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  • 51.
    Byass, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Ghebreyesus, Tedros A
    Making the world's children count.2005Inngår i: Lancet, ISSN 1474-547X, Vol. 365, nr 9465, s. 1114-6Artikkel i tidsskrift (Fagfellevurdert)
  • 52.
    Byass, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hounton, Sennen
    Ouédraogo, Moctar
    Somé, Henri
    Diallo, Ibrahima
    Fottrell, Edward
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Emmelin, Axel
    Meda, Nicolas
    Direct data capture using hand-held computers in rural Burkina Faso: experiences, benefits and lessons learnt.2008Inngår i: Trop Med Int Health, ISSN 1365-3156, Vol. 13 Suppl 1, s. 25-30Artikkel i tidsskrift (Fagfellevurdert)
  • 53.
    Byass, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Worku, Alemayehu
    Emmelin, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Berhane, Yemane
    DSS and DHS: longitudinal and cross-sectional viewpoints on child and adolescent mortality in Ethiopia2007Inngår i: Population Health Metrics, E-ISSN 1478-7954, Vol. 5, nr 1, s. Article nr 12-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In countries where routine vital registration data are scarce, Demographic Surveillance Sites (DSS: locally defined populations under longitudinal surveillance for vital events and other characteristics) and Demographic and Health Surveys (DHS: periodic national cluster samples responding to cross-sectional surveys) have become standard approaches for gathering at least some data. This paper aims to compare DSS and DHS approaches, seeing how they complement each other in the specific instance of child and adolescent mortality in Ethiopia.

    METHODS: Data from the Butajira DSS 1987-2004 and the Ethiopia DHS rounds for 2000 and 2005 formed the basis of comparative analyses of mortality rates among those aged under 20 years, using Poisson regression models for adjusted rate ratios.

    RESULTS: Patterns of mortality over time were broadly comparable using DSS and DHS approaches. DSS data were more susceptible to local epidemic variations, while DHS data tended to smooth out local variation, and be more subject to recall bias.

    CONCLUSION: Both DSS and DHS approaches to mortality surveillance gave similar overall results, but both showed method-dependent advantages and disadvantages. In many settings, this kind of joint-source data analysis could offer significant added value to results.

    Fulltekst (pdf)
    DSS and DHS: longitudinal and cross-sectional viewpoints on child and adolescent mortality in Ethiopia
  • 54. Byskov, Jens
    et al.
    Bloch, Paul
    Blystad, Astrid
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Fylkesnes, Knut
    Kamuzora, Peter
    Kombe, Yeri
    Kvåle, Gunnar
    Marchal, Bruno
    Martin, Douglas K
    Michelo, Charles
    Ndawi, Benedict
    Ngulube, Thabale J
    Nyamongo, Isaac
    Olsen, Oystein E
    Onyango-Ouma, Washington
    Sandøy, Ingvild F
    Shayo, Elizabeth H
    Silwamba, Gavin
    Songstad, Nils Gunnar
    Tuba, Mary
    Accountable priority setting for trust in health systems: the need for research into a new approach for strengthening sustainable health action in developing countries2009Inngår i: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 7, s. 23-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Despite multiple efforts to strengthen health systems in low and middle income countries, intended sustainable improvements in health outcomes have not been shown. To date most priority setting initiatives in health systems have mainly focused on technical approaches involving information derived from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed. Accountability for Reasonableness (AFR) is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must identify and consider the full range of relevant values. AFR consists of four conditions: i) relevance to the local setting, decided by agreed criteria; ii) publicizing priority-setting decisions and the reasons behind them; iii) the establishment of revisions/appeal mechanisms for challenging and revising decisions; iv) the provision of leadership to ensure that the first three conditions are met. REACT - "REsponse to ACcountable priority setting for Trust in health systems" is an EU-funded five-year intervention study started in 2006, which is testing the application and effects of the AFR approach in one district each in Kenya, Tanzania and Zambia. The objectives of REACT are to describe and evaluate district-level priority setting, to develop and implement improvement strategies guided by AFR and to measure their effect on quality, equity and trust indicators. Effects are monitored within selected disease and programme interventions and services and within human resources and health systems management. Qualitative and quantitative methods are being applied in an action research framework to examine the potential of AFR to support sustainable improvements to health systems performance. This paper reports on the project design and progress and argues that there is a high need for research into legitimate and fair priority setting to improve the knowledge base for achieving sustainable improvements in health outcomes.

    Fulltekst (pdf)
    fulltext
  • 55.
    Chikovore, Jeremiah
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Gender power dynamics in sexual and reproductive health. A qualitative study in Chiredzi District, Zimbabwe2004Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    This thesis presents perspectives of men regarding abortion, contraceptive use and sexuality. Contrary to what we had expected, men expressed anxiety over abortion and contraceptive use, not because the issues concerned women’s health, but rather because men associated them with extramarital sexual activity they thought women were concealing. To understand the meanings of sexuality and factors shaping these meanings appeared to be a necessary step in promoting women’s health. We thus included in the study participants with different characteristics including men, women and adolescents, and used a variety of qualitative methods to explore in-depth these issues.

    Men’s anxiety over wives’ sexuality seemed to be exacerbated by their separation from the family through labour migration, and their inability to play the expected role of the family breadwinner. The men described using different strategies to ensure their wives did not use contraceptives. Men’s perspectives and the related dynamics seem therefore to be a manifestation of contradictory experiences of gender power within contexts of spousal separation.

    The thesis also illuminates the paradoxical situation of adolescents and adolescent sexual and reproductive health. As guardians, the men described how they are intolerant to premarital sex and pregnancy, which might threaten the expected bride wealth from the marriage of a daughter or sister. They therefore respond with violence. Ironically, information or service which would enable unmarried girls to prevent pregnancy is also denied. This is so in spite of the great concern by families over premarital pregnancy, and common knowledge that young girls are sexually abused by adult men. The men and boys described the pressure they exert on the girls for sex, but also how they then blame the girls for deliberately becoming pregnant in order to trap them into marriage. The boys are nevertheless anxious about pregnancy also for fear of family violence and the threat of being forced to terminate schooling. The girls expressed feeling trapped between the violence from guardians and partners, a situation which may lead to unsafe abortion.

    The silence, denial and violence imply the young people generally cannot discuss sexual abuse or abortion with parents, or seek health care when needed. Rather, sexually transmitted infections may be ndured or even self-treated, and abortion sought in silence. Preventive actions such as condom use are similarly difficult for the youth. The knowledge the youth may have about AIDS may also simply become a burden when room for applying it is limited.

    This thesis challenges public health promotion approaches that assume firstly a universal manifestation of gender power, and secondly ability of individuals to effect behaviour change once provided with information regardless of contextual factors. Whether in AIDS education or involvement of men in sexual and reproductive health, understanding social contexts and dynamics, and identities and experiences within these contexts is crucial.

    Fulltekst (pdf)
    FULLTEXT01
  • 56.
    Chikovore, Jeremiah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindmark, Gunilla
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Mbizvo, MT
    Ahlberg, BM
    The hide and seek game: men’s perspectives on abortion and contraceptive use within marriage in a rural community in Zimbabwe2002Inngår i: Journal of Biosocial Science, ISSN 0021-9320, E-ISSN 1469-7599, Vol. 34, nr 3, s. 317-332Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This paper is based on a study aimed at understanding the perceptions of men to induced abortion and contraceptive use within marriage in rural Zimbabwe. Two qualitative methods were combined. Men were found to view abortion not as a reproductive health problem for women. Instead, they described abortion as a sign of illicit sexual activity and contraceptive use as a strategy married women use to conceal their involvement in extramarital sexual activity. Men felt anxious and vulnerable for lack of control over women. In the absence of verbal communication on sexual matters, women and men resort to what are called here 'hide-and-seek' strategies, where women acquire and use contraceptives secretly while men search for evidence of such use. It is concluded that promoting women's sexual and reproductive health requires both short- and long-term strategies. The short-term strategy would entail providing women with reproductive technology they can use without risking violence. The long-term strategy would entail understanding men's concerns and the way these are manifested. In turn this requires the use of methodologies that encourage dialogue with research participants, in order to capture their deep meanings and experiences.

