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  • 1.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Alberts, M
    Burger, S
    Motherhood, migration and mortality in Dikgale: modelling life events among women in a rural South African community2011In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 125, no 5, p. 318-323Article in journal (Refereed)
    Abstract [en]

    Objectives: Although particular types of life events in populations are often studied separately, this study investigated the joint effects of three major event types in South African women’s lives: motherhood, migration and mortality.

    Study design: Data were taken from a health and demographic surveillance site (HDSS) over an 11-year period, reflecting the entire population of a defined geographic area as an open cohort, in which individuals participated in regular longitudinal surveillance for health and demographic events. This HDSS is a member of the Indepth Network.

    Methods: Multivariate Poisson regression models were built for each of the three life event types, in which individual person-time observed out of the total possible 11-year period was used as a rate multiplier. These models were used to calculate adjusted incidence rate ratios for each factor.

    Results: In the 21,587 person–years observed for women aged 15–49 years, from 1996 to 2006, adjusted rate ratios for mortality and migration increased substantially over time, while motherhood remained fairly constant. Women who migrated were less likely to bear children; temporary migrants were at greater risk of dying, while permanent in-migrants had higher survival rates. Women who subsequently died were much less likely to bear children or migrate.

    Conclusions: The associations between motherhood, migration and mortality among these rural South African women were complex and dynamic. Extremely rapid increases in mortality over the period studied are presumed to reflect the effects of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. Understanding these complex interactions between various life events at population level is crucial for effective public health planning and service delivery.

  • 2.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Berhane, Y
    Emmelin, Anders
    Kebede, D
    Andersson, T
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The role of demographic surveillance systems (DSS) in assessing the health of communities: an example from rural Ethiopia2002In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 116, no 3, p. 145-150Article in journal (Refereed)
    Abstract [en]

    Longitudinal demographic surveillance systems (DSSs) in selected populations can provide important information in situations where routine health information is incomplete or absent, particularly in developing countries. The Butajira Rural Health Project is one such example, initiated in rural Ethiopia in 1987. DSSs rely on regular community-based surveillance as a means of vital event registration, among a sufficient population base to draw meaningful conclusions about rates and trends in relatively rare events such as maternal death. Enquiries into specific health problems can also then use this framework to quantify particular issues or evaluate interventions. Demographic characteristics and trends for a rural Ethiopian population over a 10-y period are presented as an illustration of the DSS approach, based on 336 000 person-years observed. Overall life expectancy at birth was 50 y. Demographic parameters generally showed modest trends towards improvement over the 10-y period. The DSS approach is useful in characterising populations at the community level over a period of time, providing important information for health planning and intervention. Methodological issues underlying this approach need further exploration and development.

  • 3.
    Fottrell, Edward
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Identifying humanitarian crises in population surveillance field sites: simple procedures and ethical imperatives.2009In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 123, no 2, p. 151-155Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Effective early warning systems of humanitarian crises may help to avert substantial increases in mortality and morbidity, and prevent major population movements. The Butajira Rural Health Programme (BRHP) in Ethiopia has maintained a programme of epidemiological surveillance since 1987. Inspection of the BRHP data revealed large peaks of mortality in 1998 and 1999, well in excess of the normally observed year-to-year variation. Further investigation and enquiry revealed that these peaks related to a measles epidemic, and a serious episode of drought and consequent food insecurity that went undetected by the BRHP. This paper applies international humanitarian crisis threshold definitions to the BRHP data in an attempt to identify suitable mortality thresholds that may be used for the prospective detection of humanitarian crises in population surveillance sites in developing countries.

    STUDY DESIGN: Empirical investigation using secondary analysis of longitudinal population-based cohort data.

    METHODS: The daily, weekly and monthly thresholds for crises in Butajira were applied to mortality data for the 5-year period incorporating the crisis periods of 1998-1999. Days, weeks and months in which mortality exceeded each threshold level were identified. Each threshold level was assessed in terms of prospectively identifying the true crisis periods in a timely manner whilst avoiding false alarms.

    RESULTS: The daily threshold definition is too sensitive to accurately detect impending or real crises in the population surveillance setting of the BRHP. However, the weekly threshold level is useful in identifying important increases in mortality in a timely manner without the excessive sensitivity of the daily threshold. The weekly threshold level detects the crisis periods approximately 2 weeks before the monthly threshold level.

