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  • 1. Cox, Bianca
    et al.
    Vicedo-Cabrera, Ana M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gasparrini, Antonio
    Roels, Harry A.
    Martens, Evelyne
    Vangronsveld, Jaco
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nawrot, Tim S.
    Ambient temperature as a trigger of preterm delivery in a temperate climate2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 12, p. 1191-1199Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Recent evidence suggests that elevated ambient temperatures may trigger preterm delivery. Since results from studies in temperate climates are inconclusive, we investigated the association between temperature and the risk of preterm birth in Flanders (Belgium).

    METHODS: We used data on 807 835 singleton deliveries (January 1998-July 2011). We combined a quasi-Poisson model with distributed lag non-linear models to allow for delayed and non-linear temperature effects, accounting for the daily pregnancies at risk and their gestational age distribution.

    RESULTS: For moderate heat (95th vs 50th centile) up to 1 day before delivery (lag 0-1), the risk of preterm birth increased by 8.5% (95% CI 2.4% to 15.0%) when minimum temperature increased from 8.3°C to 16.3°C and by 9.6% (95% CI 1.1% to 18.7%) when maximum temperature increased from 14.7°C to 26.5°C. Corresponding estimates for extreme heat (99th vs 50th centile) were 15.6% (95% CI 4.8% to 27.6%) for minimum temperature (19.0°C vs 8.3°C) and 14.5% (95% CI 0.5% to 30.6%) for maximum temperature (30.7°C vs 14.7°C). Despite the increased risk of preterm birth associated with cold at lag 2 (and lag 1 for minimum temperature), cumulative cold effects were small. The per cent change in preterm birth associated with moderate cold (5th vs 50th centile) up to 3 days before delivery (lag 0-3) was 2.1% (95% CI -4.1% to 8.7%) for minimum temperature (-2.0°C vs 8.3°C) and 0.6% (95% CI -7.3% to 9.2%) for maximum temperature (2.5°C vs 14.7°C).

    CONCLUSIONS: Even in a temperate climate, ambient temperature may trigger preterm delivery, suggesting that pregnant women should avoid temperature extremes.

  • 2. Cuypers, Koenraad
    et al.
    Krokstad, Steinar
    Holmen, Turid Lingaas
    Knudtsen, Margunn Skjei
    Bygren, Lars Olov
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Holmen, Jostein
    Patterns of receptive and creative cultural activities and their association with perceived health, anxiety, depression and satisfaction with life among adults: the HUNT study, Norway2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 8, p. 698-703Article in journal (Refereed)
    Abstract [en]

    Background Cultural participation has been used both in governmental health policies and as medical therapy, based on the assumption that cultural activities will improve health. Previous population studies and a human intervention study have shown that religious, social and cultural activities predict increased survival rate. The aim of this study was to analyse the association between cultural activity and perceived health, anxiety, depression and satisfaction with life in both genders. Methods The study is based on the third population-based Nord-Trondelag Health Study (2006-2008), including 50 797 adult participants from Nord-Trondelag County, Norway. Data on cultural activities, both receptive and creative, perceived health, anxiety, depression and satisfaction with life were collected by comprehensive questionnaires. Results The logistic regression models, adjusted for relevant cofactors, show that participation in receptive and creative cultural activities was significantly associated with good health, good satisfaction with life, low anxiety and depression scores in both genders. Especially in men, attending receptive, rather than creative, cultural activities was more strongly associated with all health-related outcomes. Statistically significant associations between several single receptive, creative cultural activities and the health-related outcome variables were revealed. Conclusion This population-based study suggests gender-dependent associations between cultural participation and perceived health, anxiety, depression and satisfaction with life. The results support hypotheses on the effect of cultural activities in health promotion and healthcare, but further longitudinal and experimental studies are warranted to establish a reliable cause-effect relationship.

  • 3. Ferrario, Marco M.
    et al.
    Veronesi, Giovanni
    Kee, Frank
    Chambless, Lloyd E.
    Kuulasmaa, Kari
    Jorgensen, Torben
    Amouyel, Philippe
    Arveiler, Dominique
    Bobak, Martin
    Cesana, Giancarlo
    Drygas, Wojciech
    Ferrieres, Jean
    Giampaoli, Simona
    Iacoviello, Licia
    Nikitin, Yuri
    Pajak, Andrzej
    Peters, Annette
    Salomaa, Veikko
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Tamosiunas, Abdonas
    Wilsgaard, Tom
    Tunstall-Pedoe, Hugh
    Determinants of social inequalities in stroke incidence across Europe: a collaborative analysis of 126 635 individuals from 48 cohort studies2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 12, p. 1210-1216Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge on the origins of the social gradient in stroke incidence in different populations is limited. This study aims to estimate the burden of educational class inequalities in stroke incidence and to assess the contribution of risk factors in determining these inequalities across Europe.

