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Hjälm, Anna
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Publications (8 of 8) Show all publications
Hellquist, B. N., Czene, K., Hjälm, A., Nyström, L. & Jonsson, H. (2015). Effectiveness of population-based service screening with mammography for women ages 40 to 49 years with a high or low risk of breast cancer: socioeconomic status, parity, and age at birth of first child. Cancer, 121(2), 251-258
Open this publication in new window or tab >>Effectiveness of population-based service screening with mammography for women ages 40 to 49 years with a high or low risk of breast cancer: socioeconomic status, parity, and age at birth of first child
Show others...
2015 (English)In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 121, no 2, p. 251-258Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Invitation to mammography screening of women aged 40 to 49 years is a matter of debate in many countries and a cost-effective alternative in countries without screening among women aged 40 to 49 years could be inviting those at higher risk. The relative effectiveness of mammography screening was estimated for subgroups based on the breast cancer risk factors parity, age at time of birth of first child, and socioeconomic status (SES).

METHODS: The SCReening of Young Women (SCRY) database consists of all women aged 40 to 49 years in Sweden between 1986 and 2005 and was split into a study and control group. The study group consisted of women residing in areas in which women aged 40 to 49 years were invited to screening and the control group of women in areas in which women aged 40 to 49 years were not invited to screening. Rate ratio (RR) estimates were calculated for 2 exposures: invitation and attendance.

RESULTS: There were striking similarities noted in the RR pattern for women invited to and attending screening and no statistically significant difference or trend in the RR was noted by risk group. The RR estimates increased by increasing parity for parity of 0 to 2 and ranged from 0.55 (95% confidence interval [95% CI], 0.38-0.79) to 0.79 (95% CI, 0.65-0.95) for attending women. The RR for women with high SES was lower than that for women with low SES (RR, 0.72 [95% CI, 0.60-0.86] and RR, 0.79 [95% CI, 0.63-0.99], respectively). For women aged 20 to 24 years at the time of the birth of their first child, the RR was 0.73 (95% CI, 0.58-0.91) and estimates for other ages were similar.

CONCLUSIONS: There was no statistically significant difference noted in the relative effectiveness of mammography screening by parity, age at the time of birth of the first child, or SES. Cancer 2014.

Keywords
mammography, cancer screening, breast cancer, mortality, risk factors, socioeconomic status (SES), parity
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-95817 (URN)10.1002/cncr.29011 (DOI)000347540900012 ()25242087 (PubMedID)881251 (Local ID)881251 (Archive number)881251 (OAI)
Available from: 2014-11-05 Created: 2014-11-05 Last updated: 2019-02-15Bibliographically approved
Hjälm, A. (2014). The ‘Stayers’: Dynamics of Lifelong Sedentary Behaviour in an Urban Context. Population, Space and Place, 20(6), 569-580
Open this publication in new window or tab >>The ‘Stayers’: Dynamics of Lifelong Sedentary Behaviour in an Urban Context
2014 (English)In: Population, Space and Place, ISSN 1544-8444, E-ISSN 1544-8452, Vol. 20, no 6, p. 569-580Article in journal (Refereed) Published
Abstract [en]

Migration has, over the years, attracted infinitely more attention than non-migration or staying. In this paper, the focus is set on those individuals who have demonstrated lifelong sedentary behaviour. The aim of the study is to scrutinise the ways in which people who have lived their entire life in the same place make sense of their sedentary, or immobile, lifestyle. The study builds upon semi-structured interviews, conducted in 2011–2012, with persons aged 60 years and older who were living in an urban area in northern Sweden. Initially, the different definitions of staying are highlighted by the informants, and the flexibility of the concept is addressed. The findings indicate that even though reasons for staying might be harder to articulate than reasons for migration, the explanations given are still complex and multi-layered. The findings also suggest that the decision to stay is not a choice made once and then never renegotiated but rather a decision made over and over again. Furthermore, the significance of intertwined lives, both with living relatives and with preceding and following generations, is analysed. Finally, the results from the study challenge earlier pictures of stayers – where they were portrayed as stigmatised – and highlight the need to consider staying, as well as moving, as a conscious choice in order that we may gain a better understanding of the dynamics of staying.

