 and 1700 Hz, when ICP was >= 12 mmHg above baseline ICP, DPOAE angles increased significantly and DPOAE magnitudes decreased significantly, but less robustly. DISCUSSION: Significant changes in DPOAE angle and magnitude are seen when ICP is >= 12 mmHg above a subject's supine baseline ICP during CSF infusion testing. These results suggest that the changes in DPOAE angle and magnitude seen with change in ICP are physiologically based, and suggest that it should be possible to detect pathological ICP elevation using DPOAE measurements. To use DPOAE for noninvasive estimation of ICP during spaceflight will require baseline measurements in the head-up, supine, and head-down positions to obtain baseline DPOAE values at different ICP ranges.

  • 9150.
    Wilunda, Boniface
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Self-reported functional health and quality of life in older adults in Nairobi’s informal settlements2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
180181182183184185186 9101 - 9150 of 9497
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