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  • 1. Ascher, H
    et al.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Kristiansson, B
    Lindberg, T
    Stenhammar, L
    [Infant food and celiac disease. Risk of increase when changing the diet]1994In: Lakartidningen, ISSN 0023-7205, Vol. 91, no 49, p. 4641-3Article in journal (Other academic)
  • 2.
    Baranowska-Rataj, Anna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    De Luna, Xavier
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Does the number of siblings affect health in midlife?: Evidence from the Swedish Prescribed Drug Register2016In: Demographic Research, ISSN 1435-9871, Vol. 35, p. 1259-1302, article id 43Article in journal (Refereed)
    Abstract [en]

    Background: In many societies, growing up in a large family is associated with receiving less parental time, attention, and financial support. As a result, children with a large number of siblings may have worse physical and mental health outcomes than children with fewer siblings.

    Objective: Our objective is to examine the long-term causal effects of sibship size on physical and mental health in modern Sweden.

    Methods: We employ longitudinal data covering the entire Swedish population from the Multigenerational Register and the Medical Birth Register. This data includes information on family size and on potential confounders such as parental background. We use the Prescribed Drug Register to identify the medicines that have been prescribed and dispensed. We use instrumental variable models with multiple births as instruments to examine the causal effects of family size on the health outcomes of children, as measured by receiving medicines at age 45.

    Results: Our results indicate that in Sweden, growing up in a large family does not have a detrimental effect on physical and mental health in midlife.

    Contribution: We provide a systematic overview of the health-related implications of growing up in a large family. We adopt a research design that gives us the opportunity to make causal inferences about the long-term effects of family size. Moreover, our paper provides evidence on the links between family size and health outcomes in the context of a developed country that implements policies oriented towards reducing social inequalities in health and other living conditions.

  • 3.
    Berhan, Yonas
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Möllsten, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Carlsson, Annelie
    Lund Univ, Dept Clin Sci, Lund, Sweden.
    Högberg, Lotta
    Linköping Univ, Dept Clin & Expt Med, Div Pediat, Linköping, Sweden.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Five-region study finds no evidence of undiagnosed type 2 diabetes in Swedish 11- to 13-year-olds2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 10, p. 1078-1082Article in journal (Refereed)
    Abstract [en]

    AIM: Childhood obesity is now an established public health problem in most developed countries, and there is concern about a parallel increase of type 2 diabetes. The aim of this study was to estimate the prevalence of undiagnosed type 2 diabetes in overweight Swedish school children from 11 to 13 years of age.

    METHODS: Body mass index (BMI) was measured in 5528 schoolchildren in the 6th grade, from 11 to 13 years of age, in five different regions in Sweden. Overweight was defined by international age- and sex-specific BMI cut-offs, corresponding to adult BMI cut-offs of 25 kg/m(2) at 18 years of age (ISO-BMI ≥25, n = 1275). Haemoglobin A1c (HbA1c) was measured in 1126 children with ISO-BMI ≥25. Children with a Diabetes Control and Complications Trial aligned HbA1c ≥6.1% on two occasions underwent an oral glucose tolerance test (OGTT) to establish the diabetes diagnosis.

    RESULTS: Of 1126 children with ISO-BMI ≥25, 24 (2.1%) had at least one HbA1c value ≥6.1%. Three of them had HbA1c ≥6.1% on two occasions, and all of them had a normal OGTT.

    CONCLUSION: In this cross-sectional, population-based screening study of a high-risk group of 11- to 13-year-old Swedish school children, we found no indication of undiagnosed diabetes or impaired glucose tolerance.

  • 4.
    Berhan, Yonas
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Möllsten, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Carlsson, Annelie
    Högberg, Lotta
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Screening for undiagnosed type-2 diabetes in Swedish 6th grade school childrenManuscript (preprint) (Other academic)
    Abstract [en]

    Aims: To estimate the prevalence of undiagnosed type-2 diabetes in overweight Swedish school children 11-13 years old.

    Methods: BMI was measured in 5 528 school-children (11-13 years of age) attending the 6th grade, in five different regions in Sweden. Overweight was defined by international age-sex specific BMI cut-offs, corresponding to adult BMI cut-offs of 25 kg/m² at 18 years of age (ISO-BMI ≥25, n=1 275). Haemoglobin A1c (HbA1c) was measured in 1 126 children with ISO-BMI ≥25. Children with a DCCT-aligned HbA1c ≥ 6.1% on two occasions underwent an oral glucose-tolerance test (OGTT) to establish diabetes diagnosis.

    Results: Twenty four children (2.1%) had at least one HbA1c-value ≥6.1%. Three of them had HbA1c ≥6.1% on two occasions and all of them had a normal OGTT.

    Conclusion: In this cross-sectional population-based screening study of a high risk group of 11-13 years old Swedish school children we found no indication of undiagnosed diabetes or impaired glucose tolerance.Key

  • 5.
    Browaldh, Lars
    et al.
    Sachsska barnsjukhuset, Södersjukhuset, Stockholm.
    Sandström, Olof
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Agardh, Daniel
    barnmedicinska kliniken Malmö och Lund, Skånes universitetssjukhus.
    Stenhammar, Lars
    Vrinnevisjukhuset, Norrköping.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Celiaki är en vanlig sjukdom som är lätt att missa2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 11, p. 484-488Article in journal (Refereed)
    Abstract [sv]

    Celiaki ansågs länge som en ovanlig barnsjukdom, men är en vanlig sjukdom som drabbar alla åldrar.  Genomförda screeningar av normalbefolkningen visar att merparten inte fått dia­gnos eller behandling. Den kliniska bilden varierar: alltifrån diffusa besvär eller inga symtom alls till allvarliga gastrointestinala symtom med grav avmagring och tillväxtrubbning till följd av malabsorption. Klinisk misstanke om eller hereditet för celiaki bör föranleda analys av specifika serologiska markörer. Gastroskopi med tunntarmsbiopsi bör övervägas för att bekräfta eller utesluta diagnosen.

