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  • 101.
    Anticona, Cynthia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Bergdahl, Ingvar A
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lead exposure among children from native communities of the Peruvian Amazon basin2012Ingår i: Revista panamericana de salud pùblica, ISSN 1020-4989, E-ISSN 1680-5348, Vol. 31, nr 4, s. 296-302Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. To assess potential risk factors associated with elevated blood lead levels (BLLs) among children in two communities from the Corrientes River basin in the Peruvian Amazon.

    Methods. Children aged 0-17 years were screened for BLLs, hemoglobin levels, and anthropometric measures. Dwelling, family, and child data were collected through a parental questionnaire. Statistical analysis included descriptive and bivariate analysis. Multiple linear and logistic regressions using generalized estimating equations were also conducted to determine associated risk factors. A map of each community was drawn to examine the spatial distribution of BLLs.

    Results. Of 208 children (88 from 23 households of the Peruanito community and 120 from 28 households of Santa Isabel), 27.4% had BLLs >= 10 mu g/dL. The geometric mean (+/- standard deviation) BLL was 8.7 +/- 4.0 mu g/dL (range 3.0-26.8 mu g/dL). In the total population, linear regression analysis indicated that age was positively associated with BLLs (P < 0.05). Logistic regression analysis showed that boys had 2.12 times greater odds of having BLLs >= 10 mu g/dL than girls (P < 0.05). Among the children 0-3 years, those whose mothers had BLLs >= 10 mu g/dL had 45.0% higher odds of presenting BLLs >= 10 mu g/dL than children whose mothers had BLLs < 10 mu g/dL (P < 0.05).

    Conclusions. Older age, male gender, and mothers' BLL >= 10 mu g/dL were the main risk factors for elevated BLLs. The higher risk in boys 7-17 years suggests that exposure could be related to specific activities in this group, such as fishing and hunting. Continuous monitoring of BLLs in the Corrientes River population is recommended.

  • 102.
    Anticona, Cynthia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sources and risk factors for lead exposure in indigenous children of the Peruvian Amazon, disentangling connections with oil activity2012Ingår i: International journal of occupational and environmental health, ISSN 1077-3525, E-ISSN 2049-3967, Vol. 18, nr 4, s. 268-277Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: In the Corrientes river basin, Peruvian Amazon, lead exposure among indigenous communities was first reported in 2006. To address controversy regarding the main source of exposure, this study aimed to identify the sources and risk factors for lead exposure among children from the communities in question, and to clarify the potential relationship with oil activity.Methods: This cross-sectional study was conducted in six communities. Participants were children aged 0–17 years and their mothers. Data collection included blood lead levels (BLLs) and hemoglobin determination, a questionnaire on risk factors and environmental sampling. We used age-stratified multivariate regression models, with generalized estimating equation to account for correlation within households.Results: Twenty-seven percent of the children had BLLs ≧10 μg/dl. Mother's BLLs ≧10 μg/dl, playing and chewing lead scraps, fishing ≧three times/week, and living in highly oil-exposed communities increased the risk of having BLLs ≧10 μg/dl. Lead concentrations in sediment, soil, dust, and fish samples were below reference values.Conclusions: Mother's BLLs ≧10 μg/dl, playing and chewing lead scraps to manufacture fishing sinkers were the most important risk factors for children’s BLLs ≧10 μg/dl. The connection with oil activity appears to be through access to metal lead from the industry's wastes.

  • 103.
    Anticona, Cynthia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Coe, Anna-Britt
    Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Easier said than done: applying the Ecohealth principles to a study of heavy metals exposure among indigenous communities of the Peruvian Amazon2013Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, artikel-id 437Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The renewed interest in community participation in health research is linked to its potential for bridging gaps between research and practice. Its main attributes are the generation of knowledge that can lead to socially robust, long-lasting solutions and the creation of a colearner relationship between researchers and research users. Following this philosophy, Ecohealth has evolved into a specialized framework for participatory research on the impact of pollution on ecosystems and human health. However, its principles pose considerable challenges. Its outcomes are strongly influenced by contextual factors that are impossible to control for ahead of time.

    This paper describes how the Ecohealth principles were applied to an epidemiological study of heavy metals exposure among indigenous communities of the Peruvian Amazon. It illustrates how knowledge generated from participatory research does not necessarily imply solving a public health problem. This study aimed to contribute to the understanding of the benefits and barriers of following the basic principles of the Ecohealth approach, and assist researchers working in similar contexts.

    Research process Based upon their personal experience as participant observers, the authors describe the research process; then, they discuss the most important challenges faced, their implications, and the attempted strategies for resolution.

    Challenges Challenges were grouped into four themes: (1) building trust; (2) one partnership, many stakeholders, multiple agendas; (3) being a researcher; and (4) communicating complex and unexpected findings.

    Conclusions Integrating the principles of transdisciplinarity and participation posed a series of challenges to the research process that were difficult, and sometimes impossible to overcome. However, positive outcomes from this experience were the lessons learned by the different actors. Despite the lack of immediate action, it is expected that useful interventions to prevent and control lead exposure in the Corrientes population will be implemented in the medium term.

  • 104.
    Anticona Huaynate, Cynthia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lead exposure in indigenous children of the Peruvian Amazon: seeking the hidden source,venturing into participatory research2012Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Introduction. In 2006, a Peruvian environmental agency reported the presence of elevated blood lead levels (BLLs) in indigenous communities of the Corrientes river basin. This is a territory in the Peruvian Amazon where oil activity has been associated with serious environmental effects, with impact on an ongoing social conflict. This PhD project aimed to determine the lead sources, risk factors and pathways in children of these communities and to suggest control and prevention strategies. Given the arguments attributing the lead source to the oil activity pollution, the second objective was to clarify any potential connection between the two. This project was conducted by a collaborative research partnership with the regional health authorities and the community-based organization. The third objective was to characterize the challenges, facilitating factors and the lessons learned from the research process.

    Methods. Two epidemiological studies were conducted. Study I (2009) was carried out in three communities and study II (2010) in six communities with different levels of exposure to oil activity. The participants were children 0–17 years old. Data collection included: determination of BLLs, hemoglobin levels and anthropometric indicators, a risk factor questionnaire, an environmental assessment and a risk map. Data analysis included univariate, bivariate and multivariate logistic regression. Data for the third objective came from field notes, documents, interviews and a process of collective reflection.

    Results. Study I (n= 221) found no significant difference in the geometric mean(GM) BLLs between the communities exposed and not exposed to oil activity. Older age and being a boy were found as risk factors for BLLs ≥ 10 μg/dL. In study II (n= 346), age stratified logistic regression models indicated that children 0–3 years whose mothers had BLLs ≥ 10 μg/dL, children 0–6 years who played with pieces of lead and children 7–17 years who fished 3 times or more per weekor chewed pieces of lead to manufacture fishing sinkers had a significant increased risk of having BLLs ≥ 10 μg/dL. Children who lived in communities near oil battery facilities also had a significant increased risk of having BLLs ≥ 10 μg/dL. In both studies, environmental samples showed lead concentrations below reference levels. The challenges and facilitating factors identified focused on five interrelated themes: i) mutual trust, ii) multiple agendas, iii) equal participation, iv) competing research paradigms and v) complex and unexpected findings.

    Conclusions. Metal lead appeared to be the main source of exposure. Playing with pieces of lead and chewing pieces of lead to construct fishing sinkers appeared to be pathways of exposure for children aged 0–6 years and 7–17 years, respectively. Mothers’ BLLs > 10 μg/dL was a risk factor for BLLs > 10 μg/dL in children aged 0–3 years. Living in a community with high exposure to oil activity was a risk factor for BLLs > 10 μg/dL. The identified connection with oil activity was the proximity of communities to oil battery facilities and thus greater access to lead from cables and other industrial waste. Despite the numerous challenges, participatory research appears to be the most appropriate approach for this type of context. The study findings led us to recommend:i) a comprehensive community-based lead control and prevention plan,ii) the introduction of substitute non-harmful material(s) for fishing sinkers and iii) secure containment of the oil company’s waste deposits.

  • 105.
    Anyango, Cartrine
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    “I am their youth clinic”: - perceptions and attitudes towards Swedish youth clinics from the perspective of African immigrant parents2019Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction: Good health for young people is essential for they are both the present and the hope of tomorrow’s generation. Despite youth being in general a healthy period, young people are also in the high end of experiencing negative health outcomes including sexual and reproductive health. Parent-young people communication play a great role in shaping their sexual and reproductive health and decisions. Many studies have targeted youth clinics from different perspectives, but none from the perspective of immigrant parents with African origin. Thus, the aim of this study was to explore the perceptions and attitudes towards the Swedish youth clinic services from the perspective of the African immigrant parents.

    Methods: A qualitative study design was selected using semi-structured interviews with African immigrant parents in a medium sized city in northern Sweden. A semi structured interview guide with open ended questions was utilized following an emergent design. Four parents were interviewed. The interviews were recorded and later transcribed verbatim. Data was analysed inductively using qualitative content analysis.

    Results: Overall, the participants had mixed feelings about the youth clinics and services in almost all aspects. Parents acknowledged, appreciated, but on the other hand feared, the youth clinics which they perceived as providing too much freedom and openness regarding sexual and reproductive services and communication. Parents perceived culture and religion as playing a pivotal role in shaping parent-young people communication and sources of sexual and reproductive health information.

    Conclusion: This study shows that parents’ role could influence young people in accessing sexual and reproductive services. Parent-young people communication skills need to be improved by programs aimed at building parents’ skills through training. Due to the dilemma on cultural safe services depicted, a follow-up study to explore the perceptions from the perspective of the young people with African background in Sweden, is recommended.

  • 106.
    Anåker, Anna
    et al.
    Falun, Sweden.
    Nilsson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Elf, Marie
    Falun, Sweden.
    Nurses' perceptions of climate and environmental issues: a qualitative study2015Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 71, nr 8, s. 1883-1891Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study was to explore nurses' perceptions of climate and environmental issues and examine how nurses perceive their role in contributing to the process of sustainable development.

    BACKGROUND: Climate change and its implications for human health represent an increasingly important issue for the healthcare sector. According to the International Council of Nurses Code of Ethics, nurses have a responsibility to be involved and support climate change mitigation and adaptation to protect human health.

    DESIGN: This is a descriptive, explorative qualitative study.

    METHODS: Nurses (n = 18) were recruited from hospitals, primary care and emergency medical services; eight participated in semi-structured, in-depth individual interviews and 10 participated in two focus groups. Data were collected from April-October 2013 in Sweden; interviews were transcribed verbatim and analysed using content analysis.