  • 57. Collin, Pekka
    et al.
    Kaukinen, Katri
    Vogelsang, Harald
    Korponay-Szabó, Ilma
    Sommer, Rudolf
    Schreier, Elisabeth
    Volta, Umberto
    Granito, Alessandro
    Veronesi, Lorenza
    Mascart, Françoise
    Ocmant, Annick
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lagerqvist, Carina
    Bürgin-Wolff, Annemarie
    Hadziselimovic, Faruk
    Furlano, Raoul I
    Sidler, Marc A
    Mulder, Chris J J
    Goerres, Marije S
    Mearin, M Luisa
    Ninaber, Maarten K
    Gudmand-Høyer, Eivind
    Fabiani, Elisabetta
    Catassi, Carlo
    Tidlund, Helena
    Alainentalo, Lisbeth
    Mäki, Markku
    Antiendomysial and antihuman recombinant tissue transglutaminase antibodies in the diagnosis of coeliac disease: a biopsy-proven European multicentre study.2005Inngår i: Eur J Gastroenterol Hepatol, ISSN 0954-691X, Vol. 17, nr 1, s. 85-91Artikkel i tidsskrift (Fagfellevurdert)
  • 58.
    Collinson, Mark A
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Striving against adversity.: the dynamics of migration, health and poverty in rural South Africa2009Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

     Background: The study is based in post-apartheid South Africa and looks at the health and well being of households in the rural northeast. Temporary migration remains important in South Africa because it functions as a mainstay for income and even survival of rural communities. The economic base of rural South Africans is surprisingly low because there is high inequity at a national level, within and between racial groups. There has now been a democratic system in place for 15 years and there is no longer restriction of mobility, but there remain high levels of poverty in rural areas and rising mortality rates. Migration patterns did not change after apartheid in the manner expected. We need to examine consequences of migration and learn how to offset negative impacts with targeted policies.

    Aims: To determine a relevant typology of migration in a typical rural sending community, namely the Agincourt sub-district of Mpumalanga, South Africa, and relate it to the urban transition at a national level – Paper (I) . To evaluate the dynamics of socio-economic status in this rural community and examine the relationship with migration – Paper (II). To explore, using longitudinal methods, the impact of migration on key dimensions of health, including adult and child mortality, and sexual partnerships, over a period of an emerging HIV/AIDS epidemic – Papers (III), (IV) and (V).

    Methods: The health and socio-demographic surveillance system (HDSS) is a large open cohort where the migration dynamics are monitored as they unfold. They are recorded as temporary or permanent migration. Settled refugees are captured using nationality on entry into the HDSS. Longitudinal methods, namely a household panel and two discrete time event history analyses, are used to examine consequences of migration.

    Results: Migration features prominently and different types have different age and sex profiles. Temporary migration impacts the most on socio-economic status (SES) and health, but permanent migration and the settlement of former refugees are also important. Remittances from migrants make a significant difference to SES. For the poorest households the key factors improving SES are government grants and female temporary migration, while for less poor it is male temporary migration and local employment. Migration has been associated with HIV. Migrants that return more frequently may be less exposed to outside partners and therefore less implicated in the HIV epidemic. There are links between migration and mortality including a higher risk of dying for returnee migrants compared to permanent residents. A mother’s migration can impact on child survival after accounting for other factors. There remains a higher mortality risk for children of Mozambican former refugee parents.

    Interpretation: Migration changes the risks and resources for health with positive and negative implications. Measures such as improved transportation and roads should be seen as a positive, not a negative intervention, even though it will create more migration. Health services need to adapt to a reality of high levels of circular migration ranging from budget allocation to referral systems. Data should be enhanced at a national level by accounting for temporary migration in national censuses and surveys. At individual level we can offset negative consequences by treating migrants as persons striving against adversity, instead of unwelcome visitors in our better-off communities. 

    Fulltekst (pdf)
    FULLTEXT01
  • 59.
    Collinson, Mark A
    et al.
    University of Witwatersrand, South Africa; Umeå universitet, Umeåpå.
    Clark, Samuel J
    University of Witwatersrand, South Africa, University of Washington, USA.
    Gerritsen, Annette M
    University of Venda, South Africa.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Kahn, Kathleen
    University of Witwatersrand, South Africa.
    Tollman, Stephen
    University of Witwatersrand, South Africa.
    The dynamics of poverty and migration in a rural South African community, 2001-2005Manuskript (preprint) (Annet vitenskapelig)
  • 60.
    Collinson, Mark A
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Tollman, Stephen M
    Brown University, USA.
    Kahn, Kathleen
    Brown University, USA.
    Migration, settlement change and health in post-apartheid South Africa: triangulating health and demographic surveillance with national census data.2007Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Scandinavian journal of public health. Supplement, ISSN 1403-4956, Vol. Suppl. 69, s. 77-84Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: World population growth will be increasingly concentrated in the urban areas of the developing world; however, some scholars caution against the oversimplification of African urbanization noting that there may be "counter-urbanization" and a prevailing pattern of circular rural-urban migration. The aim of the paper is to examine the ongoing urban transition in South Africa in the post-apartheid period, and to consider the health and social policy implications of prevailing migration patterns. METHODS: Two data sets were analysed, namely the South African national census of 2001 and the Agincourt health and demographic surveillance system. A settlement-type transition matrix was constructed on the national data to show how patterns of settlement have changed in a five-year period. Using the sub-district data, permanent and temporary migration was characterized, providing migration rates by age and sex, and showing the distribution of origins and destinations. FINDINGS: The comparison of national and sub-district data highlight the following features: urban population growth, particularly in metropolitan areas, resulting from permanent and temporary migration; prevailing patterns of temporary, circular migration, and a changing gender balance in this form of migration; stepwise urbanization; and return migration from urban to rural areas. CONCLUSIONS: Policy concerns include: rural poverty exacerbated by labour migration; explosive conditions for the transmission of HIV; labour migrants returning to die in rural areas; and the challenges for health information created by chronically ill migrants returning to rural areas to convalesce. Lastly, suggestions are made on how to address the dearth of relevant population information for policy-making in the fields of migration, settlement change and health.

  • 61.
    Collinson, Mark A
    et al.
    University of Witwatersrand, South Africa; University of Umeå, Sweden.
    White, Michael J
    Brown University, USA.
    Short, Susan
    Brown University, USA.
    Lurie, Mark
    Brown University, SUA.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Kahn, Kathleen
    University of Witwatersrand, South Africa; Umeå University, Sweden.
    Clark, Samuel J
    University of Witwatersrand, South Africa.
    Tollman, Stephen M
    University of Witwatersrand,South Africa; University of Umeå, Sweden.
    Child mortality, migration and parental presence in rural South Africa near the border with MozambiqueManuskript (preprint) (Annet vitenskapelig)
  • 62. Cook, Ian
    et al.
    Alberts, Marianne
    Burger, Sandy
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    All-cause mortality trends in Dikgale, rural South Africa, 1996-2003.2008Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, nr 7, s. 753-60Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: The Dikgale Demographic Surveillance System (DDSS) site, established in 1995, is one of three rural surveillance sites in South Africa. This paper describes detailed mortality patterns of a rural African population in the central region of Limpopo Province. METHODS: These data were based on yearly household visits to collect data on vital events, covering 63, 873 person-years of observation over eight years. RESULTS: Crude mortality was 7.5 per 1,000 person-years (females: 6.9, males: 8.1). Under-1 year and under-5 years mortality was 15.1 and 5.8 per 1,000 person-years, respectively. Life expectancy at birth was 64.3 years (females: 68.1, males: 60.0). For the two four-year periods (1996-9 and 2000-3) under-20 years mortality risk decreased (rate ratio=0.45, 95% CI: 0.25 to 0.80) while 20-49 years mortality risk increased (rate ratio=1.55, 95% CI: 1.10 to 2.20). Multivariate mortality risk for migrants remained relatively constant (0.71, 95% CI: 0.54 to 0.94) across the two four-year periods, but has increased 2.5-fold in all DDSS +50 year-old adults across the two four-year periods. CONCLUSIONS: The DDSS mortality estimates appear to have remained relatively constant while recent mortality estimates for the Agincourt Demographic and Health Surveillance System (ADHSS) site suggest that mortality risk is higher and life expectancy is lower in ADHSS residents. Moreover, DDSS mortality estimates are substantially more favourable compared with provincial and national mortality estimates.