  • 6.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The global burden of childhood coeliac disease: a neglected component of diarrhoeal mortality?2011In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 6, no 7, p. e22774-Article in journal (Refereed)
    Abstract [en]

    Objectives Coeliac disease has emerged as an increasingly recognised public health problem over the last half-century, and is now coming to be seen as a global phenomenon, despite a profound lack of globally representative epidemiological data. Since children with coeliac disease commonly present with chronic diarrhoea and malnutrition, diagnosis is often overlooked, particularly in poorer settings where children often fail to thrive and water-borne infectious diarrhoeas are common. This is the first attempt to make global estimates of the burden of coeliac disease in childhood.

    Methods We built a relatively crude model of childhood coeliac disease, incorporating estimates of population prevalence, probability of non-diagnosis, and likelihood of mortality among the undiagnosed across all countries from 1970 to 2010, based around the few available data. All our assumptions are stated in the paper and the model is available as a supplementary file.

    Findings Our model suggests that in 2010 there were around 2.2 million children under 5 years of age living with coeliac disease. Among these children there could be 42,000 deaths related to coeliac disease annually. In 2008, deaths related to coeliac disease probably accounted for approximately 4% of all childhood diarrhoeal mortality.

    Conclusions Although coeliac disease may only account for a small proportion of diarrhoeal mortality, these deaths are not preventable by applying normal diarrhoea treatment guidelines, which may even involve gluten-based food supplements. As other causes of diarrhoeal mortality decline, coeliac disease will become a proportionately increasing problem unless consideration is given to trying gluten-free diets for children with chronic diarrhoea and malnutrition.

  • 7. Chaparro, M Pia
    et al.
    de Luna, Xavier
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    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 Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindgren, Urban
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic and social geography.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Koupil, Ilona
    Childhood family structure and women's adult overweight risk: A longitudinal study2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 5, p. 511-519Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to investigate whether women's adult overweight and obesity risk was associated with their childhood family structure, measured as their mothers' marital status history, during the women's first 18 years of life.

    METHODS: Using linked register data, we analyzed 30,584 primiparous women born in Sweden in 1975 who were between 19-35 years of age when their height and pre-pregnancy weight was recorded. The outcomes were women's overweight/obesity (body mass index (BMI) ≥ 25 kg/m(2)) and obesity (BMI ≥ 30 kg/m(2)) and the predictor was mothers' marital status history, which was summarized using sequence analysis. We carried out nested logistic regression models adjusting for women's age and maternal sociodemographic characteristics.

    RESULTS: Mothers' marital status history was summarized into six clusters: stable marriage, stable cohabitation, married then divorcing, cohabiting then separating, varied transitions, and not with father. In fully adjusted models and compared with women whose mothers belonged to the stable marriage cluster: (1) women whose mothers belonged to the other marital status clusters had higher odds of overweight/obesity (odds ratio (OR) ranging 1.15-1.19; p < 0.05); and (2) women whose mothers belonged to the stable cohabitation (OR = 1.31; 95% confidence interval (CI) = 1.14-1.52), cohabiting then separating (OR = 1.23; 95% CI = 1.01-1.49), varied transitions (OR = 1.24; 95% CI = 1.11-1.39), and not with father (OR = 1.24; 95% CI = 1.00-1.54) clusters had higher odds of obesity.

    CONCLUSIONS: Women whose mothers were not in stable marriage relationships had higher odds of being overweight or obese in adulthood. The finding that even women raised in the context of stable cohabitation had higher odds of being overweight or obese is intriguing as these relationships are socially accepted in Sweden.

  • 8.
    Chaparro, M Pia
    et al.
    Centre for Health Equity Studies (CHESS).
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Koupil, Ilona
    Centre for Health Equity Studies (CHESS).
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Häggström, Jenny
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    de Luna, Xavier
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Lindgren, Urban
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Regional inequalities in overweight and obesity among first-time pregnant women in Sweden, 1992–20102015In: 22nd European Congress on Obesity (ECO2015), Prague, Czech Republic, May 6-9, 2015: abstracts, S. Karger, 2015, Vol. 8: suppl 1, p. 119-119Conference paper (Refereed)
  • 9.
    Chaparro, M. Pia
    et al.
    Centre for Health Equity Studies (CHESS).
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Koupil, Ilona
    Centre for Health Equity Studies (CHESS).
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Häggström, Jenny
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    de Luna, Xavier
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Lindgren, Urban
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Regional inequalities in pre-pregnancy overweight and obesity in Sweden, 1992, 2000, and 20102015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 5, p. 534-539Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate regional differences and time trends in women’s overweight and obesity in Sweden. Methods: Using datafrom the Swedish Medical Birth Register (women aged ⩾18 years, first pregnancy only) and the Total Population Registeraccessed through the Umeå SIMSAM Lab, age-standardized prevalence of pre-pregnancy overweight/obesity (BMI ⩾ 25 kg/m2) and obesity (BMI ⩾ 30 kg/m2) were estimated by county for the years 1992, 2000, and 2010. Maps were created usingArcMap v10.2.2 to display regional variations over time and logistic regression analyses were used to assess if the observedtrends were significant. Results: The prevalence of pre-pregnancy overweight/obesity and obesity increased significantly inall Swedish counties between 1992, and 2010. In 2010, Södermanland and Gotland exhibited the highest age-standardizedoverweight/obesity (39.7%) and obesity (15.1%) prevalence, respectively. The sharpest increases between 1992 and 2010were observed in Västerbotten for overweight/obesity (75% increase) and in Gotland for obesity (233% increase). Across theyears, Stockholm had the lowest prevalence of overweight/obesity (26.3% in 2010) and obesity (7.3% in 2010) and one ofthe least steep increases in prevalence of both between 1992 and 2010. Conclusions: Substantial regional differencesin pre-pregnancy overweight and obesity prevalence are apparent in Sweden. Further research should elucidatethe mechanisms causing these differences.

