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  • 2801. Xuan, Le Thi Thanh
    et al.
    Egondi, Thaddaeus
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. African Population and Health Research Center, Nairobi, Kenya.
    Ngoan, Le Tran
    Toan, Do Thi Thanh
    Huong, Le Thi
    Seasonality in mortality and its relationship to temperature among the older population in Hanoi, Vietnam2014Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, artikel-id 23115Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Several studies have established a relationship between temperature and mortality. In particular, older populations have been shown to be vulnerable to temperature effects. However, little information exists on the temperature-mortality relationship in Vietnam. OBJECTIVES: This article aims to examine the monthly temperature-mortality relationship among older people in Hanoi, Vietnam, over the period between 2005 and 2010, and estimate seasonal patterns in mortality. METHODS: We employed Generalized Additive Models, including smooth functions, to model the temperature-mortality relationships. A quasi-Poisson distribution was used to model overdispersion of death counts. Temporal trends, seasonality, and population size were adjusted for while estimating changes in monthly mortality over the study period. A cold month was defined as a month with a mean temperature below 19 degrees C. RESULTS: This study found that the high peak of mortality coincided with low temperatures in the month of February 2008, during which the mean temperature was the lowest in the whole study period. There was a significant relationship between mean monthly temperature and mortality among the older people (pB0.01). Overall, there was a significant decrease in the number of deaths in the year 2009 during the study period. There was a 21% increase in the number of deaths during the cold season compared to the warm season. The increase in mortality during the cold period was higher among females compared to males (female: IRR [incidence relative risk] = 1.23; male: IRR = 1.18). CONCLUSIONS: Cold temperatures substantially increased mortality among the older population in Hanoi, Vietnam, and there were gender differences. Necessary preventive measures are required to mitigate temperature effects with greater attention to vulnerable groups.

  • 2802.
    Yahia, Abdelrahman
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Cost-effectiveness for Safe Steps health intervention, a mobile based intervention for falling prevention in elderly.2019Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction: Falling is a major health concern in elderly which is associated with huge societal costs. Exercise based interventions have been proven to be effective to reduce accidental falls. Safe Steps is a mobile based intervention which helps elderly to exercise, attain better strength and balance to reduce falls. The study investigates the cost effectiveness of Safe Steps intervention.

    Methods: Markov model was constructed to capture the long-term effect of the intervention compared to no intervention arm. Deterministic analysis was initially conducted, then a probabilistic sensitivity analysis with altered assumptions to test uncertainty effect.

    Results: deterministic analysis resulted in an ICER of -839 Thousand SEKs/QALY gained which suggests lower costs and higher QALYS gained through the intervention. Sensitivity analysis showed possibly low effect of uncertainty for most of the parameters and assumptions, however the model output seemed to be sensitive to the assumptions about intervention cost.

    Discussion: The base case showed ICER estimates below the commonly accepted thresholds. Uncertainty is still a key issue that has to be further investigated. However, quantifying uncertainties in the factors affecting the intervention cost effectiveness could guide future research insightfully.

    Conclusion: The Safe Steps intervention seems to be highly cost effective according to the estimates produced by this model.

  • 2803.
    Yahia, Abdelrahman
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Effect of regulatory changes on pharmacy practice in Sweden: Interpretative literature review2018Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction: Pharmaceutical care services are crucial to guarantee safe and effective medication use through utilization of pharmacists’ knowledge about drugs. Regulations set the conditions and platforms that these services are provided through. Hence, regulatory changesdirectly affect the shape of the whole pharmacy practices.

    Objectives: to study how current regulations and recent regulatory changes in Sweden affect pharmaceutical care provision, particularly,counseling in community pharmacies.

    Methods: Scoping literature review was conducted, articles were searched through PubMed database and through reviewing the references of the selected articles, and interpretative analysis was carried out.

    Results: the development of pharmaceutical sector after re-regulation of community pharmacies (liberalization) seem to be more businessoriented and market responsive rather than focusing on pharmaceutical care and Regulations and regulatory changes, generally, do not seem to support sufficiently or advance pharmaceutical care and patient counseling.

    Discussion: Imbalance between stakeholders resulted in domination of politicians view and marginal role for professional organizations. Market mechanisms and consumer empowerment could interfere with proper healthcare provision, and its effects on the pharmacy sector should be studied further. However, opportunities for advancement still exist to build on such as robust drug related problems (DRP) systems for collection, analysis and classification, and some efforts to set practice standards. Some solutions could build on this such as parallel standardization efforts by pharmacists and developing stronger feedback and rewarding mechanisms.

  • 2804. Yamamoto, Shelby
    et al.
    Sie, Ali
    Sauerborn, Rainer
    Institute of Public Health, University of Heidelberg .
    Cooking fuels and the push for cleaner alternatives: a case study from Burkina Faso2009Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, s. 156-164Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: More than 95% of the population in Burkina Faso uses some form of solid biomass fuel. When these fuels are burned in traditional, inefficient stoves, pollutant levels within and outside the home can be very high. This can have important consequences for both health and climate change. Thus, the push to switch to cleaner burning fuels is advantageous. However, there are several considerations that need to be taken into account when considering the use and promotion of different fuel types.

    Objective: In the setting of the semi-urban area of Nouna, Burkina Faso, we examine the common fuel types used (wood, charcoal and liquid petroleum gas (LPG)) in terms of consumption, energy, availability, air pollution and climate change.

    Results and conclusion: Although biomass solid fuel does offer some advantages over LPG, the disadvantages make this option much less desirable. Lower energy efficiencies, higher pollutant emission levels, the associated health consequences and climate change effects favour the choice of LPG over solid biomass fuel use. Further studies specific to Burkina Faso, which are lacking in this region, should also be undertaken in this area to better inform policy decisions.

  • 2805.
    Yanamandra, Kiran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk kemi och biofysik.
    Alexeyev, Oleg
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Zamotin, Vladimir
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk kemi och biofysik.
    Srivastava, Vaibhav
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Umeå Plant Science Centre (UPSC).
    Shchukarev, Andrey
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Brorsson, Ann-Christin
    Department of Chemistry, University of Cambridge, Cambridge, United Kingdom.
    Tartaglia, Gian Gaetano
    Department of Chemistry, University of Cambridge, Cambridge, United Kingdom.
    Vogl, Thomas
    Institute of Immunology, University of Münster, Münster, Germany.
    Kayed, Rakez
    Department of Neurology, University of Texas Medical Branch, Galveston, Texas, United States of America.
    Wingsle, Gunnar
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Umeå Plant Science Centre (UPSC).
    Olsson, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Dobson, Christopher M
    Department of Chemistry, University of Cambridge, Cambridge, United Kingdom.
    Bergh, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Elgh, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Morozova-Roche, Ludmilla A
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk kemi och biofysik.
    Amyloid formation by the pro-inflammatory S100A8/A9 proteins in the ageing prostate2009Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 4, nr 5, s. e5562-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The conversion of soluble peptides and proteins into polymeric amyloid structures is a hallmark of many age-related degenerative disorders, including Alzheimer's disease, type II diabetes and a variety of systemic amyloidoses. We report here that amyloid formation is linked to another major age-related phenomenon - prostate tissue remodelling in middle-aged and elderly men.

    Methodology/Principal Findings By using multidisciplinary analysis of corpora amylacea inclusions in prostate glands of patients diagnosed with prostate cancer we have revealed that their major components are the amyloid forms of S100A8 and S100A9 proteins associated with numerous inflammatory conditions and types of cancer. In prostate protease rich environment the amyloids are stabilized by dystrophic calcification and lateral thickening. We have demonstrated that material closely resembling CA can be produced from S100A8/A9 in vitro under native and acidic conditions and shows the characters of amyloids. This process is facilitated by calcium or zinc, both of which are abundant in ex vivo inclusions. These observations were supported by computational analysis of the S100A8/A9 calcium-dependent aggregation propensity profiles. We found DNA and proteins from Escherichia coli in CA bodies, suggesting that their formation is likely to be associated with bacterial infection. CA inclusions were also accompanied by the activation of macrophages and by an increase in the concentration of S100A8/A9 in the surrounding tissues, indicating inflammatory reactions.

    Conclusions/Significance These findings, taken together, suggest a link between bacterial infection, inflammation and amyloid deposition of pro-inflammatory proteins S100A8/A9 in the prostate gland, such that a self-perpetuating cycle can be triggered and may increase the risk of malignancy in the ageing prostate. The results provide strong support for the prediction that the generic ability of polypeptide chains to convert into amyloids could lead to their involvement in an increasing number of otherwise apparently unrelated diseases, particularly those associated with ageing.

  • 2806. Yang, Fei
    et al.
    Pedersen, Nancy L
    Ye, Weimin
    Liu, Zhiwei
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Forsgren, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Trolle Lagerros, Ylva
    Bellocco, Rino
    Alfredsson, Lars
    Knutsson, Anders
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Galanti, Maria Rosaria
    Lager, Anton C J
    Araghi, Marzieh
    Lundberg, Michael
    Magnusson, Cecilia
    Wirdefeldt, Karin
    Moist smokeless tobacco (Snus) use and risk of Parkinson's disease2017Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, nr 3, s. 872-880Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Cigarette smoking is associated with a lower risk of Parkinson's disease. It is unclear what constituent of tobacco smoke may lower the risk. Use of Swedish moist smokeless tobacco (snus) can serve as a model to disentangle what constituent of tobacco smoke may lower the risk. The aim of this study was to determine whether snus use was associated with a lower risk of Parkinson's disease.

    METHODS: Individual participant data were collected from seven prospective cohort studies, including 348 601 men. We used survival analysis with multivariable Cox regression to estimate study-specific relative risk of Parkinson's disease due to snus use, and random-effects models to pool estimates in a meta-analysis. The primary analyses were restricted to never-smokers to eliminate the potential confounding effect of tobacco smoking.

    RESULTS: During a mean follow-up time of 16.1 years, 1199 incident Parkinson's disease cases were identified. Among men who never smoked, ever-snus users had about 60% lower Parkinson's disease risk compared with never-snus users [pooled hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.28-0.61]. The inverse association between snus use and Parkinson's disease risk was more pronounced in current (pooled HR 0.38, 95% CI 0.23-0.63), moderate-heavy amount (pooled HR 0.41, 95% CI 0.19-0.90) and long-term snus users (pooled HR 0.44, 95% CI 0.24-0.83).

    CONCLUSIONS: Non-smoking men who used snus had a substantially lower risk of Parkinson's disease. Results also indicated an inverse dose-response relationship between snus use and Parkinson's disease risk. Our findings suggest that nicotine or other components of tobacco leaves may influence the development of Parkinson's disease.

  • 2807. Yang, Lei
    et al.
    Liu, Huan
    Guo, Xiong
    Lammi, Mikko Juhani
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB). School of Public Health, Health Science Center, Xi'an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, Xi'an, People's Republic of China.
    The potential biochemical markers of Kashin-Beck disease: a meta-analysis2016Ingår i: Biomarkers, ISSN 1354-750X, E-ISSN 1366-5804, Vol. 21, nr 7, s. 633-638Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The objective of this study is to explore the cytokines in serum, synovial fluid as potential biomarkers of Kashin-Beck disease (KBD) and to further understand the role of these cytokines in the pathogenesis of KBD.

    METHODS: A systematic electronic database search was performed from inception up to 15 March 2015. Meta-analysis was performed for cytokines more than one repetition in studies with available data. The effect size was summarized as standardized mean difference (SMD) with 95% confidence intervals (CIs) by a random effect model.

    RESULTS: A total of 18 articles were included. The pooled standardized mean differences showed the serum levels of tumor necrosis factor alpha (2.72, 95% CI: 1.8 5-3.59), interleukin-1 beta (1.21, 95% CI: 0.6 1-1.80), and nitric oxide (2.60, 95% CI: 1.5 2-3.68) were significantly higher in adult KBD patients compared with that in healthy controls.

    CONCLUSIONS: There was explicit evidence showing that the tumor necrosis factor alpha, interleukin-1 beta and nitric oxide were closely related to the presence of KBD, and these cytokines played a vital role in the pathogenesis of KBD.