  • 63. Cvetkovic, Jasmina Trifunovic
    et al.
    Wiklund, Per Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Medicin.
    Ahmed, Ejaz
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Lefvert, Ann Kari
    Polymorphisms of IL-1beta, IL-1Ra, and TNF-alpha genes: A nested case-control study of their association with risk for stroke2005Inngår i: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 14, nr 1, s. 29-35Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Certain alleles of cytokine genes interleukin-1 beta (IL-1β), interleukin-1 receptor antagonist (IL-1Ra), and tumor necrosis factor alpha (TNF-α) are correlated with increased production of the proteins. The aim of this study was to investigate polymorphisms of these genes and their possible correlation with the development of stroke. This matched case-control study was nested within the population-based Västerbotten Intervention Program (VIP) cohort and the Northern Sweden World Health Organization MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases) cohort, based on individuals who were free from cardiovascular events when the cohorts were established. After an average period of 34.1 months, 113 individuals developed stroke and to each case 2 individuals not suffering from cardiovascular events were matched to serve as controls. Polymerase chain reaction amplification was used to analyze genetic polymorphisms. There was no association between polymorphic sites of the IL-1β and IL-1Ra genes and stroke. Carriage of haplotype A2+IL-1β/A2+IL-1Ra was significantly increased in normotensive cases (23.1%) compared with normotensive controls (8.9%) (odds ratio [OR] = 3.07; P = .045). In hypertensive male cases, there was an association between the A1A1 genotype of TNF-α and risk of stroke (OR = 2.46; P = .034). Our findings indicate an association between allele A1 of the TNF-α NcoI polymorphism and stroke in hypertensive male cases, as well as an association between haplotype A2+IL-1β/A2+IL-1Ra and stroke in normotensive cases.

  • 64.
    Dahlblom, Kjerstin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Home alone: sibling caretakers in León, Nicaragua2008Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Sibling caretaking, although common across time and cultures, has not been well researched from the carer’s point of view. In Nicaragua, ranked as one of the poorest countries in the Americas, sibling caretaking is common. The country’s historical background and its state of chronic poverty, widespread unemployment, loose family structures, and migration and mobility makes of the old practise of shared management child care a necessity. Households headed by sing¬le mothers constitute a particular Nica¬raguan charact¬eristic. Many children are expected to help in their own families and care for their siblings and other children living in their households. In its broadest sense sibling caretaking is a public health concern, and we conducted this study to widen the understanding of the phenomenon as it is represented in a setting undergoing a rapid social transition.

    The main objectives were to identify, describe and analyse the life situation of sibling caretakers in poor areas in León, Nicaragua, with focus on how they perceived it themselves. A combined qualitative and quantitative methodological design was used, mainly applying an ethnographic approach. A further ambition was to explore involvement of children in a participatory research process in accordance with the ‘Convention on the Rights of the Child’.

    The overall emotion expressed among the caretakers was pride, even if their situation often was characterized by stress and coping problems. They perceived their work as important for their families and they appreciated to fend for their siblings. Household work and nurturing of siblings were shaping the future lives of the caretakers and constituted part of their socialization.

    Even if many of these children achieve essential life skills as caretakers, they are at risk of falling behind as they grow older. Their long-term personal development is likely to be hampered by the obligations they have as caretakers. The carers' awareness of missing out on education was the most problematic issue for them.

    From a societal point of view, caretaking has negative consequences. The individual child is marginalised with limited access to basic education, contributing to overall low educational levels in Nicaragua.

    While the structuring conditions leading to sibling caretaking may be difficult to change, awareness of how these can affect children might make way for improvements in terms of access to school education and support from the society. The knowledge gained from this study should be further utilised to plan for interventions that take children’s perspectives into consideration.

    Fulltekst (pdf)
    FULLTEXT01
  • 65.
    Dahlblom, Kjerstin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Herrera Rodríguez, Andrés
    Peña, Rodolfo
    Dahlgren, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Home alone: children as caretakers in León, Nicaragua2009Inngår i: Children and society, ISSN 0951-0605, Vol. 23, nr 1, s. 43-56Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This article seeks to explore and understand the life situations of sibling caretakers in poor areas in León, Nicaragua. The every day lives for caretakers were studied through observations and interviews with children, informants and parents. The children themselves were satisfied and proud to be trusted as caretakers and felt useful in contributing to their families' livelihood. However, in a life course perspective the caretaking role implies a narrowing of life options. Early on they seem to acquire essential life skills but as they grow older many are at risk of falling behind due to their marginalised situation and lack of basic education.

  • 66.
    Dahlgren, Lars
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Emmelin, Maria
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Winkvist, Anna
    Qualitative methodology for international public health2007Bok (Annet vitenskapelig)
  • 67.
    Dahlgren, Lars
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Starrin, Bengt
    Emotioner, vardagsliv & samhälle : en introduktion till emotionssociologi2004Bok (Annet vitenskapelig)
  • 68.
    Dahlqvist, Johanna
    et al.
    Umeå universitet, Medicinsk fakultet, Klinisk vetenskap, Öron- näs- och halssjukdomar.
    Dahlqvist, Åke
    Umeå universitet, Medicinsk fakultet, Klinisk vetenskap, Öron- näs- och halssjukdomar.
    Marklund, Marie
    Umeå universitet, Medicinsk fakultet, Odontologi, Ortodonti.
    Berggren, Diana
    Umeå universitet, Medicinsk fakultet, Klinisk vetenskap, Öron- näs- och halssjukdomar.
    Stenlund, Hans
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Franklin, Karl
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Lungmedicin.
    Physical findings in the upper airways related to obstructive sleep apnea in men and women2007Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 127, nr 6, s. 623-630Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    CONCLUSIONS:There are gender differences when it comes to the risk factors for sleep apnea. Large tonsils, a high tongue and a wide uvula are risk factors for sleep apnea in men, while large tonsils and a retrognathic mandible are risk factors in women. Upper airway abnormalities including mandibular retrognathia are, however, unable to predict sleep apnea among snorers being investigated for suspected sleep apnea.

    OBJECTIVES: To identify gender-specific risk factors for obstructive sleep apnea and the diagnostic performance from physical upper airway examinations among snoring men and women investigated because of suspected sleep apnea.

    PATIENTS AND METHODS: The dimensions of the uvula, tonsils, velopharynx and tongue, and nasal septal deviation, mandibular position, neck circumference, weight, and height were systematically scored in 801 consecutive snoring patients (596 men and 205 women), who had been referred for a primary sleep apnea recording.

    RESULTS: In men, large tonsils, a high tongue, and a wide uvula were independent factors associated with an apnea-hyopnea index of > 15. In women, large tonsils and mandibular retrognathia were independent factors associated with an apnea-hypopnea index of > 15. The positive predictive values for upper airway abnormalities ranged between 0.20 and 0.25 in men and between 0.09 and 0.15 in women.