  • 10. Collin, Pekka
    et al.
    Kaukinen, Katri
    Vogelsang, Harald
    Korponay-Szabó, Ilma
    Sommer, Rudolf
    Schreier, Elisabeth
    Volta, Umberto
    Granito, Alessandro
    Veronesi, Lorenza
    Mascart, Françoise
    Ocmant, Annick
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lagerqvist, Carina
    Bürgin-Wolff, Annemarie
    Hadziselimovic, Faruk
    Furlano, Raoul I
    Sidler, Marc A
    Mulder, Chris J J
    Goerres, Marije S
    Mearin, M Luisa
    Ninaber, Maarten K
    Gudmand-Høyer, Eivind
    Fabiani, Elisabetta
    Catassi, Carlo
    Tidlund, Helena
    Alainentalo, Lisbeth
    Mäki, Markku
    Antiendomysial and antihuman recombinant tissue transglutaminase antibodies in the diagnosis of coeliac disease: a biopsy-proven European multicentre study.2005In: Eur J Gastroenterol Hepatol, ISSN 0954-691X, Vol. 17, no 1, p. 85-91Article in journal (Refereed)
  • 11. Dalmar, Abdirisak Ahmed
    et al.
    Hussein, Abdullahi Sheik
    Walhad, Said Ahmed
    Ibrahim, Abdirashid Omer
    Abdi, Abshir Ali
    Ali, Mohamed Khalid
    Ereg, Derie Ismail
    Egal, Khadra Ali
    Shirwa, Abdulkadir Mohamed
    Aden, Mohamed Hussain
    Yusuf, Marian Warsame
    Abdi, Yakoub Aden
    Freij, Lennart
    Johansson, Annika
    Mohamud, Khalif Bile
    Abdulkadir, Yusuf
    Emmelin, Maria
    Eriksen, Jaran
    Erlandsson, Kerstin
    Gustafsson, Lars L.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Klingberg-Allvin, Marie
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Källestål, Carina
    Målqvist, Mats
    Osman, Fatumo
    Persson, Lars-Åke
    Sahlén, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1348693Article in journal (Refereed)
    Abstract [en]

    This paper presents an initiative to revive the previous Somali-Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.

  • 12. Danielsson, L
    et al.
    Stenhammar, L
    Ascher, H
    Cavell, B
    Dannaeus, A
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lindberg, T
    Lindquist, B
    [Gluten intolerance in children--diagnostic routines in Sweden 1996. Great variations in celiac disease studies]1997In: Lakartidningen, ISSN 0023-7205, Vol. 94, no 37, p. 3165-8Article in journal (Other academic)
  • 13. Danielsson, L
    et al.
    Stenhammar, L
    Ascher, H
    Cavell, B
    Dannaeus, A
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lindberg, T
    Lindquist, B
    [Proposed criteria for diagnosis of celiac disease in children]1998In: Lakartidningen, ISSN 0023-7205, Vol. 95, no 20, p. 2342-3Article in journal (Other academic)
  • 14.
    Edin, Kerstin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/ Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Nilsson, Bo
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/ Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Norris, Shane A
    Kahn, Kathleen
    Umeå University, Faculty of Arts, Department of culture and media studies. MRC/ Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Perspectives on intimate relationships among young people in rural South Africa: the logic of risk2016In: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351, Vol. 18, no 9, p. 1010-1024Article in journal (Refereed)
    Abstract [en]

    This paper explores how young people in rural South Africa understand gender, dating, sexuality and risk-taking in adolescence. The empirical material drawn upon consists of 20 interviews with young men and women (aged 18-19) and reflects normative gender patterns characterised by compulsory heterosexuality and dating as obligatory, and representing key symbols of normality. However, different meanings of heterosexual relationships are articulated in the interviews, for example in the recurring concept of 'passing time', and these meanings show that a relationship can be something arbitrary: a way to reduce boredom and have casual sex. Such a rationale for engaging in a relationship reflects one of several other normative gender patterns, which relate to the trivialisation of dating and sexual risk-taking, and which entail making compromises and legitimising deviations from the 'ideal' life-script and the hope of a better future. However, risks do not exclusively represent something bad, dangerous or immoral, because they are also used as excuses to avoid sex, HIV acquisition and early pregnancy. In conclusion, various interrelated issues can both undermine and/or reinforce risk awareness and subsequent risk behaviour. Recognition of this tension is essential when framing policies to support young people to reduce sexual risk-taking behaviour.