    Materials and methods: The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) Study comprises 48 cohorts recruited mostly in the 1980s and 1990s in four European regions using standardised procedures for baseline risk factor assessment and fatal and non-fatal stroke ascertainment and adjudication during follow-up. Among the 126 635 middle-aged participants, initially free of cardiovascular diseases, generating 3788 first stroke events during a median follow-up of 10 years, we estimated differences in stroke rates and HRs for the least versus the most educated individuals.

    Results: Compared with their most educated counterparts, the overall age-adjusted excess hazard for stroke was 1.54 (95% CI 1.25 to 1.91) and 1.41 (95% CI 1.16 to 1.71) in least educated men and women, respectively, with little heterogeneity across populations. Educational class inequalities accounted for 86–413 and 78–156 additional stroke events per 100 000 person-years in the least compared with most educated men and women, respectively. The additional events were equivalent to 47%–130% and 40%–89% of the average incidence rates. Inequalities in risk factors accounted for 45%–70% of the social gap in incidence in the Nordic countries, the UK and Lithuania-Kaunas (men), but for no more than 17% in Central and South Europe. The major contributors were cigarette smoking, alcohol intake and body mass index.

    Conclusions: Social inequalities in stroke incidence contribute substantially to the disease rates in Europe. Healthier lifestyles in the most disadvantaged individuals should have a prominent impact in reducing both inequalities and the stroke burden.

  • 4.
    Fottrell, Edward
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Tollman, Stephen
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Golooba-Mutebi, Frederick
    Kahn, Kathleen
    The epidemiology of 'bewitchment' as a lay-reported cause of death in rural South Africa2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 8, p. 704-709Article in journal (Refereed)
    Abstract [en]

    Background Cases of premature death in Africa may be attributed to witchcraft. In such settings, medical registration of causes of death is rare. To fill this gap, verbal autopsy (VA) methods record signs and symptoms of the deceased before death as well as lay opinion regarding the cause of death; this information is then interpreted to derive a medical cause of death. In the Agincourt Health and Demographic Surveillance Site, South Africa, around 6% of deaths are believed to be due to ‘bewitchment’ by VA respondents.

    Methods Using 6874 deaths from the Agincourt Health and Socio-Demographic Surveillance System, the epidemiology of deaths reported as bewitchment was explored, and using medical causes of death derived from VA, the association between perceptions of witchcraft and biomedical causes of death was investigated.

    Results The odds of having one's death reported as being due to bewitchment is significantly higher in children and reproductive-aged women (but not in men) than in older adults. Similarly, sudden deaths or those following an acute illness, deaths occurring before 2001 and those where traditional healthcare was sought are more likely to be reported as being due to bewitchment. Compared with all other deaths, deaths due to external causes are significantly less likely to be attributed to bewitchment, while maternal deaths are significantly more likely to be.

    Conclusions Understanding how societies interpret the essential factors that affect their health and how health seeking is influenced by local notions and perceived aetiologies of illness and death could better inform sustainable interventions and health promotion efforts.

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  • 5.
    Gustafsson, Per E
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Theorell, Töres
    Westerlund, Hugo
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Socioeconomic status over the life course and allostatic load in adulthood: results from the Northern Swedish Cohort2011In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 65, p. 986-992Article in journal (Refereed)
    Abstract [en]

    Background Although several studies have reported rather consistent associations between socioeconomic status (SES) and allostatic load (AL), so far no study has examined the influence of SES over the life course on AL. The aim of the present study was to investigate the association between SES over the life course and AL in mid-adulthood, guided by the conceptual models of cumulative risk, critical period and social chain of risk.

    Methods The sample comprises a 27-year prospective cohort (n=1071) from northern Sweden. Participants (n=855, 79.8%) completed questionnaires at the ages of 16, 21, 30 and 43 years. A health examination was performed at age 43 years after an overnight fast, including physical examination and blood sampling, and participants completed 1-day salivary cortisol sampling (four samples). SES was based on parental occupation at age 16 years and participants' own occupation at ages 21, 30 and 43 years. Information on daily smoking, snuff use, high alcohol consumption and physical inactivity was reported by the participants. An AL index was constructed from tertiles of 12 biological parameters.