  • 69.
    D'Ambruoso, Lucia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Ouedraogo, Moctar
    Maternal death due to postpartum hemorrhage after snakebite2008Inngår i: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 102, nr 1, s. 71-Artikkel i tidsskrift (Fagfellevurdert)
  • 70.
    Danielsson, Ingela
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Blom, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Nilses, Carin
    Heimer, Gun
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Gendered patterns of high violence exposure among Swedish youth2009Inngår i: Acta obstetricia et gynecologica Scandinavica, ISSN 1600-0412, Vol. 88, nr 5, s. 528-35Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The WHO describes violence as a global public health problem. In contrast to domestic violence, violence against youth has been little explored. Our aims were to investigate the prevalence and gender differences in relation to emotional, physical and sexual abuse among young men and women attending youth health centers in Sweden, the current adverse effects of the abuse and the perpetrators of the abuse. DESIGN: Cross-sectional study. SETTING: Nationally representative youth health centers in Sweden. POPULATION AND METHODS: In total, 2,250 women and 920 men aged 15-23 years answered a validated questionnaire about emotional, physical and sexual abuse. RESULTS: A total of 33% (CI: 31-35) of the young women and 18% (CI: 16-21) of the young men had been exposed to emotional abuse during the past year. For physical abuse, 18% (CI: 17-20) of the women and 27% (CI: 24-30) of the men stated that they had been abused during the past year. The gender differences for sexual abuse were pronounced, with 14% (CI: 12-15) of the young women and 4.7% (CI: 3.3-6.0) of the men stating that they had been abused during the past 12 months. The young women reported more severe adverse effects from all types of abuse and were more often abused by a person close to them. CONCLUSIONS: The exposure to violence among young people is alarming and presents prominent gender differences, and should be taken into serious consideration as it is a matter of health, democracy and human rights.

  • 71. Danielsson, L
    et al.
    Stenhammar, L
    Ascher, H
    Cavell, B
    Dannaeus, A
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindberg, T
    Lindquist, B
    [Gluten intolerance in children--diagnostic routines in Sweden 1996. Great variations in celiac disease studies]1997Inngår i: Lakartidningen, ISSN 0023-7205, Vol. 94, nr 37, s. 3165-8Artikkel i tidsskrift (Annet vitenskapelig)
  • 72. Danielsson, L
    et al.
    Stenhammar, L
    Ascher, H
    Cavell, B
    Dannaeus, A
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindberg, T
    Lindquist, B
    [Proposed criteria for diagnosis of celiac disease in children]1998Inngår i: Lakartidningen, ISSN 0023-7205, Vol. 95, nr 20, s. 2342-3Artikkel i tidsskrift (Annet vitenskapelig)
  • 73.
    Dapi N., Léonie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Socioeconomic and sex differences in adolescents’ dietary intake, anthropometry and physical activity in Cameroon, Africa2010Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: People in Cameroon are experiencing a dietary transition characterized by changing from traditional food habits to increased intake of highly processed sweet and fatty food. The rapid change in food pattern combined with an increased sedentary lifestyle has resulted in a rather high prevalence of obesity, hypertension, cardiovascular diseases and type 2 diabetes. Nutritional intake is important during adolescence for growth spurt, health, cognitive development and performance in school.

    Objective: The aim of this thesis was to assess dietary intake, anthropometry and physical activity of adolescents according to sex and socioeconomic status (SES) and to investigate food perceptions of adolescents living in urban and rural areas of Cameroon.

    Methods: Girls and boys, 12-16 years of age, were randomly selected from schools in urban and rural areas. Food frequency questionnaire, 24-hour dietary and physical activity recalls, anthropometric measurements, qualitative interviews and a background questionnaire were used for data collection.

    Results: The proportion of overweight was three times higher in girls (14%) compared to boys (4%). Stunting and underweight were more common among boys (15% and 6%) than girls (5% and 1%). The prevalence of stunting was two times higher among the urban adolescents with low SES (12%) compared to those with high SES (5%). The rural adolescents had the highest proportion of stunting but more muscle that the urban adolescents. The rural adolescents ate in order to live and to maintain health. Urban adolescents with low SES ate in order to maintain health, while those with high SES ate for pleasure. More than 30% of the adolescents skipped breakfast in the urban area. Urban adolescents with high SES and girls reported a more frequent consumption of in-between meals and most food groups compared to the rural adolescents, boys and those with low SES. Over 55% of the adolescents had a protein intake below 10% of the energy (E%). Twenty-six percent of the adolescents had fat intake below 25 E%, and 25% had fat intake above 35 E%. A large proportion of the adolescents had an intake of micronutrients below the estimated average recommendation. Boys and the adolescents with low SES reported a higher energy expenditure and physical activity level than girls and the adolescents with high SES, respectively. Both under- and over-reporting of energy intake were common among the adolescents.

    Conclusions: The present study showed that nutrient inadequacy, stunting, underweight, as well as overweight and obesity were common among the adolescents in Cameroon. Therefore an intervention program targeting both under- and overnutrition among school adolescents is needed. Sex and socioeconomic differences also need to be considered.

    Fulltekst (pdf)
    FULLTEXT02
  • 74.
    Dapi N., Léonie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Nouedoui, Christophe
    Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
    Håglin, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Adolescents´ food habits and nutritional status in urban and rural areas in Cameroon, Africa2005Inngår i: Scandinavian Journal of Nutrition/Næringsforskning, ISSN 1102-6480, E-ISSN 1651-2359, Vol. 49, nr 4, s. 151-158Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Food intake in Cameroon is based on three meals daily. The diet in rural areas is based on traditional staple foods, while that of the urban population incorporates more modern foods. The health and nutrition of adolescents is important as their eating behaviour and nutrition will affect their future health.

    Objective: To describe and compare food habits and nutritional status of adolescents in Cameroon.

    Design: A cross-sectional study using an unquantified food frequency questionnaire and anthropometric data, in urban and rural areas. Fifty-two adolescents, 12_/15 years old, were selected from schools.

    Results : Frequencies of consumption of meat, vegetables, cereals, milk products and junk food were significantly higher in urban than in rural adolescents (11.8 vs 4.5, 9.5 vs 3.9, 16.5 vs 11.9, 5.7 vs 0.8, 24.2 vs 8.7, respectively). The frequency of in-between meals was higher in urban than in rural adolescents (4.9 vs 0.9, respectively). Arm muscle area (AMA, mm2) and waist/hip ratio were significantly higher in rural than in urban adolescents (3554 vs 2802 and 0.82 vs 0.79, respectively). Body mass index (BMI, kg m_2) was higher in rural than urban adolescents, although not significant (20.6 vs 19.4, respectively). There was a positive significant correlation between BMI and AMA in urban and rural areas (r_/0.67 and r_/0. 72, respectively).

    Conclusions: Despite a lower frequency of food consumption, rural adolescents had higher AMA and waist/hip ratio than urban adolescents. Less junk food and more traditional food consumption, more manualactivities and walking in rural adolescents could explain these results.

  • 75.
    Dapi N., Léonie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Nouedoui, Christophe
    Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
    Håglin, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Socioeconomic and gender differences in adolescents´ nutritional status in urban Cameroon, Africa2009Inngår i: Nutrition Research, ISSN 0271-5317, E-ISSN 1879-0739, Vol. 29, nr 5, s. 313-319Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to assess adolescents' nutritional status according to socioeconomic status (SES) and sex using anthropometry in urban Cameroon, Africa. Adolescent boys (n = 248) and girls (n = 333) 12 to 16 years old were recruited from randomly selected schools in a cross sectional study in Yaoundé city and grouped according to SES. Weight, height, skinfold thickness, and circumferences were measured, and body mass index, waist/hip ratio, arm muscle, and arm fat areas were calculated. Stunting, underweight, and overweight were determined using international cutoff points. Adolescents with medium and high SES were less likely to be stunted than adolescents with low SES (odds ratio [OR], 0.40; P < .01). Prevalences of stunting (12%, 6%, and 5%) and underweight (3%, 4%, and 1%) were higher among the adolescents with low and medium SES than those with high SES. Overweight prevalence was high among the adolescents with low (8%), medium (11%), and high (9%) SES. The OR for overweight was higher among girls than boys (OR, 4.13; P < .001). Girls were less likely to be stunted and underweight than boys (OR, 0.29 [P < .001] and OR, 0.20 [P < .01], respectively). Prevalences of stunting (15% and 6%) and underweight (5% and 2%) were higher among boys than girls. Pubescent adolescents were less likely to be stunted than nonpubescent (OR, 0.53; P < .05). Adolescents with low and medium SES were more underweight and stunted than adolescents with high SES. Girls were more overweight, less stunted, and underweight than boys.

