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  • 1.
    Ahlgren, Roger
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Bergh, Kurt
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hauer, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Jonsson, Mona
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lindberg, Kerstin
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Nygren, Charlotte
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Reivell, Gun-Britt
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Rönnlund, Ulla
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Sandahl, Carla
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Dahlgren, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Kostvetenskaplig kompetens: belyst med kvalitativ metod1996Rapport (Övrigt vetenskapligt)
  • 2.
    Berggren, Linda
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Talvia, S.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Rönnlund, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för tillämpad utbildningsvetenskap.
    Waling, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    The lived experiences of school lunch: an empathy-based study with children in Sweden2019Ingår i: Children's Geographies, ISSN 1473-3285, E-ISSN 1473-3277Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    School lunch is in general regulated through policies and agendas constituted by the perspectives of adults. In this article, we focus on children’s lived experiences of school lunch with a special emphasis on emotions and how they relate to social and physical dimensions. This study draws on empathy-based stories written by 10–11 year olds (n = 171) from schools in Sweden. We identified three themes: Interaction and exposure, Routines and restrictions and Food and eating. The children’s lived experiences of school lunch and the emotions attached to them are closely associated and intertwined with the socio-spatial dimension of school lunch. A pleasant meal experience seems to require harmonization between the physical and social space whilst negative experiences contain tensions between them, something that actors working with school lunch and school lunch environments should take in consideration when resourcing, planning and scheduling school lunch, and also when designing new school restaurants.

  • 3.
    Berggren, Linda
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Talvia, Sanna
    Child and Youth Research institute, Turku, Finland,.
    Fossgard, Eldbjørg
    Faculty of Education, Bergen University College, Bergren, Norway,.
    Björk Arnfjörð, Unnur
    School of Education, University of Iceland.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ólafsdóttir, Anna
    School of Education, University of Iceland.
    Gunnarsdóttir, Ingibjörg
    The National University Hospital of Iceland , Unit for Nutrition Research, Reykjavik, Iceland.
    Wergedahl, Hege
    Faculty of Education, Bergen University College, Bergren, Norway,.
    Lagström, Hanna
    University of Turku, Turku Institute of Child and Youth Research, Turku, Finland.
    Waling, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Perspectives about health outcomes related to food among Nordic children2016Konferensbidrag (Refereegranskat)
    Abstract [en]

    Perspectives about health outcomes related to food among Nordic children

    Linda Berggren* 1, Sanna Talvia2, Eldbjørg Fossgard3, Unnur Björk Arnfjörð4, Agneta Hörnell 1, Anna Ólafsdóttir 4,Ingibjörg Gunnarsdóttir 5, Hege Wergedahl 3, Hanna Lagström 6, Maria Waling1, Cecilia Olsson1

    1Umeå University, Department of food and nutrition, Umeå, Sweden, 2Child and Youth Research institute, Turku, Finland,3Faculty of Education, Bergen University College, Bergren, Norway, 4School of Education, University of Iceland, 5TheNational University Hospital of Iceland , Unit for Nutrition Research, Reykjavik, Iceland, 6University of Turku, TurkuInstitute of Child and Youth Research, Turku, Finland

    Preferred presentation type: Only Poster

    Background and aims: Dietary intake in school has previously been studied but little is known about Nordic children’sperspectives on food healthiness in the school lunch context. This study aims to explore 10-year-old Nordic children’sperspectives on outcomes of healthy eating in the school lunch context.

    Methods: Seventy-two focus groups were conducted in Sweden, Finland, Norway and Iceland with a total of 423participants. A flexible topic guide and 14 preselected photos displaying different school lunch contexts were used asstimuli material. Interviews were transcribed and analyzed using thematic analysis.

    Results: Children reasoned that school lunch are and should be healthy since the food eaten at school has short andlong term outcomes related to cognitive and physical health. It was commonly expressed that food eaten in school affectsschool work and functioning in learning activities. It was also stated that food eaten in school can have negative andpositive effects on your mood, e.g. eating unhealthy food or an insufficient amount of food, puts you in a bad mood whichcan affect the rest of the school day. The discussions mainly relied on negative short term effects such as feeling ill andreduced stamina. Some food and food groups such as vegetables, milk and fish, were mentioned in a more positivesense highlighting the positive short- and long term outcomes on health. When describing the long-term outcomes ofeating, children mentioned that healthy eating helps to build muscles, grow and prevent diseases, such as cancer anddiabetes. Sugar and fat was frequently mentioned as being the cause of overweight and some other diseases.

    Conclusion: In general, Nordic children have an adequate understanding of established relations between food andhealth. Yet, we know that many pupils do not eat according to recommendations. This highlights the importance of takingthe complexity of food choice into consideration in nutritional education.

    Disclosure of Interest: None to declare

  • 4.
    Berggren, Linda
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Talvia, Sanna
    Fossgard, Eldbjørg
    Björk Arnfjörð, Unnur
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ólafsdóttir, Anna Sigríður
    Gunnarsdóttir, Ingibjörg
    Wergedahl, Hege
    Lagström, Hanna
    Waling, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Nordic children's conceptualizations of healthy eating in relation to school lunch2017Ingår i: Health Education, ISSN 0965-4283, E-ISSN 1758-714X, Vol. 117, nr 2, s. 130-147Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Pupils' perspective should be better taken into account when developing nutrition education at school. The purpose of this paper is to explore Nordic children's perspectives on the healthiness of meals in the context of school lunches.