  • 15.
    Edvardsson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Garvare, Rickard
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Nyström, Monica E
    Medical Management Centre, Department of Learning, Informatics, Management & Ethics, Karolinska Institutet, Stockholm Sweden .
    Sustainable practice change. Professionals' experiences with a multisectoral child health promotion programme in Sweden.2011In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, no 1, p. 61-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: New methods for prevention and health promotion and are constantly evolving; however, positive outcomes will only emerge if these methods are fully adopted and sustainable in practice. To date, limited attention has been given to sustainability of health promotion efforts. This study aimed to explore facilitators, barriers, and requirements for sustainability as experienced by professionals two years after finalizing the development and implementation of a multisectoral child health promotion programme in Sweden (the Salut programme). Initiated in 2005, the programme uses a 'Salutogenesis' approach to support health-promoting activities in health care, social services, and schools.

    METHODS: All professionals involved in the Salut Programme's pilot areas were interviewed between May and September 2009, approximately two years after the intervention package was established and implemented. Participants (n=23) were midwives, child health nurses, dental hygienists/dental nurses, and pre-school teachers. Transcribed data underwent qualitative content analysis to illuminate perceived facilitators, barriers, and requirements for program sustainability.

    RESULTS: The programme was described as sustainable at most sites, except in child health care. The perception of facilitators, barriers, and requirements were largely shared across sectors. Facilitators included being actively involved in intervention development and small-scale testing, personal values corresponding to programme intentions, regular meetings, working close with collaborators, using manuals and a clear programme branding. Existing or potential barriers included insufficient managerial involvement and support and perceived constraints regarding time and resources. In dental health care, barriers also included conflicting incentives for performance. Many facilitators and barriers identified by participants also reflected their perceptions of more general and forthcoming requirements for program sustainability.

    CONCLUSIONS: These results contribute to the knowledge of processes involved in achieving sustainability in health promotion initiatives. Facilitating factors include involving front-line professionals in intervention development and using small scale testing; however, the success of a program requires paying attention to the role of managerial support and an overall supportive system. In summary, these results emphasise the importance for both practitioners and researchers to pay attention to parallel processes at different levels in multidisciplinary improvement efforts intended to ensure sustainable practice change.

  • 16.
    Edvardsson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Garvare, Rickard
    Nyström, Monica E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Small, Rhonda
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Giving offspring a healthy start: parents' experiences of health promotion and lifestyle change during pregnancy and early parenthood2011In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, p. 936-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There are good opportunities in Sweden for health promotion targeting expectant parents and parents of young children, as almost all are reached by antenatal and child health care. In 2005, a multisectoral child health promotion programme (the Salut Programme) was launched to further strengthen such efforts.

    METHODS: Between June and December 2010 twenty-four in-depth interviews were conducted separately with first-time mothers and fathers when their child had reached 18 months of age. The aim was to explore their experiences of health promotion and lifestyle change during pregnancy and early parenthood. Qualitative manifest and latent content analysis was applied.

    RESULTS: Parents reported undertaking lifestyle changes to secure the health of the fetus during pregnancy, and in early parenthood to create a health-promoting environment for the child. Both women and men portrayed themselves as highly receptive to health messages regarding the effect of their lifestyle on fetal health, and they frequently mentioned risks related to tobacco and alcohol, as well as toxins and infectious agents in specific foods. However, health promotion strategies in pregnancy and early parenthood did not seem to influence parents to make lifestyle change primarily to promote their own health; a healthy lifestyle was simply perceived as 'common knowledge'. Although trust in health care was generally high, both women and men described some resistance to what they saw as preaching, or very directive counselling about healthy living and the lack of a holistic approach from health care providers. They also reported insufficient engagement with fathers in antenatal care and child health care.

    CONCLUSION: Perceptions about risks to the offspring's health appear to be the primary driving force for lifestyle change during pregnancy and early parenthood. However, as parents' motivation to prioritise their own health per se seems to be low during this period, future health promoting programmes need to take this into account. A more gender equal provision of health promotion to parents might increase men's involvement in lifestyle change. Furthermore, parents' ranking of major lifestyle risks to the fetus may not sufficiently reflect those that constitute greatest public health concern, an area for further study.

  • 17.
    Edvardsson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Garvare, Rickard
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Small, Rhonda
    Nyström, Monica E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Improving child health promotion practices in multiple sectors: outcomes of the Swedish Salut Programme2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 1, p. 920-Article in journal (Refereed)
    Abstract [en]

    Background: To improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme) on professionals' self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation.

    Methods: A before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation) in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points.

    Results: Self-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1) an increase in the extent to which midwives in antenatal care raised issues related to men's violence against women, 2) an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3) an increased use of motivational interviewing (MI) and separate 'fathers visits' in child health care 4) improvements in the supply of healthy snacks and beverages in open pre-schools and 5) increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff.

    Conclusion: This multisectoral programme for health promotion, based on sector-specific intervention packages developed and tested by end users, and introduced via interactive multisectoral seminars, shows potential for improving health promotion practices and collaboration across sectors. Consideration of the key facilitators and barriers for programme implementation as highlighted in this study can inform future improvement efforts.

  • 18.
    Edvardsson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. La Trobe University, Melbourne, Australia.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Small, Rhonda
    La Trobe University, Melbourne, Australia.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    A population-based study of overweight and obesity in expectant parents: socio-demographic patterns and within-couple associations2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, article id 923Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Overweight and obesity in pregnancy increase the risk of several adverse pregnancy outcomes. However, both mothers' and fathers' health play an important role for long-term health outcomes in offspring. While aspects of health and lifestyle of pregnant women have been reported, the health of expectant fathers and correlations of health variables within couples have received less attention. This study aimed to explore the prevalence and socio-demographic patterns of overweight and obesity in Swedish expectant parents, and to assess within-couple associations.

    METHODS: This population-based, cross-sectional study investigated self-reported data from 4352 pregnant women and 3949 expectant fathers, comprising 3356 identified couples. Data were collected in antenatal care clinics between January 2008 and December 2011. Descriptive, correlation and logistic regression analyses were performed.