    RESULTS: Two main themes were identified from the interviews: (i) an incongruence between climate and environmental issues and nurses' daily work; and (ii) public health work is regarded as a health co-benefit of climate change mitigation. While being green is not the primary task in a lifesaving, hectic and economically challenging context, nurses' perceived their profession as entailing responsibility, opportunities and a sense of individual commitment to influence the environment in a positive direction.

    CONCLUSIONS: This study argues there is a need for increased awareness of issues and methods that are crucial for the healthcare sector to respond to climate change. Efforts to develop interventions should explore how nurses should be able to contribute to the healthcare sector's preparedness for and contributions to sustainable development.

  • 107. Appelros, Peter
    et al.
    Jonsson, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Asberg, Signild
    Asplund, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Glader, Eva-Lotta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Asberg, Kerstin Hulter
    Norrving, Bo
    Stegmayr, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Terent, Andreas
    Trends in Stroke Treatment and Outcome between 1995 and 2010: Observations from Riks-Stroke, the Swedish Stroke Register2014Ingår i: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 37, nr 1, s. 22-29Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Continuous changes in stroke treatment and care, as well as changes in stroke characteristics, may alter stroke outcome over time. The aim of this paper is to describe time trends for treatment and outcome data, and to discuss if any such changes could be attributed to quality changes in stroke care.

    Methods: Data from Riks-Stroke, the Swedish stroke register, were analyzed for the time period of 1995 through 2010. The total number of patients included was 320,181. The following parameters were included: use of computed tomography (CT), stroke unit care, thrombolysis, medication before and after the stroke, length of stay in hospital, and discharge destination. Three months after stroke, data regarding walking, toileting and dressing ability, as well social situation, were gathered. Survival status after 7, 27 and 90 days was registered. Results: In 1995, 53.9% of stroke patients were treated in stroke units. In 2010 this proportion had increased to 87.5%. Fewer patients were discharged to geriatric or rehabilitation departments in later years (23.6% in 2001 compared with 13.4% in 2010), but more were discharged directly home (44.2 vs. 52.4%) or home with home rehabilitation (0 vs. 10.7%). The need for home help service increased from 18.2% in 1995 to 22.1% in 2010. Regarding prevention, more patients were on warfarin, antihypertensives and statins both before and after the stroke. The functional outcome measures after 3 months did improve from 2001 to 2010. In 2001, 83.8% of patients were walking independently, while 85.6% were independent in 2010. For toileting, independence increased from 81.2 to 84.1%, and for dressing from 78.0 to 80.4%. Case fatality (CF) rates after 3 months increased from 18.7% (2001) to 20.0% (2010). This trend is driven by patients with severe strokes.

    Conclusions: Stroke outcomes may change over a relatively short time period. In some ways, the quality of care has improved. More stroke patients have CT, more patients are treated in stroke units and more have secondary prevention. Patients with milder strokes may have benefited more from these measures than patients with severe strokes. Increased CF rates for patients with severe stroke may be caused by shorter hospital stays, shorter in-hospital rehabilitation periods and lack of suitable care after discharge from hospital. (C) 2013 S. Karger AG, Basel

  • 108. Araghi, Marzieh
    et al.
    Galanti, Maria Rosaria
    Lundberg, Michael
    Liu, Zhiwei
    Ye, Weimin
    Lager, Anton
    Engström, Gunnar
    Manjer, Jonas
    Alfredsson, Lars
    Knutsson, Anders
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Gylling, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lagerros, Ylva Trolle
    Bellocco, Rino
    Pedersen, Nancy L
    Östergren, Per-Olof
    Magnusson, Cecilia
    Smokeless tobacco (snus) use and colorectal cancer incidence and survival: Results from nine pooled cohorts2017Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, nr 8, s. 741-748Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: Although smoking is considered to be an established risk factor for colorectal cancer, the current evidence on the association between smokeless tobacco and colorectal cancer is scant and inconclusive. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess this association.

    METHODS: A total of 417,872 male participants from nine cohort studies across Sweden were followed up for incidence of colorectal cancer and death. Outcomes were ascertained through linkage to health registers. We used shared frailty models with random effects at the study level to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

    RESULTS: During 7,135,504 person-years of observation, 4170 men developed colorectal cancer. There was no clear association between snus use and colorectal cancer overall. Exclusive current snus users, however, had an increased risk of rectal cancer (HR 1.40: 95% CI 1.09, 1.79). There were no statistically significant associations between snus use and either all-cause or colorectal cancer-specific mortality after colorectal cancer diagnosis.

    CONCLUSIONS: Our findings, from a large sample, do not support any strong relationships between snus use and colorectal cancer risk and survival among men. However, the observed increased risk of rectal cancer is noteworthy, and in merit of further attention.

  • 109.
    Arinaitwe, Moses
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Initiative and Innovation: A Narrative Account of Rural Hospital Workers in Eastern Uganda2012Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 110.
    Arista, Nora Nindi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Does Health Insurance Protect Indonesians from Catastrophic Health Expenditure and Impoverishment?: The Analysis of if Health Insurance is protective against Catastrophic Health Expenditure and Impoverishment In Indonesia2017Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: The World Health Organization has called for implementing universal health coverage to protect households from catastrophic health expenditure and impoverishment. However, few studies in Indonesia has focused on the benefits of health insurance in protecting against catastrophic health expenditure and impoverishment. This study aims to examine whether health insurance protects the household from catastrophic health expenditure and impoverishment and if so what characteristics are to some extent associated with catastrophic health expenditure and impoverishment.

    Methods: Cross-sectional data at household level from Indonesia Family Life Survey (IFLS) in wave 5 (2014-2015) have been used. 14.080 households are included in the analysis. The distribution of health payments and catastrophic expenditure methodology was used to measure catastrophic health expenditure and impoverishment. Multiple logistic regressions were done for examining the association between catastrophic health spending, impoverishment and health insurance, after adjusting for other socio-demographic factors (household size, area, health care utilization, chronic disease, etc.). Sensitivity analysis was used to check the sensitivity of the main result.

    Results: Household with up to one-third and more than two third of the family member have health insurance have a lower risk of catastrophic health spending. In contrast, we found a non-significant association of health insurance and impoverishment after adjustment (p>0.05). The household characteristics that are associated with catastrophic health expenditure and impoverished were a family lives in rural area, have more than two third of its member have chronic diseases, have higher inpatient visit, have at least one member<5 years old or >55 years old, and lower level of education for a household leader.

    Conclusion: This study found that health insurance has the possibility to protect the households from catastrophic health expenditure, but not from impoverishment. The study presents important implications for health policymakers, which increasing the coverage of health insurance especially for vulnerable group or households in Indonesia setting is important to protect and reduce the burden of out-of-pocket health expenditures.

  • 111.
    Arista, Nora Nindi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Socioeconomic Inequalities in Smoking Behaviour among Adults in Indonesia: A Decomposition Analysis2018Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: Tobacco consumption is one of the most significant causes of premature death globally. One out of four men in the world is an active smoker with a total estimate of 933 million current smokers in 2015. Indonesia has one of the highest smoking rates in the world along with Russia and Bangladesh. Smoking was concentrated among the worst-off population in many low-middle income countries. Studies on the determinants of socioeconomic disparities in smoking in Indonesia are currently lacking. This study fills this gap of knowledge by investigating the socioeconomic inequality in smoking and socioeconomic factors explaining the disparities in smoking behaviour among adults aged 15 years old and above in Indonesia.

    Methods: This cross-sectional study utilized data from the Indonesia Family Life Survey (IFLS) Wave 5 conducted in 2014-2015. The study included 29,844 individuals aged above 15 years old. The outcome was smoking status (defined as current smokers and never smokers). Socioeconomic status was defined based on wealth index created using Principal Component Analysis on housing characteristics and ownership of assets. Socioeconomic inequalities in smoking were measured using Concentration Index (CI) and graphed as Concentration Curve (CC). The determinants of socioeconomic inequalities in smoking (including socioeconomic, material and psychosocial factors) were assessed using Wagstaff decomposition analysis. All the analyses were conducted separately for men and women.

    Result: About 70.3% of men and 2.4% of women was current smokers in Indonesia (p<0.001). The concentration index showed an existing socioeconomic inequalities in smoking behaviour was concentrated among the poorest, and the inequality was more prominent among men (CI: -0.23; 95%CI: -0.26; -0.20) compared with women (CI: -0.05; 95% CI: -0.06; -0.04)). The decomposition analysis indicated that wealth index was the major contributor to socioeconomic inequalities in both gender (men: 26.6%, women: 49.2%).

    Conclusion: Smoking is concentrated among the most impoverished population in both genders, and is more prominent among men. The major contributor to the socioeconomic inequalities in smoking is material factors, particularly the wealth index. This study confirms the multi-dimension determinants of smoking inequalities such as the sociodemographic, material, psychosocial, and health factors. Therefore, a comprehensive approach and government commitment to smoking prevention and control are needed to reduce the prevalence of smoking in Indonesia, especially among the most vulnerable group.

  • 112.
    Arnetz, Bengt B.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Department of Family Medicine, College of Human Medicine, Michigan State University, Michigan, USA; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Lewalski, Philip
    Arnetz, Judy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Department of Family Medicine, College of Human Medicine, Michigan State University, Michigan, USA; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Breejen, Karen
    Przyklenk, Karin
    Examining self-reported and biological stress and near misses among Emergency Medicine residents: a single-centre cross-sectional assessment in the USA2017Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 8, artikel-id e016479Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To examine the relationship between perceived and biological stress and near misses among Emergency Medicine residents.

    Design: Self-rated stress and stress biomarkers were assessed in residents in Emergency Medicine before and after a day shift. The supervising physicians and residents reported numbers of near misses.

    Setting: The study took place in the Emergency Department of a large trauma 1 centre, located in Detroit, USA. Participants Residents in Emergency Medicine volunteered to participate. The sample consisted of 32 residents, with complete data on 28 subjects. Residents' supervising physicians assessed the clinical performance of each resident.

    Primary and secondary outcome measures: Participants' preshift and postshift stress, biological stress (salivary cortisol, plasma interleukin-6, tumour necrosis factor-alpha (TNF-alpha) and high-sensitivity C-reactive protein), residents' and supervisors' reports of near misses, number of critically ill and patients with trauma seen during the shift.

    Results: Residents' self-reported stress increased from an average preshift level of 2.79 of 10 (SD 1.81) to a postshift level of 5.82 (2.13) (p<0.001). Residents cared for an average of 2.32 (1.52) critically ill patients and 0.68 (1.06) patients with trauma. Residents reported a total of 7 near misses, compared with 11 reported by the supervising physicians. After controlling for baseline work-related exhaustion, residents that cared for more patients with trauma and had higher levels of TNF-a reported a higher frequency of near misses (R-2=0.72; p=0.001). Residents' preshift ratings of how stressful they expected the shift to be were related to the supervising physicians' ratings of residents' near misses during the shift.