Place, publisher, year, edition, pages
John Wiley & Sons, 2014
Keywords
staying, immobility, sedentarism, ageing, Sweden, qualitative
National Category
Human Geography
Research subject
Social and Economic Geography
Identifiers
urn:nbn:se:umu:diva-74439 (URN)10.1002/psp.1796 (DOI)000340249100006 ()881251 (Local ID)881251 (Archive number)881251 (OAI)
Available from: 2013-06-28 Created: 2013-06-28 Last updated: 2019-02-15Bibliographically approved
Hjälm, A. (2012). "Because we know our limits": Elderly parents' views on intergenerational proximity and intimacy. Journal of Aging Studies, 26(3), 296-308
Open this publication in new window or tab >>"Because we know our limits": Elderly parents' views on intergenerational proximity and intimacy
2012 (English)In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 26, no 3, p. 296-308Article in journal (Refereed) Published
Abstract [en]

From an intergenerational family perspective, geographical distance and proximity have been shown to affect interaction and the extent of help and support between generations. Geographical separation and nearness hence do not only influence the family per se, but might also concern the welfare state, not least in times of population ageing. This study concerns exchange and assistance between elderly parents living very close to an adult child, and is based on interviews with 14 elderly parents. The interviews revealed that help and support flowed in both directions between the close-living generations, but that from the perspective of the elderly some types of help were more acceptable than others to give and receive. Further, the interviews suggested that living close, albeit discussed as allowing extensive interaction and support, should not be understood as a sign of wanting or even accepting more extensive help from the close-living adult child.

Place, publisher, year, edition, pages
Elsevier, 2012
Keywords
intergenerational, family, proximity, exchange, ageing, Sweden
National Category
Human Geography
Research subject
Social and Economic Geography
Identifiers
urn:nbn:se:umu:diva-53299 (URN)10.1016/j.jaging.2012.01.005 (DOI)000305260300008 ()881251 (Local ID)881251 (Archive number)881251 (OAI)
Note
Included in thesis in manuscript form.Available from: 2012-03-20 Created: 2012-03-20 Last updated: 2019-02-15Bibliographically approved
Hjälm, A. (2011). A family landscape: On the geographical distances between elderly parents and adult children in Sweden. (Doctoral dissertation). Umeå: Umeå university, Department of Social and Economic Geography
Open this publication in new window or tab >>A family landscape: On the geographical distances between elderly parents and adult children in Sweden
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

With a background in the ageing of the population and the new challenges facing individuals, families and the welfare state, the aim of this thesis is to analyse the changing family landscape and the geographical distances between elderly parents and adult children.

The thesis consists of four empirical studies derived from three different sources of data: In the first paper (Paper I), historical population data is combined with modern register data for two Swedish regions. In the second and third papers, individual-level register data covering the entire Swedish population serves as the empirical starting point. The fourth paper leaves the registers aside and builds upon interviews. Paper I provides an introduction and historical background to the question of intergenerational geographical proximity and distance. The paper analyses intergenerational distances and seeks to compare and discuss the significance of the variations. It is shown that concerning extreme proximity a great decrease has occurred over 200 years, however when it comes to having kin within reach the decrease is less dramatic, and that now, just as then, a majority of elderly parents have an adult child within reach. The article concludes that even though geographical distances between generations vary over time and space, no clear linear trend towards intergenerational geographical separation can be established. In Paper II we analyse some features and trends in intergenerational distances in Sweden. We find that 10% of all elderly parents have at least one child living very close and that a majority, 85%, have an adult child within reach. The study shows no clear trend towards increasing intergenerational separation, but suggests that periods of intense societal restructuring, such urbanisation, can lead to spells of increased intergenerational separation on an aggregated level. Paper III investigates whether, and to what extent, elderly parents and adult children move close to each other. We find that even though the older generation makes up a smaller share of the moves made, when they do move they are more likely to move closer to an adult child. Further, having more than one relative at a destination adds to the attraction, and that older elderly are less likely to move close to a child than younger elderly. One interpretation is that young-old parents serve as a resource for their adult children, while older elderly are more influenced by the need for welfare state based assistance. The last paper, IV, returns to the elderly parents living very close to an adult child. In interviews with 14 elderly the aim of the paper is to gain new understanding about the interaction between intergenerational proximity, assistance and the meaning of being close. Some of the issues raised in the paper relate to migration histories, reciprocity and independence.