    CONCLUSION: Mortality measures are highly specific indicators of the health status of populations, and simple procedures can be used to apply international crisis threshold definitions in population surveillance settings for the prospective detection of important changes in mortality rate. Standards for the timely use of surveillance data and ethical responsibilities of those responsible for the data should be made explicit to improve the public health functioning of current sentinel surveillance methodologies.

  • 4. Grjibovski, A M
    et al.
    Bygren, Lars Olov
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, 141 157 Huddinge, Sweden.
    Yngve, Agneta
    Sjöström, M
    Large social disparities in spontaneous preterm birth rates in transitional Russia2005In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 119, no 2, p. 77-86Article in journal (Refereed)
    Abstract [en]

    Objective. This study estimated the effect of maternal sociodemographic, obstetric and lifestyle factors on the risk of spontaneous preterm birth in a Russian town.

    Methods. All women with singleton pregnancies registered at prenatal care centres in Severodvinsk in 1999 comprised the cohort for this study (n = 1559). Analysis was based on spontaneous live singleton births at the maternity home (n=1103). Muttivariable logistic regression was applied to quantify the effect of the studied factors on the risk of preterm birth. Differences in gestation duration were studied using multiple Linear regression.

    Results. In total, 5.6% of all spontaneous births were preterm. Increased risks of preterm delivery were found in women with lower Levels of education and in students. Placental complications, stress and a history of fetal death in previous pregnancies were also associated with elevated risks for preterm delivery. Smoking, hypertension and multigravidity were associated with reduced length of pregnancy in metric form.

    Conclusion. In addition to medical risk factors, social factors are important determinants of preterm birth in transitional Russia. Large disparities in preterm birth rates may reflect the level of inequalities in transitional Russia. Social variations in pregnancy outcomes should be monitored.

  • 5.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Danielsson, Ulla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Bengs, Carita
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Johansson, E.E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Gender-related explanatory models of depression: a critical evaluation of medical articles2009In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 123, no 10, p. 689-693Article in journal (Refereed)
    Abstract [en]

    Objectives: Although research has consistently shown a higher prevalence of depression among women compared with men, there is a lack of consensus regarding explanatory factors for these gender-related differences. The aim of this paper was to analyse the scientific quality of different gender-related explanatory models of depression in the medical database PubMed.

    Study design: Qualitative and quantitative analyses of PubMed articles.

    Methods: In a database search in PubMed for 2002, 82 articles on gender and depression were selected and analysed with qualitative and quantitative content analyses. In total, 10 explanatory factors and four explanatory models were found. The ISI Web of Science database was searched in order to obtain the citation number and journal impact factor for each article.

    Results: The most commonly used gender-related explanatory model for depression was the biomedical model (especially gonadal hormones), followed by the sociocultural and psychological models. Compared with the other models, the biomedical model scored highest on bibliometric measures but lowest on measures of multifactorial dimensions and differences within the group of men/women.

    Conclusion: The biomedical model for explaining gender-related aspects of depression had the highest quality when bibliometric methods were used. However, the sociocultural and psychological models had higher quality than the biomedical model when multifactoriality and intersectionality were analysed. There is a need for the development of new methods in order to evaluate the scientific quality of research.

  • 6.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mechanisms for the social gradient in health: results from a 14-year follow-up of the northern swedish cohort2011In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 125, no 9, p. 567-576Article in journal (Refereed)
    Abstract [en]

    Objective: Although numerous studies have demonstrated a socio-economic gradient in health, there is still a lack of research about the mechanisms behind this gradient. The aim of this study was to analyse possible mechanisms from adolescence to adulthood to explain the socio-economic gradient in somatic symptoms among men and women in the Northern Swedish Cohort. Study design: A prospective cohort study was performed, in which all pupils (n = 1083) in the last year of compulsory school were followed for 14 years. The response rate was high, with 96.6% still participating after 14 years. The data were mainly collected through repeated comprehensive self-administered questionnaires.

    Methods: The main dependent variable was a combination of socio-economic position and somatic health at 30 years of age. Multivariate multinomial and bivariate logistic regression analyses were undertaken.

    Results: After controlling for parental working-class position and health-related selection, the authors identified mechanisms from adolescence to adulthood for the socio-economic gradient in health that were related to social relations (poor relationship with father and unemployed friends among men, violence among women), labour market experiences (unemployment among men and women, physically heavy work among women), economic hardship (among women) and poor health behaviour.