  • 76.
    Dapi N., Léonie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Omoloko, Cécile
    Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
    Dahlgren, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Håglin, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    "I eat to be happy, to be strong, and to live": perceptions of rural and urban adolescents in Cameroon, Africa2007Inngår i: Journal of nutrition education and behavior, ISSN 1499-4046, E-ISSN 1878-2620, Vol. 39, nr 6, s. 320-326Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate factors influencing rural and urban adolescents’ food perceptions during a time of nutritional transition in Cameroon, Africa.

    Design: Qualitative in-depth interviews.

    Settings: Yaoundé urban and Bandja rural areas.

    Participants: Fifteen adolescents 12 to 15 years old purposely selected from schools in urban and rural areas.

    Analysis: Interviews were audiotaped, transcribed, and analyzed using Grounded Theory method.

    Findings: Factors influencing adolescents’ food perceptions from the rural area were “to live” “health” and “poverty.” Among adolescents from the urban poor area, “health,” “beauty,” and “not enough money” were factors. Among adolescents from the urban rich area, “pleasure” and “beauty” were factors. Rural girls liked “to be fat,” whereas girls from the urban poor wanted “to be a little bit fat,” and girls from the urban rich wanted “to be normal.”

    Conclusions and Implications: Food behavior is changing from a diet composed of traditional food in rural areas to a more westernized diet in urban areas. The relationship between socioeconomic factors and nutrition needs to be examined with a sufficiently large number of adolescents to investigate these factors in a quantitative survey. Healthful local food should be available at home and from vendors. Nutrition education about food and diet-related diseases is needed in school.

  • 77. Desai, Meghna
    et al.
    Buff, Ann M
    Khagayi, Sammy
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Amek, Nyaguara
    van Eijk, Annemieke
    Slutsker, Laurence
    Vulule, John
    Odhiambo, Frank O
    Phillips-Howard, Penelope A
    Lindblade, Kimberly A
    Laserson, Kayla F
    Hamel, Mary J
    Age-specific malaria mortality rates in the KEMRI/CDC health and demographic surveillance system in western Kenya, 2003-20102014Inngår i: PLOS ONE, E-ISSN 1932-6203, Vol. 9, nr 9, artikkel-id e106197Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Recent global malaria burden modeling efforts have produced significantly different estimates, particularly in adult malaria mortality. To measure malaria control progress, accurate malaria burden estimates across age groups are necessary. We determined age-specific malaria mortality rates in western Kenya to compare with recent global estimates. We collected data from 148,000 persons in a health and demographic surveillance system from 2003-2010. Standardized verbal autopsies were conducted for all deaths; probable cause of death was assigned using the InterVA-4 model. Annual malaria mortality rates per 1,000 person-years were generated by age group. Trends were analyzed using Poisson regression. From 2003-2010, in children <5 years the malaria mortality rate decreased from 13.2 to 3.7 per 1,000 person-years; the declines were greatest in the first three years of life. In children 5-14 years, the malaria mortality rate remained stable at 0.5 per 1,000 person-years. In persons ≥15 years, the malaria mortality rate decreased from 1.5 to 0.4 per 1,000 person-years. The malaria mortality rates in young children and persons aged ≥15 years decreased dramatically from 2003-2010 in western Kenya, but rates in older children have not declined. Sharp declines in some age groups likely reflect the national scale up of malaria control interventions and rapid expansion of HIV prevention services. These data highlight the importance of age-specific malaria mortality ascertainment and support current strategies to include all age groups in malaria control interventions.

    Fulltekst (pdf)
    Fulltext
  • 78.
    Deyessa Kabeta, Negussie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Berhane, Y
    Alem, Atalay
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Kullgren, Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Depression among women in rural Ethiopia as related to socioeconomic factors: a community-based study on women in reproductive age groups2008Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, nr 6, s. 589-597Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Several previous studies have reported on socioeconomic and sociodemographic factors associated with depression among women, but knowledge in this area remains scarce regarding women living in extreme poverty in developing countries.

    OBJECTIVE: The study was aimed at examining the 12-month prevalence of depressive episodes as related to socioeconomic and sociocultural conditions of women in the reproductive age group in rural Ethiopia.

    METHODS: A community-based cross-sectional study was undertaken among 3016 randomly selected women in the age group 15-49 years. Cases of depression were identified using the Amharic version of the Composite International Diagnostic Interview. A standardized World Health Organization questionnaire was used to measure the socioeconomic status of the women and their spouses. Data were analysed among all women and then separately among currently married women.

    RESULTS: The 12-month prevalence of depression among all women was 4.4%. After adjusting for common sociodemographic characteristics, only marital status showed a significant association with depressive episode in terms of higher odds ratios (ORs) for divorced/separated women and widowed women than for not-married women (4.05 and 4.24, respectively). Among currently married women, after adjusting for common sociodemographic characteristics, living in rural villages (OR=3.78), a frequent khat-chewing habit (OR=1.61), having a seasonal job (OR=2.94) and being relatively better off in terms of poverty (OR=0.48) were independently associated with depression.

    CONCLUSIONS: The prevalence of depression among women was in the lower range as compared to studies from high-income countries, but very poor economic conditions were associated with a higher prevalence of depression in this overall very poor setting. This further supports the notion that the relative level of poverty rather than the absolute level of poverty contributes to depression among women. Whether the association with khat chewing and depression is a causative effect or can be explained by self-medication remains unclear.

  • 79.
    Deyessa Kabeta, Negussie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Berhane, Yemane
    Alem, Atalay
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Ellsberg, Mary
    Emmelin, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Kullgren, Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Intimate partner violence and depression among women in rural Ethiopia: a cross-sectional study2009Inngår i: Clinical Practice and Epidemiology in Mental Health, E-ISSN 1745-0179, Vol. 5, nr 1, s. 8-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Studies from high-income countries have shown intimate partner violence to be associated with depression among women. The present paper examines whether this finding can be confirmed in a very different cultural setting in rural Ethiopia.

    METHOD: A community-based cross-sectional study was undertaken in Ethiopia among 1994 currently married women. Using the Composite International Diagnostic Interview (CIDI), cases of depressive episode were identified according to the ICD-10 diagnosis. Using a standardized questionnaire, women who experienced violence by an intimate partner were identified. A multivariate analysis was conducted between the explanatory variables and depressive status of the women, after adjusting for possible confounders.

    RESULTS: The 12-month prevalence of depressive episode among the women was 4.8% (95% CI, 3.9% and 5.8%), while the lifetime prevalence of physical intimate partner violence was 49.5%. Physical violence (OR=2.56, 95% CI, 1.61, 4.06), childhood sexual abuse (OR=2.00, 95% CI, 1.13, 3.56), mild emotional violence (OR=3.19, 95% CI, 1.98, 5.14), severe emotional violence (OR= 3.90, 95% CI, 2.20, 6.93) and high spousal control of women (OR=3.30, 95% CI, 1.58, 6.90) by their partners were independently associated with depressive episode, even after adjusting for socioeconomic factors.

    CONCLUSIONS: The high prevalence of intimate partner violence, a factor often obscured within general life event categories, requires attention as an independent factor for depression, and thus to find new possibilities of prevention and treatment in terms of public health strategies, interventions and service provision.