    Conclusion: Residents' own ratings of near misses were associated with residents' TNF-alpha, a biomarker of systemic inflammation and the number of patients with trauma seen during the shift. In contrast, supervisor reports on residents' near misses were related only to the residents' preshift expectations of how stressful the shift would be.

  • 113. Arokiasamy, Perianayagam
    et al.
    Uttamacharya, .
    Kowal, Paul
    Capistrant, Benjamin D.
    Gildner, Theresa E.
    Thiele, Elizabeth
    Biritwum, Richard B.
    Yawson, Alfred E.
    Mensah, George
    Maximova, Tamara
    Wu, Fan
    Guo, Yanfei
    Zheng, Yang
    Kalula, Sebastiana Zimba
    Rodriguez, Aaron Salinas
    Espinoza, Betty Manrique
    Liebert, Melissa A.
    Eick, Geeta
    Sterner, Kirstin N.
    Barrett, Tyler M.
    Duedu, Kwabena
    Gonzales, Ernest
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Negin, Joel
    Jiang, Yong
    Byles, Julie
    Madurai, Savathree Lorna
    Minicuci, Nadia
    Snodgrass, J. Josh
    Naidoo, Nirmala
    Chatterji, Somnath
    Chronic Noncommunicable Diseases in 6 Low-and Middle-Income Countries: Findings From Wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (SAGE)2017Ingår i: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 185, nr 6, s. 414-428Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged >= 50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low-and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.

  • 114. Arouca, Aline B.
    et al.
    Santaliestra-Pasías, Alba M.
    Moreno, Luis A.
    Marcos, Ascensión
    Widhalm, Kurt
    Molnár, Dénes
    Manios, Yannis
    Gottrand, Frederic
    Kafatos, Anthony
    Kersting, Mathilde
    Sjöström, Michael
    Sáinz, Ángel Gutiérrez
    Ferrari, Marika
    Huybrechts, Inge
    González-Gross, Marcela
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    De Henauw, Stefaan
    Michels, Nathalie
    Diet as a moderator in the association of sedentary behaviors with inflammatory biomarkers among adolescents in the HELENA study2019Ingår i: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 58, nr 5, s. 2051-2065Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To assess if a healthy diet might attenuate the positive sedentary-inflammation relation, whereas an unhealthy diet may increase the effect of sedentary behaviors on inflammatory biomarkers.

    METHODS: In 618 adolescents (13-17 years) of the European HELENA study, data were available on body composition, a set of inflammation markers, and food intake assessed by a self-administered computerized 24 h dietary recall for 2 days. A 9-point Mediterranean diet score and an antioxidant-rich diet z-score were used as dietary indices and tested as moderators. A set of low-grade inflammatory characteristics was used as outcome: several cytokines in an inflammatory ratio (IL-6, IL-10, TNF-α, TGFβ-1), C-reactive protein, three cell-adhesion molecules (sVCAM-1, sICAM-1, sE-selectin), three cardiovascular risk markers (GGT, ALT, homocysteine) and three immune cell types (white blood cells, lymphocytes, CD3). Sedentary behaviors were self-reported and analyzed as total screen time. Multiple linear regression analyses tested moderation by diet in the sedentary behaviors-inflammation association adjusted for age, sex, country, adiposity (sum of six skinfolds), parental education, and socio-economic status.

    RESULTS: Both diet scores, Mediterranean and antioxidant-rich diet, were significant protective moderators in the effect of sedentary behaviors on alanine-transaminase enzyme (P = 0.014; P = 0.027), and on the pro/anti-inflammatory cytokine ratio (P = 0.001; P = 0.004), but not on other inflammatory parameters.

    CONCLUSION: A higher adherence to the Mediterranean diet or an antioxidant-rich diet may attenuate the onset of oxidative stress signs associated by sedentary behaviors, whereas a poor diet seems to increase inflammation.

  • 115. Arthur, Rhonda
    et al.
    Møller, Henrik
    Garmo, Hans
    Häggström, Christel
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Holmberg, Lars
    Stattin, Pär
    Malmström, Håkan
    Lambe, Mats
    Hammar, Niklas
    Walldius, Göran
    Robinson, David
    Jungner, Ingmar
    Van Hemelrijck, Mieke
    Serum glucose, triglycerides, and cholesterol in relation to prostate cancer death in the Swedish AMORIS study2019Ingår i: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 30, nr 2, s. 195-206Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Lifestyle-related conditions such as obesity are associated with prostate cancer progression, but the associations with hyperglycemia and dyslipidemia are unclear. This study, therefore, aims to examine the association of glucose, triglycerides, and total cholesterol with prostate cancer death. Methods: From the Swedish AMORIS cohort, we selected 14,150 men diagnosed with prostate cancer between 1996 and 2011 who had prediagnostic measurements of serum glucose, triglycerides, and total cholesterol. Multivariable Cox proportional hazards regressionmodels were used to determine the hazard ratios for death in relation to the aforementioned metabolic markers. Results: Using clinical cut-off points, a non-significant positive association was observed between glucose and prostate cancer death. When compared to those with glucose in the lowest quartile, those in the highest quartile had greater risk of prostate cancer death (HR 1.19; 95% CI 1.02-1.39). However, neither total cholesterol nor triglycerides were associated with prostate cancer death. Glucose and triglycerides were positively associated with overall, cardiovascular, and other deaths. Hypercholesterolemia was only associated with risk of CVD death. Conclusion: Our results suggest that glucose levels may influence prostate cancer survival, but further studies using repeated measurements are needed to further elucidate how glucose levels may influence prostate cancer progression.

  • 116. Arthur, Samuelina S.
    et al.
    Nyide, Bongiwe
    Soura, Abdramane Bassiahi
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Weston, Mark
    Sankoh, Osman
    Tackling malnutrition: a systematic review of 15-year research evidence from INDEPTH health and demographic surveillance systems2015Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, s. 1-13, artikel-id 28298Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Nutrition is the intake of food in relation to the body's dietary needs. Malnutrition results from the intake of inadequate or excess food. This can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity. Objective: To perform a systematic review to assess research conducted by the International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) of health and demographic surveillance systems (HDSSs) over a 15-year period on malnutrition, its determinants, the effects of under and over nutrition, and intervention research on malnutrition in low- and middle-income countries (LMICs). Methods: Relevant publication titles were uploaded onto the Zotero research tool from different databases (60% from PubMed). Using the keywords 'nutrition', 'malnutrition', 'over and under nutrition', we selected publications that were based only on data generated through the longitudinal HDSS platform. All titles and abstracts were screened to determine inclusion eligibility and full articles were independently assessed according to inclusion/exclusion criteria. For inclusion in this study, papers had to cover research on at least one of the following topics: the problem of malnutrition, its determinants, its effects, and intervention research on malnutrition. One hundred and forty eight paperswere identified and reviewed, and 67 were selected for this study. Results: The INDEPTH research identified rising levels of overweight and obesity, sometimes in the same settings as under-nutrition. Urbanisation appears to be protective against under-nutrition, but it heightens the risk of obesity. Appropriately timed breastfeeding interventions were protective against malnutrition. Conclusions: Although INDEPTH has expanded the global knowledge base on nutrition, many questions remain unresolved. There is a need for more investment in nutrition research in LMICs in order to generate evidence to inform policies in these settings.

  • 117.
    Arvidsson, Inger
    et al.
    Occupational and Environmental Medicine, Lund University, Sweden.
    Leo, Ulf
    Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för skolledarutveckling.
    Larsson, Anna
    Occupational and Environmental Medicine, Lund University, Sweden.
    Håkansson, Carita
    Occupational and Environmental Medicine, Lund University, Sweden.
    Persson, Roger
    Occupational and Environmental Medicine; and Department of Psychology, Lund University, Sweden; Centre for Medicine and Technology for Working Life and Society (Metalund), Lund, Sweden.
    Björk, Jonas
    Occupational and Environmental Medicine, Lund University, Sweden.
    Burnout among school teachers: quantitative and qualitative results from a follow-up study in southern Sweden2019Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, artikel-id 655Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Teachers are at high risk of stress-related disorders. This longitudinal study aimed to (a) identify which occupational, sociodemographic and life-style factors and self-efficacy at baseline that were of importance for burnout, (b) explore associations between changes in the studied factors versus changes in burnout, and (c) by interviews increase the understanding of perceived job demands among teachers.

    Methods: A cohort of 310 Swedish teachers in school-years 4–9 responded to a questionnaire of occupational, sociodemographic and life-style factors, self-efficacy and burnout, at baseline and at follow-up (mean 30 months later). A combined measure with four levels of burnout was crafted, based on exhaustion, cynicism and professional efficacy (Maslach Burnout Inventory-General Survey). Quantitative data were analysed with multiple ordinal regression, and qualitative data were analysed with content analysis of interview responses from a subgroup of the teachers (n = 81).

    Results: The occurrence of high burnout (level 2 and 3 combined) were similar at baseline and follow-up (14% vs. 15%). However, many teachers fluctuated between the levels of burnout (28% increased and 24% decreased). Burnout at baseline was of importance for change of work or being off duty at follow up. In the multi-exposure model, low self-efficacy [OR 0.42; CI 0.26–0.68] and high job demands [OR 1.97; CI 1.02–3.8] were the strongest explanatory variables. Low self-efficacy remained as the strongest explanatory factor after adjustment for burnout at baseline. Increased job demands during follow-up was associated with an increased level of burnout [OR 3.41; CI 1.73–6.69], whereas increased decision latitude was associated with a decreased level of burnout [OR 0.51; CI 0.30–0.87]. Two major categories of demands emerged in the qualitative analysis; i.e. too high workload and a sense of inadequacy.

    Conclusions: A substantial proportion of teachers showed signs of burnout at both occasions. Low self-efficacy and high job demands was of importance for burnout, and changes in burnout was further associated with changes in decision latitude. The results points to the need of actions on individual, organizational and a societal levels.