    RESULTS: The self-reported prevalence of overweight (BMI 25.0-29.99) and obesity (BMI >=30.0) was 29% among women (pre-pregnancy) and 53% among expectant fathers. In a majority of couples (62%), at least one partner was overweight or obese. The odds of being overweight or obese increased relative to partner's overweight or obesity, and women's odds of being obese were more than six times higher if their partners were also obese in comparison with women whose partners were of normal weight (OR 6.2, CI 4.2-9.3). A socio-demographic gradient was found in both genders in relation to education, occupation and area of residence, with higher odds of being obese further down the social ladder. The cumulative influence of these factors showed a substantial increase in the odds of obesity for the least compared to the most privileged (OR 6.5, CI 3.6-11.8).

    CONCLUSIONS: The prevalence of overweight and obesity in expectant parents was high, with a clear social gradient, and a minority of couples reported both partners with a healthy weight at the onset of pregnancy. Partner influence on health and health behaviours, and the role both mothers and fathers play in health outcomes of their offspring, underpin the need for a more holistic and gender inclusive approach to the delivery of pregnancy care and postnatal and child health services, with active measures employed to involve fathers.

  • 19.
    Edvardsson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Small, Rhonda
    La Trobe University, Melbourne, Australia .
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Overweight and obesity in expectant parents: socio-demographic patterns and within-couple associations. A population-based, cross-sectional study.In: Article in journal (Refereed)
  • 20.
    Eriksson, Malin
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lindgren, Urban
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Child health and place: How is neighborhood social capital associated with child health injuries?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 41-41Article in journal (Other academic)
    Abstract [en]

    Background: Child health inequalities can be explained by social determinants of health, including neighborhood social capital. Swedish research about place effects on children's health is limited. This project aims to contribute to knowledge on how neighborhood social capital may influence child health in the Swedish context. The overall research questions were: What is the incidence rate of child injuries in the living environments among boys and girls? What are the associations between neighborhood social capital and child injuries?

    Methods: Child injury data from the Umeå SIMSAM Lab were utilized, with data from all children 0-12 years of age, living in Umeå municipality during 2006-2009. Individual child injury and residential area data were linked to a neighborhood social capital index, where 49 defined neighborhoods were assigned a score from low- high in social capital, based on people’s perceptions about their neighborhoods. Individual, household and neighborhood demographic and socioeconomic variables (country of birth, educational level, income and family type) were also extracted from the Umeå SIMSAM lab. Logistic regression analyses were conducted to analyze factors associated with child injury.

    Results: We observed 3930 injury events that occurred in the living environments, experienced by 24 000 children who lived in 14 767 households within 49 neighborhoods. The incidence rate of child injuries was about 72.5/1000 for boys and 60/1000 for girls. The odds for child injures was lower in neighborhoods with high social capital compared to neighborhoods with low social capital (OR 0.87 95%CI 0.80-0.95) after controlling for demographic and socioeconomic factors at individual, household and neighborhood level. The protective effects of neighborhood social capital were stronger for girls than boys.

    Conclusions: Neighborhood social capital may have a protective effect on child injuries and especially so for girls.

    Key messages:

    • Neighborhood conditions have a significant influence on child health inequalities in the Swedish context, including inequalities in child injuries.
    • Mobilization of neighborhood social capital might be good investment for reducing child injuries.
  • 21.
    Eurenius, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Garvare, Rickard
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Westerlund, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Vägledande samspel (ICDP): vad gynnar ett framgångsrikt införande i verksamheterna och främjar ICDP ett utvecklat föräldraskap och god psykisk hälsa hos barnen?2013In: Familjepeppen - en famljestödssatsning i Umeåregionen / [ed] Widding U, Olsson J, Umeå, 2013, p. 32-36Chapter in book (Other academic)
  • 22.
    Eurenius, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Department of Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sundqvist, Magdalena
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Maternal and paternal self-rated health and BMI in relation to lifestyle in early pregnancy: The Salut Programme in Sweden2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 7, p. 730-741Article in journal (Refereed)
    Abstract [en]

    Aim: This study’s aim was to increase knowledge about maternal and paternal self-rated health and body mass index in relation to lifestyle during early pregnancy. Methods: Study subjects were expectant parents visiting antenatal care (2006—07) as part of the Salut Programme in northern Sweden. During early pregnancy, 468 females and 413 male partners completed questionnaires. The questions addressed sociodemography, self-rated general health, weight and height, satisfaction with weight, and lifestyle, such as dietary habits, physical activity, sleeping pattern, and alcohol, tobacco, and drug use. Results: Most rated their general health as good, very good, or excellent, although women less often than men (88% and 93%). The sex difference was more prominent when restricting the comparison to self-rated health being very good or excellent - 49% of the women compared to 61% of the men. Being overweight or obese was common (53% of the men and 30% of the women). Few participants fulfilled the national recommendations with respect to a health-enhancing lifestyle; this was somewhat more common for women than men. Expectant parents with normal body mass index and vigorous physical activity were more likely to have very good or excellent self-rated health. Conclusions: Most expectant parents perceived their general health as good, although this perception was less for women than men. Being overweight and having a non-health-enhancing lifestyle were more common for men than women. Thus, there is need for more powerful health-promoting interventions for expectant parents.

  • 23.
    Eurenius, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Richter Sundberg, Linda
    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.
    Silfverdal, Sven-Arne
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Social-emotional problems among three-year-olds differ based on the child's gender and custody arrangement.2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to investigate mental health with respect to social-emotional problems among three-year-olds in relation to their gender, custody arrangements and place of residence.