Place, publisher, year, edition, pages
Umeå: Umeå university, Department of Social and Economic Geography, 2011. p. 80
Series
GERUM, ISSN 1402-5205 ; 2011:1
Keywords
Family, elderly parents, adult children, intergenerational, child-parent proximity, migration, distance, ageing, support, register data, Sweden
National Category
Social and Economic Geography
Research subject
Social and Economic Geography
Identifiers
urn:nbn:se:umu:diva-38876 (URN)881251 (Local ID)978-91-978344-5-2 (ISBN)881251 (Archive number)881251 (OAI)
Public defence
2011-01-28, Samhällsvetarhuset, hörsal D, Umeå universitet, Umeå, 10:15 (English)
Opponent
Supervisors
Note
I två av delarbetena har författaren efternamnet Pettersson.Available from: 2011-01-07 Created: 2011-01-05 Last updated: 2019-02-15Bibliographically approved
Pettersson, A. & Malmberg, G. (2009). Adult children and elderly parents as mobility attractions in Sweden. Population, Space and Place, 15(4), 343-357
Open this publication in new window or tab >>Adult children and elderly parents as mobility attractions in Sweden
2009 (English)In: Population, Space and Place, ISSN 1544-8444, E-ISSN 1544-8452, Vol. 15, no 4, p. 343-357Article in journal (Refereed) Published
Abstract [en]

The aim of this paper is to investigate the extent to which elderly parents and adult children move close (or very close) to each other and how this mobility is influenced by socioeconomic conditions, family situation, gender and age. The analyses are based on register data for the years 2001 and 2002 covering all elderly parents and their adult children residing in Sweden. For instance, our analyses show a positive relationship between, on the one hand, moving close to an adult child or an elderly parent and, on the other, the presence of other family members (e.g. siblings and grandchildren). We also found that moving very close to adult children was more common among the young-old and less common among the old-old. One interpretation is that young-old parents often move close to their adult children to have social contact or assist them, but as the parents grow older and their health weakens, care becomes increasingly important and, in the Swedish welfare state, it becomes more the responsibility of public institutions.

Place, publisher, year, edition, pages
Wiley InterScience, 2009
Keywords
ageing, migration, intergenerational, Sweden, elderly, parents
National Category
Human Geography
Identifiers
urn:nbn:se:umu:diva-19982 (URN)10.1002/psp.558 (DOI)000267305600004 ()881251 (Local ID)881251 (Archive number)881251 (OAI)
Projects
Ageing and Livng Conditions
Available from: 2009-03-13 Created: 2009-03-13 Last updated: 2019-02-15Bibliographically approved
Malmberg, G. & Pettersson, A. (2007). Distance to elderly parents: Analyses of Swedish register data. Demographic Research, 17(23), 679-704
Open this publication in new window or tab >>Distance to elderly parents: Analyses of Swedish register data
2007 (English)In: Demographic Research, ISSN 1435-9871, Vol. 17, no 23, p. 679-704Article in journal (Other academic) Published
Abstract [en]

In the present study, features of and trends in child-parent proximity in Sweden are analyzed using comprehensive register data. The results show that 85% of older parents have adult children within a radius of 50 km, of which 10% live ‘just around the corner’; corresponding figures for adult children are 72% and 5%, respectively. The study gives no indication of increasing intergenerational distances. Results from logistic regressions show that adult children who are well educated, female, older, born in Sweden, who are not parents, who live in densely populated areas, and have siblings are less likely to stay in the same region as their parents.