  • 2808.
    Yavari, Leila
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Antibiotic Resistance in Salmonella enterica and the Role of Animal and Animal Food Control - A literature review of Europe and USA2012Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 2809. Ye, Yazoume
    et al.
    Hoshen, Moshe
    Kyobutungi, Catherine
    Louis, Valerie R
    Sauerborn, Rainer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. University of Heidelberg, Department of Tropical Hygiene & Public Health, Medical school, Heidelberg, Germany.
    Local scale prediction of Plasmodium falciparum malaria transmission in an endemic region using temperature and rainfall2009Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, s. 103-115Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To support malaria control strategies, prior knowledge of disease risk is necessary. Developing a model to explain the transmission of malaria, in endemic and epidemic regions, is of high priority in developing health system interventions. We develop, fit and validate a non-spatial dynamic model driven by meteorological conditions that can capture seasonal malaria transmission dynamics at the village level in a malaria holoendemic area of north-western Burkina Faso.

    Methods: A total of 676 children aged 6-59 months took part in this study. Trained interviewers visited children at home weekly from December 2003 to November 2004 for Plasmodium falciparum malaria infection detection. Anopheles daily biting rate, mortality rate and growth rate were evaluated. Digital meteorological stations measured ambient temperature, humidity and rainfall in each site.

    Results: The overall P. falciparum malaria infection incidence was 1.1 episodes per person year. There was strong seasonal variation in P. falciparum malaria infection incidence with a peak observed in August and September, corresponding to the rainy season and a high number of mosquitoes. The model estimates of monthly mosquito abundance and the incidence of malaria infection correlated well with observed values. The fit was sensitive to daily mosquito survival and daily human parasite clearance.

    Conclusion: The model has demonstrated potential for local scale seasonal prediction of P. falciparum malaria infection. It could therefore be used to understand malaria transmission dynamics using meteorological parameters as the driving force and to help district health managers in identifying high-risk periods for more focused interventions.

  • 2810. Yego, Faith H
    et al.
    D Este, Catherine
    Byles, Julie
    Nyongesa, Paul
    Williams, Jennifer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Research Centre for Gender, Health and Ageing, University of Newcastle, Newcastle, Australia.
    A case-control study of risk factors for fetal and early neonatal deaths in a tertiary hospital in Kenya2014Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, s. 389-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundIt is important to understand the risk factors for fetal and neonatal mortality which is a major contributor to high under five deaths globally. Fetal and neonatal mortality is a sensitive indicator of maternal health in society. This study aimed to examine the risk factors for fetal and early neonatal mortality at the Moi Teaching and Referral Hospital in Kenya.MethodsThis was a case-control study. Cases were fetal and early neonatal deaths (n¿=¿200). The controls were infants born alive immediately preceding and following the cases (n¿=¿400). Bivariate comparisons and multiple logistic regression analyses were undertaken.ResultsThe odds of having 0-1 antenatal visits relative to 2-3 visits were higher for cases than controls (AOR=4.5; 95% CI: 1.2-16.7; p=0.03). There were lower odds among cases of having a doctor rather than a midwife as a birth attendant (OR¿=¿0.2; 95% CI: 0.1-0.6; p¿<¿0.01). The odds of mothers having Premature Rupture of Membranes (OR¿=¿4.1; 95% CI: 1.4-12.1; p¿=¿0.01), haemorrhage (OR¿=¿4.8; 95% CI: 1.1-21.9; p¿=¿0.04) and dystocia (OR¿=¿3.6; 95% CI: 1.2-10.9; p¿=¿0.02) were higher for the cases compared with the controls. The odds of gestational age less than 37 weeks (OR¿=¿7.0; 95% CI 2.4-20.4) and above 42 weeks (OR¿=¿16.2; 95% CI 2.8-92.3) compared to 37-42 weeks, were higher for cases relative to controls (p¿<¿0.01). Cases had higher odds of being born with congenital malformations (OR¿=¿6.3; 95% CI: 1.2-31.6; p¿=¿0.04) and with Apgar scores of below six at five minutes (OR¿=¿26.4; 95% CI: 6.1-113.8; p¿<¿0.001).ConclusionInterventions that focus on educating mothers on antenatal attendance, screening, monitoring and management of maternal conditions during the antenatal period should be strengthened. Doctor attendance at each birth and for emergency admissions is important to ensure early neonatal survival and avert potential risk factors for mortality.

  • 2811. Yego, Faith
    et al.
    Stewart Williams, Jennifer
    Research Centre for Gender, Health and Ageing, HMRI Building, University of Newcastle, University Drive, 2308, Callaghan, NSW, Australia.
    Byles, Julie
    Nyongesa, Paul
    Aruasa, Wilson
    D'Este, Catherine
    A retrospective analysis of maternal and neonatal mortality at a teaching and referral hospital in Kenya2013Ingår i: Reproductive health, ISSN 1742-4755, Vol. 10, s. 13-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To measure the incidence of maternal and early neonatal mortality in women who gave birth at Moi Teaching and Referral Hospital (MTRH) in Kenya and describe clinical and other characteristics and circumstances associated with maternal and neonatal deaths following deliveries at MTRH.

    METHODS: A retrospective audit of maternal and neonatal records was conducted with detailed analysis of the most recent 150 maternal deaths and 200 neonatal deaths. Maternal mortality ratios and early neonatal mortality rates were calculated for each year from January 2004 to December 2011.

    RESULTS: Between 2004 and 2011, the overall maternal mortality ratio was 426 per 100,000 live births and the early neonatal mortality rate (<7 days) was 68 per 1000 live births. The Hospital record audit showed that half (51%) of the neonatal mortalities were for young mothers (15-24 years) and 64% of maternal deaths were in women between 25 and 45 years. Most maternal and early neonatal deaths occurred in multiparous women, in referred admissions, when the gestational age was under 37 weeks and in latent stage of labour. Indirect complications accounted for the majority of deaths. Where there were direct obstetric complications associated with the delivery, the leading cause of maternal death was eclampsia and the leading cause of early neonatal death was pre-mature rupture of membranes. Pre-term birth and asphyxia were leading causes of early neonatal deaths. In both sets of records the majority of deliveries were vaginal and performed by midwives.

    CONCLUSION: This study provides important information about maternal and early neonatal mortality in Kenya's second largest tertiary hospital. A range of socio demographic, clinical and health system factors are identified as possible contributors to Kenya's poor progress towards reducing maternal and early neonatal mortality.

  • 2812.
    Yekkalam, Negin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Patterns and risk factors of social exclusion among older people in India2012Självständigt arbete på avancerad nivå (masterexamen), 10,5 poäng / 16 hpStudentuppsats (Examensarbete)
  • 2813.
    Yekkalam, Negin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Wänman, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Associations between craniomandibular disorders, sociodemographic factors and self-perceived general and oral health in an adult population2014Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, nr 8, s. 1054-1065Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. The aim of this study was to analyze the relationships between pain in the craniomandibular region and jaw dysfunction, respectively, to sociodemographic factors and self-perceived general and oral health in a middle-aged and elderly population in Västerbotten County, Sweden.

    Materials and methods. Six hundred individuals, 35-, 50-, 65- and 75 years old, from inland and 600 individuals from coastal areas were randomly selected in 2002. Of these, 987 individuals completed a questionnaire and 779 participated in a clinical examination. Thirty-five- and 50-year-olds together constituted a middle-aged group and the rest an elderly group.

    Results. Among the middle-aged, craniomandibular pain was associated with impaired general health status, signs of temporomandibular disorder (TMD) pain were associated with female gender and living alone, jaw dysfunction symptoms were associated with university degree and chewing with caution; and signs of TMD dysfunction were associated with female gender and living in the more densely populated coastal region. Among the elderly, craniomandibular pain was more common among those living in the inland region, craniomandibular pain and signs of TMD pain were associated with impaired general health status, jaw dysfunction symptoms were associated with higher education level and self-perceived impaired general health and oral health; and signs of TMD dysfunction were associated with female gender and living in the coastal region. Dental status was not associated with craniomandibular pain.

    Conclusions. Socioeconomic factors and impaired general state of health were related to signs and symptoms indicative of CMD. These factors may influence demand for treatment among the affected.

  • 2814. Yektaei-Karin, E.
    et al.
    Zovko, A.
    Nilsson, A.
    Kanter, L.
    Radmark, O.
    Ekblom, M.
    Qian, H.
    Wallvik, Jonas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Stenke, L.
    MODULATION OF LEUKOTRIENE SIGNALING INHIBITING CELL GROWTH IN CHRONIC MYELOID LEUKEMIA2016Ingår i: Haematologica, ISSN 0390-6078, E-ISSN 1592-8721, Vol. 101, s. 731-731Artikel i tidskrift (Övrigt vetenskapligt)
  • 2815. Yezli, Saber
    et al.
    Wilder-Smith, Annelies
    Lee Kong Chain School of Medicine, Nanyang Technological University, Singapore.
    Bin Saeed, Abdulaziz A
    Carriage of Neisseria meningitidis in the Hajj and Umrah mass gatherings2016Ingår i: International Journal of Infectious Diseases, ISSN 1201-9712, E-ISSN 1878-3511, Vol. 47, s. 65-70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Meningococcal disease is a serious public health threat, especially during mass gatherings such as Hajj and Umrah which provide optimal conditions for disease transmission. The disease is caused by Neisseria meningitidis and transmitted mainly via asymptomatic carriers. A review of the literature on asymptomatic N. meningitidis carriage among Hajj and Umrah pilgrims and their household contacts was performed. Carriage studies reported carriage rates to be higher in Hajj pilgrims compared to Umrah pilgrims and that these events promote acquisition of carriage among pilgrims. With some outliers, most studies found carriage rates among pilgrims to be comparable to those in populations under non-epidemic settings. However, these results should be interpreted with caution, taking into account the limitations within the studies identified. A wide variety of N. meningitidis serogroups appear to be circulating among Hajj and Umrah pilgrims, with serogroups W135 and B being most prominent. Current Hajj and Umrah meningococcal disease preventative measures do not necessarily prevent carriage and transmission, which may result in local and international outbreaks among susceptible populations. Monitoring carriage states of visitors and local inhabitants in the Kingdom of Saudi Arabia, as well as the implementation of preventive measures that impact carriage, are warranted to reduce the risk of Hajj and Umrah-related meningococcal disease outbreaks.

  • 2816.
    Yousefi, Parshin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Overweight/obesity and lifestyle characteristics among Iranian pre-school children2012Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 2817.
    Yu, Fang-Fang
    et al.
    Institute of Endemic Diseases, School of Public Health of Health Science Center, Xi’an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, Xi’an, China.
    Zhang, Yan-Xiang
    Department of Orthopedics, Baoji People’s Hospital, Baoji, China.
    Zhang, Lian-He
    Institute of Endemic Diseases, School of Public Health of Health Science Center, Xi’an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, Xi’an, China.
    Li, Wen-Rong
    Institute of Endemic Diseases, School of Public Health of Health Science Center, Xi’an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, Xi’an, China.
    Guo, Xiong
    Institute of Endemic Diseases, School of Public Health of Health Science Center, Xi’an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, Xi’an, China.
    Lammi, Mikko
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB). Institute of Endemic Diseases, School of Public Health of Health Science Center, Xi’an Jiaotong University, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, Xi’an, China.
    Identified molecular mechanism of interaction between environmental risk factors and differential expression genes in cartilage of Kashin-Beck disease2016Ingår i: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 95, nr 52, artikel-id e5669Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    As environmental risk factors (ERFs) play an important role in the pathogenesis of Kashin-Beck disease (KBD), it is important to identify the interaction between ERFs and differentially expression genes (DEGs) in KBD. The environmental response genes (ERGs) were analyzed in cartilage of KBD in comparison to normal controls.We searched 5 English and 3 Chinese databases from inception to September 2015, to identify case-control studies that examined ERFs for KBD using integrative meta-analysis and systematic review. Total RNA was isolated from articular cartilage of KBD patients and healthy controls. Human whole genome microarray chip (Agilent) was used to analyze the amplified, labeled, and hybridized total RNA, and the validated microarray data were partially verified using real-time quantitative polymerase chain reaction (qRT-PCR). The ERGs were derived from the Comparative Toxicogenomics Database. The identified ERGs were subjected to KEGG pathway enrichment, biological process (BP), and interaction network analyses using the Database for Annotation, Visualization and Integrated Discovery (DAVID) v6.7, and STRING.The trace elements (selenium and iodine), vitamin E, and polluted grains (T-2 toxin/HT-2 toxin, deoxynivalenol, and nivalenol) were identified as the ERFs for KBD using meta-analysis and review. We identified 21 upregulated ERGs and 7 downregulated ERGs in cartilage with KBD compared with healthy controls, which involved in apoptosis, metabolism, and growth and development. KEGG pathway enrichment analysis found that 2 significant pathways were involved with PI3K-Akt signaling pathway and P53 signaling pathway, and gene ontology function analysis found 3 BPs involved with apoptosis, death, and cell death in KBD cartilage.According to previous results and our own research, we suggest that the trace element selenium and vitamin E induce PI3K-Akt signaling pathway and the mycotoxins (T-2 toxin/HT-2 toxin and DON) induce P53 signaling pathway, contributing to the development of KBD, and chondrocyte apoptosis and cell death.