  • 118.
    Asgedom, Girmay
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Clinical and immunological outcome of antiretroviral treatment in Saint Mary Axum Hospital2013Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 119. Ashraf, Ali
    et al.
    Quaiyum, M.A.
    Ng, Nawi
    Purworejo Health and Demographic Surveillance System, Indonesia.
    Van Minh, Hoang
    Razzaque, Abdur
    Masud Ahmed, Syed
    Hadi, Abdullahel
    Juvekar, Sanjay
    Kanungsukkasem, Uraiwan
    Soonthornthada, Kusol
    Huu Bich, Tran
    Self-reported use of tobacco products in nine rural INDEPTH Health and Demographic Surveillance Systems in Asia2009Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, s. 19-27Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Tobacco use is the most preventable cause of premature death and disability. Even though tobacco use is common in many Asian countries, reliable and comparable data on the burden imposed by tobacco use in this region are sparse, and surveillance systems to track trends are in their infancy.

    OBJECTIVE: To assess and compare the prevalence of tobacco use and its associated factors in nine selected rural sites in five Asian countries.

    METHODS: Tobacco use among 9,208 men and 9,221 women aged 25-64 years in nine Health and Demographic Surveillance System (HDSS) sites in five Asian countries of the INDEPTH Network were examined in 2005 as part of a broader survey of the major chronic non-communicable disease risk factors. All sites used a standardised protocol based on the WHO STEPS approach to risk factor surveillance; expanded questions of local relevance, including chewing tobacco, were also included. Multivariable logistic regression was used to assess demographic factors associated with tobacco use.

    RESULTS: Tobacco use, whether smoked or chewed, was common across all sites with some notable variations. More than 50% of men smoked daily; this applied to almost all age groups. Few women smoked daily in any of the sites. However, women were more likely to chew tobacco than men in all sites except Vadu in India. Tobacco use in men began in late adolescence in most of the sites and the number of cigarettes smoked daily ranged from three to 15. Use of both forms of tobacco, smoked and chewed, was associated with age, gender and education. Men were more likely to smoke compared to women, smoking increased with age in the four sites in Bangladesh but not in other sites and with low level of education in all the sites.

    CONCLUSION: The prevalence of tobacco use, regardless of the type of tobacco, was high among men in all of these rural populations with tobacco use started during adolescence in all HDSS sites. Innovative communication strategies for behaviour change targeting adolescents in schools and adult men and women at work or at home, may create a mass awareness about adverse health consequences of tobacco smoking or chewing tobacco. Such efforts, to be effective, however, need to be supported by strong legislation and leadership. Only four of the five countries involved in this multi-site study have ratified the Framework Convention on Tobacco Control, and even where it has been ratified, implementation is uneven.

  • 120. Aslund, Cecilia
    et al.
    Nilsson, Kent W
    Starrin, Bengt
    Sjöberg, Rickard L
    Shaming experiences and the association between adolescent depression and psychosocial risk factors.2007Ingår i: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 16, nr 5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate whether psychosocial risk factors such as parental separation, parental unemployment and experiences of sexual abuse are associated with adolescent depression, and whether shaming experiences (defined as experiences of being degraded, or ridiculed by others) may account for such an association.

    METHOD: A total of 5048 Swedish adolescents answered the Survey of Adolescent Life in Vestmanland 2004 (SALVe-2004) during classhours. The survey included questions about depressive symptoms, parental separation, parental unemployment and experiences of sexual abuse.

    RESULTS: The psychosocial risk factors studied were all associated with depression, but several of these associations became non-significant when a factor for shaming experiences was entered into the models. The explained variance for depression furthermore increased from approximately 4-7% to 17-20% when shame was included.

    CONCLUSION: Shaming experiences may mediate part of the association between psychosocial risk factors and depression. These findings may have important implications for the understanding of psychotherapeutic treatment of the effects of risk factors in depressed patients.

  • 121.
    Assarsson, Rebecka
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Petersen, Solveig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Högberg, Björn
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Strandh, Mattias
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Center for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
    Johansson, Klara
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Gender inequality and adolescent suicide ideation across Africa, Asia, the South Pacific and Latin America: a cross-sectional study based on the Global School Health Survey (GSHS)2019Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, artikel-id 1663619Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Suicide ideation is a health issue affecting adolescents worldwide. There are significant variations in suicide ideation between countries and genders, which have not been fully explained. Research is especially lacking in countries outside Europe and North America. Gender equality has been shown to matter in other aspects of adolescent mental health, such as life satisfaction, but has not been researched in relation to suicide ideation at national level.

    Objective: To investigate how national gender inequality is related to self-reported suicide ideation among adolescents, and whether this association differs between boys and girls.

    Methods: This is a cross-national, cross-sectional study using individual survey data from the Global School-based Student Health Survey, a survey in Africa, Asia, Latin America and the South Pacific, developed and supported by among others the WHO and the CDC; connecting this to national data: the gender inequality index from the UNDP; controlling for GDP per capita and secondary school enrolment. The data was analysed using a multilevel logistic regression method and included 149,306 students from 37 countries.

    Results: Higher national gender inequality, as measured by the gender inequality index, was significantly associated with a higher likelihood of suicide ideation in both girls and boys (odds ratio: 1.38 p-value: 0.015), but for girls and both sexes this was only after adjusting for selection bias due to secondary school enrolment (as well as GDP/capita). Interaction models showed that this association was stronger in boys than in girls.

    Conclusions: National gender inequality seems to be associated with higher levels of suicide ideation among adolescents in mainly low- and middle-income countries, especially among boys.

  • 122. Assi, Nada
    et al.
    Gunter, Marc J.
    Thomas, Duncan C.
    Leitzmann, Michael
    Stepien, Magdalena
    Chajès, Véronique
    Philip, Thierry
    Vineis, Paolo
    Bamia, Christina
    Boutron-Ruault, Marie-Christine
    Sandanger, Torkjel M.
    Molinuevo, Amaia
    Boshuizen, Hendriek
    Sundkvist, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Kühn, Tilman
    Travis, Ruth
    Overvad, Kim
    Riboli, Elio
    Scalbert, Augustin
    Jenab, Mazda
    Viallon, Vivian
    Ferrari, Pietro
    Metabolic signature of healthy lifestyle and its relation with risk of hepatocellular carcinoma in a large European cohort2018Ingår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 108, nr 1, s. 117-126Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Studies using metabolomic data have identified metabolites from several compound classes that are associated with disease-related lifestyle factors.

    Objective: In this study, we identified metabolic signatures reflecting lifestyle patterns and related them to the risk of hepatocellular carcinoma (HCC) in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

    Design: Within a nested case-control study of 147 incident HCC cases and 147 matched controls, partial least squares (PLS) analysis related 7 modified healthy lifestyle index (HLI) variables (diet, BMI, physical activity, lifetime alcohol, smoking, diabetes, and hepatitis) to 132 targeted serum-measured metabolites and a liver function score. The association between the resulting PLS scores and HCC risk was examined in multivariable conditional logistic regression models, where ORs and 95% CIs were computed.

    Results: The lifestyle component's PLS score was negatively associated with lifetime alcohol, BMI, smoking, and diabetes, and positively associated with physical activity. Its metabolic counterpart was positively related to the metabolites sphingomyelin (SM) (OH) C14:1, C16:1, and C22:2, and negatively related to glutamate, hexoses, and the diacyl-phosphatidylcholine PC aaC32:1. The lifestyle and metabolomics components were inversely associated with HCC risk, with the ORs for a 1-SD increase in scores equal to 0.53 (95% CI: 0.38, 0.74) and 0.28 (0.18, 0.43), and the associated AUCs equal to 0.64 (0.57, 0.70) and 0.74 (0.69, 0.80), respectively.

    Conclusions: This study identified a metabolic signature reflecting a healthy lifestyle pattern which was inversely associated with HCC risk. The metabolic profile displayed a stronger association with HCC than did the modified HLI derived from questionnaire data. Measuring a specific panel of metabolites may identify strata of the population at higher risk for HCC and can add substantial discrimination compared with questionnaire data. This trial was registered at clinicaltrials.gov as NCT03356535.

  • 123. Assi, Nada
    et al.
    Thomas, Duncan C.
    Leitzmann, Michael
    Stepien, Magdalena
    Chajès, Véronique
    Philip, Thierry
    Vineis, Paolo
    Bamia, Christina
    Boutron-Ruault, Marie-Christine
    Sandanger, Torkjel M.
    Molinuevo, Amaia
    Boshuizen, Hendriek C.
    Sundkvist, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Kühn, Tilman
    Travis, Ruth C.
    Overvad, Kim
    Riboli, Elio
    Gunter, Marc J.
    Scalbert, Augustin
    Jenab, Mazda
    Ferrari, Pietro
    Viallon, Vivian
    Are Metabolic Signatures Mediating the Relationship between Lifestyle Factors and Hepatocellular Carcinoma Risk? Results from a Nested Case–Control Study in EPIC2018Ingår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 27, nr 5, s. 531-540Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The "meeting-in-the-middle" (MITM) is a principle to identify exposure biomarkers that are also predictors of disease. The MITM statistical framework was applied in a nested case-control study of hepatocellular carcinoma (HCC) within European Prospective Investigation into Cancer and Nutrition (EPIC), where healthy lifestyle index (HLI) variables were related to targeted serum metabolites.

    Methods: Lifestyle and targeted metabolomic data were available from 147 incident HCC cases and 147 matched controls. Partial least squares analysis related 7 lifestyle variables from a modified HLI to a set of 132 serum-measured metabolites and a liver function score. Mediation analysis evaluated whether metabolic profiles mediated the relationship between each lifestyle exposure and HCC risk.

    Results: Exposure-related metabolic signatures were identified. Particularly, the body mass index (BMI)-associated metabolic component was positively related to glutamic acid, tyrosine, PC aaC38:3, and liver function score and negatively to lysoPC aC17:0 and aC18:2. The lifetime alcohol-specific signature had negative loadings on sphingomyelins (SM C16:1, C18:1, SM(OH) C14:1, C16:1 and C22:2). Both exposures were associated with increased HCC with total effects (TE) = 1.23 (95% confidence interval = 0.93-1.62) and 1.40 (1.14-1.72), respectively, for BMI and alcohol consumption. Both metabolic signatures mediated the association between BMI and lifetime alcohol consumption and HCC with natural indirect effects, respectively, equal to 1.56 (1.24-1.96) and 1.09 (1.03-1.15), accounting for a proportion mediated of 100% and 24%.

    Conclusions: In a refined MITM framework, relevant metabolic signatures were identified as mediators in the relationship between lifestyle exposures and HCC risk.

    Impact: The understanding of the biological basis for the relationship between modifiable exposures and cancer would pave avenues for clinical and public health interventions on metabolic mediators.

