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  • 1.
    Vujicic, Slobodan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Association between Nephropathia Epidemica and Poor Sleep Quality as a Long-Term Outcome2016Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Nephropathia epidemica (NE) is a common viral disease in northern Sweden. While the clinical aspects of NE have been widely described, the long-term outcomes following the recovery phase of the disease are not well known. Research on other infectious diseases shows that long-term consequences, such as chronic fatigue, poor general health, and poor sleep quality, may persist after the recovery phase of an infectious disease. The aim of this study was to investigate if there is an association between nephropathia epidemica and poor sleep quality as a long-term consequence.

    Methods: Secondary data from a survey "Patient reported long-term outcomes of Puumala virus infection in northern Sweden" was used for this study. 1132 former NE patients and 915 non-exposed subjects responded to the survey. The age range was 18-93 years. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). As a dependent variable sleep quality was evaluated as both continuous variable (PSQI total score) and a binary variable (poor sleep quality). An association between NE exposure and sleep quality was evaluated by simple and multiple linear and logistic regression models. The analyses were stratified by sex. Results with p values less than 0.05 and confidence intervals of 95% were considered statistically significant.

    Results: Former NE patients reported higher PSQI total scores than the subjects in the comparison group, indicating that exposure to NE is associated with poor sleep quality (results statistically significant). Female patients had higher PSQI total scores than male patients (result statistically significant). The linear and logistic regression analyses of NE exposure and sleep quality showed similar results. After adjusting for the other variables in the study (age, current disease, smoking, obesity and exercise) sleep quality remained significantly associated with NE exposure. In men, sleep quality showed statistically significant association with time since exposure to NE only in the "≥4 years ago" category while the other categories (2-3 years ago, 1 year ago, 6-12 months ago and 3-6 months ago) did not show statistically significant results. In women, association between time since exposure to NE and sleep quality was statistically significant for "≥4 years ago", "2-3 years ago", and "1 year ago" and not statistically significant for "6-12 months ago" and "3-6 months ago".

    Conclusion: Poor sleep quality may be a long-term outcome of nephropathia epidemica. Former NE patients have higher PSQI component scores and a higher PSQI total score, which is indicative of poor sleep quality. Sleep quality is worse in female patients than in male patients. Time since exposure to NE does not have a significant impact on sleep quality. Further research is needed to better asses sleep disturbances after exposure to nephropathia epidemica.

  • 2.
    Vujicic, Slobodan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Socioeconomic inequalities and hazardous drinking in Northern Sweden2017Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Socioeconomic inequalities in alcohol consumption have been well documented in several different countries. However, little is known about prevalence of hazardous drinking in Northern Sweden in relation to all three components of socioeconomic status: education, occupation, and income. The aim of this study is to explore the association between socioeconomic status and hazardous alcohol consumption and to measure the impact of socioeconomic inequalities on hazardous drinking patterns in Northern Sweden.

    Methods: A cross-sectional study using data from the Swedish National Public Health Survey conducted in 2014. The sample included 25,667 people (50% response rate) between 16-84 years from the four northern counties of Sweden. Hazardous alcohol consumption was measured using AUDIT-C, a short version of the World Health Organisation’s Alcohol Use Disorders Identification Test. Education, occupation and income were used as determinants of socioeconomic status. Log-binomial regression was used to assess the association between socioeconomic status and hazardous drinking. Relative index of inequalities and slope index of inequality were used to measure the magnitude of socioeconomic inequalities in alcohol consumption.

    Results: Independent of the occupational level, amount of disposable income, gender, age, and marital status, educational attainment was inversely associated with hazardous drinking (low educational level had PR=1.61 and the medium level PR=1.46). Occupation and income were not significant predictors of hazardous drinking. The relative educational inequality showed that the low-educated group of people had an increased risk of hazardous drinking compared to the high-educated group (RII=1.62), while the absolute educational inequality was not significant. Income inequality was not significant in neither relative nor absolute terms.

    Conclusion: The results suggest that educational attainment has a significant effect on hazardous alcohol consumption while occupation and income do not play a significant role in hazardous drinking behavior. Furthermore, relative educational inequality in hazardous drinking is present in Northern Sweden, while income inequality does not have a significant impact on hazardous drinking behavior. Since the present study demonstrates that higher education predicts lower prevalence of hazardous drinking policy makers could consider focusing more attention towards education among young people.

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