    METHODS: A cross-sectional population-based design was used, encompassing 7,179 three-year-olds in northern Sweden during the period 2014-2017 from the regional Salut Register. Descriptive and comparative analyses were performed based on parents' responses on the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE), supplemented with items on gender, custody arrangement and place of residence.

    RESULTS: Parental-reported social-emotional problems were found in almost 10% of the children. Boys were reported to have more problems (12.3%) than girls (5.6%) (p<0.001). Parents were most concerned about children's eating habits and interactions at mealtimes. Parents not living together reported more problems among their children than those living together (p<0.001). When stratifying by custody arrangement, girls in rural areas living alternately with each parent had more problems compared to those in urban areas (p<0.008).

    CONCLUSION: Gender and custody arrangements appear to be important factors for social-emotional problems among three-year-olds. Thus, such conditions should receive attention during preschool age, preferably by a systematic preventive strategy within Child Health Care. This article is protected by copyright. All rights reserved.

  • 24. Feldman, I.
    et al.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Haggstrom, J.
    Sampaio, F.
    Lindkvist, M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Pulkki-Brännström, Anni-Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Effectiveness of the Salut Program: a universal health promotion intervention for parents & children2016Conference paper (Refereed)
  • 25. Feldman, Inna
    et al.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Häggstrom, Jenny
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE).
    Sampaio, Filipa
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE).
    Pulkki-Brannstrom, Anni-Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Effectiveness and cost-effectiveness of the Salut Programme: a universal health promotion intervention for parents and children-protocol of a register-based retrospective observational study2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 8, article id e011202Article in journal (Refereed)
    Abstract [en]

    Introduction: There is inadequate evidence for the effectiveness and cost-effectiveness of health promotion interventions. The Salut Programme aims to reach all parents and children in the Vasterbotten County of Sweden with a combination of health promotion interventions initiated during pregnancy and continued over the childhood period. This study protocol describes an effectiveness study and an economic evaluation study, where the ongoing Salut Programme is compared to care-as-usual over the periods of pregnancy, delivery and the child's first 2 years of life. Methods: A register-based retrospective observational study design will be used with existing data sources with respect to exposures and outcomes. Outcomes of interest are clustered at 3 points: around the child's birth, 1 month after the child's birth and 2 years after the child's birth. We will simulate an experiment by retrospectively identifying and comparing children and their parents in the geographical areas where the Salut Programme was implemented since 2006 and onwards, and the areas where the Programme was not implemented before 2009. Outcomes will be analysed and compared for the premeasure period, and the postmeasure period for both groups. Our analysis combines difference-in-difference estimation with matching. A complementary analysis will be carried out on the longitudinal subsample of mothers who gave birth at least once during each of the time periods. The economic evaluation aims to capture the wider societal costs and benefits of the Salut Programme for the first 2 years of the children's lives. Incremental costs will be compared with incremental health gains and the results will be presented as a cost-consequence analysis. Ethics and dissemination: The Regional Ethical Review Board in Umea has given clearance for the Salut Programme research (2010-63-31M). No individual's identity will be revealed when presenting results. This study will provide information that can guide decision-makers to allocate resources optimally.

  • 26.
    Forsner, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Högskolan Dalarna.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nordyke, Katrina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Relaxation and guided imagery used with 12-year-olds during venipuncture in a school-based screening study2014In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 18, no 3, p. 241-252Article in journal (Refereed)
    Abstract [en]

    Needle-related procedures are reported to be problematic for children. In a school-based celiac disease screening, 12-year-olds' experiences with relaxation and guided imagery (R-GI) during venipuncture were investigated. One group tried nurse-led R-GI (n = 60) and another group received standard care (SC; n = 49). A mixed method design was applied using short written narratives, facial affective scale (FAS), and visual analog scale (VAS) for pain intensity. Qualitative content analysis highlighted that diversity and contradictions when facing blood tests. FAS scores were significantly lower in the SC group before (p = 0.01), during (p = 0.01), and after (p = 0.01) venipuncture. VAS scores did not differ between the groups. The blood test was mostly experienced as unproblematic, and GI during venipuncture did not decrease pain or affect. However, the fact that a number of children scored high FAS indicates a need for effective methods to help children cope with needle-related school-based procedures.

  • 27. Grodzinsky, E
    et al.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Juto, P
    Olcén, P
    Fälth-Magnusson, K
    Persson, L A
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    New automated immunoassay measuring immunoglobulin A antigliadin antibodies for prediction of celiac disease in childhood.2001In: Clinical and diagnostic laboratory immunology, ISSN 1071-412X, Vol. 8, no 3, p. 564-570Article in journal (Refereed)
  • 28.
    Hernell, Olle
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Forsberg, G
    Hammarström, ML
    Hammarström, S
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Celiac disease: Effect of weaning on disease risk2005In: Nestlé Nutrition Workshops, 2005, p. 27-42Conference paper (Other academic)
  • 29.
    Hernell, Olle
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Forsberg, G
    Hammarström, S
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Hammarström, M-L
    Coeliac disease: a model to study oral tolerance2002In: Gut Ecology, Martin Dunitz, London , 2002, p. 73-79Chapter in book (Other academic)
  • 30.
    Hernell, Olle
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Persson, L A
    Coeliac disease: effect of early feeding on the incidence of the disease.2001In: Early Hum Dev, ISSN 0378-3782, Vol. 65 Suppl, p. S153-60Article in journal (Refereed)
  • 31. Hogen Esch, Caroline Elisabeth
    et al.
    Rosén, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Auricchio, Renata
    Romanos, Jihane
    Chmielewska, Anna
    Putter, Hein
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Szajewska, Hania
    Koning, Frits
    Wijmenga, Cisca
    Troncone, Riccardo
    Mearin, Maria Luisa
    The preventCD study design: towards new strategies for the prevention of coeliac disease2010In: European Journal of Gastroenterology and Hepathology, ISSN 0954-691X, E-ISSN 1473-5687, Vol. 22, no 12, p. 1424-1430Article in journal (Refereed)
    Abstract [en]

    PreventCD is expected to elucidate some of the genetic and immunological mechanisms involved in the process of immune intolerance.