    Results Cumulative socioeconomic disadvantage was related to AL in both women and men. The association was largely explained by health behaviours in men, but was independent of health behaviours in women. In women, an association was observed between AL and SES in adolescence, whereas in men only current SES was related to AL, independently of current health behaviours.

    Conclusions SES over the life course influences the level of multi-systemic dysregulation in mid-adulthood, with the strongest support for the cumulative risk model.

  • 6.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Klara
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Annandale, Ellen
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Christianson, Monica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Elwer, Sofia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Eriksson, Carola
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gilenstam, Kajsa
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Harryson, Lisa
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Stenberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Verdonk, Petra
    Central gender theoretical concepts in health research: the state of the art2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 2, p. 185-190Article in journal (Refereed)
    Abstract [en]

    Despite increasing awareness of the importance of gender perspectives in health science, there is conceptual confusion regarding the meaning and the use of central gender theoretical concepts. We argue that it is essential to clarify how central concepts are used within gender theory and how to apply them to health research. We identify six gender theoretical concepts as central and interlinked-but problematic and ambiguous in health science: sex, gender, intersectionality, embodiment, gender equity and gender equality. Our recommendations are that: the concepts sex and gender can benefit from a gender relational theoretical approach (ie, a focus on social processes and structures) but with additional attention to the interrelations between sex and gender; intersectionality should go beyond additive analyses to study complex intersections between the major factors which potentially influence health and ensure that gendered power relations and social context are included; we need to be aware of the various meanings given to embodiment, which achieve an integration of gender and health and attend to different levels of analyses to varying degrees; and appreciate that gender equality concerns absence of discrimination between women and men while gender equity focuses on women's and men's health needs, whether similar or different. We conclude that there is a constant need to justify and clarify our use of these concepts in order to advance gender theoretical development. Our analysis is an invitation for dialogue but also a call to make more effective use of the knowledge base which has already developed among gender theorists in health sciences in the manner proposed in this paper.

  • 7.
    Harryson, Lisa
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Novo, Mehmet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Is gender inequality in the domestic sphere associated with psychological distress among women and men? Results from the Northern Swedish Cohort2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 3, p. 271-276Article in journal (Refereed)
    Abstract [en]

    Aim The aim of this study was to analyse whether gender inequality in the domestic sphere was associated with psychological distress among women and men.

    Methods In a cohort study, all pupils in the last year of compulsory school in a middle-sized industrial town in northern Sweden were followed until the age of 42. For this study a sample of cohabiting participants (n¼372 women, 352 men) was selected. Gender inequality was measured as perceptions of gender inequality in the couple relationship, time spent on household work, responsibility for domestic work and childcare, and was analysed in relation to psychological distress, after taking possible background variables as well as earlier health status into account.

    Results In the multivariate analyses, perception of gender inequality in the couple relationship was associated with psychological distress for both women (OR 2.23, CI 1.20 to 4.18) and men (OR 3.51, CI 1.69 to 7.31). For women only, taking whole responsibility for domestic work was associated with the outcome (OR 2.17, CI 1.05 to 4.48). For men, taking less than half of the responsibility for domestic work was associated with psychological distress (OR 2.25, CI 1.24 to 3.91).

    Conclusions Gender inequality in the domestic sphere seems to be an important determinant of psychological distress for both women and men.

  • 8. Hawton, K
    et al.
    Arensman, E
    Wasserman, D
    Hultén, A
    Bille-Brahe, U
    Bjerke, T
    Crepet, P
    Deisenhammer, E
    Kerkhof, A
    De Leo, D
    Michel, K
    Ostamo, A
    Philippe, A
    Querejeta, I
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Schmidtke, A
    Temesváry, B
    Relation between attempted suicide and suicide rates among young people in Europe.1998In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 52, no 3, p. 191-4Article in journal (Refereed)
    Abstract [en]

    Rates of attempted suicide and suicide in the young covary. The recent increase in attempted suicide rates in young male subjects in several European countries could herald a further increase in suicide rates.