    Conclusion: These analyses contribute to the development of epidemiological methods for analysing mechanisms for the socio-economic gradient in health. (C) 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  • 7. Hang, Hoang Minh
    et al.
    Bach, T T
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Unintentional injuries over a 1-year period in a rural Vietnamese community: describing an iceberg.2005In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 119, no 6, p. 466-473Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To document unintentional injuries in a rural community over a 1-year period as a basis for prioritizing preventive activities. STUDY DESIGN: Quarterly home visits over 1 year to elicit experience of injury among household members in the preceding 3 months. METHODS: In total, 24,776 people living in rural communities in the Bavi District, Northern Vietnam, were surveyed in home visits during 2000. In the home visits, injuries that needed care or disrupted normal activities were recorded, together with their circumstances. RESULTS: Overall, 2079 new non-fatal injuries were recorded over 23,338 person-years, a rate of 89/1000 person-years-at-risk. Males had a significantly higher injury rate than females for all age groups except for those aged 35-59 years and the elderly (P<0.05). The elderly were at highest risk of injury (P<0.05), particularly females. Home injuries occurred at the highest overall rate, particularly among the elderly. Road traffic injuries were most common among children. Most injuries involved contact with another object. Less than one-quarter of injury victims sought care at a health facility. CONCLUSIONS: Community-based household surveys revealed the hidden part of the injury iceberg, as well as showing high incidence rates, indicating that injury is an important public health problem which should be a priority for intervention in rural Vietnam, and probably elsewhere. This comprehensive study is intended to contribute evidence and methods to the Ministry of Health's national programme for injury prevention, and to a wider audience.

  • 8. Hang, Hoang Minh
    et al.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Difficulties in getting treatment for injuries in rural Vietnam2009In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 123, no 1, p. 58-65Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Knowledge about the health-seeking behaviour of injury patients is important for the improvement of community health services. The aims of this study were: (1) to describe the healthcare-seeking behaviour of injury patients; (2) to examine factors associated with injury patients seeking care at health facilities; and (3) to describe the costs of health care for injury patients. STUDY DESIGN: This study took place in Bavi District, northern Vietnam within a longitudinal community surveillance site (FilaBavi). All non-fatal unintentional injuries occurring in a sample of 24,776 people during 2000 were recorded. METHOD: The injury questionnaire included information on care-seeking behaviour, severity and consequences of injury. Both univariate and multivariate logistic regression models were used to find associations between sociodemographic factors and utilization of any health services, as well as for each type of health service used, compared with the group who did not use any health services. RESULT: Of 24,776 persons living in the study area, 1917 reported 2079 new non-fatal debilitating injuries during the four 3-month periods of observation. Health-seeking behaviour relating to the first 1917 injuries was analysed. Self-treatment was most common (51.7%), even in cases of severe injury. There was low usage of public health services (23.2%) among injury patients. Long distances, poor economic status and residence in difficult geographic areas such as highlands and mountains were barriers for seeking health services. A large proportion of household income was spent on treating injury patients. Poor people spent a greater proportion of their income on health care than the rich, and often used less qualified or untrained private providers. CONCLUSIONS: These results demonstrate the logistical and financial difficulties associated with the treatment of injuries in rural Vietnam. This suggests the need to make public health subsidies available more efficiently and equitably. Whilst this study looked at the situation specifically in the context of injury treatment, it is likely that similar patterns apply in other areas of health care.

  • 9. Huong, Dao Lan
    et al.
    Van Minh, Hoang
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Van, Do Duc
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Socio-economic status inequality and major causes of death in adults: a 5-year follow-up study in rural Vietnam.2006In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 120, no 6, p. 497-504Article in journal (Refereed)
  • 10.
    Kallin, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Jensen, Jane
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nyberg, L
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Predisposing and precipitating factors for falls among older people in residential care2002In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 116, no 5, p. 263-271Article in journal (Refereed)
    Abstract [en]

    Falls and their consequences are serious health problems among older populations. To study predisposing and precipitating factors for falls among older people in residential care we used a cross-sectional study design with a prospective follow up for falls. Fifty-eight women and 25 men, with a mean age of 79.6 y, were included and prospectively followed up regarding falls for a period of 1 y after baseline assessments. All those who fell were assessed regarding factors that might have precipitated the fall. The incidence rate was 2.29 falls/person years. Antidepressants (selective serotonin reuptake inhibitors, SSRIs), impaired vision and being unable to use stairs without assistance were independently associated with being a 'faller'. Twenty-eight (53.8%) of the fallers suffered injuries as a result of their falls, including 21 fractures. Twenty-seven percent of the falls were judged to be precipitated by an acute illness or disease and 8.6% by a side effect of a drug. Acute symptoms of diseases or drug side effects were associated with 58% of the falls which resulted in fractures. We conclude that SSRIs seem to constitute one important factor that predisposes older people to fall, once or repeatedly. Since acute illnesses and drug side-effects were important precipitating factors, falls should be regarded as a possible symptom of disease or a side-effect of a drug until it is proven otherwise.