  • 32.
    Holmström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Oudin, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    de Luna, Xavier
    Umeå University, Faculty of Social Sciences, Department of Statistics.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Lindgren, Urban
    Umeå University, Faculty of Social Sciences, Department of Social and Economic Geography.
    Bergdahl, Ingvar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    SIMSAM-nätverket i Umeå strävar mot att bli ett framstående center för registerforskning som knyter samman barndomen med livslång hälsa och välfärd2011In: SVEPET - Medlemstidning för Svensk Epidemiologisk Förening (SVEP), ISSN 1101-4385, Vol. 29, no 3, p. 8-9Article in journal (Other academic)
    Abstract [sv]

    Vetenskapsrådets SIMSAM initiativ syftar till att stärka multidisciplinär registerforskning i Sverige. Inom SIMSAM-nätverket i Umeå arbetar vi tvärvetenskapligt med sikte på att utvecklas till ett center med excellens kring mikrodataforskning som knyter samman barndomen med livslång hälsa och välfärd. Just nu fokuserar vi på att få tillgång till sammanlänkade data från ett flertal nationella och regionala register för att komma vidare med vår planerade forskning. Dessutom har Umeå-nätverket nyligen fått i uppdrag att leda den nationella samordningen av SIMSAM initiativet.

  • 33. Holowko, N.
    et al.
    Chaparro, M. P.
    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, G.
    Koupil, Ilona
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Department of Sociology. Centre for Health Equity Studies,Stockholm University/Karolinska Institutet, Stockholm.
    Goodman, A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Department of Sociology.
    Social inequality in BMI change and gestational weight gain in the first and second pregnancy among women in Sweden2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, p. 3-4Article in journal (Other academic)
  • 34.
    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.

  • 35. Husby, Steffen
    et al.
    Olsson, Cecilia
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Celiac disease and risk management of gluten2014In: Risk management for food allergy / [ed] Madsen CB, Crevel RWR, Mills C, Taylor SL, Elsevier, 2014, p. 129-152Chapter in book (Other academic)
    Abstract [en]

    Celiac disease (CD) is a distinct disease caused by gluten from wheat and other related prolamins from rye and barley. CD is chronic, may affect multiple organs, and has autoimmune components. The clinical presentation may be diverse, reaching from frank mal-absorption to effects such as iron deficiency, anemia, or osteoporosis. The main autoantigen in CD is transglutaminase 2 (TG2), and IgA anti-TG2 antibodies have a high diagnostic accuracy. New guidelines for the diagnosis of CD in children and adolescents have recently been published. CD may be diagnosed at any age and in most populations CD is common, affecting approximately 1% of the general population. The cornerstone treatment of CD is a gluten-free diet. The diet may be cumbersome, and in children as well as adults diet adherence may present a considerable challenge. Maximal levels for gluten content in gluten-free foods are given in Codex Alimentarius. Governmental support for patients and families is important, and education and participation in a celiac patient organization is of value.

  • 36.
    Häggström, Jenny
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Sampaio, Filipa
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Pulkki-Brännström, Anni-Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Feldman, Inna
    Is the Salut Programme an effective and cost-effective universal health promotion intervention for parents and their children?: a register-based retrospective observational study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 9, article id e016732Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study investigates the effectiveness and cost-effectiveness of the Salut Programme, a universal health promotion intervention, compared with care-as-usual, over the periods of pregnancy, delivery and the child's first 2 years of life.

    METHOD: We adopted a register-based retrospective observational design using existing data sources with respect to both exposures and outcomes. Health outcomes and costs were compared between geographical areas that received care-as-usual (non-Salut area) and areas where the programme was implemented (Salut area). We included mothers and their children from both the Salut and non-Salut areas if: (1) the child was born 2002-2004 (premeasure period) or (2) the child was born 2006-2008 (postmeasure period). The effectiveness study adopted two strategies: (1) a matched difference-in-difference analysis using data from all participants and (2) a longitudinal analysis restricted to mothers who had given birth twice, that is, both in the premeasure and postmeasure periods. The economic evaluation was performed from a healthcare and a limited societal perspective. Outcomes were clustered during pregnancy, delivery and birth and the child's first 2 years.

    RESULTS: Difference-in-difference analyses did not yield any significant effect on the outcomes. Longitudinal analyses resulted in significant positive improvement in Apgar scores, reflecting the newborn's physical condition, with more children having a normal Apgar score (1 min +3%, 5 min +1%). The cost of the programme was international dollar (INT$)308/child. From both costing perspectives, the programme yielded higher effects and lower costs than care-as-usual, being thus cost-saving (probability of around 50%).

    CONCLUSIONS: Our findings suggest that the Salut Programme is an effective universal intervention to improve maternal and child health, and it may be good value for money; however, there is large uncertainty around the cost estimates.