  • 9.
    Holowko, Natalie
    et al.
    Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
    Chaparro, M Pia
    Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mishra, Gita
    Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
    Koupil, Ilona
    Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Goodman, Anna
    Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
    Social inequality in pre-pregnancy BMI and gestational weight gain in the first and second pregnancy among women in Sweden2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 12, p. 1154-1161Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: High pre-pregnancy body mass index (BMI) and inappropriate gestational weight gain (GWG) are associated with adverse short and long-term maternal and neonatal outcomes and may act as modifiable risk factors on the path to overweight/obesity, but their social patterning is not well established. This study investigates the association of education with BMI and GWG across two consecutive pregnancies.

    METHODS: The study includes 163 352 Swedish women, having their first and second singleton birth in 1982-2010. In both pregnancies, we investigated the association of women's education with (1) pre-pregnancy weight status and (2) adequacy of GWG. We used multinomial logistic regression, adjusting for child's birth year, mother's age and smoking status.

    RESULTS: Overall, the odds of starting either pregnancy at an unhealthy BMI were higher among women with a low education compared to more highly-educated women. Lower education also predicted a greater increase in BMI between pregnancies, with this effect greatest among women with excessive GWG in the first pregnancy (p<0.0001 for interaction). Education was also inversely associated with odds of excessive GWG in both pregnancies among healthy weight status women, but this association was absent or even weakly reversed among overweight and obese women.

    CONCLUSIONS: Lower educated women had the largest BMI increase between pregnancies, and these inequalities were greatest among women with excessive GWG in the first pregnancy. The importance of a healthy pre-pregnancy BMI, appropriate GWG and a healthy postpartum weight should be communicated to all women, which may assist in reducing existing social inequalities in body weight.

  • 10. Hondula, David M
    et al.
    Davis, Robert E
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Saha, Michael V
    A time series approach for evaluating intra-city heat-related mortality2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 8, p. 707-712Article in journal (Refereed)
    Abstract [en]

    Extreme heat is a leading cause of weather-related mortality. Most research has considered the aggregate response of the populations of large metropolitan areas, but the focus of heat-related mortality and morbidity investigations is shifting towards a more fine-scale approach in which impacts are measured in smaller units such as postal codes. However, most existing statistical techniques to model the relationship between temperature and mortality cannot be directly applied to the intra-city scale because small sample sizes inhibit proper modelling of seasonality and long-term trends. Here we propose a time series technique based on local-scale mortality observations that can provide more reliable information about vulnerability within metropolitan areas. The method combines a generalised additive model with direct standardisation to account for changing death rates in intra-city zones. We apply the method to a 26-year time series of postal code-referenced mortality data from Philadelphia County, USA, where we find that heat-related mortality is unevenly spatially distributed. Fifteen of 46 postal codes are associated with significantly increased mortality on extreme heat days, most of which are located in the central and western portions of the county. In some cases the local death rate is more than double the county average. Identification of high-risk areas can enable targeted public health intervention and mitigation strategies.

  • 11.
    Ivarsson, Anneli
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Persson, L A
    Children born in the summer have increased risk for coeliac disease.2003In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 57, no 1, p. 36-39Article in journal (Refereed)
  • 12.
    Krishnan, Anand
    et al.
    Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
    Dwivedi, Purva
    Gupta, Vivek
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Pandav, Chandrakant S
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Socioeconomic development and girl child survival in rural North India: solution or problem?2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 5, p. 419-426Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Socioeconomic development has been considered as a solution to the problem of sex differentials at birth and under-five mortality. This paper analyses longitudinal data from the Ballabgarh Health and Demographic Surveillance System (HDSS) site in north India to check its veracity.

    METHODS: A cohort of children born between 1 January 2006 and 31 December 2011 at Ballabgarh HDSS were followed till death, emigration, 3 years of age or end of the study. Socioeconomic status (SES) was measured by caste, parental combined years of schooling and wealth index and divided into low, mid and high strata for each of them. Sex ratio at birth (SRB) was reported as the number of girls per 1000 boys. The Kaplan-Meier survival curves were drawn and a Cox Proportional HR of girls over boys was estimated.

    RESULTS: A total of 12 517 native born children (25 797 child years) were enrolled of which 710 died (death rate of 56.7/1000-live births and 27.5/1000 child-years. Socioeconomically advantaged children had significantly lower death rates. The SRB (10-16% lower) and neonatal death rate were consistently adverse for girls in the advantaged groups by all the three indicators of SES. The first month survival rates were better for girls in the lower SES categories (significant only in caste (HR 0.58; 0.37 to 0.91). High SES categories consistently showed adverse survival rates for girls (HR of 1.22 to 1.59).