  • 80. Duffy, SW
    et al.
    Chen, THH
    Smith, RA
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Lenner, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Törnberg, S
    Frisell, J
    Holmberg, L
    Effect of mammographic service screening on stage at presentation of breast cancers in Sweden.2007Inngår i: Cancer, ISSN 0008-543X, Vol. 109, nr 11, s. 2205-2212Artikkel i tidsskrift (Fagfellevurdert)
  • 81. Duffy, SW
    et al.
    Tabar, L
    Chen, THH
    Smith, RA
    Holmberg, L
    Jonsson, Håkan
    Lenner, Per
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Törnberg, S
    Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with extended data.2006Inngår i: Cancer Epid Biomarkers & Prevention, Vol. 15, s. 45-51Artikkel i tidsskrift (Fagfellevurdert)
  • 82. Duffy, SW
    et al.
    Tabar, L
    Chen, THH
    Smith, RA
    Holmberg, L
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Lenner, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Törnberg, S
    Reduction in Breast Cancer Mortality from the Organised Service Screening with Mammography:: 2. Validation with Alternative Analytic Methods2006Inngår i: Cancer Epidemiology Biomarkers & Prevention, Vol. 15, s. 52-56Artikkel i tidsskrift (Fagfellevurdert)
  • 83.
    Edin, Kerstin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Mäns makt och vanmakt: Intervjuer med terapeuter som möter våldsbenägna män2004Inngår i: Nationellt seminarium om mansforskning: 11-12 mars 2003/2004, 2004, s. 25-73Konferansepaper (Annet vitenskapelig)
  • 84.
    Edin, Kerstin
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Violent men: ordinary and deviant. Discourses of professionals working with men inclined to violence.2007Inngår i: Present challenges in gender research, Umeå University, Umeå , 2007Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 85.
    Edin, Kerstin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Dahlgren, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Lalos, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    The pregnancy put the screws on: discourses of professionals working with men inclined to violence2009Inngår i: Men and Masculinities, ISSN 1097-184X, E-ISSN 1552-6828, Vol. 11, nr 3, s. 307-324Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Qualitative research interviews were conducted with professionals working with men inclined to violence. The aim was to explore professional discourses about intimate partner violence with special reference to gender and to the partner's period of pregnancy. Three major findings are presented. Firstly, the professionals had a rather fixed understanding of opposite gender positions as well as a split picture of the violent man as both weak and tough, thus violence may result from poor self-confidence combined with a desire for power and control and the fear of losing it. Secondly, the pregnancy was identified as a stressor that, together with other circumstances, could trigger violence. Thirdly, the topic of pregnancy and other relational topics were typically omitted from the conversations with men inclined to violence. This study discusses inconsistencies that might counteract the professionals' intentions of building an alternative masculinity in men inclined to violence.

  • 86.
    Edin, Kerstin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Dahlgren, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Lalos, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    "Keeping up a front": narratives about intimate partner violence, pregnancy, and antenatal care2010Inngår i: Violence against Women, ISSN 1077-8012, E-ISSN 1552-8448, Vol. 16, nr 2, s. 189-206Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Nine women who had been subjected to severe intimate partner violence during pregnancy narrated their ambiguous and contradictory feelings and the various balancing strategies they used to overcome their complex and difficult situations. Because allowing anyone to come close posed a threat, the women mostly denied the situation and kept up a front to hide the violence from others. Three women disclosed ongoing violence to the midwives, but only one said such disclosure was helpful. This article highlights the complexity of being pregnant when living with an abusive partner and challenges antenatal care policies from the perspective of pregnant women.

  • 87.
    Edin, Kerstin E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Perspectives on intimate partner violence, focusing on the period of pregnancy2006Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [sv]

    Målet med denna avhandling var att undersöka partnerrelaterat våld mot kvinnor i Sverige från olika perspektiv och med ett särskilt fokus på graviditetsperioden.

    Syftet var: 1) att ta reda på barnmorskors erfarenheter, attityder och rutiner angående partnerrelaterat våld mot gravida kvinnor inom mödravården; 2) att utforska hur personer som arbetar inom olika program för våldsbenägna män (inom och utom kriminalvården) talar om manligt och kvinnligt och om partnerrelaterat våld, speciellt i förhållande till graviditet; och 3) att belysa kvinnors erfarenheter av att bli och vara gravid samtidigt som de var utsatta för våld i relationen, samt deras möten med barnmorskorna på mödravårdscentralen.

    Data för tre studier samlades in under åren 1998-2003 med kvantitativa och kvalitativa metoder. En enkät skickades till alla yrkesverksamma mödravårdsbarnmorskor i Västerbotten och analyserades statistiskt och med innehållsanalys. Forskningsintervjuerna utfördes och analyserades enligt ’grundad teori’ (för att skapa teoretiska förklaringsmodeller), ’diskursanalys’ (för att visa hur ett gemensamt språkbruk konstruerar ’sanning’) och ’narrativ metod’ (för att tolka och återberätta innebörden i personliga berättelser).

    Resultaten från de studier som lade grunden till denna avhandling visar på problemets komplexitet, både från de professionellas och från kvinnornas perspektiv. Barnmorskorna (artikel I) var yrkeskunniga men också kunniga om partnerrelaterat våld mot kvinnor, men utan PM eller andra riktlinjer, så blev de osäkra och ställde sällan direkta frågor eftersom ämnet ansågs vara känsligt och tabubelagt. De professionella (artikel II-III) som arbetade med våldsbenägna män i olika program (inom eller utanför kriminalvården) krävde att män skulle ta ansvar för sitt våld. De ansåg att våldsamma män var tämligen vanliga män men avvikande i särskilda avseenden såsom i samspel, kommunikation, nära relationer och i deras kvinnosyn. De professionella beskrev stereotyper om könsskillnader och hur aggressivitet kan starta på olika sätt hos olika typer av män och ansåg också att graviditet kan utlösa konflikter och våld. Likväl så ingick i programmen vanligtvis inte känsliga frågor, om t.ex. graviditet och samlevnad, och trots en god vilja och avsikt att skapa en ’ny maskulinitet’, så tycktes deras strategier och tankegångar rent av kunna motverka deras egna goda syften. De nio intervjuade kvinnorna (artikel IV) som hade varit utsatta för våld beskrev hur deras liv hade varit komplicerade och blivit till en mardröm då deras hjärtevän hade förvandlats till en förövare. Två kvinnor bröt upp från sina relationer under graviditeten på grund av livshotande våld medan de andra för det mesta höll uppe en fasad och dolde det pågående våldet inför barnmorskan och andra alltmedan de gick balansgång mellan hopp och förtvivlan eller väntade på rätt tidpunkt att ge sig av.

    Förutom kvinnornas berättelser om partnerrelaterat våld under graviditet (artikel IV) så presenterades två professionella grupper och deras gemensamma svårigheter gällande tabun och känsliga frågor utanför det man vanligtvis sysslade med i sin profession (artikel I-III). Barnmorskorna var yrkeskunniga men hade ingen handlingsplan för att kunna bemöta och identifiera komplexiteten i våldsutsatta gravida kvinnors situation som ofta består i att dölja och balansera. De professionella i program för män konfronterade tydligt mäns våld och hade ambitionen att utmana deras maskulinitet, men då de i samtalen exempelvis förbisåg att ta upp vissa känsliga frågor kan utfallet ifrågasättas.

    Fulltekst (pdf)
    FULLTEXT01
  • 88.
    Edin, Kerstin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Violence against pregnant women will remain hidden as long as no direct questions are asked.2002Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 18, nr 4, s. 268-278Artikkel i tidsskrift (Fagfellevurdert)
  • 89.
    Edin, Kerstin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lalos, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Dahlgren, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Violent men: ordinary and deviant.2008Inngår i: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, Vol. 23, nr 2, s. 225-244Artikkel i tidsskrift (Fagfellevurdert)
  • 90. Edin-Liljegren, A
    et al.
    Hassler, Sven
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Sjölander, Per
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Daerga, L
    Risk factors for cardiovascular diseases among Swedish Sami: a controlled cohort study2004Inngår i: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 63, nr Suppl 2, s. 292-297Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate the occurrence of clinical, psychosocial and behavioural risk factors for cardiovascular diseases (CVD) among reindeer herding (RS) and non-reindeer herding Sami (NRS). STUDY DESIGN: A retrospective cohort study, comparing risk factors behind CVD between Sami and non-Sami, RS and NRS, and Sami men and women. METHODS: A cohort of 611 Swedish Sami (276 men and 335 women) was constructed from national population registers. A twice as large control cohort of non-Sami was created, matched by age, gender and area of residence. Information on risk factors was obtained from a database containing clinical and psychosocial-behavioural data from a regional CVD preventive programme for the period 1990-2001. RESULTS: The Sami and the non-Sami showed similar risk factor patterns. The main differences were related to working conditions and lifestyle factors of the RS. The RS men had lower blood pressure, were more physically active and had higher job demand and decision latitude. The RS women showed more negative scores on the indices of the job strain model. CONCLUSIONS: Previously reported differences in CVD mortality between Sami and non-Sami, and Sami men and women, can only partly be explained by different exposure to the psychosocial and behaviour risk factors investigated in this study.