  • 124. Audet, Carolyn M.
    et al.
    Ngobeni, Sizzy
    Graves, Erin
    Wagner, Ryan G.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. MRC/Wits Agincourt Research Unit, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
    Mixed methods inquiry into traditional healers' treatment of mental, neurological and substance abuse disorders in rural South Africa2017Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, nr 12, artikel-id e0188433Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Traditional healers are acceptable and highly accessible health practitioners throughout sub-Saharan Africa. Patients in South Africa often seek concurrent traditional and allopathic treatment leading to medical pluralism. Methods & findings: We studied the cause of five traditional illnesses known locally as "Mavabyi ya nhloko" (sickness of the head), by conducting 27 in-depth interviews and 133 surveys with a randomly selected sample of traditional healers living and working in rural, northeastern South Africa. These interviews were carried out to identify treatment practices of mental, neurological, and substance abuse (MNS) disorders. Participating healers were primarily female (77%), older in age (median: 58.0 years; interquartile range [IQR]: 50-67), had very little formal education (median: 3.7 years; IQR: 3.2-4.2), and had practiced traditional medicine for many years (median: 17 years; IQR: 9.5-30). Healers reported having the ability to successfully treat: seizure disorders (47%), patients who have lost touch with reality (47%), paralysis on one side of the body (59%), and substance abuse (21%). Female healers reported a lower odds of treating seizure disorders (Odds Ratio (OR): 0.47), patients who had lost touch with reality (OR: 0.26; p-value<0.05), paralysis of one side of the body (OR: 0.36), and substance abuse (OR: 0.36) versus males. Each additional year of education received was found to be associated with lower odds, ranging from 0.13-0.27, of treating these symptoms. Each additional patient seen by healers in the past week was associated with roughly 1.10 higher odds of treating seizure disorders, patients who have lost touch with reality, paralysis of one side of the body, and substance abuse. Healers charged a median of 500 South African Rand (similar to US$35) to treat substance abuse, 1000 Rand (similar to US$70) for seizure disorders or paralysis of one side of the body, and 1500 Rand (similar to US$105) for patients who have lost touch with reality. Conclusions: While not all healers elect to treat MNS disorders, many continue to do so, delaying allopathic health services to acutely ill patients.

  • 125.
    Augustsson, Åsa-Maja
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Harryson, Lisa
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Det oändliga moderskapet: föräldrars upplevelser av föräldraledighet och hälsa i en könad kontext2015Ingår i: Tidskrift för Genusvetenskap, ISSN 1654-5443, E-ISSN 2001-1377, Vol. 36, nr 1-2, s. 121-141Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Ojämlikt uttag av föräldraledigheten inte bara cementerar föräldraskap och könsroller, det har även negativa konsekvenser för föräldrars möjligheter att uppnå välmående och hälsa. Åsa-Maja Augustsson och Lisa Harryson visar hur framförallt "det oändliga moderskapet" har förödande konsekvenser för såväl mödrar som fäder i heterosexuella parrelationer.

  • 126.
    Aweesha, Huzeifa
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    “The owner of the house has the responsibility to coordinate, but must be in the position to do that”: Sudan health sector development partners’ attitude and adherence to the development effectiveness principles2016Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Sudan health sector development scene is problematic and entails reviews. This study aim was to explore the relations between the different development partners in Sudan health sector, with distinctive attention to discovering the partners’ attitude and adherence to the three development effectiveness principles of ownership, alignment and harmonization. A qualitative design was embraced. Using the Paris declaration commitments understanding and analysis framework, a semi structured study guide was developed. Sixteen in-depth interviews were conducted with different stakeholders from Sudan Ministry of Health, bilateral donors, development Banks, United Nations agencies, International NGOs and Civil Society Organizations. Documents reviews and coordination meetings observations were supplementary. Framework method was used for data analysis, supported with a positional map. Results showed that Sudan health sector suffer from limited fund with diverse vulnerability-tailored support and priorities. The hostile partners are trying to cooperate with a dominating government while the civil society is marginalised. The partners believe that ownership is important, but many concerns were raised. The government of Sudan was deemed blameable as the owner of the house has responsibility to coordinate, but must be in position to do that. Conflictive views were presented on the priority for systems strengthening or utilisation. The general believe was that progress needs effort, collaboration, commitment, clarity and time. In conclusion, further resources allocation is crucial to achieve the development targets. The government of Sudan needs to seek a balance between strengthening its ownership and improving international relations and gain partners trust. This entails flexibility, open dialogue, reasoning in decision making, policy coherence and less administrative load and restrictions. Other Partners meanwhile need to support the government not only in capacity and systems strengthening, but with endorsing cooperation and utilising the national systems. Last but not least, the role of civil society needs to be appreciated and supported. Further research on civic society characteristics and engagement within Sudan, and mutual accountability mechanisms as well, should be encouraged. Finally, serious measures to insure peace and stability are crucial

  • 127.
    Axelsson, Per
    Umeå universitet, Humanistiska fakulteten, Centrum för samisk forskning (CeSam). Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    Urfolkshälsa: utmanande  och svårfångad2015Ingår i: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 92, nr 6, s. 726-735Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Föreliggande artikel ger en kortare historisk överblick kring den samiska folkhälsoforskningen för att sedan diskutera en av de utmaningar som svensk folkhälsoforskning på detta område står inför, nämligen frånvaron av välgrundad statistik. Forskning om samernas hälsotillstånd är präglad av att ha varit föremål för studier av Statens rasbiologiska institut mellan 1920- och 1950-tal, och har framförallt ägt rum de senaste 20 åren. Idag finns dock en brist på aktuella epidemiologiska studier och detta kan länkas till avsaknaden av etnicitet som kategori i officiell statistik i Sverige. Detta är en känslig fråga och nya etiska principer behöver arbetas fram där samerna som grundlagsenligt erkänt urfolk, själva tillåts bestämma över om man vill inhämta statistik, vilken statistik som skulle vara relevant och hur den bör insamlas.

  • 128.
    Axelsson, Per
    et al.
    Umeå universitet, Humanistiska fakulteten, Centrum för samisk forskning (CeSam).
    Sköld, Peter
    Umeå universitet, Humanistiska fakulteten, Centrum för samisk forskning (CeSam).
    Tano, Sofia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Företagsekonomi.
    Sweden: the Sami2016Ingår i: A global snapshot of indigenous and tribal peoples' health: the Lancet–Lowitja Institute collaboration / [ed] Kate Silburn, Hannah Reich & Ian Anderson, Carlton South, Victoria, Australia: The Lowitja Institute , 2016, , s. 2s. 46-47Kapitel i bok, del av antologi (Refereegranskat)
  • 129.
    Azad, Arif
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    The UK immigration/ policies and their impactas on migrants´ health2016Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction: Migration is a major policy issue in todays. In recent year there has been surging interest in health and migration as interdepend issues. However, despite the interdependent nature of heath and migration, there is correspondingly less focus on health –related aspects of migration. Though there is EU-wide immigration policy on controlling migration flow there is less coordination on health aspects of migration. This is happening against the back drop where EU restrictive policies are giving rise to irregular and risky migration pathway with attended health risks. Yet there is no coordination between the two policy domains. In an effort at controlling migrants flow, interception countries are being funded to keep migrants in health damaging detention centre and refugee’s camps. The complex nature of migration has posed fresh new challenges in relation to aligning the two policy areas. The migration process framework conceptualizes the 5 phases of the migration flows to devise better coordination between immigration and health polices and offers pathway to design health policy intervention to address specific health needs of migrants in each phase. In the UK there is much media and political focus on containing the number entering the country without any corresponding heed to their health needs. 

    Methods: The aim of the study is to conduct literature review of the of the UK immigration and health policies and their impact on migrant’s health and their right to healthcare. The study used Pub-med, google scholar, website of UK government department, NGO’s and research institute reports on migration to search and select the relevant literature. The identified and selected literate was analysed by using the migration process framework. The study uses the modified 4-staged migration framework as a conceptual tool to analyse and identify gaps in the immigration and health policies of UK.

    Results: The results of the analysis reveal that UK immigration and health policies have developed in tandem.  The UK immigration and health policies align well with the pre-departure phase and the destination phases with dominant emphasis on containment of communicable disease. Yet the travel and inception phases of the migration framework are not well aligned in relation to the health needs of migrants. There is little coordination on the health needs of returnee migrants between the country of origin and destination. There is profound lack of lack of cooperation of Uk with interception countries, EU and the country of origin on managing interception and return phases of the migration.

    Conclusion: Migration and health are becoming inextricably intertwined despite being considered separate policy areas. The migration process framework seeks to integrate both policy domains. Applying the framework to UK reveals immigration and health policies are aligned where pre-departure phase is concerned. The coordination during inception/travel and return phase with the country of origin and EU is noticeably lacking. There is a gradual restriction of health coverage to different group of migrants with the irregular and refused asylum-seeker the worst affected. The role of media and politicians is important in initiating rational debate. Research is needed into doctor dual loyalty and how to join-up immigration and health with the health needs of migrants in the front-front of the policy making process.   

  • 130.
    Azadi, Niloofar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Perspectives of Iranian Female University Students on Sexual and Reproductive Health in two Different Contexts: Iran and Sweden2013Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 131.
    Azinheira Ramos, Marta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Alzheimer’s disease: Perceptions about everyday life activities and the implications of social / healthcare support. A qualitative case study in Portugal2013Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 132. Backhans, Mona Christina
    et al.
    Burström, Bo
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Månsdotter, Anna
    Pioneers and laggards: Is the effect of gender equality on health dependent on context?2009Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 68, s. 1388-1395Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study combines data at individual and area level to examine interactions between equality within couples and gender equality in the municipality in which individuals live. The research question is whether the context impacts on the association between gender equality and health. The material consists of data on 37,423 men and 37,616 women in 279 Swedish municipalities, who had their first child in 1978. The couples were classified according to indicators of their level of gender equality in 1980 in the public sphere (occupation and income) and private sphere (child care leave and parental leave) compared to that of their municipality. The health outcome is compensated days from sickness insurance during 1986-1999 with a cut-off at the 85% percentile. Data were analysed using logistic regression with the overall odds as reference. The results concerning gender equality in the private sphere show that among fathers, those who are equal in an equal municipality have lower levels of sick leave than the average while laggards (less equal than their municipality) and modest laggards have higher levels. In the public sphere, pioneers (more equal t han their municipality) fare better than the average while laggards fare worse. For mothers, those who are traditional in their roles in the public sphere are protected from high levels of sick leave, while the reverse is true for those who are equal. Traditional mothers in a traditional municipality have the lowest level of sick leave and pioneers the highest. These results show that there are distinct benefits as well as disadvantages to being a gender pioneer and/or a laggard in comparison to your municipality. The associations are markedly different for men and women.