    CONCLUSIONS: Better socioeconomic situation worsened the sex differentials, especially at birth. Therefore, specific interventions targeting gender issues are required, at least as a short-term measure.

  • 13. Leddy, Anna M.
    et al.
    Lippman, Sheri A.
    Neilands, Torsten B.
    Twine, Rhian
    Ahern, Jennifer
    Gomez-Olive, Francesc Xavier
    DeLong, Stephanie M.
    MacPhail, Catherine
    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 (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Pettifor, Audrey E.
    Community collective efficacy is associated with reduced physical intimate partner violence (IPV) incidence in the rural province of Mpumalanga, South Africa: findings from HPTN 0682019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 2, p. 176-181, article id 752Article in journal (Refereed)
    Abstract [en]

    Background Intimate partner violence (IPV) is a human rights violation and is associated with a variety of adverse physical and mental health outcomes. Collective efficacy, defined as mutual trust among community members and willingness to intervene on the behalf of the common good, has been associated with reduced neighbourhood violence. Limited research has explored whether community collective efficacy is associated with reduced incidence of IPV. This is of particular interest among adolescent girls and young women (AGYW) in sub-Saharan Africa, where the burden of HIV is greatest and IPV is common. Methods We collected longitudinal data among 2533 AGYW (ages 13-20) enrolled in the HPTN 068 cohort in Mpumalanga province, South Africa between 2011 and 2016. We included participants from 26 villages where community surveys were collected during the HPTN 068 study. Collective efficacy was measured at the village level via two population-based cross-sectional surveys in 2012 and 2014. Multivariable Poisson generalised estimating equation regression models estimated the relative risk ratio (RR) between village collective efficacy scores and subsequent physical IPV 12 month incidence, adjusting for village-level clustering and covariates. Results Thirty-eight per cent of the cohort (n=950) reported at least one episode of recent physical IPV during follow-up. For every SD higher level of collective efficacy, there was a 6% lower level of physical IPV incidence (adjusted RR: 0.94; 95% CI 0.89 to 0.98) among AGYW after adjusting for covariates. Conclusions Community-level interventions that foster the development of collective efficacy may reduce IPV among AGYW.

  • 14. Månsdotter, Anna
    et al.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lundberg, Michael
    Winkvist, Anna
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Parental share in public and domestic spheres: a population study on gender equality, death, and sickness.2006In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 60, no 7, p. 616-620Article in journal (Refereed)
  • 15. Payne, Collin F.
    et al.
    Davies, Justine I.
    Gomez-Olive, F. Xavier
    Hands, Katherine J.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Kobayashi, Lindsay C.
    Tipping, Brent
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Wade, Alisha
    Witham, Miles D.
    Cross-sectional relationship between haemoglobin concentration and measures of physical and cognitive function in an older rural South African population2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 9, p. 796-802Article in journal (Refereed)
    Abstract [en]

    Background: Age cohort differences in haemoglobin concentrations and associations with physical and cognitive performance among populations of lower income and middle-income countries have not previously been described. We examined the association between these factors among older men and women in rural South Africa.

    Methods: We analysed cross-sectional data from a population-based study of rural South African men and women aged 40 and over (n=4499), with data drawn from questionnaire responses, a cognitive battery, objective physical function tests and blood tests. Anaemia was defined as a haemoglobin concentration <12 g/dL for women and <13 g/dL for men. We related haemoglobin concentrations to each of age, grip strength, walk speed and a latent cognitive function z-score for men and women separately. We used unadjusted correlations and linear models to adjust for comorbidities and inflammation.

    Results: In total, 1042 (43.0%) women and 833 (40.1%) men were anaemic. Haemoglobin concentrations were inversely correlated with age for men but not for women; in adjusted analyses, haemoglobin was 0.3 g/dL lower per decade older for men (95% CI 0.2 to 0.4 g/dL). In adjusted analyses, haemoglobin concentration was independently associated with grip strength in women (B=0.391, 95% CI 0.177 to 0.605), but this did not reach significance in men (B=0.266, 95% CI -0.019 to 0.552); no associations were observed between haemoglobin levels and walk speed or cognitive score.