  • 91.
    Edlund, Curt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Långtidssjukskrivna och deras medaktörer: en studie om sjukskrivning och rehabilitering2001Doktoravhandling, monografi (Annet vitenskapelig)
    Abstract [en]

    Aims: The starting point of this study was the experience of great problems with persons on long-term sick leave in the county of Västerbotten. In order to illuminate the situation we designed a study of the actors most involved who dealt with persons on long-term sick leave. These actors were the medical doctors; the employers: the social insurance officials; and members of the board of social insurance and persons reporting on the cases to the board. One aim was to describe and analyse the situation for persons on sick leave. Another aim was to describe and analyse the perception of the role the different actors played when dealing with persons on long-term sick leave. The third aim was to describe and analyse the different actors' views of each other, and of the co-operation around the persons on long-term sick leave.

    Method and material: Interviews with persons on sick leave, employers, social insurance officials and medical doctors. Questionnaires were sent to persons on sick leave, doctors and the members of the board of social insurance and those reporting on the cases. The interviews were audio- taped and transcribed word by word. Coding and analysis of collected data was done simultaneously by performing new interviews, using an adjusted form of grounded theory with the purpose of trying to find patterns and contexts. The aim was to describe the subjective experiences of how the actors look upon their situation and their way of coping with it.

    Results: The interviews with the employers showed great differences in attitudes and ways of treating employees, which also led to different models for dealing with work environment, sickness absence and rehabilitation. We divided the employers into five different "ideal types". Two of them could be described as "well-functioning" with regard to rehabilitation, and three of them as "less well-functioning". A high degree of flexibility characterises the successful employer, and he also takes good care of his personnel. The good employer also co-operates with other actors. The employers that are not well-functioning are not engaged in making adjustments, and have little confidence in their staff; the unions within their field are weak.

    Interviews with medical doctors revealed that they felt lonely, and that the demands were frustrating to them. They also had feelings of losing the locus of control. The doctors showed lack of knowledge of the labour market and the social insurance legislation, which made their work harder. They experienced that their lack of time made sickness periods longer.

    Among the results from the interviews with social insurance officials can be mentioned that they had good knowledge about laws, but sometimes it was difficult to use their knowledge and methods due to lack of flexibility. They experienced feelings of loneliness and had great difficulty in making decisions. Co-operation with partners often did not work out - the officials did not demand so much of their co-actors.

    The results of the questionnaire directed towards the members of the board of social insurance and those who reported on the cases did not show statistically significant differences between the three counties. The members of the board had almost the same proposals for decision as those who reported on the cases. There were no significant differences between men and women in decision-making. As a whole the members of the board seemed to be skilled in their knowledge of how to use the social insurance legislation.

    The results of the interviews with persons on sick leave showed that those persons had difficulties in asking for help and support. They felt such loyalty to their employers that they did not ask for adjustments of working places when needed. At the same time they were disappointed that the employers were not sufficiently involved in making it possible to come back to work again. More than half of the respondents had not received enough support from the employers, the medical doctors or the social insurance officials. Most of them felt frustrated, with little or no hope for the future.

    The results of the questionnaire to persons on long-term sick leave showed that women took a greater responsibility for their own rehabilitation, while the employers showed an earlier interest in sick male employees than in sick female employees. The employers were also keener to adjust the working places for men than for women. Despite those factors, women more often met their employers than men did, and they also had a more positive attitude to social insurance officials and doctors than men had. People with longer education took greater responsibility for their rehabilitation than those with shorter education. Compared to older people, younger persons were more optimistic about their future health and work, and also expressed that work was not so stressful.

    Fulltekst (pdf)
    Långtidssjukskrivna och deras medaktörer
  • 92.
    Edvardsson, Berit
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Stenberg, Berndt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Dermatologi och venereologi.
    Bergdahl, Jan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Eriksson, N
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Lindén, G
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Widman, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Medical and social prognoses of non-specific building-related symptoms (Sick Building Syndrome): a follow-up study of patients previously referred to hospital2008Inngår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 81, nr 7, s. 805-812Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives The aim of this study was to describe and analysethe medical and social prognoses of patients with nonspeciWcbuilding-related symptoms.Methods A follow-up questionnaire focusing on current medical and social status, care, treatment, other actions taken and personality traits was sent to 239 patients with non-speciWc building-related symptoms assessed during theperiod between1986 and 1998 at University Hospital in Umeå, Sweden. The response rate was 79%.Results Fatigue, irritation of the eyes, and facial erythemawere the most common weekly symptoms reported atfollow-up. As females constituted 92% of the respondents,statistical analyses were restricted to women. The level andseverity of symptoms decreased over time, although nearlyhalf of the patients claimed that symptoms were more or lessunchanged after 7 years or more, despite actions taken.Twenty-Wve percent of the patients were on the sick-list, and20% drew disability pension due to persistent symptoms atfollow-up. The risk of having no work capabilities at followupwas signiWcantly increased if the time from onset to Wrstvisit at the hospital clinic was more than 1 year. This riskwas also signiWcantly higher if the patient at the Wrst visithad Wve or more symptoms. All risk assessments wereadjusted for length of follow-up. Symptoms were oftenaggravated by diVerent situations in everyday life.Conclusions Long-lasting symptoms aggravated by environmentalfactors exist within this group of patients. Theresults support that early and comprehensive measures forrehabilitation are essential for the patients.

  • 93.
    Edvardsson, Kristina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Edvardsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Raising issues about children's overweight: maternal and child health nurses' experiences2009Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, nr 12, s. 2542-2551Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: This paper is a report of a study carried out to describe maternal and child health nurses' experiences of communicating and raising issues with parents about children's overweight. BACKGROUND: Children's overweight and obesity are rapidly increasing in many countries around the world. Maternal and child health nurses are in a unique position to influence parents, but studies of their experiences in communicating with parents about overweight are lacking. METHOD: Ten maternal and child health nurses in culturally diverse rural and urban areas in Melbourne, Australia, were interviewed in 2007. Data were analysed using qualitative content analysis to identify key categories. FINDINGS: During the analysis, eight categories were identified. In summary, nurses described it as difficult to raise weight issues, especially if parents were overweight themselves. The growth chart was felt to be an essential tool in discussions about weight and nurses often described themselves as holding 'expert' roles in conversations. Denial, defensiveness and excuses about children being overweight were common reactions among parents and were described as difficult to deal with. However, a strong nurse-parent relationship was experienced as facilitating conversations about weight. CONCLUSION: Raising issues about weight can be difficult, especially if parents are overweight themselves. Further research in communications is needed to understand and approach parents better--especially overweight parents--about their children's weight. Interventions involving patient-centred approaches in this context have potential, but the area is still relatively unexplored. Maternal and child health centres could be important contributors in such future interventions.

  • 94.
    Ekblom, Kim
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Hultdin, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Stegmayr, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Kariologi.
    Van Guelpen, Bethany
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Johansson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Wiklund, Per-Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Marklund, Stefan L
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Iron stores and HFE genotypes are not related to increased risk of ischemic stroke.: a prospective nested case-referent study2007Inngår i: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 24, nr 5, s. 405-411Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: High iron levels can increase the formation of noxious oxygen radicals, which are thought to contribute to cerebrovascular disease. The aim of this prospective study was to determine if iron status and HFE genotypes constitute risk factors for stroke.

    Methods: First-ever stroke cases (231 ischemic and 42 hemorrhagic) and matched double referents from the population-based Northern Sweden cohorts were studied in a nested case-referent setting.