  • 133.
    Backman, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lung function and prevalence trends in asthma and COPD: the Obstructive Lung Disease in Northern Sweden Thesis XVI2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background

    Asthma and chronic obstructive pulmonary disease (COPD) are common obstructive airway diseases with a substantial burden in terms of morbidity, mortality and costs. Smoking is the single most important risk factor for COPD, and is associated with incident asthma. It is important to know if the prevalence of asthma and COPD is increasing or decreasing in the population in order to effectively allocate health care resources. The definitions of these diseases have varied over time which makes it difficult to measure changes in prevalence. The preferred method is to estimate the prevalence with the same procedures and definitions based on cross-sectional population samples with identical age distributions in the same geographical area at different time points. Measurements of lung function (spirometry) are required to diagnose COPD, and spirometry is used to evaluate disease severity and progress of both asthma and COPD, where observed values are compared to reference values. The most commonly used reference values in Sweden are published during the mid 1980s, and there are few evaluations of how appropriate they are today based on Swedish population samples. The aim of the thesis was to estimate trends in the prevalence of asthma and COPD in relation to smoking habits, and to evaluate and estimate reference values for spirometry.

    Methods

    The project was based on population-based samples of adults from the Obstructive Lung Disease in Northern Sweden (OLIN) studies. Postal questionnaires were sent to large cohorts, recruited in 1992 (n=4851, 20-69 years), 1996 (n=7420, 20-74 years) and 2006 (n=6165, 20-69 years), respectively. The questionnaire included questions on respiratory symptoms and diseases, their comorbidities and several possible risk factors including smoking habits. Structured interviews and spirometry were performed in random samples of the responders to the 1992 and 2006 surveys, of which n=660 (in 1994) and n=623 (in 2009) were within identical age-spans (23-72 years). The trend in asthma prevalence was estimated by comparing the postal questionnaire surveys in 1996 and 2006, and the trend in COPD prevalence was estimated by comparing the samples participating in dynamic spirometry in 1994 and 2009, respectively. The prevalence of COPD was estimated based on two different definitions of COPD. Commonly used reference values for spirometry were evaluated based on randomly sampled healthy non-smokers defined in clinical examinations of participants in the 2006 postal questionnaire (n=501). The main focus of the evaluation was the global lung function initiative (GLI) reference values published in 2012, for which Z-scores and percent of predicted values were analysed. New sex-specific reference values for spirometry were estimated by linear regression, with age and height as predictors. These new OLIN reference values were also evaluated on a sample of healthy non-smokers identified in the population-based West Sweden Asthma Study.

    Results

    Although the prevalence of smoking decreased from 27.4% to 19.1%, p<0.001, between 1996 and 2006, the prevalence of physician-diagnosed asthma increased from 9.4% to 11.6%, p<0.001. The prevalence of symptoms common in asthma such as recurrent wheeze did not change significantly between the surveys or tended to decrease, while bronchitis symptoms such as cough and sputum production decreased significantly. The evaluation of the GLI reference values showed that the predicted values were significantly lower compared to the observed values in Norrbotten, which makes the percent of predicted too high. This was especially true for FVC percent predicted with a mean of 106%. In general, the deviations were more pronounced among women. New OLIN reference values valid for the Norrbotten sample were modelled and showed a high external validity when applied on the sample from western Sweden. The prevalence of moderate to severe COPD decreased substantially over the 15-year period between 1994 and 2009, regardless of definition.

    Conclusions

    In parallel with substantially decreased smoking habits in the population between 1996 and 2006, the prevalence of several airway symptoms decreased while the prevalence of physician-diagnosed asthma increased. These results suggest increased diagnostic activity for asthma, but may also suggest that the asthma prevalence has continued to increase. In contrast to asthma, the prevalence of COPD tended to decrease and moderate to severe COPD decreased substantially. The continuous decrease in smoking in Sweden during several decades prior to the study period is most likely contributing to these results. The evaluation of reference values showed that the GLI reference values were lower than the observed spirometric values in the population, especially for women, why the new up-to date reference values may be of importance for disease evaluation in epidemiology and in the health care as well.

  • 134.
    Backman, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Eriksson, Berne
    Halmstad, Sweden.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Stridsman, Caroline
    Luleå, Sweden.
    Jansson, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Lundbäck, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Decreased prevalence of moderate to severe COPD over 15 years in northern SwedenManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background: The burden of COPD in terms of mortality, morbidity, costs and prevalence has increased worldwide. Recent results on prevalence in Western Europe are conflicting. In Sweden smoking prevalence has steadily decreased over the past 30 years. 

    Aim: The aim was to study changes in prevalence and risk factor patterns of COPD in the same area and within the same age-span 15 years apart.

    Material and methods: Two population-based cross-sectional samples in ages 23-72 years participating at examinations in 1994 and 2009, respectively, were compared in terms of COPD prevalence, severity and risk factor patterns. Two different definitions of COPD were used; FEV1/FVC<LLN and FEV1/FVC<0.7. The severity of COPD was assessed by FEV1, both as % of predicted and in relation to the LLN.

    Results: The prevalence of COPD decreased significantly from 9.5% to 6.3% (p=0.030) according to the FEV1/FVC<LLN criterion, while the decrease based on the FEV1/FVC<0.7 criterion from 10.5% to 8.5% was non-significant. The prevalence of moderate to severe COPD decreased substantially and significantly, and the risk factor pattern was altered in 2009 when, beside age and smoking, also socio-economic status based on occupation was significantly associated with COPD. 

    Conclusions: Changes in both prevalence and risk factor patterns of COPD were observed between surveys. Following a continuing decrease in smoking habits over several decades, a decrease in the prevalence of moderate to severe COPD was observed from 1994 to 2009 in northern Sweden.

  • 135.
    Backman, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Studies, Department of Research and Development, Norrbotten County Council, Luleå.
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Studies, Department of Research and Development, Norrbotten County Council, Luleå.
    Jansson, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Studies, Department of Research and Development, Norrbotten County Council, Luleå,.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. The OLIN Studies, Department of Research and Development, Norrbotten County Council, Luleå, Sweden.
    Lundbäck, Bo
    The OLIN Studies, Department of Research and Development, Norrbotten County Council, Luleå, Sweden ; Krefting Research Centre/Department of Internal Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Studies, Department of Research and Development, Norrbotten County Council, Luleå.
    Prevalence trends in respiratory symptoms and asthma in relation to smoking: two cross-sectional studies ten years apart among adults in northern Sweden2014Ingår i: The World Allergy Organization journal, ISSN 1939-4551, Vol. 7, nr 1, s. 1-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Smoking is considered to be the single most important preventable risk factor for respiratory symptoms. Estimating prevalence of respiratory symptoms is important since they most often precede a diagnosis of an obstructive airway disease, which places a major burden on the society. The aim of this study was to estimate prevalence trends of respiratory symptoms and asthma among Swedish adults, in relation to smoking habits. A further aim was to estimate the proportion of respiratory symptom and asthma prevalence attributable to smoking.

    METHODS: Data from two large-scale cross-sectional surveys among adults performed in northern Sweden in 1996 and 2006 were analysed. Identical methods and the same questionnaire were used in both surveys. The association between smoking, respiratory symptoms and asthma was analysed with multiple logistic regression analyses. Changes in prevalence of respiratory symptoms and asthma from 1996 to 2006 were expressed as odds ratios. Additionally, the population attributable risks of smoking were estimated.

    RESULTS: The prevalence of most respiratory symptoms decreased significantly from 1996 to 2006. Longstanding cough decreased from 12.4 to 10.1%, sputum production from 19.0 to 15.0%, chronic productive cough from 7.3 to 6.2%, and recurrent wheeze from 13.4 to 12.0%. Any wheeze and asthmatic wheeze remained unchanged. This parallels to a decrease in smoking from 27.4 to 19.1%. In contrast, physician-diagnosed asthma increased from 9.4 to 11.6%. The patterns were similar after correction for confounders. All respiratory symptoms were highly associated with smoking, and the proportion of respiratory symptoms in the population attributed to smoking (PAR) ranged from 9.8 to 25.5%. In 2006, PAR of smoking was highest for recurrent wheeze (20.6%).

    CONCLUSIONS: In conclusion, we found that respiratory symptoms, in particular symptoms common in bronchitis, decreased among adults in northern Sweden, parallel to a decrease in smoking from 1996 to 2006. In contrast, the prevalence of physician-diagnosed asthma increased during the same time-period. Up to one fourth of the respiratory symptom prevalence in the population was attributable to smoking.

  • 136.
    Backman, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Jansson, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Stridsman, Caroline
    Eriksson, Berne
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Eklund, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Sandström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Lundbäck, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Severe asthma: A population study perspective2019Ingår i: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, nr 6, s. 819-828Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Severe asthma is a considerable challenge for patients, health care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study.

    OBJECTIVE: To describe characteristics and estimate the prevalence of severe asthma in a large adult population-based asthma cohort followed for 10-28 years.

    METHODS: N=1006 subjects with asthma participated in a follow-up during 2012-14, when 830 (mean age 59y, 56% women) still had current asthma. Severe asthma was defined according to three internationally well-known criteria: the ATS workshop definition from 2000 used in the US Severe Asthma Research Program (SARP), the 2014 ATS/ERS Task force definition and the GINA 2017. All subjects with severe asthma according to any of these criteria were undergoing respiratory specialist care, and were also contacted by telephone to verify treatment adherence.

    RESULTS: The prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS Taskforce), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >40% had uncontrolled asthma according to the asthma control test. Severe asthma was related to age >50 years, nasal polyposis, impaired lung function, sensitization to aspergillus, and tended to be more common in women. Further, neutrophils in blood significantly discriminated severe asthma from other asthma.

    CONCLUSIONS AND CLINICAL RELEVANCE: Severe asthma differed significantly from other asthma in terms of demographic, clinical and inflammatory characteristics, results suggesting possibilities for improved treatment regimens of severe asthma. The prevalence of severe asthma in this asthma cohort was 4-6%, corresponding to approximately 0.5% of the general population.