  • 37. Högberg, L
    et al.
    Webb, C
    Fälth-Magnusson, K
    Forslund, T
    Magnusson, K-E
    Danielsson, L
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sandström, Olof
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Sundqvist, T
    Children with screening-detected coeliac disease show increased levels of nitric oxide products in urine2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 7, p. 1023-1027Article in journal (Refereed)
    Abstract [en]

    Aim: Increased concentration of nitric oxide (NO) metabolites, nitrite and nitrate, in the urine is a strong indication of ongoing small intestinal inflammation, which is a hallmark of the enteropathy of coeliac disease (CD). It has previously been shown that children with symptomatic, untreated CD have increased levels of NO oxidation products in their urine. The aim of this study was to investigate whether screening-detected, asymptomatic coeliac children display the same urinary nitrite/nitrate pattern.

    Methods: In a multicenter screening study, serum samples were collected from 7208 12-year-old children without previously diagnosed CD. Sera were analysed for anti-human tissue transglutaminase (tTG) of isotype IgA. Small bowel biopsy was performed in antibody-positive children, yielding 153 new cases of CD. In the screening-detected individuals, the sum of nitrite and nitrate concentrations in the urine was analysed and used as an indicator of NO production. For comparison, 73 children with untreated, symptomatic CD were studied.

    Results: The nitrite/nitrate levels in children with screening-detected CD and those with untreated symptomatic CD did not differ significantly. Both groups had significantly increased urinary nitrite/nitrate concentrations compared to the children with normal small bowel biopsy (p < 0.001).

    Conclusion: Children with screening-detected CD have increased production of NO just as children with untreated symptomatic CD. High NO metabolite levels in the urine may indicate a pathogenetic feature of CD and be a marker of major clinical importance.

  • 38.
    Höög, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Garvare, Rickard
    Division of Quality Management, Luleå University of Technology, Luleå.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyström, Monica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Challenges in managing a multi-sectoral health promotion program2013In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 26, no 4, p. 368-386Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to investigate program management teams’ views on issuesand challenges in managing a large, multi-sectoral child health promotion program in Sweden.

    Design/methodology/approach: In total, 17 participants representing two autonomous programmanagement teams, one strategic and one operational, were interviewed. Analysis of interview datawas complemented with reviews of program documents.

    Findings: Program management teams identified important issues concerning the program’sformal structure, goals, role distribution, and change and dissemination processes, but lacked a sharedmental model of the situation. Inter and intra group communication, long- and short-term strategicplanning were further areas in need of improvement. While issues and challenges might seem to beagreed upon by the program’s change agents, closer inspection reveals variation in key characteristicsas well as in perspectives on solutions.

    Originality/value: Health promotion programs are challenging. Researchers trying tounderstand program success have focused on particular interventions, contextual factors andprogram recipients. Less research has focused on the internal processes of teams tasked withwide-ranging change mandates and the effects such processes can have on program outcomes. Thisstudy contributes to a deeper understanding on internal processes and mental models of changeagent teams.

  • 39.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Celiac disease - is there a dietary prevention?2004In: Proceedings of the 18th meeting of the working group on Prolamin analysis and toxicity, 2004, p. 165-171Conference paper (Other academic)
  • 40.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    On the multifactorial aetiology of coeliac disease2001In: Scandinavian Journal of Nutrition/Näringsforskning, Vol. 45, p. 184-185Article in journal (Other academic)
  • 41.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    On the multifactorial etiology of celiac disease2001Doctoral thesis, comprehensive summary (Other academic)
  • 42.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    The incidence of celiac disease in the county of Västerbotten reported to the European multicenter study1992In: Common food intolerance I: Epidemiology of Coeliac Disease, Karger, Basel , 1992Chapter in book (Other (popular science, discussion, etc.))
  • 43.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    The Swedish epidemic of coeliac disease explored using an epidemiological approach--some lessons to be learnt.2005In: Best Pract Res Clin Gastroenterol, ISSN 1521-6918, Vol. 19, no 3, p. 425-40Article in journal (Refereed)
  • 44.
    Ivarsson, Anneli
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    de Luna, Xavier
    Umeå University, Faculty of Social Sciences, Department of Statistics.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Lindgren, Urban
    Umeå University, Faculty of Social Sciences, Department of Social and Economic Geography.
    Bergdahl, Ingvar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Registerdata om barndomen: kunskapsbas för hållbar hälsa och välfärd2010In: SVEPET. Medlemsbladet för Svensk Epidemiologisk Förening (Svep), Vol. 28, no 3, p. 4-6Article in journal (Other academic)
  • 45.
    Ivarsson, Anneli
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Hernell, O
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    On the multifactorial aetiology of coeliac disease2004In: Annales Nestlé, Vol. 62, p. 107-18Article in journal (Other academic)
  • 46.
    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. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Utredning av celiaki. Minskat antal barn får diagnosen celiaki.1998In: Små & Stora Nyheter, Vol. 2, p. 14-15Article in journal (Other (popular science, discussion, etc.))
  • 47.
    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)
  • 48.
    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.
    Persson, LÅ
    Celiaki - en ny folksjukdom?1994In: Vår Föda, Vol. 46, p. 481-485Article in journal (Other academic)
  • 49.
    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.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Persson, Lars Ake
    Breast-feeding protects against celiac disease.2002In: Am J Clin Nutr, ISSN 0002-9165, Vol. 75, no 5, p. 914-21Article in journal (Refereed)
  • 50.
    Ivarsson, Anneli
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Högberg, L
    Stenhammar, L
    The Swedish Childhood Coeliac Disease Working Group after 20 years: history and future.2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 9, p. 1429-1431Article in journal (Refereed)
123 1 - 50 of 143
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