  • 11.
    Novak, Masuma
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Social and health-related correlates of intergenerational and intragenerational social mobility among Swedish men and women2012In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 126, no 4, p. 349-357Article in journal (Refereed)
    Abstract [en]

    Background: The present study explored the pattern and the determinants of social mobility among men and women both at inter and intragenerational transitional periods. Specifically the study addressed what impact do the various health related measures, health-behaviours, psychosocial environments at home and school, material resources, and ethnicity have on the chances and the direction of social mobility.

    Methods: A Swedish 14-year prospective longitudinal study with 96.5% response rate. Detail information on 546 men and 495 women regarding their occupation, health status, health-related behaviour, psychosocial environment at home and school, material recourses and ethnicity prior to mobility were available from ages 16, 21 and 30. Odds Ratios and 99% confidence interval were calculated using logistic regression to determine social mobility.

    Results: At the inter-generational analyses, being liked in school (liked by the teachers and students) predicted upward mobility in men and women. Additionally, being taller predicted upward mobility in women. Downward mobility was predicted by being less liked in school and smoking for both men and women. Additionally, having an unemployed family member for men and not having an own room for women predicted downward mobility. At the intra-generational analyses, less alcohol consumption for men and better financial resources for women predicted upward mobility. Downward mobility among men was predicted by smoking and having restricted financial resources. The chances and the directions of mobility were not influenced by ethnic background.

    Conclusions: Except height among women, health status was not associated with mobility in this cohort for men or for women neither internor intra-generationally, however material deprivation, economical deprivation, poor health behaviours, and unfavourable school environment were.

  • 12. Olofsson, N.
    et al.
    Lindqvist, K.
    Danielsson, Ingela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Fear of crime and psychological and physical abuse associated with ill health in a Swedish population aged 65-84 years2012In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 126, no 4, p. 358-364Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess the association between fear of crime and/or psychological and/or physical abuse in relation to self-reported physical and psychological health, using a large representative sample of elderly women and men in Sweden. Study design: Cross-sectional national survey. Methods: Data were taken from a nationwide representative public health survey (2006). Men and women between the ages of 65 and 84 years were selected for the present analyses (4386 men and 4974 women). The response rate for this age group was 59% for men and 70% for women. Results: Psychological and physical abuse against elderly women and men led to higher odds ratios for negative health outcomes, independently of socio-economic status. Strong correlation was found between psychological abuse and negative health outcomes in both men and women, while the correlation was less strong for physical abuse, especially among women. The men had high odds ratios for suicidal thoughts and even for attempted suicide in connection with physical and psychological abuse and fear of crime. Conclusions: The study provides representative results addressing an extensive negative health outcome panorama caused by fear of crime and exposure to abuse. (C) 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  • 13. Pindus, Mihkel
    et al.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Public Health, University of Tartu, Tartu, Estonia.
    Modig, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Close proximity to busy roads increases the prevalence and onset of cardiac disease: results from RHINE Tartu2015In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 129, no 10, p. 1398-1405Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To analyze whether living close to a busy road would increase the risk of having cardiac disease and hypertension.

    STUDY DESIGN: Longitudinal cross-sectional study.

    METHODS: We used cross-sectional longitudinal questionnaire data from the RHINE study for Tartu in 2000/2001 and 2011/2012. Home addresses of the respondents were geocoded and traffic data obtained from annually conducted traffic counts in Tartu. Relationships between proximity to a busy road and self-reported cardiac disease and hypertension were analyzed with multiple logistic regression.