    Conclusions: Anaemia was prevalent in this study population of middle-aged and older, rural South African adults, but in contrast to high-income countries, it was not associated with poor physical or cognitive function. Our findings need to be replicated in other populations.

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  • 16.
    Pulkki-Brännström, Anni-Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Häggström, Jenny
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sampaio, Filipa
    Feldman, Inna
    The equity impact of a universal child health promotion programme2020In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Real-world evaluations of complex interventions are scarce. We evaluated the effect of the Salut Programme, a universal child health promotion intervention in northern Sweden, on income-related inequalities in positive birth outcomes and healthcare utilisation up to 2 years after delivery.

    METHODS: Using the mother's place of residence at delivery, the child and the mother were classified as belonging to either the control area (received care-as-usual) or the intervention area (where the intervention was implemented from 2006) and either the premeasure (children born between 2002 and 2004) or the postmeasure (children born between 2006 and 2008) period. Parents' earned income was used as the socioeconomic ranking variable. The Relative Concentration Index was computed for six binary birth outcome indicators and for inpatient and day patient care for children and their mothers. Changes in inequality over time were compared using a difference-in-difference approach.

    RESULTS: Income-related inequalities in birth outcomes and child healthcare utilisation were absent, except that full-term pregnancies were concentrated among the poor at premeasure in the intervention area. In contrast, mothers' healthcare utilisation was significantly pro-poor in the control area. The extent of inequality changed differentially between premeasure and postmeasure for two birth outcomes: full-term pregnancies and infants with normal birth weight. Inequalities in healthcare utilisation did not change significantly in either area over time.

    CONCLUSION: In northern Sweden, income-related inequalities in birth outcomes and child healthcare utilisation are largely absent. However, relative inequalities in mothers' healthcare utilisation are large. We found no evidence that the Salut Programme affected changes in inequality over time.

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  • 17. Rubanzana, Wilson
    et al.
    Hedt-Gauthier, Bethany L.
    Ntaganira, Joseph
    Freeman, Michael D.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine. Oregon Health & Science University, School of Medicine, Portland, Oregon, USA; Faculty of Health Sciences, Department of Forensic Medicine, Aarhus University, Aarhus, Denmark.
    Exposure to genocide and risk of suicide in Rwanda: a population-based case-control study2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 2, p. 117-122Article in journal (Refereed)
    Abstract [en]

    Background In Rwanda, an estimated one million people were killed during the 1994 genocide, leaving the country shattered and social fabric destroyed. Large-scale traumatic events such as wars and genocides have been linked to endemic post-traumatic stress disorder, depression and suicidality. The study objective was to investigate whether the 1994 genocide exposure is associated with suicide in Rwanda. Methods We conducted a population-based case-control study. Suicide victims were matched to three living controls for sex, age and residential location. Exposure was defined as being a genocide survivor, having suffered physical/sexual abuse in the genocide, losing a first-degree relative in the genocide, having been convicted for genocide crimes or having a first-degree relative convicted for genocide. From May 2011 to May 2013, 162 cases and 486 controls were enrolled countrywide. Information was collected from the police, local village administrators and family members. Results After adjusting for potential confounders, having been convicted for genocide crimes was a significant predictor for suicide (OR=17.3, 95% CI 3.4 to 88.1). Being a survivor, having been physically or sexually abused during the genocide, and having lost a first-degree family member to genocide were not significantly associated with suicide. Conclusions These findings demonstrate that individuals convicted for genocide crimes are experiencing continued psychological disturbances that affect their social reintegration into the community even 20 years after the event. Given the large number of genocide perpetrators reintegrated after criminal courts and Gacaca traditional reconciling trials, suicide could become a serious public health burden if preventive remedial action is not identified.

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  • 18.
    Santosa, Ailiana
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Schröders, Julia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Vaezghasemi, Masoud
    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).
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Inequality in disability-free life expectancies among older men and women in six countries with developing economies2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 9, p. 855-861Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It is unclear whether the increase in life expectancy (LE) globally is coupled with a postponement of morbidity and disability. Evidence on trends and determinants of disability-free life expectancies (DFLEs) are available in high-income countries but less in low and middle-income countries (LMICs). This study examines the levels of and inequalities in LE, disability and DFLE between men and women across different age groups aged 50 years and over in six countries with developing economies.