  • 2818. Yuan, Beibei
    et al.
    Målqvist, Mats
    Trygg, Nadja
    Qian, Xu
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Thomsen, Sarah
    What interventions are effective on reducing inequalities in maternal and child health in low- and middle-income settings? A systematic review.2014Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, s. 634-Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: The deadline for achieving Millennium Development Goals 4 and 5 is approaching, but inequalities between disadvantaged and other populations is a significant barrier for progress towards achieving these goals. This systematic review aims to collect evidence about the differential effects of interventions on different sociodemographic groups in order to identify interventions that were effective in reducing maternal or child health inequalities.

    Methods: We searched the PubMed, EMBASE and other relevant databases. The reference lists of included reviews were also screened to find more eligible studies. We included experimental or observational studies that assessed the effects of interventions on maternal and child health, but only studies that report quantitative inequality outcomes were finally included for analysis.

    Results: 22 articles about the effectiveness of interventions on equity in maternal and child health were finally included. These studies covered five kinds of interventions: immunization campaigns, nutrition supplement programs, health care provision improvement interventions, demand side interventions, and mixed interventions. The outcome indicators covered all MDG 4 and three MDG 5 outcomes. None of the included studies looked at equity in maternal mortality, adolescent birth rate and unmet need for family planning. The included studies reported inequalities based on gender, income, education level or comprehensive socioeconomic status. Stronger or moderate evidence showed that all kinds of the included interventions may be more effective in improving maternal or child health for those from disadvantaged groups.

    Conclusion: Studies about the effectiveness of interventions on equity in maternal or child health are limited. The limited evidence showed that the interventions that were effective in reducing inequity included the improvement of health care delivery by outreach methods, using human resources in local areas or provided at the community level nearest to residents and the provision of financial or knowledge support to demand side.

  • 2819.
    Zaba, Basia
    et al.
    London School of Hygiene & Tropical Medicine, London, UK.
    Calvert, Clara
    London School of Hygiene & Tropical Medicine, London, UK.
    Marston, Milly
    London School of Hygiene & Tropical Medicine, London, UK.
    Isingo, Raphael
    National Institute for Medical Research, Tanzania, Mwanza, Tanzania.
    Nakiyingi-Miiro, Jessica
    MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
    Lutalo, Tom
    Rakai Health Sciences Program, Rakai, Uganda.
    Crampin, Amelia
    Karonga Prevention Study, Karonga, Malawi and London School of Hygiene & Tropical Medicine, London, UK.
    Robertson, Laura
    INDEPTH Network, Accra, Ghana.
    Herbst, Kobus
    Africa Centre for Health and Population Studies, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
    Newell, Marie-Louise
    Africa Centre for Health and Population Studies, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
    Todd, Jim
    London School of Hygiene & Tropical Medicine, London, UK.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. INDEPTH Network, Accra, Ghana.
    Boerma, Ties
    WHO, Geneva, Switzerland.
    Ronsmans, Carine
    London School of Hygiene & Tropical Medicine, London, UK.
    Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community-based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA)2013Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 381, nr 9879, s. 1763-1771Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Model-based estimates of the global proportions of maternal deaths that are in HIV-infected women range from 7% to 21%, and the effects of HIV on the risk of maternal death is highly uncertain. We used longitudinal data from the Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA) network to estimate the excess mortality associated with HIV during pregnancy and the post-partum period in sub-Saharan Africa.

    METHODS: The ALPHA network pooled data gathered between June, 1989 and April, 2012 in six community-based studies in eastern and southern Africa with HIV serological surveillance and verbal-autopsy reporting. Deaths occurring during pregnancy and up to 42 days post partum were defined as pregnancy related. Pregnant or post-partum person-years were calculated for HIV-infected and HIV-uninfected women, and HIV-infected to HIV-uninfected mortality rate ratios and HIV-attributable rates were compared between pregnant or post-partum women and women who were not pregnant or post partum.

    FINDINGS: 138,074 women aged 15-49 years contributed 636,213 person-years of observation. 49,568 women had 86,963 pregnancies. 6760 of these women died, 235 of them during pregnancy or the post-partum period. Mean prevalence of HIV infection across all person-years in the pooled data was 17.2% (95% CI 17.0-17.3), but 60 of 118 (50.8%) of the women of known HIV status who died during pregnancy or post partum were HIV infected. The mortality rate ratio of HIV-infected to HIV-uninfected women was 20.5 (18.9-22.4) in women who were not pregnant or post partum and 8.2 (5.7-11.8) in pregnant or post-partum women. Excess mortality attributable to HIV was 51.8 (47.8-53.8) per 1000 person-years in women who were not pregnant or post partum and 11.8 (8.4-15.3) per 1000 person-years in pregnant or post-partum women.

    INTERPRETATION: HIV-infected pregnant or post-partum women had around eight times higher mortality than did their HIV-uninfected counterparts. On the basis of this estimate, we predict that roughly 24% of deaths in pregnant or post-partum women are attributable to HIV in sub-Saharan Africa, suggesting that safe motherhood programmes should pay special attention to the needs of HIV-infected pregnant or post-partum women.

  • 2820. Zaccardi, Francesco
    et al.
    Franks, Paul W.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Department of Clinical Sciences, Lund University, Sweden.
    Dudbridge, Frank
    Davies, Melanie J.
    Khunti, Kamlesh
    Yates, Thomas
    Mortality risk comparing walking pace to handgrip strength and a healthy lifestyle: A UK Biobank study2019Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, artikel-id UNSP 2047487319885041Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: Brisk walking and a greater muscle strength have been associated with a longer life; whether these associations are influenced by other lifestyle behaviours, however, is less well known.

    Methods: Information on usual walking pace (self-defined as slow, steady/average, or brisk), dynamometer-assessed handgrip strength, lifestyle behaviours (physical activity, TV viewing, diet, alcohol intake, sleep and smoking) and body mass index was collected at baseline in 450,888 UK Biobank study participants. We estimated 10-year standardised survival for individual and combined lifestyle behaviours and body mass index across levels of walking pace and handgrip strength.

    Results: Over a median follow-up of 7.0 years, 3808 (1.6%) deaths in women and 6783 (3.2%) in men occurred. Brisk walkers had a survival advantage over slow walkers, irrespective of the degree of engagement in other lifestyle behaviours, except for smoking. Estimated 10-year survival was higher in brisk walkers who otherwise engaged in an unhealthy lifestyle compared to slow walkers who engaged in an otherwise healthy lifestyle: 97.1% (95% confidence interval: 96.9–97.3) vs 95.0% (94.6–95.4) in women; 94.8% (94.7–95.0) vs 93.7% (93.3–94.2) in men. Body mass index modified the association between walking pace and survival in men, with the largest survival benefits of brisk walking observed in underweight participants. Compared to walking pace, for handgrip strength there was more overlap in 10-year survival across lifestyle behaviours.

    Conclusion: Except for smoking, brisk walkers with an otherwise unhealthy lifestyle have a lower mortality risk than slow walkers with an otherwise healthy lifestyle.

  • 2821.
    Zakreen, Asad
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Does unemployment contribute to an increased medicine use among Swedish adults?2019Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: Previous studies have shown that unemployment leads to negative effects on different aspects of health. However not many studies have been done on whether there is increased medicine use during unemployment. My aim therefore was to look at how unemployment might lead to increased usage of medicine and then afterwards look at different population subgroups such as age and gender.

    Methods: Primary data was utilized from a previous study done in Sweden and specific responses were taken from it such as age, gender, employment status, previous health of the past 5 years, usage of chronic disease medicines, usage of acute disease medicines. This data was analysed through logistic regression, odds ratio and confidence intervals were assessed.

    Results: There was a statistically non-significant relation between unemployment and medicine use (for both chronic and acute disease medicines). Grouped data overall also showed the same results for both gender and age indicating non-significance between the two variables apart from the (24-37 years) age group in which there was 66% less odds of using acute meds.

    Conclusions: My study shows that there is no increased usage of medicines during unemployment apart from asthma medicine users in which there is 56% less chances of using medicine if unemployed. From this study I tried to analyse if unemployment places an increased stress on the individuals and health sector in particular. My study also opens the way for further research to be done in this particular area as looking into increased medicine use would be beneficial for the health sector and labour sector from a financial point of view considering the increased stress it would put on it.

  • 2822. Zamora-Ros, R
    et al.
    Sacerdote, C
    Ricceri, F
    Weiderpass, E
    Roswall, N
    Buckland, G
    St-Jules, D E
    Overvad, K
    Kyrø, C
    Fagherazzi, G
    Kvaskoff, M
    Severi, G
    Chang-Claude, J
    Kaaks, R
    Nöthlings, U
    Trichopoulou, A
    Naska, A
    Trichopoulos, D
    Palli, D
    Grioni, S
    Mattiello, A
    Tumino, R
    Gram, I T
    Engeset, D
    Huerta, J M
    Molina-Montes, E
    Argüelles, M
    Amiano, P
    Ardanaz, E
    Ericson, U
    Lindkvist, B
    Nilsson, Lena Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Kiemeney, L A
    Ros, M
    Bueno-de-Mesquita, H B
    Peeters, P H M
    Khaw, K-T
    Wareham, N J
    Knaze, V
    Romieu, I
    Scalbert, A
    Brennan, P
    Wark, P
    Vineis, P
    Riboli, E
    González, C A
    Flavonoid and lignan intake in relation to bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study2014Ingår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 111, nr 9, s. 1870-1880Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is growing evidence of the protective role of dietary intake of flavonoids and lignans on cancer, but the association with bladder cancer has not been thoroughly investigated in epidemiological studies. We evaluated the association between dietary intakes of total and subclasses of flavonoids and lignans and risk of bladder cancer and its main morphological type, urothelial cell carcinoma (UCC), within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. METHODS: A cohort of 477 312 men and women mostly aged 35-70 years, were recruited in 10 European countries. At baseline, dietary flavonoid and lignan intakes were estimated using centre-specific validated questionnaires and a food composition database based on the Phenol-Explorer, the UK Food Standards Agency and the US Department of Agriculture databases. RESULTS: During an average of 11 years of follow-up, 1575 new cases of primary bladder cancer were identified, of which 1425 were UCC (classified into aggressive (n=430) and non-aggressive (n=413) UCC). No association was found between total flavonoid intake and bladder cancer risk. Among flavonoid subclasses, significant inverse associations with bladder cancer risk were found for intakes of flavonol (hazard ratio comparing fifth with first quintile (HRQ5-Q1) 0.74, 95% confidence interval (CI): 0.61-0.91; P-trend=0.009) and lignans (HRQ5-Q1 0.78, 95% CI: 0.62-0.96; P-trend=0.046). Similar results were observed for overall UCC and aggressive UCC, but not for non-aggressive UCC. CONCLUSIONS: Our study suggests an inverse association between the dietary intakes of flavonols and lignans and risk of bladder cancer, particularly aggressive UCC.