  • 137. Baiden, Frank
    et al.
    Bawah, Ayaga
    Biai, Sidu
    Binka, Fred
    Boerma, Ties
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Chandramohan, Daniel
    Chatterji, Somnath
    Engmann, Cyril
    Greet, Dieltiens
    Jakob, Robert
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Kunii, Osamu
    Lopez, Alan D
    Murray, Christopher JL
    Nahlen, Bernard
    Rao, Chalapati
    Sankoh, Osman
    Setel, Philip W
    Shibuya, Kenji
    Soleman, Nadia
    Wright, Linda
    Yang, Gonghuan
    Setting international standards for verbal autopsy2007Ingår i: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 85, nr 8, s. 570-571Artikel i tidskrift (Refereegranskat)
  • 138. Bajraktari, G. Gani
    et al.
    Bytyci, I.
    Henein, Mark
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    LA diameter more than 40 mm predicts recurrence of atrial fibrillation after trans-catheter ablation: a systematic review and meta-analysis2017Ingår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, nr Supplement: 1, s. 431-432, artikel-id Meeting Abstract: P1758Artikel i tidskrift (Refereegranskat)
  • 139. Bajraktari, G. Gani
    et al.
    Bytyci, I.
    Henein, Mark
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Reduced LA strain predicts atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis2017Ingår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, nr Supplement: 1, s. 430-431, artikel-id Meeting Abstract: P1755Artikel i tidskrift (Refereegranskat)
  • 140.
    Bajraktari, Saranda
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Municipality decision-making on health promotion for old people:: Using the MRC guidelines as a tool2016Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: The population in the world is growing older which calls for effective preventive and health-promoting interventions in order to help elderly maintain a good quality of life. It is up to the decision-makers to choose which interventions to implement. However, many health promotion interventions often miss to report information that is relevant for a decision-maker to know. The aim of this study was to identify factors important for decision-making in the existing health promotion literature in the Nordic countries.

    Method: This study made use of the MRC guidelines to identify eight criteria (Context, Content, Theory application, Target population, Efficacy and Effectiveness, Cost-Effectiveness, Feasibility studies and Experiences of Participants) relevant for the decision-making process. Information on each criterion was gathered from eleven identified preventive and health-promoting interventions, selected from PubMed, that met the eligibility criteria.

    Results: The extent to which the factors have been reported have implications on the existing knowledge-base for decisions on health promotion interventions. Only one study reported on all eight identified criteria relevant for decision-making, while more than half of the studies missed information on theory application, cost-effectiveness, feasibility and experiences of participants.

    Conclusion: This study is the first to try to compare health promotion interventions for old people in the Nordic countries. Despite the rather small number of studies analysed, it provides some groundwork for further research and a deeper comparison between health promotion interventions targeting old people and their usefulness for a decision-maker.

  • 141.
    Bakouni, Ghalib Mohammed
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Diabetic retinopathy as a cause of visual impairment and blindness and the possibilities of prevention by using anti vascular endothelial growth factors.: A literature review2016Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Purpose of literature review

     Diabetic retinopathy is a very important public health problem and an important cause of visual impairment and blindness worldwide. In addition, visual impairment and blindness are very important public health problems. The number of diabetic retinopathy patients is expected to increase all over the world in the next few decades. In addition, diabetic retinopathy and its complications are still the leading causes of preventable blindness in working-age men and women. Anti-VEGFs have made a revolution in the prevention of visual impairment and blindness caused by diabetic retinopathy and its complications over the last ten years.

    The aim of this literature review is to provide an overview of studies and articles which examined the role of Anti-VEGFs (Avastin and Lucentis)  in the prevention of visual impairment and blindness caused by diabetic retinopathy. 

    Methodology

    Pubmed database was searched for relevant articles, studies and clinical trials in humans about the role of anti vascular endothelial growth factors in the prevention of visual impairment and blindness caused by diabetic retinopathy. 

    Results and discussion

    In this review, sixteen studies and articles about the role of Anti-VEGFs in the prevention of visual impairment and blindness caused by diabetic retinopathy were found. These studies and articles emphasized on the role of intravitreal Anti-VEGFs in the treatment of diabetic retinopathy and diabetic macular edema and in the prevention of visual impairment and blindness in proliferative diabetic retinopathy and diabetic macular edema. Intravitreal Anti-VEGFs have shown good effects and promising results in their ability to make retinal neovascularization regress. But these Anti-VEGFs have an important limitation which is their short duration. In addition, these Anti-VEGFs cannot substitute the laser treatment which is the treatment of choice for proliferative diabetic retinopathy. 

    Conclusion

    The introduction of Anti-VEGFs into practice gave hope to many diabetic retinopathy patients facing the threat of visual impairment and blindness. However, using intravitreal Anti-VEGFs is a valuable additional treatment in proliferative diabetic retinopathy and diabetic macular edema to prevent visual impairment and reduce the chances of blindness.

  • 142.
    Bakouni, Mohammed Ghalib
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Abedpour Dehkordi, Adel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Does phacoemulsification cataract surgery accelerate the progression of diabetic retinopathy six to twelve months postoperatively?: A systematic review2015Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 143. Balasingam, Shobana
    et al.
    Wilder-Smith, Annelies
    Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore 308232, Singapore.
    Randomized controlled trials for influenza drugs and vaccines: a review of controlled human infection studies2016Ingår i: International Journal of Infectious Diseases, ISSN 1201-9712, E-ISSN 1878-3511, Vol. 49, s. 18-29Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Controlled human infection, the intentional infection of healthy volunteers, allows disease pathogenesis to be studied and vaccines and therapeutic interventions to be evaluated in a controlled setting. A systematic review of randomized controlled trials of countermeasures for influenza that used the experimental human infection platform was performed. The primary objective was to document the scope of trials performed to date and the main efficacy outcome in the trials. The secondary objective was to assess safety and identify serious adverse events.

    METHODS: The PubMed database was searched for randomized controlled influenza human challenge studies with predetermined search terms. Review papers, papers without outcomes, community-acquired infections, duplicated data, pathogenesis studies, and observational studies were excluded.

    RESULTS: Twenty-six randomized controlled trials published between 1947 and 2014 fit the study inclusion criteria. Two-thirds of these trials investigated antivirals and one-third investigated influenza vaccines. Among 2462 subjects inoculated with influenza virus, the incidence of serious adverse events was low (0.04%). These challenge studies helped to down-select three antivirals and one vaccine that were subsequently approved by the US Food and Drug Administration (FDA).

    CONCLUSIONS: Controlled human infection studies are an important research tool in assessing promising influenza vaccines and antivirals. These studies are performed quickly and are cost-effective and safe, with a low incidence of serious adverse events.

  • 144.
    Baldeh, Samba N
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Impact of cooking fuels and other factors on acute respiratory infection among children under-fives in The Gambia2019Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction: Solid fuels still stand as the most widely major source of energy for cooking globally, more than half of the population in the world are using solid fuels for the preparation of their daily meals. About 2.4 billion of the population depend on biomass (wood, animal dung, crop wastes) and o.6 billion on coal. Epidemiologically the hazard associated with the exposure to indoor air pollution generated as result of the used of biomass fuels may account for about two million deaths in developing countries and 4% of the global burden of disease. This study aims to find out the impact of cooking fuels and other factors on acute respiratory infection among children under five in The Gambia.

    Methods: Data from the nationally representative Gambia demographic and health survey was used to select all children less than five years old. The number of under five children was 8088 and after exclusion due to missing data and those who didn’t answer the questions, the unweighted children (n= 7605) and the weighted number of children was 7266. The outcome measure was acute respiratory infection and the exposure variables is cooking fuels. The other factors that were captures in the study were child age, gender, mother’s education, household wealth quintile and residence. In the analysis, descriptive statistics was used to estimate the frequencies and distribution of each of the variable. Logistic regression and chi squares test were also used in the analysis to investigate the relation between cooking fuels and acute respiratory infection.

    Results: The finding of this study shows that more than three quarter (80%) of the children belong to household that used wood/straw as their main source of cooking fuels while the remaining use other fuels. Before adjusting for other variables cooking fuels was not significant but after adjusting for residence a decrease risk of ARI was observed in the household that used wood compared to charcoal (adjusted OR = 0.71 0.52 -0 .97). In this study there was no significant association between cooking fuels and acute respiratory infection. It was also noticed that children whose mothers are educated were more likely to suffered from ARI compared to those belonging to mothers with no education and the same trends was observed for mother’s occupation.

    Conclusion: There is no association reported between the types of cooking fuel and ARI in The Gambia. This and other study that use similar approaches and did not find any association. However, majority of studies were able to establish association with ARI. Other factors like gender of the child, mother’s education, mother’s occupation predicted a significant association with ARI. There is need for more further research since many studies around the world are reporting increase risk of ARI among those who are using cooking fuels.

  • 145. Bals, Robert
    et al.
    Boyd, Jeanette
    Esposito, Susanna
    Foronjy, Robert
    Hiemstra, Pieter S.
    Jimenez-Ruiz, Carlos A.
    Katsaounou, Paraskevi
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Metz, Carlos
    Schober, Wolfgang
    Spira, Avrum
    Blasi, Francesco
    Electronic cigarettes: a task force report from the European Respiratory Society2019Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 53, nr 2, artikel-id 1801151Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a marked increase in the development and use of electronic nicotine delivery systems or electronic cigarettes (ECIGs). This statement covers electronic cigarettes (ECIGs), defined as "electrical devices that generate an aerosol from a liquid" and thus excludes devices that contain tobacco. Database searches identified published articles that were used to summarise the current knowledge on the epidemiology of ECIG use; their ingredients and accompanied health effects; second-hand exposure; use of ECIGs for smoking cessation; behavioural aspects of ECIGs and social impact; in vitro and animal studies; and user perspectives. ECIG aerosol contains potentially toxic chemicals. As compared to conventional cigarettes, these are fewer and generally in lower concentrations. Second-hand exposures to ECIG chemicals may represent a potential risk, especially to vulnerable populations. There is not enough scientific evidence to support ECIGs as an aid to smoking cessation due to a lack of controlled trials, including those that compare ECIGs with licenced stop-smoking treatments. So far, there are conflicting data that use of ECIGs results in a renormalisation of smoking behaviour or for the gateway hypothesis. Experiments in cell cultures and animal studies show that ECIGs can have multiple negative effects. The long-term effects of ECIG use are unknown, and there is therefore no evidence that ECIGs are safer than tobacco in the long term. Based on current knowledge, negative health effects cannot be ruled out.