    METHODS: This study utilised the cross-sectional data (n=32 724) from the WHO Study on global AGEing and adult health (SAGE) in China, Ghana, India, Mexico, the Russian Federation and South Africa in 2007-2010. Disability was measured with the activity of daily living (ADL) instrument. The DFLE was estimated using the Sullivan method based on the standard period life table and ADL-disability proportions.

    RESULTS: The disability prevalence ranged from 13% in China to 54% in India. The prevalence of disability was highest and occurred at younger age in both sexes in India. Women were more disadvantaged with higher prevalence of disability across all age groups, and the situation was worst among older women in Mexico and the Russian Federation. Though women had higher LE, their proportion of remaining LE free from disability was lower than men.

    CONCLUSIONS: There are inequalities in the levels of disability and DFLE among men and women in different age groups among people aged over 50 years in these six countries. Countermeasures to decrease intercountry and gender gaps in DFLE, including improvements in health promotion and healthcare distribution, with a gender equity focus, are needed.

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  • 19. Theorell, Töres
    et al.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Magnusson Hanson, Linda
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Westerlund, Hugo
    Job strain and depressive symptoms in men and women: a prospective study of the working population in Sweden2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 1, p. 78-82Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several prospective studies have indicated increased risk of developing depressive symptoms in employees who report psychologically demanding and uncontrollable work (job strain). There are diverging findings regarding gender differences in this relationship. The aim was to analyse whether men and women differ with regard to the prospective relationship between adverse psychosocial work environment and depressive symptoms during a 2-year period.

    METHOD: The Swedish Longitudinal Occupational Survey of Health cohort based on representative recruitment of working men and women in Sweden was used. 2731 men and 3446 women had answered questions regarding work environment and mental health in 2008 and 2010. Psychological demands, decision authority, age and income as well as depressive symptoms in 2008 were used as predictors of depressive symptoms in 2010.

    RESULTS: Women reported less decision authority at work and their demand level developed more unfavourably than did men's-resulting in increased job strain gap between men and women from 2008 to 2010. The relationship between demand and decision authority (and job strain) on one hand and depressive symptoms on the other hand was not statistically different in men and women.

    CONCLUSIONS: Overall, women reported higher levels of job strain than men. In Sweden, job strain was as strongly related to depressive symptoms among men as among women.

  • 20. Verguet, Stéphane
    et al.
    Jassat, Waasila
    Bertram, Melanie Y.
    Tollman, Stephen M
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. University of the Witwatersrand, Johannesburg, South Africa and INDEPTH Network, Accra, Ghana.
    Murray, Christopher J. L.
    Jamison, Dean T.
    Hofman, Karen J.
    Impact of supplemental immunisation activity (SIA) campaigns on health systems: findings from South Africa2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 11, p. 947-952Article in journal (Refereed)
    Abstract [en]

    Background Supplemental immunisation activity (SIA) campaigns provide children with an additional dose of measles vaccine and deliver other childhealth interventions including vitamin A supplements, deworming medications and oral polio vaccines. They also require the mobilisation of a large health workforce. We assess the impact of the implementation of SIA campaigns on selected routine child and maternalhealth services in South Africa (SA).

    Methods We use district-level monthly headcount data for 52 South African districts for the period 2001-2010, sourced from the District Health Information System, SA. The data include 12 child and maternalhealth headcount indicators including routine immunisation, and maternal and reproductivehealth indicators. We analyse the association between the implementation of the 2010 SIA campaign and the change (decrease/increase) in headcounts, using a linear regression model.

    Results We find a significant decrease for eight indicators. The total number of fully immunised children before age 1 decreased by 29% (95% CI 23% to 35%, p<0.001) during the month of SIA implementation; contraceptive use and antenatal visits decreased by 7-17% (p0.02) and about 10% (p<0.001), respectively.

    Conclusions SIA campaigns may negatively impact health systems during the period of implementation by disrupting regular functioning and diverting resources from other activities, including routine child and maternal health services. SIA campaigns present multidimensional costs that need to be explicitly considered in benefit-cost assessments.

  • 21.
    Wennberg, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafsson, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Howard, Bethany
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Television viewing over the life course and the metabolic syndrome in mid-adulthood: a longitudinal population-based study2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, no 10, p. 928-933Article in journal (Refereed)
  • 22. Westerlund, Hugo
    et al.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Theorell, Töres
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Parental academic involvement in adolescence, academic achievement over the life course and allostatic load in middle age: a prospective population-based cohort study2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 6, p. 508-513Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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