    Results: For total iron binding capacity, an increased risk of ischemic stroke was seen in the highest quartile (OR 1.80; 95% CI 1.14-2.83; p for trend 0.012). The highest quartile of transferrin iron saturation showed a decreased risk of ischemic stroke in men (OR 0.44; 95% CI 0.22-0.87; p for trend 0.028), but not in women. There was an increased risk of hemorrhagic stroke in the second (OR 4.07; 95% CI 1.09-15.20) and third quartile (OR 4.22; 95% CI 1.08-16.42) of ferritin. Neither quartiles of plasma iron concentrations nor the HFE C282Y and H63D genotypes were associated with ischemic or hemorrhagic stroke.

    Conclusions: Iron stores were not positively related to increased risk of ischemic stroke. Furthermore, HFE genotypes did not influence the risk of ischemic or hemorrhagic stroke. Copyright (c) 2007 S. Karger AG, Basel.

  • 95.
    Eliasson, Mats
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Stegmayr, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Time trends in population cholesterol levels 1986-2004: influence of lipid-lowering drugs, obesity, smoking and educational level. The northern Sweden MONICA study.2006Inngår i: J Intern Med, ISSN 0954-6820, Vol. 260, nr 6, s. 551-9Artikkel i tidsskrift (Fagfellevurdert)
  • 96.
    Ellberg, Lotta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindh, Viveca
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    “We feel like one, they see us as two”: new parents' discontent with postnatal care2010Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, nr 4, s. 463-468Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective postnatal care has gone through remarkable changes, such as reducing the length of hospital stay and increasing the parents’ responsibility. Focusing on dissatisfaction, this study describes how new parents experience postpartum care.

    Design cross-sectional, population-based study, based on questionnaires.

    Participants 1474 parents.

    Measurements and findings the questionnaires, posted six months after childbirth, addressed how parents experienced postnatal care. The data were analysed with descriptive statistics and content analysis.

    Key conclusions a main finding was that the close emotional attachment between the parents was not always supported by staff. The father was treated as an outsider and the care was described as ‘a woman's world’. The asymmetric encounter between parents and staff was pronounced with respect to decision-making, and some designated this as ‘paternalism’. A great deal of the discontent with health care may be due to organisational failure, and the postnatal care should be more prioritised in the health-care organisation.

    Implications for practice midwives should acknowledge that parents, irrespective of gender, should have equal opportunities as parents during postpartum care as parenting is a joint project.

  • 97.
    Ellberg, Lotta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Källén, Karin
    Department of Reproductive Epidemiology, Tornblad Institute, Lund University, Lund, Sweden.
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lindh, Viveca
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Maternity care options influences readmission of newborns2008Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, nr 5, s. 579-583Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To analyse morbidity and mortality in healthy newborn infants in relation to various routines of post-natal follow-up. Design: cross-sectional study. Setting: maternity care in Sweden. Population: healthy infants born at term between 1999 and 2002 (n = 197 898).

    Methods: Assessment of post-natal follow-up routines after uncomplicated childbirth in 48 hospitals and data collected from the Swedish Medical Birth Register, Hospital Discharge Register and Cause-of-Death Register. Main outcome measure: neonatal mortality and readmission as proxy for morbidity.

    Results: During the first 28 days, 2.1% of the infants were readmitted generally because of infections, jaundice and feeding-related problems. Infants born in hospitals with a routine neonatal examination before 48 h and a home care programme had a readmission rate [OR, 1.3 (95% CI, 1.16–1.48)] higher than infants born in hospitals with routine neonatal examination after 48 h and 24-h care. There were 26 neonatal deaths.

    Conclusion: Post-delivery care options and routines influence neonatal morbidity as measured by hospital readmission rate. A final infant examination at 49–72 h and an active follow-up programme may reduce the risk of readmission.

  • 98.
    Ellsberg, Mary Carroll
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Department of Preventive Medicine, Nicaraguan Autonomous National University, León, Nicaragua.
    Candies in hell: research and action on domestic violence against women in Nicaragua2000Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The overall aim of the research was to explore the magnitude and characteristics of domestic violence against women in Leon, Nicaragua. A cross-sectional survey was carried out among a representative sample of 488 women between the ages of 15-49 years. In-depth interviews were performed with women who had experienced violence. Also, participatory techniques were used in 19 focus groups of men and women from diverse sectors of Nicaraguan society to gain an understanding of how Nicaraguans view social and legal sanctions for domestic violence.

    Among ever-married women (n=360) lifetime prevalence of physical violence was 52%, and current prevalence (during the last 12 months) was 27%. Seventy percent of the violence was classified as severe. No significant differences were found with regard to women's age, educational attainment, or occupation and the prevalence of partner abuse. Significant positive associations were found between the risk of wife abuse and poverty, number of children, history of violence in husband's family, husband's controlling behavior and lack of social networks. Abused women were six times more likely to present emotional distress than non-abused women. Emotional distress was more related to the severity of the abuse than to how long ago it had taken place. A significant positive association was found between wife abuse and problems among the children, including physical abuse. Nearly half of the abused women reported that their children had witnessed the violence. Both the qualitative as well as the quantitative data indicated that abused women frequently experience feelings of shame, isolation and entrapment, which in turn contribute to their difficulty in recognizing the violence and disengaging from the violent relationship. Women in Nicaragua used a variety of strategies to protect themselves from violence and most abused women eventually did leave abusive relationships. Temporary leaving and help seeking were critical steps in the process of overcoming violence. However, many women indicated that they did not receive support for their situation.

    The results of the prevalence survey were compared to findings from two other population-based studies carried out subsequently in Nicaragua. This comparison suggested that under-reporting is a significant threat to the validity of prevalence research on violence, and underscored the importance of incorporating specific measures to enhance disclosure into the research plan, such as providing more than one opportunity to disclose violence and using behaviorally specific language.

    Moreover, measures that have been primarily viewed from the perspective of ethics and safety, such as ensuring privacy and confidentiality and providing special training and support for interviewers, may have a significant impact on data quality, due to their effect on the disclosure of violence.

    The survey results and the narrative analysis suggest that domestic violence is a serious public health problem in Nicaragua. The focus group research found that opinions regarding domestic violence differed sharply between men and women, but that broad sectors of society felt that psychological violence was as serious as physical violence, and that new laws and programs were needed to punish violent offenders and to prevent future violence.

    The results of the research were discussed widely in Nicaragua, and contributed to the debate on the reform of the Nicaraguan Criminal Code with regard to sanctions for domestic violence and protection for victims of violence.

    Fulltekst (pdf)
    fulltext
  • 99.
    Emmelin, Anders
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Counted - and then?: trends in child mortality within an Ethiopian demographic surveillance site2009Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background

    Knowledge of the state of health of a population is necessary for planning for health services for that population. It is  a paradox that the health of populations is most commonly measured by mortality and cause of death patterns, but the absence of medical services available to a majority of the world population has made it unavoidable to equate “state of health” with “cause of death pattern”.

    In the absence of population registration, mortality and causes of death must be studied in samples from the population. The research presented in this thesis mainly has been done within such a sample in a collaborative project between Umeå university and the Addis Ababa university in Ethiopia. This research started 1986 and has run continuously since then. The thesis attempts to measure the effect that social and geographical inequalities has had on the mortality of the children in the study population.

    Population and Methods

    The population that is included in the demographic surveillance is the children under five years of age in nine rural and one urban community in central Ethiopia. Mortality and causes of death among the children have been followed since 1987.

    Results

    The mortality of the children in the study is high by international comparisons. The most important reason for mortality differences within the population is the difference in living conditions and societal services between the rural and urban areas. Approximately 45% of the child deaths could have been prevented if living conditions and services had been equal to rural and urban children.

    Conclusions

    Information concerning mortality and cause of death patterns are essential to planning. In order to empower the population, knowledge of the mortality and most common causes of death must be known to them.

    Fulltekst (pdf)
    FULLTEXT01
  • 100.
    Emmelin, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Fantahun, Mesganaw
    Berhane, Yemane
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Trends in under-five mortality in rural Ethiopia: 18 years of follow-up in the Butajira demographic surveillanceManuskript (Annet vitenskapelig)
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