    RESULTS: In terms of total traffic (≥10,000 vehicles per day) within a 150-m zone of a busy road, the odds ratio (OR) for prevalence of cardiac disease was significant in 2000/2001 (1.91, 95% CI 1.15-3.16) and 2011/2012 (1.58, 95% CI 1.01-2.47). Prevalence of hypertension was significant only in 2011/2012 (1.61, 95% CI 1.08-2.39). In terms of heavy duty vehicle traffic (≥500 vehicles per day) within a 150-m zone in 2000/2001, the OR was 1.52 (95% CI 1.04-2.24) and 1.49 (95% CI 1.02-2.17) respectively for the prevalence of cardiac disease and hypertension. In 2011/2012 no significant relationship between heavy duty vehicle traffic and cardiac disease or hypertension was found. We also saw a significant relationship between total traffic and the onset of cardiac disease (OR = 2.04, 95% CI 1.07-3.87).

    CONCLUSIONS: This study showed that living closer than 150 m to a busy road can increase the odds of having cardiac disease and hypertension, which should be taken into account in city planning.

  • 14.
    Pérez-Urdiales, Iratxe
    et al.
    Department of Nursing I, University of the Basque Country (UPV/EHU), Biscay, Spain.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Nursing I, University of the Basque Country (UPV/EHU), Biscay, Spain.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Free clinic utilisation by immigrants after the introduction of a restrictive health policy in the Basque Country (Spain)2018In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 163, p. 9-15Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Policies restricting healthcare access for immigrants were applied in times of reduced public funding for welfare in Spain. This study aimed to assess the impact of the implementation of a more restrictive health policy in the Basque Country region, Decree 114/2012, on the number of consultations attended at a free clinic, where the majority of patients are undocumented immigrants.

    STUDY DESIGN: Interrupted time series.

    METHODS: A negative binomial regression model was applied in two phases to the number of healthcare consultations during the period 2007-2017 (n = 9272) to estimate the level and trend changes associated with the implementation of the policy. Data were analysed separately by sex and adjusted for consultations' seasonality and unemployment rate and the sex-specific percentage of migrant population in Biscay province as confounding factors.

    RESULTS: Different trends of attendance between men and women were observed during the whole period, constituting 76.94% and 23.06% of all consultations, respectively. After the implementation of the decree, the number of consultations for women per trimester decreased and increased for men by 1%, although it was not statistically significant in either of the trends.

    CONCLUSIONS: No clear relationship between the implementation of the Basque Decree 114/2012 and an increase in the attendance of immigrants in a free clinic during the studied period was found.

  • 15.
    Reine, Ieva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Novo, Mehmed
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Hammarström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Unemployment and ill health - a gender analysis: results from a 14-year follow-up of the Northern Swedish cohort2013In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 127, no 3, p. 214-222Article in journal (Refereed)
    Abstract [en]

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

  • 16.
    Reine, Ieva
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Novo, Mehmed
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Does the association between ill health and unemployment differ between young people and adults?: results from a 14-year follow-up study with a focus on psychological health and smoking2004In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 118, no 5, p. 337-345Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

  • 17.
    Stenlund, Tova
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Lidén, E.
    Department of Occupational and Environmental Medicine, Örebro Hospital, Sweden.
    Andersson, K.
    Department of Occupational and Environmental Medicine, Örebro Hospital, Sweden.
    Garvill, Jörgen
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Annoyance and health symptoms and their influencing factors: A population-based air pollution intervention study2009In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 123, no 4, p. 339-345Article in journal (Refereed)
    Abstract [en]

    Objectives: Interventions for reducing air pollution are important means for improving public health. The role of psychological factors in understanding annoyance and health symptoms due to air pollution is limited and further investigation is required. This study aimed to investigate the effects of an intervention to reduce air pollution (predominantly dust and soot) with respect to perceived pollution, risk perception, annoyance and health symptoms. Another objective was to test a model that describes interrelationsbetween air pollution, perceived pollution, health risk perception, annoyance and health symptoms.

    Study design: An interventional, population-based questionnaire study.

    Methods: Surveys were performed before (pre-test) and after (post-test) closure of a sinter plant. Instead,pellets were shipped to the community’s harbour for steel production. Individuals in the community aged 18–75 years were selected at random for participation in the pre-test (n ¼ 738; 74% of the sample participated) and post-test (n ¼ 684; 68% of the sample participated). The two samples were representative of the populations at the two points in time, and thus not identical.

    Results: After the sinter plant was closed, the environment was perceived as being less dusty, the residentswere more positive in their risk perception, and they reported less annoyance due to dust, soot andodorous substances. No difference was found for health symptoms between the pre-test and the posttest.Based on path analyses, a model is proposed of inter-relations between air pollution, perceived pollution, health risk perception, annoyance and health symptoms.