  • 2823. Zamora-Ros, Raul
    et al.
    Luján-Barroso, Leila
    Bueno-de-Mesquita, H Bas
    Dik, Vincent K
    Boeing, Heiner
    Steffen, Annika
    Tjønneland, Anne
    Olsen, Anja
    Bech, Bodil Hammer
    Overvad, Kim
    Boutron-Ruault, Marie-Christine
    Racine, Antoine
    Fagherazzi, Guy
    Kuhn, Tilman
    Katzke, Verena
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Tumino, Rosario
    Panico, Salvatore
    Vineis, Paolo
    Grioni, Sara
    Palli, Domenico
    Weiderpass, Elisabete
    Skeie, Guri
    Huerta, José María
    Sánchez, María-José
    Argüelles, Marcial
    Amiano, Pilar
    Ardanaz, Eva
    Nilsson, Lena Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Wallner, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Lindkvist, Björn
    Wallström, Peter
    Peeters, Petra H M
    Key, Timothy J
    Khaw, Kay-Thee
    Wareham, Nicholas J
    Freisling, Heinz
    Stepien, Magdalena
    Ferrari, Pietro
    Gunter, Marc J
    Murphy, Neil
    Riboli, Elio
    González, Carlos A
    Tea and coffee consumption and risk of esophageal cancer: the European Prospective Investigation into Cancer and Nutrition (EPIC) study2014Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 135, nr 6, s. 1470-1479Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Epidemiological data regarding tea and coffee consumption and risk of esophageal cancer (EC) is still inconclusive. We examined the association of tea and coffee consumption with EC risk among 442,143 men and women without cancer at baseline from 9 countries of the European Prospective Investigation into Cancer and Nutrition (EPIC). Tea and coffee intakes were recorded using country-specific validated dietary questionnaires. Cox regression models were used to analyze the relationships between tea and coffee intake and EC risk. During a mean follow-up of 11.1 years, 339 participants developed EC, of which 142 were esophageal adenocarcinoma (EAC) and 174 were esophageal squamous cell carcinoma (ESCC). In the multivariable models, no significant associations between tea (mostly black tea), and coffee intake and risk of EC, EAC and ESCC were observed. In stratified analyses, among men coffee consumption was inversely related to ESCC (HR for comparison of extreme tertiles 0.42, 95% CI 0.20-0.88; P-trend=0.022), but not among women. In current smokers, a significant and inverse association was observed between ESCC risk and tea (HR 0.46, 95% CI 0.23-0.93; P-trend=0.053) and coffee consumption (HR 0.37, 95% CI 0.19-0.73; P-trend=0.011). However, no statistically significant findings were observed using the continuous variable (per 100mL/d). These data did not show a significant association between tea and coffee consumption and EC, EAC and ESCC, although a decreased risk of ESCC among men and current smokers is suggested, but need to be confirmed in further prospective studies including more cases.

  • 2824.
    Zehravi, Ferrukh
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Decomposition of socioeconomic inequality in cognitive performance among adults aged 50+ in China: Results from WHO SAGE Wave 12019Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 2825.
    Zehravi, Ferrukh
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    The burden of self-reported arthritis on BMI, self-reported mobility and timed gait speed among adults aged 50+ in China, Ghana, India, Mexico, Russia and South Africa: Results from WHO SAGE WAVE 12018Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 2826. Zetterström Dahlqvist, H.
    et al.
    Landstedt, Evelina
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Gillander Gådin, K.
    A Latent Class Analysis of Violence Multi-Victimization in Youth2018Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, s. 483-484Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: Violence among youth is common and has been linked to poor mental health outcomes. There is some evidence that there are groups of youth who are victims of more than one form of violence but more knowledge is needed in terms of patterning of subgroups of multiple violence victimization.

    Aim: To explore if there are distinct subgroups of youth with particular patterns of violence victimization.

    Methods: Survey data from a Swedish sample (n = 1,569) of youth 14-16 years old were used (females 48.4%). Using a broad definition of violence, respondents indicated if they had experienced physical violence, threat of physical violence, bullying, sexual harassment, cyber bullying, online sexual victimizayion, and other adverse sexual experience in the past six months as well as lifetime physical violence victimization. Distinct subgroups of youth within the data set with particular patterns of violence victimization were identified using Latent Class Analysis (LCA). Model fit was assessed using the Akaike information criterion (AIC) and the Bayesian information criterion (BIC), with smaller values indicating better model fit.

    Results: Preliminary results show three distinct subgroups: 1. Sexualized violence off- and online (girls 66.6%), 2. Bullying only (girls 47.5%) and 3. Multi-victimization including threat of physical violence, violence in the past six months and lifetime, sexual harassment on- and offline, bullying on- and offline as well as other adverse sexual experience (girls 47.6%).

    Conclusions: Three distinct subgroups of violence victimization in a sample of 14-16 year old youth was evident in the data. There was a greater representation of girls in the sexualized violence sub-group. Further research as well as preventive programs should acknowledge that many young people are victims of several types of violence. Future research should also investigate the implications of multi-victimization on mental health outcomes.

    Key messages:

    • Three distinct subgroups of violence victimization was present in the data: 1. Sexualized violence off- and online 2. Bullying only and 3. Multi-victimization.

    • While the gendered pattern of the Bullying only and Multi-victimization subgroups were fairly balanced, a substantially greater proportion of girls were represented in the Sexualized violence group.

  • 2827. Zetterström Dahlqvist, Heléne
    et al.
    Landstedt, Evelina
    Hälsovetenskap, Mittuniversitetet, Sundsvall.
    Gillander Gådin, Katja
    Depressive symptoms and the associations with individual, psychosocial, and structural determinants in Swedish adolescents2012Ingår i: Health, ISSN 1949-5005, Vol. 4, nr 10, s. 881-889Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Depressive symptoms in adolescents are an in-creasing public health issue in Sweden and in most Western countries. Aim: To explore how individual, psychosocial, and structural deter-minants are associated with depressive symp-toms in Swedish adolescents. Methods: A web- based questionnaire was answered by 1193 13- to 16-year-old boys (n = 566) and girls (n = 627). Stepwise logistic regressions were employed to analyse the association between depressive sym- ptoms and various determinants at the individ-ual level (self-efficacy), the psychosocial level (parental, peer, and teacher support, school de-mands, sexual harassment, and bullying) and the structural level (family affluence, having less money than friends, and parental foreign back-ground). Results: Determinants at the individual, psychosocial, and structural levels were inde-pendently associated with high levels of depres-sive symptoms in both boys and girls. The full model explained a high proportion of the vari-ance in depressive symptoms in both genders; 34.1% in boys and 36.8% in girls. The psycho-social level contributed the most to explaining the variance in depressive symptoms in boys. In girls, when harassment variables were separated from psychosocial variables, the harassment var- iables contributed as much to the full model as the rest of the psychosocial variables combined. Conclusions: Addressing psychosocial determi-nants provides the greatest benefits for prevent-ing depressive symptoms in adolescents. Ac-knowledging the association between sexual harassment and depressive symptoms for girls and having less money than their friends for boys and girls are particularly important.

  • 2828. Zetterström Dahlqvist, Heléne
    et al.
    Landstedt, Evelina
    Department of Health Sciences, Mitthögskolan, Sundsvall.
    Gillander Gådin, Katja
    What students do schools allocate to a cognitive-behavioural intervention?: Characteristics of adolescent participants in Northern Sweden2015Ingår i: International Journal of Circumpolar Health, ISSN 2242-3982, E-ISSN 2242-3982, Vol. 74, artikel-id 29805Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Adolescents are a vulnerable group when it comes to the risk of developing depression. Preventing the onset of depressive episodes in this group is therefore a major public health priority. In the last decades, school-based cognitive-behavioural interventions have been a common primary prevention approach. However, evidence on what girls actually are allocated to such interventions when no researchers are involved is scarce.

    OBJECTIVE: To explore how a selective cognitive-behavioural program (Depression In Swedish Adolescents) developed to prevent depression in adolescents, was implemented in a naturalistic setting in schools in northern part of Sweden. The focus was on characteristics of participants allocated to the intervention.

    DESIGN: Cross-sectional baseline data on depressive symptoms, school environment and socio-economic factors were collected in 2011 by means of questionnaires in schools in a municipality in the northern part of Sweden. Intervention participants were identified in a follow-up questionnaire in 2012. Students (n=288) included in the analyses were in the ages of 14-15.

    RESULTS: Sixty-six girls and no boys were identified as intervention participants. They reported higher levels of depressive symptoms, lower personal relative affluence, more sexual harassment victimization and less peer support compared to female non-participants (n=222). Intervention participants were more likely to attend schools with a higher proportion of low parental education levels and a lower proportion of students graduating with a diploma.

    CONCLUSIONS: The developers of the intervention originally intended the program to be universal or selective, but it was implemented as targeted in these schools. It is important for school administrations to adhere to program fidelity when it comes to what students it is aimed for. Implications for effectivenss trials of cognitive-behavioural interventions in the school setting is discussed.

  • 2829. Zhang, Jiwen
    et al.
    Jin, Xia
    Zhu, Zhaoyin
    Huang, Li
    Liang, Shaojun
    Xu, Yuan
    Liao, Ruyan
    Zhou, Licheng
    Zhang, Yan
    Wilder-Smith, Annelies
    Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
    Early detection of Zika virus infection among travellers from areas of ongoing transmission in China2016Ingår i: Journal of Travel Medicine, ISSN 1195-1982, E-ISSN 1708-8305, Vol. 23, nr 5, artikel-id taw047Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Nine imported Zika virus (ZIKV) infections (four through temperature monitoring and epidemiological investigation at entry and five by active surveillance tracking of index case contacts during follow-up; from Venezuela [n = 5], Samoa [n = 3] and both Samoa and Fiji [n = 1]) were detected in mainland China from February 1 to 29, 2016. The minimal incubation period lasted 5.2 days, with mean lag time to diagnosis of 2.6 days. Diagnosis relied on positive real-time reverse transcriptase polymerase chain reaction for ZIKV RNA in serum (n = 7), urine (n = 4) or saliva (n = 3), respectively. All cases recovered rapidly without serious complications.

  • 2830. Zhang, Lei
    et al.
    Qiao, Qing
    Laatikainen, Tiina
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Jousilahti, Pekka
    Onat, Altan
    Nilsson, Peter
    Tuomilehto, Jaakko
    The impact of dyslipidaemia on incidence of coronary heart disease in Finns and Swedes with different categories of glucose tolerance2011Ingår i: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 91, nr 3, s. 406-412Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The association of dyslipidaemia with incidence of coronary heart disease (CHD) has not been well studied in people with different glucose categories.

    Methods: Data from six population-based prospective studies in Finland and Sweden, with 4818 men and 4269 women aged 25–89 years who were free of CHD and without a prior history of diabetes at baseline, were jointly analysed. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD incidence were estimated.

    Results: 457 participants developed CHD during follow-up of 10 years. The multivariate adjusted HRs (95% CIs) for CHD incidence were 1.39 (1.08–1.80), 0.57 (0.39–0.84), 1.21 (1.07–1.37), 1.56 (1.21–2.01) and 1.74 (1.34–2.26), respectively, corresponding to a one unit increase in Z-scores of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), non-HDL-C and TC to HDL ratio, in people with newly diagnosed diabetes. The prediction was also significant in non-diabetic population except for TG in individuals with normoglycaemia and TG and HDL-C in those with isolated IFG.

    Conclusion: Adverse lipid profiles were related to increased CHD incidence in normoglycaemic, fasting hyperglycaemic and diabetic individuals, but not in people with IGT. The findings may imply considering different management strategies in people with fasting or post-load hyperglycaemia.

  • 2831.
    Zhang, Yin-Ping
    et al.
    Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China.
    Wei, Huan-Huan
    Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China.
    Wang, Wen
    Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China.
    Xia, Ru-Yi
    Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China.
    Zhou, Xiao-Ling
    Department of Orthopaedics, the 1st Attached Hospital, Xi’an Jiaotong University, Xi'an, People’s Republic of China.
    Porr, Caroline
    School of Nursing, Memorial University, St. John’s, Canada.
    Lammi, Mikko
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Cross-cultural adaptation and validation of the osteoporosis assessment questionnaire short version (OPAQ-SV) for Chinese osteoporotic fracture females2016Ingår i: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 35, nr 4, s. 1003-1010Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Osteoporosis Assessment Questionnaire Short Version (OPAQ-SV) was cross-culturally adapted to measure health-related quality of life in Chinese osteoporotic fracture females and then validated in China for its psychometric properties. Cross-cultural adaptation, including translation of the original OPAQ-SV into Mandarin Chinese language, was performed according to published guidelines. Validation of the newly cross-culturally adapted OPAQ-SV was conducted by sampling 234 Chinese osteoporotic fracture females and also a control group of 235 Chinese osteoporotic females without fractures, producing robust content, construct, and discriminant validation results. Major categories of reliability were also met: the Cronbach alpha coefficient was 0.975, indicating good internal consistency; the test-retest reliability was 0.80; and principal component analysis resulted in a 6-factor structure explaining 75.847 % of the total variance. Further, the Comparative Fit Index result was 0.922 following the modified model confirmatory factor analysis, and the chi-squared test was 1.98. The root mean squared error of approximation was 0.078. Moreover, significant differences were revealed between females with fractures and those without fractures across all domains (p < 0.001). Overall, the newly cross-culturally adapted OPAQ-SV appears to possess adequate validity and reliability and may be utilized in clinical trials to assess the health-related quality of life in Chinese osteoporotic fracture females.