  • 146.
    Baltussen, Rob
    et al.
    Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
    Mikkelsen, Evelinn
    Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
    Tromp, Noor
    Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Byskov, Jens
    University of Copenhagen, Frederiksberg, Denmark.
    Olsen, Oystein
    Department of Global Public Health and Primary Care University of Bergen, Bergen, Norway.
    Bærøe, Kristine
    4Department of Global Public Health and Primary Care University of Bergen, Bergen, Norway.
    Hontelez, Jan A
    Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
    Singh, Jerome
    7Centre for the AIDS Programme of Research in South Africa, Durban, South Africa.
    Norheim, Ole F
    Department of Global Public Health and Primary Care University of Bergen, Bergen, Norway.
    Balancing efficiency, equity and feasibility of HIV treatment in South Africa: development of programmatic guidance2013Ingår i: Cost effectiveness and resource allocation : C/E, ISSN 1478-7547, Vol. 11, nr 1, artikel-id 26Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    South Africa, the country with the largest HIV epidemic worldwide, has been scaling up treatment since 2003 and is rapidly expanding its eligibility criteria. The HIV treatment programme has achieved significant results, and had 1.8 million people on treatment per 2011. Despite these achievements, it is now facing major concerns regarding (i) efficiency: alternative treatment policies may save more lives for the same budget; (ii) equity: there are large inequalities in who receives treatment; (iii) feasibility: still only 52% of the eligible population receives treatment.Hence, decisions on the design of the present HIV treatment programme in South Africa can be considered suboptimal. We argue there are two fundamental reasons to this. First, while there is a rapidly growing evidence-base to guide priority setting decisions on HIV treatment, its included studies typically consider only one criterion at a time and thus fail to capture the broad range of values that stakeholders have. Second, priority setting on HIV treatment is a highly political process but it seems no adequate participatory processes are in place to incorporate stakeholders' views and evidences of all sorts.We propose an alternative approach that provides a better evidence base and outlines a fair policy process to improve priority setting in HIV treatment. The approach integrates two increasingly important frameworks on health care priority setting: accountability for reasonableness (A4R) to foster procedural fairness, and multi-criteria decision analysis (MCDA) to construct an evidence-base on the feasibility, efficiency, and equity of programme options including trade-offs. The approach provides programmatic guidance on the choice of treatment strategies at various decisions levels based on a sound conceptual framework, and holds large potential to improve HIV priority setting in South Africa.

  • 147.
    Balwiire, Davis
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    DOES MATERNAL POSTPARTUM DEPRESSION AFFECT EARLY CHILD DEVELOPMENT?: A study protocol for a prospective cohort study in rural Uganda2019Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: Mothers in Uganda and all over the world are at risk to postpartum depression due to diverse factors present in their communities. Approximately 10% to 15% suffer from postpartum depression with its prevalence at 6.1% in Uganda. It has adverse effects on mothers and their families with severe consequences. Depressed mothers loose interest in most aspects of their life including their children who are strongly dependent on them, leading to serious neglect. This may affect the children’s development.

    Aims: The aim of this study protocol is to examine if maternal postpartum depression affects child development amongst one-year olds in rural Uganda.

    Methods: It will be a prospective cohort study and a quantitative approach will be used with structured questionnaires for data collection that’s maternal postpartum depression status and socio demography data, and the child’s development. Mother’s postpartum depression will be assessed first at 2 months after birth. Secondly their children’s development will be measured and assessed at 6 months and at 12 months in the one-year follow-up period. A sample of 114 mother-infant pairs is required and quantitative statistical methods will be used for data analyzes.

    Expected Outcomes: This study will generate scientific knowledge on the effects of postpartum depression on child development in a rural setting of a developing country. The findings will identify which children are at most risk of having development issues. Lastly, the findings could be used to formulate appropriate strategies and interventions to combat depression and its effects on child development.

  • 148. Bamia, Christina
    et al.
    Lagiou, Pagona
    Buckland, Genevieve
    Grioni, Sara
    Agnoli, Claudia
    Taylor, Aliki J.
    Dahm, Christina C.
    Overvad, Kim
    Olsen, Anja
    Tjonneland, Anne
    Cottet, Vanessa
    Boutron-Ruault, Marie-Christine
    Morois, Sophie
    Grote, Verena
    Teucher, Birgit
    Boeing, Heiner
    Buijsse, Brian
    Trichopoulos, Dimitrios
    Adarakis, George
    Tumino, Rosario
    Naccarati, Alessio
    Panico, Salvatore
    Palli, Domenico
    Bueno-de-Mesquita, H. Bas
    van Duijnhoven, Fraenzel J. B.
    Peeters, Petra H. M.
    Engeset, Dagrun
    Skeie, Guri
    Lund, Eiliv
    Sanchez, Maria-Jose
    Barricarte, Aurelio
    Huerta, Jose-Maria
    Ramon Quiros, J.
    Dorronsoro, Miren
    Ljuslinder, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Drake, Isabel
    Key, Timothy J.
    Khaw, Kay-Tee
    Wareham, Nick
    Romieu, Isabelle
    Fedirko, Veronika
    Jenab, Mazda
    Romaguera, Dora
    Norat, Teresa
    Trichopoulou, Antonia
    Mediterranean diet and colorectal cancer risk: results from a European cohort2013Ingår i: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 28, nr 4, s. 317-328Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The authors investigated the association of adherence to Mediterranean diet with colorectal cancer (CRC) risk in the European Prospective Investigation into Cancer and nutrition study. Adherence to Mediterranean diet was expressed through two 10-unit scales, the Modified Mediterranean diet score (MMDS) and the Centre-Specific MMDS (CSMMDS). Both scales share the same dietary components but differ in the cut-off values that were used for these components in the construction of the scales. Adjusted hazard ratios (HR) for the associations of these scales with CRC incidence were estimated. After 5,296,617 person-years of follow-up, 4,355 incident CRC cases were identified. A decreased risk of CRC, of 8 and 11 % was estimated when comparing the highest (scores 6-9) with the lowest (scores 0-3) adherence to CSMMDS and MMDS respectively. For MMDS the HR was 0.89 (95 % confidence interval (CI): 0.80, 0.99). A 2-unit increment in either Mediterranean scale was associated with a borderline statistically significant 3 to 4 % reduction in CRC risk (HR for MMDS: 0.96; 95 % CI: 0.92, 1.00). These associations were somewhat more evident, among women, were mainly manifested for colon cancer risk and their magnitude was not altered when alcohol was excluded from MMDS. These findings suggest that following a Mediterranean diet may have a modest beneficial effect on CRC risk.

  • 149. Bamia, Christina
    et al.
    Lagiou, Pagona
    Jenab, Mazda
    Trichopoulou, Antonia
    Fedirko, Veronika
    Aleksandrova, Krasimira
    Pischon, Tobias
    Overvad, Kim
    Olsen, Anja
    Tjønneland, Anne
    Boutron-Ruault, Marie-Christine
    Fagherazzi, Guy
    Racine, Antoine
    Kuhn, Tilman
    Boeing, Heiner
    Floegel, Anna
    Benetou, Vasiliki
    Palli, Domenico
    Grioni, Sara
    Panico, Salvatore
    Tumino, Rosario
    Vineis, Paolo
    Bueno-de-Mesquita, H B As
    Dik, Vincent K
    Bhoo-Pathy, Nirmala
    Uiterwaal, Cuno S P M
    Weiderpass, Elisabete
    Lund, Eiliv
    Quirós, J Ramón
    Zamora-Ros, Raul
    Molina-Montes, Esther
    Chirlaque, Maria-Dolores
    Ardanaz, Eva
    Dorronsoro, Miren
    Lindkvist, Björn
    Wallström, Peter
    Nilsson, Lena Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Khaw, Kay-Tee
    Wareham, Nick
    Bradbury, Kathryn E
    Travis, Ruth C
    Ferrari, Pietro
    Duarte-Salles, Talita
    Stepien, Magdalena
    Gunter, Marc
    Murphy, Neil
    Riboli, Elio
    Trichopoulos, Dimitrios
    Coffee, tea and decaffeinated coffee in relation to hepatocellular carcinoma in a European population: multicentre, prospective cohort study2015Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 136, nr 8, s. 1899-1908Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Inverse associations of coffee and/or tea in relation to hepatocellular carcinoma (HCC) risk have been consistently identified in studies conducted mostly in Asia where consumption patterns of such beverages differ from Europe. In the European Prospective Investigation into Cancer and nutrition (EPIC), we identified 201 HCC cases among 486,799 men/women, after a median follow-up of 11 years. We calculated adjusted hazard ratios (HRs) for HCC incidence in relation to quintiles/categories of coffee/tea intakes. We found that increased coffee and tea intakes were consistently associated with lower HCC risk. The inverse associations were substantial, monotonic and statistically significant. Coffee consumers in the highest compared to the lowest quintile had lower HCC risk by 72% [HR: 0.28; 95% confidence intervals (CIs): 0.16-0.50, p-trend < 0.001]. The corresponding association of tea with HCC risk was 0.41 (95% CI: 0.22-0.78, p-trend = 0.003). There was no compelling evidence of heterogeneity of these associations across strata of important HCC risk factors, including hepatitis B or hepatitis C status (available in a nested case-control study). The inverse, monotonic associations of coffee intake with HCC were apparent for caffeinated (p-trend = 0.009), but not decaffeinated (p-trend = 0.45) coffee for which, however, data were available for a fraction of subjects. Results from this multicentre, European cohort study strengthen the existing evidence regarding the inverse association between coffee/tea and HCC risk. Given the apparent lack of heterogeneity of these associations by HCC risk factors and that coffee/tea are universal exposures, our results could have important implications for high HCC risk subjects.

  • 150. Banda, Emmanuel
    et al.
    Svanemyr, Joar
    Sandoy, Ingvild Fossgard
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Zulu, Joseph Mumba
    Acceptability of an economic support component to reduce early pregnancy and school dropout in Zambia: a qualitative case study2019Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, nr 1, artikel-id 1685808Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Cash Transfer (CT) schemes have become popular poverty reducing measures in many low and middle-income countries. Research indicates that when provided to girls in resource poor settings, cash transfers can increase education and postpone marriage and pregnancy. However, a few studies indicate that they can also have negative effects which can affect their acceptability, such as generating intra-community tensions.

    Objective: Conceptually informed by Rogers’ diffusion of innovation theory, this paper explores factors affecting the acceptability of economic support in a randomized controlled trial in rural Monze and Pemba Districts of Southern Province in Zambia.

    Methods: Qualitative data were collected through five focus group discussions and six in-depth, semi-structured interviews and analysed using thematic analysis. This study was done in the combined arm of a trial where girls received both economic support and participated in youth clubs offering sexuality and life-skills education.

    Results: In the study communities, acceptability was encouraging by the belief that economic support provided benefits beyond beneficiaries and that it improved access to education, and reduced teen pregnancies, marriages and school drop-out. However, provision of economic support only to selected girls and their parents and fear among some that the support was linked to satanic practices negatively affected acceptability. These fears were mitigated through community sensitisations.

    Conclusion: The study demonstrated that relative advantage, observability, simplicity and compatibility were key factors in influencing acceptability of the economic support. However, to enhance acceptability of cash transfer schemes aimed at addressing early marriage and pregnancy, it is important to explore socio-cultural factors that create suspicions and negative perceptions and to provide schemes that are perceived as relatively better than available similar schemes, understood, compatible and viable beyond the immediate beneficiary.

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