    Conclusion: The intervention was successful with respect to perceived dust and soot pollution; toannoyance attributed to dust, soot and odorous substances; and to risk perception. The path analysessuggest that perceived pollution and health risk perception play important roles in understanding and predicting environmentally induced annoyance and health symptoms.

  • 18. Tercero, F
    et al.
    Andersson, R
    Peña, Rodolfo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Department of Preventive Medicine, Health and Demography Research Centre, National Autonomous University of Nicaragua, León, Nicaragua.
    Rocha, J
    Castro, N
    The epidemiology of moderate and severe injuries in a Nicaraguan community: a household-based survey2006In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 120, no 2, p. 106-114Article in journal (Refereed)
    Abstract [en]

    Although injuries constitute a major public health problem worldwide, the magnitude and nature of this problem is difficult to establish in low-income settings due to the lack of valid and representative data. In Nicaragua, several parallel studies have been carried out attempting to assess levels and patterns of injury using various sources of information. The objective of this study was to describe the magnitude and profile of moderate and severe injuries in a well-defined community in Nicaragua. The study was conducted using a household-based survey design. Randomized cluster sampling provided information from 10,797 households (63,886 inhabitants). The outcomes included fatal and non-fatal injuries registered during a recall period of 6 weeks. Seven percent of all. injuries were classified as moderate or severe. The estimated annual incidence rate of moderate/severe injuries was 27.6 per 1000 [95% confidence intervals (CI): 26.4-29.2], white the mortality and impairment rates were 108.9 (95% CI: 83.5-134.4) and 95.3 (95% CI: 71.4-119.2) per 100,000 inhabitants, respectively. Home and traffic areas were the main environments associated with injury occurrence. The most affected groups were the elderly, children and mates. No differences were found between urban and rural areas. Only 9% of all cases, including minor injuries, sought hospital treatment. The main causes of non-fatal injuries were falls, traffic and cuts, whereas fatalities were largely associated with intentional injuries. For every death due to injury, there was one permanent disability, 25 moderate/severe injuries and 354 minor injuries. This study provides a broad description of injury magnitudes and patterns in a defined Nicaraguan community, and demonstrates the aggregate injury pyramid of the same community. It also identifies the issue of severity and concludes with a recommendation to apply different criteria of severity. Our results support the call for a careful evaluation of injury data sources and severity scores when planning injury prevention programmes.

  • 19.
    Virtanen, P.
    et al.
    Tampere School of Public Health, University of Tampere, Medisiinarinkatu, Tampere, Finland.
    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.
    Health status and health behaviour as predictors of the occurrence of unemployment and prolonged unemployment2013In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 127, no 1, p. 46-52Article in journal (Refereed)
    Abstract [en]

    Objectives: Earlier research on health-related selection into unemployment has been based on relatively severe health problems, leaves questions unanswered about particular problems, follow-up times have been short and the measurement of unemployment utilised has been crude. The present study explores the effects of suboptimal health on employment in the long term, with statistics that enable assessment of the occurrence and extent of unemployment. Study design: Employment status of a population cohort (n = 1083) was measured half-yearly from 18 to 42 years of age with four follow-up surveys. Methods: Health status at 30 years of age was assessed with nine indicators. Their associations with the occurrence of a period of unemployment during the subsequent 12 years were analysed with Cox proportional hazard models, and generalized linear models were applied in assessing their associations with prolonged unemployment. Results: Suboptimal self-rated health and suboptimal mood were the most robust predictors of both occurrence of unemployment {hazard rates 1.48 [95% confidence interval (CI) 1.13-1.94] and 1.59 (95% CI 1.19-2.12), respectively} and prolonged unemployment [risk ratios 1.95 (95% CI 1.66-2.29) and 1.44 (95% CI 1.24-1.67), respectively]. Significant associations, particularly with prolonged unemployment, were also seen for musculoskeletal pain, suboptimal sense functions and sleep quality, and smoking and risky alcohol intake. Conclusions: There is health-related selection into unemployment in early middle age, irrespective of unemployment earlier in the life course. High risk ratios for prolonged unemployment suggest that selection takes place, in particular, at re-employment. The findings indicate the need for policies to prevent those with a history of health problems being at a disadvantage in terms of future employment. (C) 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

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