  • 2832. Zhang, Yue
    et al.
    Gu, Yi'an
    Wang, Na
    Zhao, Qi
    Ng, Nawi
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Wang, Ruiping
    Zhou, Xiaoyan
    Jiang, Yonggen
    Wang, Weibing
    Zhao, Genming
    Association between anthropometric indicators of obesity and cardiovascular risk factors among adults in Shanghai, China2019Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, nr 1, artikel-id 1035Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To determine the optimal cut-off values and evaluate the associations of body mass index (BMI), waist circumference (WC) and waist-height ratio (WHtR) with cardiovascular disease (CVD) risk factors. Methods: A large-scale cross-sectional survey was conducted among 35,256 adults aged 20-74 years in Shanghai between June 2016 and December 2017. Receiver operating characteristic (ROC) analyses were conducted to assess the optimal cut-off anthropometric indices of CVD risk factors including hypertension, diabetes, dyslipidemia and hyperuricemia. Multivariate Logistic regression models were preformed to evaluate the odds ratio of CVD risk factors. Results: The area under the curve (AUC) of WHtR was significantly greater than that of BMI or WC in the prediction of hypertension and diabetes, and AUCs were higher in women than men. The optimal cut-off values of WHtR were approximately 0.51 in both sexes, while the cut-off values of BMI and WC were higher for men compared with women. The optimal cutoff values of BMI and WC varied greatly across different age groups, but the difference in WHtR was relatively slight. Among women, the optimal threshold of anthropometric indices appeared to increase with age for hypertension and diabetes. The odds ratio between anthropometric indices and CVD risk factors were attenuated with age. WHtR had the greatest odds ratio for CVD risk factors among adults under 60 years old except for women with hypertension, while among 60-74 years, BMI yielded the greatest odds ratio in terms of all CVD outcomes except for women with diabetes. Conclusions: WHtR had the best performance for discriminating hypertension and diabetes and potentially be served as a standard screening tool in public health. The associations between three anthropometric indices and CVD risk factors differed by sex and decreased with age. These findings indicated a need to develop age- and gender-specific difference and make effective strategies for primary prevention of CVDs.

  • 2833. Zhao, Y.
    et al.
    Nicoll, Rachel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Diederichsen, A.
    Mickley, H.
    Ovrehus, K.
    Zamorano, P.
    Gueret, P.
    Schmermund, A.
    Maffei, E.
    Cademartiri, F.
    Budoff, M.
    Henein, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Coronary calcification and male gender predict significant stenosis in symptomatic patients in northern and southern Europe and the USA: A Euro-CCAD study2016Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Significant stenosis is the principal cause of stable angina but its predictors and their variation by geographical region are unclear.

    Methods and Results: From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 5515 symptomatic patients from northern Europe (Denmark, France, Germany), southern Europe (Italy, Spain) and USA. All had conventional cardiovascular risk factor assessment, angiography and CT scanning for coronary artery calcium (CAC) scoring. There were considerable differences in the patient characteristics between the groups, with the USA patients being younger and having more diet and lifestyle-related risk factors, although hypertension may have been better controlled than in Europe. USA patients had a two-fold increase in prevalence of significant stenosis and a three-fold increase in median CAC score. In all three groups, the log CAC score proved to be the strongest predictor of >50% stenosis followed by male gender. In the USA group there were no additional independently predictive risk factors, although in northern Europe obesity, hypertension, smoking and hypercholesterolaemia remained predictive, with all risk factors other than age and hypertension proving to be predictive in the southern Europe group. Without the CAC score as a variable, male gender followed by diabetes were the most important predictors in all three regions, with hypertension also proving predictive in northern Europe.

     Conclusion:  In symptomatic patients, the CAC score and male gender were the most important predictors of significant stenosis in symptomatic patients in northern and southern Europe and the USA.

  • 2834. Zheng, Hou-Feng
    et al.
    Duncan, Emma
    Eriksson, Joel
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Yerges-Armstrong, Laura M.
    Leo, Paul J.
    Vandenput, Liesbeth
    Nicholson, Geoffrey
    Ladouceur, Martin
    Prince, Richard L.
    Leslie, William D.
    Eisman, John A.
    Goltzman, David
    Jones, Graeme
    Xiao, Yongjun
    Liu, Jeff
    Reid, Lanr
    Sambrook, Philip N.
    Dennison, Elaine M.
    Danoy, Patrick
    Wilson, Scott G.
    McCloskey, Eugene
    Eastell, Richard
    Spector, Tim
    Mitchell, Braxton D.
    Streeten, Elizabeth A.
    Brommage, Robert
    Lorentzon, Mattias
    Pettersson, Ulrika
    Brown, Matthew A.
    Ohlsson, Claes
    Richards, J. Brent
    WNT16 is associated with bone mineral density, osteoporotic fracture and bone strength: a large-scale meta-analysis of genomewide association studies2012Ingår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 23, nr Suppl 2, s. S402-S403Artikel i tidskrift (Övrigt vetenskapligt)
  • 2835. Zheng, Hou-Feng
    et al.
    Forgetta, Vincenzo
    Hsu, Yi-Hsiang
    Estrada, Karol
    Rosello-Diez, Alberto
    Leo, Paul J.
    Dahia, Chitra L.
    Park-Min, Kyung Hyun
    Tobias, Jonathan H.
    Kooperberg, Charles
    Kleinman, Aaron
    Styrkarsdottir, Unnur
    Liu, Ching-Ti
    Uggla, Charlotta
    Evans, Daniel S.
    Nielson, Carrie M.
    Walter, Klaudia
    Pettersson-Kymmer, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    McCarthy, Shane
    Eriksson, Joel
    Kwan, Tony
    Jhamai, Mila
    Trajanoska, Katerina
    Memari, Yasin
    Min, Josine
    Huang, Jie
    Danecek, Petr
    Wilmot, Beth
    Li, Rui
    Chou, Wen-Chi
    Mokry, Lauren E.
    Moayyeri, Alireza
    Claussnitzer, Melina
    Cheng, Chia-Ho
    Cheung, Warren
    Medina-Gomez, Carolina
    Ge, Bing
    Chen, Shu-Huang
    Choi, Kwangbom
    Oei, Ling
    Fraser, James
    Kraaij, Robert
    Hibbs, Matthew A.
    Gregson, Celia L.
    Paquette, Denis
    Hofman, Albert
    Wibom, Carl
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Tranah, Gregory J.
    Marshall, Mhairi
    Gardiner, Brooke B.
    Cremin, Katie
    Auer, Paul
    Hsu, Li
    Ring, Sue
    Tung, Joyce Y.
    Thorleifsson, Gudmar
    Enneman, Anke W.
    van Schoor, Natasja M.
    de Groot, Lisette C. P. G. M.
    van der Velde, Nathalie
    Melin, Beatrice
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Kemp, John P.
    Christiansen, Claus
    Sayers, Adrian
    Zhou, Yanhua
    Calderari, Sophie
    van Rooij, Jeroen
    Carlson, Chris
    Peters, Ulrike
    Berlivet, Soizik
    Dostie, Josee
    Uitterlinden, Andre G.
    Williams, Stephen R.
    Farber, Charles
    Grinberg, Daniel
    LaCroix, Andrea Z.
    Haessler, Jeff
    Chasman, Daniel I.
    Giulianini, Franco
    Rose, Lynda M.
    Ridker, Paul M.
    Eisman, John A.
    Nguyen, Tuan V.
    Center, Jacqueline R.
    Nogues, Xavier
    Garcia-Giralt, Natalia
    Launer, Lenore L.
    Gudnason, Vilmunder
    Mellstrom, Dan
    Vandenput, Liesbeth
    Amin, Najaf
    van Duijn, Cornelia M.
    Karlsson, Magnus K.
    Ljunggren, Osten
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Rousseau, Francois
    Giroux, Sylvie
    Bussiere, Johanne
    Arp, Pascal P.
    Koromani, Fjorda
    Prince, Richard L.
    Lewis, Joshua R.
    Langdahl, Bente L.
    Hermann, A. Pernille
    Jensen, Jens-Erik B.
    Kaptoge, Stephen
    Khaw, Kay-Tee
    Reeve, Jonathan
    Formosa, Melissa M.
    Xuereb-Anastasi, Angela
    Akesson, Kristina
    McGuigan, Fiona E.
    Garg, Gaurav
    Olmos, Jose M.
    Zarrabeitia, Maria T.
    Riancho, Jose A.
    Ralston, Stuart H.
    Alonso, Nerea
    Jiang, Xi
    Goltzman, David
    Pastinen, Tomi
    Grundberg, Elin
    Gauguier, Dominique
    Orwoll, Eric S.
    Karasik, David
    Davey-Smith, George
    Smith, Albert V.
    Siggeirsdottir, Kristin
    Harris, Tamara B.
    Zillikens, M. Carola
    van Meurs, Joyce B. J.
    Thorsteinsdottir, Unnur
    Maurano, Matthew T.
    Timpson, Nicholas J.
    Soranzo, Nicole
    Durbin, Richard
    Wilson, ScottG.
    Ntzani, Evangelia E.
    Brown, Matthew A.
    Stefansson, Kari
    Hinds, David A.
    Spector, Tim
    Cupples, L. Adrienne
    Ohlsson, Claes
    Greenwood, Celia M. T.
    Jackson, Rebecca D.
    Rowe, David W.
    Loomis, Cynthia A.
    Evans, David M.
    Ackert-Bicknell, Cheryl L.
    Joyner, Alexandra L.
    Duncan, Emma L.
    Kiel, Douglas P.
    Rivadeneira, Fernando
    Richards, J. Brent
    Whole-genome sequencing identifies EN1 as a determinant of bone density and fracture2015Ingår i: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 526, nr 7571, s. 112-+Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The extent to which low-frequency (minor allele frequency (MAF) between 1-5%) and rare (MAF <= 1%) variants contribute to complex traits and disease in the general population is mainly unknown. Bone mineral density (BMD) is highly heritable, a major predictor of osteoporotic fractures, and has been previously associated with common genetic variants(1-8), as well as rare, population specific, coding variants(9). Here we identify novel non-coding genetic variants with large effects on BMD (n(total) = 53,236) and fracture (n(total) = 508,253) in individuals of European ancestry from the general population. Associations for BMD were derived from whole-genome sequencing (n = 2,882 from UK10K (ref. 10); a population-based genome sequencing consortium), whole-exome sequencing (n = 3,549), deep imputation of genotyped samples using a combined UK10K/1000 Genomes reference panel (n = 26,534), and de novo replication genotyping (n = 20,271). We identified a low-frequency non-coding variant near a novel locus, EN1, with an effect size fourfold larger than the mean of previously reported common variants for lumbar spine BMD8 (rs11692564(T), MAF51.6%, replication effect size510.20 s.d., P-meta = 2 x 10(-14)), which was also associated with a decreased risk of fracture (odds ratio = 0.85; P = 2 x 10(-11); ncases = 98,742 and ncontrols = 409,511). Using an En1cre/flox mouse model, we observed that conditional loss of En1 results in low bone mass, probably as a consequence of high bone turnover. We also identified a novel low frequency non-coding variant with large effects on BMD near WNT16 (rs148771817(T), MAF = 1.2%, replication effect size +10.41 s.d., P-meta = 1 x 10(-11)). In general, there was an excess of association signals arising from deleterious coding and conserved non-coding variants. These findings provide evidence that low-frequency non-coding variants have large effects on BMD and fracture, thereby providing rationale for whole-genome sequencing and improved imputation reference panels to study the genetic architecture of complex traits and disease in the general population.