Keywords
adult children, intergenerational contacts, child-parent proximity, logistic regression analysis, old parents, distance, ageing, registerdata, Sweden
Identifiers
urn:nbn:se:umu:diva-7501 (URN)10.4054/DemRes.2007.17.23 (DOI)881251 (Local ID)881251 (Archive number)881251 (OAI)
Available from: 2008-01-10 Created: 2008-01-10 Last updated: 2019-02-15Bibliographically approved
Hellquist, B. N., Czene, K., Hjälm, A., Nyström, L. & Jonsson, H.Effectiveness of population-based service screening with mammography for women ages 40 to 49 years with high and low risk of breast cancer: socioeconomic status, parity and age at birth of first child.
Open this publication in new window or tab >>Effectiveness of population-based service screening with mammography for women ages 40 to 49 years with high and low risk of breast cancer: socioeconomic status, parity and age at birth of first child
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background Whether women in age 40-49 years should be invited to mammography screening or not is debated in many countries and a cost-effective alternative in countries with no screening in age 40-49 years could be selective screening i.e. inviting women at higher risk. In the current study relative effectiveness of mammography screening was estimated for subgroups based on the breast cancer risk factors parity, age at birth of first child and socioeconomic status (SES).

Methods The SCReening of Young women (SCRY) database consist of all women in age 40-49 years in Sweden in 1986-2005 and is split into a study and control group. The study group consists of women in areas where women age 40-49 years were invited to screening and the control group of women in areas where women 40-49 years were not. Rate ratio (RR) estimates were calculated for risk groups. Two exposures were considered; invitation to mammography screening and attendance.

Results There were striking similarities in the RR pattern for women invited to and attending in screening for all three risk factors and there was no statistically significant difference or trend in the RR by risk group. The RR estimates increased by increasing parity for parity 0 to 2 and ranged from 0.55 (95% CI 0.38-0.79) to 0.79 (95% CI 0.65-0.95) for women attending screening. The RR for white collar workers (low SES) was lower than for blue collar workers (high SES), 0.72 (95% CI 0.60-0.86) and 0.79 (95% CI 0.63-0.99) respectively for attending. For women 20-24 years at birth of first child RR was estimated at 0.73 (95% CI 0.58-0.91) for attending and estimates for other ages were similar.

Conclusion There was no statistically significant difference in relative effectiveness of mammography screening by parity, age at birth of first child or socio-economic status.

Keywords
mammography, cancer screening, breast cancer, mortality, risk factors, socioeconomic status, parity
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
urn:nbn:se:umu:diva-86206 (URN)881251 (Local ID)881251 (Archive number)881251 (OAI)
Available from: 2014-02-20 Created: 2014-02-20 Last updated: 2019-02-15Bibliographically approved
Hjälm, A.Intergenerational proximity and distance over 200 years: examples from two Swedish regions.
Open this publication in new window or tab >>Intergenerational proximity and distance over 200 years: examples from two Swedish regions
(English)Manuscript (preprint) (Other academic)
Abstract [en]

In most Western societies of today populations are ageing, which is expected to pose new challenges to the welfare state. Still, the family might also be affected by an ageing population, if more extensive needs of the elderly cannot be met by the welfare state. For the family, one important factor for managing intergenerational interaction is geographical proximity, and living close has been shown to be a vital prerequisite for help and assistance between elderly parents and adult children. When it comes to the possibility to interact with kin, a common notion has been that as society develops through industrialisation, urbanisation and individualisation, families and kin become less dependent on each other and more spread out geographically, which would challenge their possibilities to offer assistance to each other. In this paper, intergenerational geographical distance in modern and historical times is examined through the unique possibility to combine population register data from six cross-section years stretching from 1820 to 2002. The main finding from the study is that there has been a dramatic decrease over time in generations living extremely close to each other. On the other hand, when it comes to having an adult child within time adjusted daily reach the decline has been much less drastic. Intergenerational geographical distances, beyond the extreme proximity, thus seem to be stable and resilient even though society is changing.

Keywords
family, elderly parents, intergenerational, geographical proximity, ageing
National Category
Social and Economic Geography
Research subject
Social and Economic Geography
Identifiers
urn:nbn:se:umu:diva-38874 (URN)881251 (Local ID)881251 (Archive number)881251 (OAI)
Available from: 2011-01-05 Created: 2011-01-05 Last updated: 2019-02-15Bibliographically approved
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