  • 2836. Zheng, Hou-Feng
    et al.
    Tobias, Jon H
    Duncan, Emma
    Evans, David M
    Eriksson, Joel
    Paternoster, Lavinia
    Yerges-Armstrong, Laura M
    Lehtimäki, Terho
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Kähönen, Mika
    Leo, Paul J
    Raitakari, Olli
    Laaksonen, Marika
    Nicholson, Geoffrey C
    Viikari, Jorma
    Ladouceur, Martin
    Lyytikäinen, Leo-Pekka
    Medina-Gomez, Carolina
    Rivadeneira, Fernando
    Prince, Richard L
    Sievanen, Harri
    Leslie, William D
    Mellström, Dan
    Eisman, John A
    Movérare-Skrtic, Sofia
    Goltzman, David
    Hanley, David A
    Jones, Graeme
    St Pourcain, Beate
    Xiao, Yongjun
    Timpson, Nicholas J
    Smith, George Davey
    Reid, Ian R
    Ring, Susan M
    Sambrook, Philip N
    Karlsson, Magnus
    Dennison, Elaine M
    Kemp, John P
    Danoy, Patrick
    Sayers, Adrian
    Wilson, Scott G
    Nethander, Maria
    McCloskey, Eugene
    Vandenput, Liesbeth
    Eastell, Richard
    Liu, Jeff
    Spector, Tim
    Mitchell, Braxton D
    Streeten, Elizabeth A
    Brommage, Robert
    Pettersson-Kymmer, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Brown, Matthew A
    Ohlsson, Claes
    Richards, J Brent
    Lorentzon, Mattias
    WNT16 influences bone mineral density, Cortical bone thickness, bone strength, and Osteoporotic fracture risk2012Ingår i: PLoS genetics, ISSN 1553-7404, Vol. 8, nr 7, s. e1002745-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We aimed to identify genetic variants associated with cortical bone thickness (CBT) and bone mineral density (BMD) by performing two separate genome-wide association study (GWAS) meta-analyses for CBT in 3 cohorts comprising 5,878 European subjects and for BMD in 5 cohorts comprising 5,672 individuals. We then assessed selected single-nucleotide polymorphisms (SNPs) for osteoporotic fracture in 2,023 cases and 3,740 controls. Association with CBT and forearm BMD was tested for ∼2.5 million SNPs in each cohort separately, and results were meta-analyzed using fixed effect meta-analysis. We identified a missense SNP (Thr>Ile; rs2707466) located in the WNT16 gene (7q31), associated with CBT (effect size of -0.11 standard deviations [SD] per C allele, P = 6.2×10(-9)). This SNP, as well as another nonsynonymous SNP rs2908004 (Gly>Arg), also had genome-wide significant association with forearm BMD (-0.14 SD per C allele, P = 2.3×10(-12), and -0.16 SD per G allele, P = 1.2×10(-15), respectively). Four genome-wide significant SNPs arising from BMD meta-analysis were tested for association with forearm fracture. SNP rs7776725 in FAM3C, a gene adjacent to WNT16, was associated with a genome-wide significant increased risk of forearm fracture (OR = 1.33, P = 7.3×10(-9)), with genome-wide suggestive signals from the two missense variants in WNT16 (rs2908004: OR = 1.22, P = 4.9×10(-6) and rs2707466: OR = 1.22, P = 7.2×10(-6)). We next generated a homozygous mouse with targeted disruption of Wnt16. Female Wnt16(-/-) mice had 27% (P<0.001) thinner cortical bones at the femur midshaft, and bone strength measures were reduced between 43%-61% (6.5×10(-13)<P<5.9×10(-4)) at both femur and tibia, compared with their wild-type littermates. Natural variation in humans and targeted disruption in mice demonstrate that WNT16 is an important determinant of CBT, BMD, bone strength, and risk of fracture.

  • 2837. Zhou, Bin
    et al.
    Bentham, James
    Di Cesare, Mariachiara
    Bixby, Honor
    Danaei, Goodarz
    Hajifathalian, Kaveh
    Taddei, Cristina
    Carrillo-Larco, Rodrigo M.
    Djalalinia, Shirin
    Khatibzadeh, Shahab
    Lugero, Charles
    Peykari, Niloofar
    Zhang, Wan Zhu
    Bennett, James
    Bilano, Ver
    Stevens, Gretchen A.
    Cowan, Melanie J.
    Riley, Leanne M.
    Chen, Zhengming
    Hambleton, Ian R.
    Jackson, Rod T.
    Kengne, Andre Pascal
    Khang, Young-Ho
    Laxmaiah, Avula
    Liu, Jing
    Malekzadeh, Reza
    Neuhauser, Hannelore K.
    Soric, Maroje
    Starc, Gregor
    Sundstrom, Johan
    Woodward, Mark
    Ezzati, Majid
    Abarca-Gomez, Leandra
    Abdeen, Ziad A.
    Abu-Rmeileh, Niveen M.
    Acosta-Cazares, Benjamin
    Adams, Robert J.
    Aekplakorn, Wichai
    Afsana, Kaosar
    Aguilar-Salinas, Carlos A.
    Agyemang, Charles
    Ahmad, Noor Ani
    Ahmadvand, Alireza
    Ahrens, Wolfgang
    Ajlouni, Kamel
    Akhtaeva, Nazgul
    Al-Raddadi, Rajaa
    Ali, Mohamed M.
    Ali, Osman
    Alkerwi, Ala'a
    Aly, Eman
    Amarapurkar, Deepak N.
    Amouyel, Philippe
    Amuzu, Antoinette
    Andersen, Lars Bo
    Anderssen, Sigmund A.
    Angquist, Lars H.
    Anjana, Ranjit Mohan
    Ansong, Daniel
    Aounallah-Skhiri, Hajer
    Araujo, Joana
    Ariansen, Inger
    Aris, Tahir
    Arlappa, Nimmathota
    Arveiler, Dominique
    Aryal, Krishna K.
    Aspelund, Thor
    Assah, Felix K.
    Assuncao, Maria Cecilia F.
    Avdicova, Maria
    Azevedo, Ana
    Azizi, Fereidoun
    Babu, Bontha V.
    Bahijri, Suhad
    Balakrishna, Nagalla
    Bamoshmoosh, Mohamed
    Banach, Maciej
    Bandosz, Piotr
    Banegas, Jose R.
    Barbagallo, Carlo M.
    Barcelo, Alberto
    Barkat, Amina
    Barros, Aluisio J. D.
    Barros, Mauro V.
    Bata, Iqbal
    Batieha, Anwar M.
    Batyrbek, Assembekov
    Baur, Louise A.
    Beaglehole, Robert
    Ben Romdhane, Habiba
    Benet, Mikhail
    Benson, Lowell S.
    Bernabe-Ortiz, Antonio
    Bernotiene, Gailute
    Bettiol, Heloisa
    Bhagyalaxmi, Aroor
    Bharadwaj, Sumit
    Bhargava, Santosh K.
    Bi, Yufang
    Bikbov, Mukharram
    Bista, Bihungum
    Bjerregaard, Peter
    Bjertness, Espen
    Bjertness, Marius B.
    Bjorkelund, Cecilia
    Blokstra, Anneke
    Bo, Simona
    Bobak, Martin
    Boeing, Heiner
    Boggia, Jose G.
    Boissonnet, Carlos P.
    Bongard, Vanina
    Borchini, Rossana
    Bovet, Pascal
    Braeckman, Lutgart
    Brajkovich, Imperia
    Branca, Francesco
    Breckenkamp, Juergen
    Brenner, Hermann
    Brewster, Lizzy M.
    Bruno, Graziella
    Bueno-de-Mesquita,
    Bugge, Anna
    Burns, Con
    Bursztyn, Michael
    Cabrera de Leon, Antonio
    Cacciottolo, Joseph
    Cai, Hui
    Cameron, Christine
    Can, Gunay
    Candido, Ana Paula C.
    Capuano, Vincenzo
    Cardoso, Viviane C.
    Carlsson, Axel C.
    Carvalho, Maria J.
    Casanueva, Felipe F.
    Casas, Juan-Pablo
    Caserta, Carmelo A.
    Chamukuttan, Snehalatha
    Chan, Angelique W.
    Chan, Queenie
    Chaturvedi, Himanshu K.
    Chaturvedi, Nishi
    Chen, Chien-Jen
    Chen, Fangfang
    Chen, Huashuai
    Chen, Shuohua
    Cheng, Ching-Yu
    Cherkaoui Dekkaki, Imane
    Chetrit, Angela
    Chiolero, Arnaud
    Chiou, Shu-Ti
    Chirita-Emandi, Adela
    Chirlaque, Maria-Dolores
    Cho, Belong
    Cho, Yumi
    Christofaro, Diego G.
    Chudek, Jerzy
    Cifkova, Renata
    Cinteza, Eliza
    Claessens, Frank
    Clays, Els
    Concin, Hans
    Cooper, Cyrus
    Cooper, Rachel
    Coppinger, Tara C.
    Costanzo, Simona
    Cottel, Dominique
    Cowell, Chris
    Craig, Cora L.
    Crujeiras, Ana B.
    Cruz, Juan J.
    D'Arrigo, Graziella
    d'Orsi, Eleonora
    Dallongeville, Jean
    Damasceno, Albertino
    Dankner, Rachel
    Dantoft, Thomas M.
    Dauchet, Luc
    Davletov, Kairat
    De Backer, Guy
    De Bacquer, Dirk
    de Gaetano, Giovanni
    De Henauw, Stefaan
    de Oliveira, Paula Duarte
    De Smedt, Delphine
    Deepa, Mohan
    Dehghan, Abbas
    Delisle, Helene
    Deschamps, Valerie
    Dhana, Klodian
    Di Castelnuovo, Augusto F.
    Dias-da-Costa, Juvenal Soares
    Diaz, Alejandro
    Dickerson, Ty T.
    Do, Ha T. P.
    Dobson, Annette J.
    Donfrancesco, Chiara
    Donoso, Silvana P.
    Doering, Angela
    Dorobantu, Maria
    Doua, Kouamelan
    Drygas, Wojciech
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    Ferrieres, Jean
    Finn, Joseph D.
    Fischer, Krista
    Foger, Bernhard
    Foo, Leng Huat
    Forslund, Ann-Sofie
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Högskolan Dalarna.
    Fouad, Heba M.
    Francis, Damian K.
    Franco, Maria do Carmo
    Franco, Oscar H.
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    So, Hung-Kwan
    Sobngwi, Eugene
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Solfrizzi, Vincenzo
    Sonestedt, Emily
    Song, Yi
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    Sung, Yn-Tz
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    Jose Tormo, Maria
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    Tshepo, Lechaba
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    Turley, Maria L.
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    Vanuzzo, Diego
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    Verstraeten, Roosmarijn
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    Walton, Janette
    Bebakar, Wan Mohamad Wan
    Mohamud, Wan Nazaimoon Wan
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    Wang, Ming-Dong
    Wang, Qian
    Wang, Ya Xing
    Wang, Ying-Wei
    Wannamethee, S. Goya
    Wareham, Nicholas
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    Weerasekera, Deepa
    Whincup, Peter H.
    Widhalm, Kurt
    Widyahening, Indah S.
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    Wijga, Alet H.
    Wilks, Rainford J.
    Willeit, Johann
    Willeit, Peter
    Williams, Emmanuel A.
    Wilsgaard, Tom
    Wojtyniak, Bogdan
    Wong-McClure, Roy A.
    Wong, Justin Y. Y.
    Wong, Tien Yin
    Woo, Jean
    Wu, Aleksander Giwercman
    Wu, Frederick C.
    Wu, Shouling
    Xu, Haiquan
    Yan, Weili
    Yang, Xiaoguang
    Ye, Xingwang
    Yiallouros, Panayiotis K.
    Yoshihara, Akihiro
    Younger-Coleman, Novie O.
    Yusoff, Ahmad Faudzi
    Zainuddin, Ahmad Ali
    Zambon, Sabina
    Zampelas, Antonis
    Zdrojewski, Tomasz
    Zeng, Yi
    Zhao, Dong
    Zhao, Wenhua
    Zheng, Wei
    Zheng, Yingfeng
    Zhu, Dan
    Zhussupov, Baurzhan
    Zimmermann, Esther
    Cisneros, Julio Zuniga
    Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1018 population-based measurement studies with 88.6 million participants2018Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, nr 3, s. 872-883iArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure.

    Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group-and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure.

    Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association.

    Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.

  • 2838.
    Zhu, Jijia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    The Risk Factors of Depression among older people in China2012Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 2839. Zhu, Ying
    et al.
    Wei, Yongyue
    Zhang, Ruyang
    Dong, Xuesi
    Shen, Sipeng
    Zhao, Yang
    Bai, Jianling
    Albanes, Demetrius
    Caporaso, Neil E.
    Landi, Maria Teresa
    Zhu, Bin
    Chanock, Stephen J.
    Gu, Fangyi
    Lam, Stephen
    Tsao, Ming-Sound
    Shepherd, Frances A.
    Tardon, Adonina
    Fernandez-Somoano, Ana
    Fernandez-Tardon, Guillermo
    Chen, Chu
    Barnett, Matthew J.
    Doherty, Jennifer
    Bojesen, Stig E.
    Johansson, Mattias
    Brennan, Paul
    Mckay, James D.
    Carreras-Torres, Robert
    Muley, Thomas
    Risch, Angela
    Wichmann, Heunz-Erich
    Bickeboeller, Heike
    Rosenberger, Albert
    Rennert, Gad
    Saliba, Walid
    Arnold, Susanne M.
    Field, John K.
    Davies, Michael P. A.
    Marcus, Michael W.
    Wu, Xifeng
    Ye, Yuanqing
    Le Marchand, Loic
    Wilkens, Lynne R.
    Melander, Olle
    Manjer, Jonas
    Brunnstrom, Hans
    Hung, Rayjean J.
    Liu, Geoffrey
    Brhane, Yonathan
    Kachuri, Linda
    Andrew, Angeline S.
    Duell, Eric J.
    Kiemeney, Lambertus A.
    van der Heijden, Erik H. F. M.
    Haugen, Aage
    Zienolddiny, Shanbeh
    Skaug, Vidar
    Grankvist, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap.
    Johansson, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap.
    Woll, Penella J.
    Cox, Angela
    Taylor, Fiona
    Teare, Dawn M.
    Lazarus, Philip
    Schabath, Matthew B.
    Aldrich, Melinda C.
    Houlston, Richard S.
    McLaughlin, John
    Stevens, Victoria L.
    Shen, Hongbing
    Hu, Zhibin
    Dai, Juncheng
    Amos, Christopher I.
    Han, Younghun
    Zhu, Dakai
    Goodman, Gary E.
    Chen, Feng
    Christiani, David C.
    Elevated Platelet Count Appears to Be Causally Associated with Increased Risk of Lung Cancer: A Mendelian Randomization Analysis2019Ingår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 28, nr 5, s. 935-942Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Platelets are a critical element in coagulation and inflammation, and activated platelets are linked to cancer risk through diverse mechanisms. However, a causal relationship between platelets and risk of lung cancer remains unclear. Methods: We performed single and combined multiple instrumental variable Mendelian randomization analysis by an inverse-weighted method, in addition to a series of sensitivity analyses. Summary data for associations between SNPs and platelet count are from a recent publication that included 48,666 Caucasian Europeans, and the International Lung Cancer Consortium and Transdisciplinary Research in Cancer of the Lung data consisting of 29,266 cases and 56,450 controls to analyze associations between candidate SNPs and lung cancer risk. Results: Multiple instrumental variable analysis incorporating six SNPs showed a 62% increased risk of overall nonsmall cell lung cancer [NSCLC; OR, 1.62; 95% confidence interval (CI), 1.15-2.27; P = 0.005] and a 200% increased risk for small-cell lung cancer (OR, 3.00; 95% CI, 1.27-7.06; P = 0.01). Results showed only a trending association with NSCLC histologic subtypes, which may be due to insufficient sample size and/or weak effect size. A series of sensitivity analysis retained these findings. Conclusions: Our findings suggest a causal relationship between elevated platelet count and increased risk of lung cancer and provide evidence of possible antiplatelet interventions for lung cancer prevention. Impact: These findings provide a better understanding of lung cancer etiology and potential evidence for antiplatelet interventions for lung cancer prevention.

  • 2840.
    Zingmark, Magnus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Health and Social Care Administration, Municipality of Östersund, 83182 Östersund, Sweden.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Dahlin-Ivanoff, Synneve
    Göteborgs universitet.
    Gustafsson, Susanne
    Göteborgs universitet.
    Modelling long-term cost-effectiveness of health promotion for community-dwelling older people2019Ingår i: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 16, nr 4, s. 395-404Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The effectiveness of health promotion for community-dwelling older people is well documented; however, there is a general lack of health economic evaluations. The aim of the present study was to evaluate long-term cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, for community-dwelling older people in relation to no intervention. We applied a Markov model including five states defined in relation to level of dependency of home help and place of residency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention and a no-intervention control group, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years. Sensitivity analyses included higher intervention costs, lower intervention effects and additional intervention costs and effects related to booster sessions. The results of all analyses indicated that health promotion implemented for community-dwelling older people in the format of senior meetings or a preventive home visit was cost-effective. Both interventions lead to QALY gains and reduce societal costs at any follow-up over 4 years, and thus, resources can be used to implement other interventions. The most important factor for the magnitude of QALY gains and cost savings was the intervention effect. Yearly booster sessions implemented for those persons who maintained their level of functioning extended the intervention effects adding additional QALYs and further reducing societal costs.

  • 2841. Zulu, Joseph M.
    et al.
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sandøy, Ingvild Fossgard
    Blystad, Astrid
    Mulubwa, Chama
    Makasa, Mpundu C.
    Michelo, Charles
    Musonda, Patrick
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Community based interventions for strengthening adolescent sexual reproductive health and rights: how can they be integrated and sustained? A realist evaluation protocol from Zambia2018Ingår i: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 15, artikel-id 145Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Research that explores how community-based interventions for strengthening adolescent sexual reproductive health and rights (SRHR) can be integrated and sustained in community health systems, is, to the best of our knowledge, very scarce, if not absent. It is important to document mechanisms that shape integration process in order to improve health systems' responsiveness towards adolescents' SRHR. This realist evaluation protocol will contribute to this knowledge in Zambia where there is increased attention towards promoting maternal, neonatal and child health as a means of addressing the current high early pregnancy and marriage rates. The protocol will ascertain: why, how, and under what conditions the integration of SRHR interventions into Zambian community health systems will optimise (or not) acceptability and adoption of SRHR services. This study is embedded within a randomized controlled trial - "Research Initiative to Support the Empowerment of Girls (RISE) "-which aims to reduce adolescent girl pregnancies and marriages through a package of interventions including economic support to families, payment of school fees to keep girls in school, pocket money for girls, as well as youth club and community meetings on reproductive health.

    Methods: This is a multiple-case study design. Data will be collected from schools, health facilities and communities through individual and group interviews, photovoice, documentary review, and observations. The study process will involve 1) developing an initial causal theory that proposes an explanation of how the integration of a community-based intervention that aimed to integrate adolescent SRHR into the community health system may lead to adolescent-friendly services; 2) refining the causal theory through case studies; 3) identifying contextual conditions and mechanisms that shape the integration process; and 4) finally proposing a refined causal theory and set of recommendations to guide policy makers, steer further research, and inform teaching programmes.

    Discussion: The study will document relevant values as well as less formal and horizontal mechanisms which shape the integration process of SRHR interventions at community level. Knowledge on mechanisms is essential for guiding development of strategies for effectively facilitating the integration process, scaling up processes and sustainability of interventions aimed at reducing SRH problems and health inequalities among adolescents.

  • 2842.
    Zulu, Joseph M.
    et al.
    University of Zambia.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Michelo, Charles
    University of Zambia.
    George, Asha
    University of the Western Cape.
    Schneider, Helen
    University of the Western Cape.
    Integrating community health assistant-driven sexual and reproductive health services in the community health system in Nyimba district in Zambia: mapping key actors, points of integration, and conditions shaping the process2019Ingår i: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 16, nr 1, artikel-id 122Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Although large scale public sector community health worker programs have been key in providing sexual and reproductive health (SRH) services in low- and middle-income countries, their integration process into community health systems is not well understood. This study aimed to identify the conditions and strategies through which Community Health Assistants (CHAs) gained entry and acceptability into community health systems to provide SRH services to youth in Zambia. The country's CHA program was launched in 2010.

    Methodology: A phenomenological design was conducted in Nyimba district. All nine CHAs deployed in Nyimba district were interviewed in-depth on their experiences of navigating the introduction of SRH services for youth in community settings, and the data obtained analyzed thematically.

    Results: In delivering SRH services targeting youth, CHAs worked with a range of community actors, including other health workers, safe motherhood action groups, community health workers, neighborhood health committees, teachers, as well as political, traditional and religious leaders. CHAs delivered SRH education and services in health facilities, schools, police stations, home settings, and community spaces. They used their health facility service delivery role to gain trust and entry into the community, and they also worked to build relationships with other community level actors by holding regular joint meetings, and acting as brokers between the volunteer health workers and the Ministry of Health. CHAs used their existing social networks to deliver SRH services to adolescents. By embedding the provision of information about SRH into general life skills at community level, the topic's sensitivity was reduced and its acceptability was enhanced. Further, support from community leaders towards CHA-driven services promoted the legitimacy of providing SRH for youth. Factors limiting the acceptability of CHA services included the taboo of discussing sexuality issues, a gender discriminatory environment, competition with other providers, and challenges in conducting household visits.

    Conclusion: Strengthening CHAs' ability to negotiate and navigate and gain acceptability in the community health system as they deliver SRH, requires support from both the formal health system and community networks. Limitations to the acceptability of CHA-driven SRH services are a product of challenges both in the community and in the formal health system.

  • 2843. Zulu, Joseph M
    et al.
    Michelo, Charles
    Msoni, Carol
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Byskov, Jens
    Blystad, Astrid
    Increased fairness in priority setting processes within the health sector: the case of Kapiri-Mposhi District, Zambia2014Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, s. 75-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The challenge of priority setting (PS) in health care within contexts of severe resource limitations has continued to receive attention. Accountability for Reasonableness (AFR) has emerged as a useful framework to guide the implementation of PS processes. In 2006, the AFR approach to enhance legitimate and fair PS was introduced by researchers and decision makers within the health sector in the EU funded research project entitled 'Response to Accountable priority setting for Trust in health systems' (REACT). The project aimed to strengthen fairness and accountability in the PS processes of health systems at district level in Zambia, Tanzania and Kenya. This paper focuses on local perceptions and practices of fair PS (baseline study) as well as at the evolution of such perceptions and practices in PS following an AFR based intervention (evaluation study), carried out at district level in Kapiri-Mposhi District in Zambia. Methods: Data was collected using in depth interviews (IDIs), focus group discussions (FGDs) and review of documents from national to district level. The study population for this paper consisted of health related stakeholders employed in the district administration, in non-governmental organizations (NGO) and in health facilities. Results: During the baseline study, concepts of legitimacy and fairness in PS processes were found to be grounded in local values of equity and impartiality. Government and other organizational strategies strongly supported devolution of PS and decision making procedures. However, important gaps were identified in terms of experiences of stakeholder involvement and fairness in PS processes in practice. The evaluation study revealed that a transformation of the views and methods regarding fairness in PS processes was ongoing in the study district, which was partly attributed to the AFR based intervention. Conclusions: The study findings suggest that increased attention was given to fairness in PS processes at district level. The changes were linked to a number of simultaneous factors among them the concepts introduced by the present project with its emphasis on fairness and enhanced participation. A responsive leadership that was increasingly accountable to its operational staff and communities emerged as one of the key elements in driving the processes forward.

  • 2844.
    Zulu, Joseph Mumba
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Michelo, Charles
    Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
    Innovation in health service delivery: integrating community health assistants into the health system at district level in Zambia2015Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, s. 38-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To address the huge human resources for health gap in Zambia, the Ministry of Health launched the National Community Health Assistant Strategy in 2010. The strategy aims to integrate community-based health workers into the health system by creating a new group of workers, called community health assistants (CHAs). However, literature suggests that the integration process of national community-based health worker programmes into health systems has not been optimal. Conceptually informed by the diffusion of innovations theory, this paper qualitatively aimed to explore the factors that shaped the acceptability and adoption of CHAs into the health system at district level in Zambia during the pilot phase. Methods: Data gathered through review of documents, 6 focus group discussions with community leaders, and 12 key informant interviews with CHA trainers, supervisors and members of the District Health Management Team were analysed using thematic analysis. Results: The perceived relative advantage of CHAs over existing community-based health workers in terms of their quality of training and scope of responsibilities, and the perceived compatibility of CHAs with existing groups of health workers and community healthcare expectations positively facilitated the integration process. However, limited integration of CHAs in the district health governance system hindered effective programme trialability, simplicity and observability at district level. Specific challenges at this level included a limited information flow and sense of programme ownership, and insufficient documentation of outcomes. The district also had difficulties in responding to emergent challenges such as delayed or non-payment of CHA incentives, as well as inadequate supervision and involvement of CHAs in the health posts where they are supposed to be working. Furthermore, failure of the health system to secure regular drug supplies affected health service delivery and acceptability of CHA services at community level. Conclusion: The study has demonstrated that implementation of policy guidelines for integrating community-based health workers in the health system may not automatically guarantee successful integration at the local or district level, at least at the start of the process. The study reiterates the need for fully integrating such innovations into the district health governance system if they are to be effective.

  • 2845.
    Zulu, Joseph Mumba
    et al.
    Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia .
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Michelo, Charles
    Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia .
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Developing the national community health assistant strategy in Zambia: a policy analysis2013Ingår i: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 11, s. 24-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In 2010, the Ministry of Health in Zambia developed the National Community Health Assistant strategy, aiming to integrate community health workers (CHWs) into national health plans by creating a new group of workers, called community health assistants (CHAs). The aim of the paper is to analyse the CHA policy development process and the factors that influenced its evolution and content. A policy analysis approach was used to analyse the policy reform process.

    METHODOLOGY: Data were gathered through review of documents, participant observation and key informant interviews with CHA strategic team members in Lusaka district, and senior officials at the district level in Kapiri Mposhi district where some CHAs have been deployed.

    RESULTS: The strategy was developed in order to address the human resources for health shortage and the challenges facing the community-based health workforce in Zambia. However, some actors within the strategic team were more influential than others in informing the policy agenda, determining the process, and shaping the content. These actors negotiated with professional/statutory bodies and health unions on the need to develop the new cadre which resulted in compromises that enabled the policy process to move forward. International agencies also indirectly influenced the course as well as the content of the strategy. Some actors classified the process as both insufficiently consultative and rushed. Due to limited consultation, it was suggested that the policy content did not adequately address key policy content issues such as management of staff attrition, general professional development, and progression matters. Analysis of the process also showed that the strategy might create a new group of workers whose mandate is unclear to the existing group of health workers.

    CONCLUSIONS: This paper highlights the complex nature of policy-making processes for integrating CHWs into the health system. It reiterates the need for recognising the fact that actors' power or position in the political hierarchy may, more than their knowledge and understanding of the issue, play a disproportionate role in shaping the process as well as content of health policy reform.

  • 2846.
    Zulu, Joseph Mumba
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Michelo, Charles
    Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hope and despair: community health assistants' experiences of working in a rural district in Zambia2014Ingår i: Human Resources for Health, ISSN 1478-4491, E-ISSN 1478-4491, Vol. 12, nr 1, artikel-id 30Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In order to address the challenges facing the community-based health workforce in Zambia, the Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called community health assistants (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work.

    METHODS: A phenomenological approach was used to examine CHAs' experiences. Data collected through in-depth interviews with 12 CHAs in Kapiri Mposhi district and observations were analysed using a thematic analysis approach.

    RESULTS: Personal characteristics such as previous experience and knowledge, passion to serve the community and a desire to improve skills motivated people to become CHAs. Health systems characteristics such as an inclusive work culture in some health posts motivated CHAs to work. Conversely, a non-inclusive work culture created a social structure which constrained CHAs' ability to learn, to be innovative and to effectively conduct their duties. Further, limited supervision, misconceptions about CHA roles, poor prioritisation of CHA tasks by some supervisors, as well as non- and irregular payment of incentives also adversely affected CHAs' ability to work effectively. In addition, negative feedback from some colleagues at the health posts affected CHA's self-confidence and professional outlook. In the community, respect and support provided to CHAs by community members instilled a sense of recognition, appreciation and belonging in CHAs which inspired them to work. On the other hand, limited drug supplies and support from other community-based health workers due to their exclusion from the government payroll inhibited CHAs' ability to deliver services.

    CONCLUSIONS: Programmes aimed at integrating community-based health workers into health systems should adequately consider multiple incentives, effective management, supervision and support from the district. These should be tailored towards enhancing the individual, health system and community characteristics that positively impact work motivation at the local level if such programmes are to effectively contribute towards improved primary healthcare.

  • 2847.
    Zulu, Joseph Mumba
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Public Health, School of Medicine, University of Zambia, P.O. Box 50110, Lusaka, Zambia.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Michelo, Charles
    Univ Zambia, Sch Med, Dept Publ Hlth, Lusaka, Zambia.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Integrating national community-based health worker programmes into health systems: a systematic review identifying lessons learned from low-and middle-income countries2014Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, nr 1, artikel-id 987Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Despite the development of national community-based health worker (CBHW) programmes in several low- and middle-income countries, their integration into health systems has not been optimal. Studies have been conducted to investigate the factors influencing the integration processes, but systematic reviews to provide a more comprehensive understanding are lacking.

    METHODS: We conducted a systematic review of published research to understand factors that may influence the integration of national CBHW programmes into health systems in low- and middle-income countries. To be included in the study, CBHW programmes should have been developed by the government and have standardised training, supervision and incentive structures. A conceptual framework on the integration of health innovations into health systems guided the review. We identified 3410 records, of which 36 were finally selected, and on which an analysis was conducted concerning the themes and pathways associated with different factors that may influence the integration process.

    RESULTS: Four programmes from Brazil, Ethiopia, India and Pakistan met the inclusion criteria. Different aspects of each of these programmes were integrated in different ways into their respective health systems. Factors that facilitated the integration process included the magnitude of countries' human resources for health problems and the associated discourses about how to address these problems; the perceived relative advantage of national CBHWs with regard to delivering health services over training and retaining highly skilled health workers; and the participation of some politicians and community members in programme processes, with the result that they viewed the programmes as legitimate, credible and relevant. Finally, integration of programmes within the existing health systems enhanced programme compatibility with the health systems' governance, financing and training functions. Factors that inhibited the integration process included a rapid scale-up process; resistance from other health workers; discrimination of CBHWs based on social, gender and economic status; ineffective incentive structures; inadequate infrastructure and supplies; and hierarchical and parallel communication structures.

    CONCLUSIONS: CBHW programmes should design their scale-up strategy differently based on current contextual factors. Further, adoption of a stepwise approach to the scale-up and integration process may positively shape the integration process of CBHW programmes into health systems.

  • 2848.
    Åhman, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Edvardsson, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Judith Lumley Centre, La Trobe University, Melbourne, Australia.
    Kidanto, Hussein Lesio
    Ngarina, Matilda
    Small, Rhonda
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    'Without ultrasound you can't reach the best decision': midwives' experiences and views of the role of ultrasound in maternity care in Dar Es Salaam, Tanzania2018Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, s. 28-34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To explore Tanzanian midwives' experiences and views of the role of obstetric ultrasound in relation to clinical management of pregnancy, and in situations where maternal and fetal health interests conflict. Method: In 2015, five focus group discussions were conducted with midwives (N = 31) at three public referral hospitals in the Dar es Salaam region as part of the CROss Country Ultrasound Study (CROCUS). Results: Ultrasound was described as decisive for proper management of pregnancy complications. Midwives noted an increasing interest in ultrasound among pregnant women. However, concerns were expressed about the lack of ultrasound equipment and staff capable of skilful operation. Further, counselling regarding medical management was perceived as difficult due to low levels of education among pregnant women. Conclusion: Ultrasound has an important role in management of pregnancy complications. However, lack of equipment and shortage of skilled healthcare professionals seem to hamper use of obstetric ultrasound in this particular low-resource setting. Increased availability of obstetric ultrasound seems warranted, but further investments need to be balanced with advanced clinical skills' training as barriers, including power outages and lack of functioning equipment, are likely to continue to limit the provision of pregnancy ultrasound in this setting.

  • 2849.
    Åhman, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Kidanto, Hussein Lesio
    Ngarina, Matilda
    Edvardsson, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.
    Small, Rhonda
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    'Essential but not always available when needed': an interview study of physicians' experiences and views regarding use of obstetric ultrasound in Tanzania2016Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, artikel-id 31062Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The value of obstetric ultrasound in high-income countries has been extensively explored but evidence is still lacking regarding the role of obstetric ultrasound in low-income countries.

    Objective: We aimed to explore experiences and views among physicians working in obstetric care in Tanzania, on the role of obstetric ultrasound in relation to clinical management.

    Design: A qualitative study design was applied. Data were collected in 2015, through 16 individual interviews with physicians practicing in obstetric care at hospitals in an urban setting in Tanzania. Data were analyzed using qualitative content analysis.

    Results: Use of obstetric ultrasound in the management of complicated pregnancy was much appreciated by participating physicians, although they expressed considerable concern about the lack of ultrasound equipment and staff able to conduct the examinations. These limitations were recognized as restricting physicians' ability to manage complications adequately during pregnancy and birth. Better availability of ultrasound was requested to improve obstetric management. Concerns were also raised regarding pregnant women's lack of knowledge and understanding of medical issues which could make counseling in relation to obstetric ultrasound difficult. Although the physicians perceived a positive attitude toward ultrasound among most pregnant women, occasionally they came across women who feared that ultrasound might harm the fetus.

    Conclusions: There seems to be a need to provide more physicians in antenatal care in Tanzania with ultrasound training to enable them to conduct obstetric ultrasound examinations and interpret the results themselves. Physicians also need to acquire adequate counseling skills as counseling can be especially challenging in this setting where many expectant parents have low levels of education. Providers of obstetric care and policy makers in Tanzania will need to take measures to ensure appropriate use of the scarce resources in the Tanzanian health care system and prevent the potential risk of overuse of ultrasound in pregnancy.

  • 2850.
    Åsberg, Signild
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Eriksson, Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Statin therapy and the risk of intracerebral haemorrhage: a nationwide observational study2015Ingår i: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, s. 46-49Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The association between statin therapy and intracerebral haemorrhage is still unclear. The aim was to investigate whether prior use of statin was associated with risk of intracerebral haemorrhage.

    METHODS: Between 2006 and 2009, we identified 7696 cases of intracerebral haemorrhage that were first-ever strokes in the Swedish Stroke Register and 14 670 stroke-free controls that were matched on age and gender in the Population Register. Drug therapy at the time of intracerebral haemorrhage was extracted from the Drug Prescription Register. The risk of intracerebral haemorrhage with statins was estimated by conditional logistic regression.

    RESULTS: In cases and controls, the median age was 73 years and 53% were men. Intracerebral haemorrhage cases had higher prevalence of antithrombotic therapy, hypertension, and diabetes than controls. Statins were used by 1276 (16·6%) of the intracerebral haemorrhage cases and by 2552 (17·4%) of the controls. The crude odds ratios of intracerebral haemorrhage did not differ significantly between patients with and without statins, but after adjustment for antithrombotic therapy, hypertension, and diabetes, patients with statins had a decreased risk of intracerebral haemorrhage (odds ratio = 0·68, 95% confidence interval, 0·63-0·74). The highest proportion (>20%) of antecedent statins was seen in the 70-84 age group, for both cases and controls.

    CONCLUSIONS: In this matched case-controlled study, statin therapy was associated with a decreased risk of incident intracerebral haemorrhage. Future studies on risk of stroke with statin therapy after intracerebral haemorrhage are needed.

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