    Design/methodology/approach: In total, 78 focus group discussions were conducted with 10-11-year-old girls and boys (n=457) from schools in Finland, Iceland, Norway and Sweden, which were participating in the Nordic school meal project ProMeal during the school year 2013-2014. A flexible discussion guide and stimulus material in the form of 14 photographs displaying different school lunch contexts were used. The discussions were analyzed using thematic analysis.

    Findings: These Nordic children seem to share the adult-set aim of healthy eating in the school context as a socio-cultural norm. Although healthy eating was constructed as a rational, normative and acceptable way to eat at school, unhealthy eating was emphasized as negotiably acceptable when eaten occasionally and under certain circumstances (e.g. at special occasions). Unhealthy eating also comprised emotionally laden descriptions such as enjoyment and disgust.

    Practical implications: Children's conceptualizations of healthy eating are connected to nutritional, socio-cultural, emotional and normative dimensions, which should be reflected also when developing nutrition education in school.

    Originality/value: The need for research exploring children's experiences of, and understandings about, school lunch motivated this unique multicenter study with a large number of participating children. In the focus groups a child-oriented, photo-elicitation method was used.

  • 5.
    Cecilia, Olsson
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Waling, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    School meals do not have a given place in Swedish school's quality management2016Ingår i: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 75, nr 8, s. 961-971Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Sweden is one of three countries worldwide which has a legal requirement to ensure that pupils in compulsory school should be offered free, nutritious school meals. Furthermore, the law states that school meal provision should be included in schools' internal quality management (IQM) system. The objective of this study was to examine to what extent schools in Sweden are following the legal requirement to include school meals in IQM and the relationship between this inclusion and the application of government advisory guidelines regarding school meals.

    Design: Cross-sectional study. Setting: Head teachers evenly distributed across all regions in Sweden representing municipality schools, independent schools and Sami schools. Method: Web-based questionnaire completed by 216 head teachers.

    Results: About half of the schools did not meet the legal requirement to include schools meals in the IQM. Furthermore, familiarity with and use of the National Food Agency (NFA) guidelines and the web-based tool School Food Sweden, as well as activities considered as part of a pedagogical school meal and the inclusion of school meals in interdisciplinary work, were reported to be less common in schools not including school meals in their IQM system.

    Conclusion: Findings suggest that when there is inclusion of school meals in a school's quality management system, the school is also more likely to include school meals as part of educational activities. By acknowledging school meal provision as part of the educational process, possibilities are opened up for health-promoting activities to prevent non-communicable disease.

  • 6. Husby, Steffen
    et al.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Celiac disease and risk management of gluten2014Ingår i: Risk management for food allergy / [ed] Madsen CB, Crevel RWR, Mills C, Taylor SL, Elsevier, 2014, s. 129-152Kapitel i bok, del av antologi (Övrigt vetenskapligt)
    Abstract [en]

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

  • 7.
    Hörnell, Agneta
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Waling, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Olafsdottir, Anna Sigridur
    School of Education, University of Iceland, Reykjavik, Iceland.
    Lagström, Hanna
    Turku Institute of Child and Youth Research, University of Turku, Turku, Finland.
    Wergedahl, Hege
    Faculty of Education, Bergen University College, Bergen, Norway,.
    Jonsson, Bert
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Fossgard, Eldbjörg
    Faculty of Education, Bergen University College, Bergen, Norway.
    Holthe, Asle
    Faculty of Education, Bergen University College, Bergen, Norway.
    Talvia, Sanna
    Turku Institute of Child and Youth Research, University of Turku, Turku, Finland.
    Gunnarsdottir, Ingibjörg
    Unit for Nutrition Research, Landspitali, The National University Hospital of Iceland, and Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
    School meals and health: the PROMEAL-study2016Ingår i: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 60, nr 1, artikel-id 31961Artikel i tidskrift (Refereegranskat)
  • 8.
    Jonsson, Bert
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Waling, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Olafsdottir, Anna S
    Lagström, Hanna
    Wergedahl, Hege
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Fossgard, Eldbjörg
    Holthe, Asle
    Talvia, Sanna
    Gunnarsdottir, Ingibjörg
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    The effect of schooling on basic cognition in selected Nordic Countries2017Ingår i: Europe's Journal of Psychology, ISSN 1841-0413, E-ISSN 1841-0413, Vol. 13, nr 4, s. 645-666Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The present study investigated schooling effects on cognition. Cognitive data were collected as part of a research project (ProMeal) that investigated school meals and measured the intake of school lunch in relation to children’s health, cognitive function, and classroom learning in four Nordic countries, among children between 10–11 years of age. It was found that Finnish pupils attending 4th grade were not, on any measure, outperformed by Norwegian and Icelandic pupils attending 5th and Swedish pupils attending 4th grade on a task measuring working memory capacity, processing speed, inhibition, and in a subsample on response- and attention control. Moreover, boys were found to perform superior to girls on tasks measuring processing speed. However, girls were found to perform better on tasks related to attention and self-control. The results are discussed in relation to the reciprocal association between cognition and schooling and whether these results reflect quality differences between schools in the four Nordic countries; most notably in comparison to Finland.

  • 9. Juniusdottir, Ragnheidur
    et al.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Gunnarsdottir, Ingibjorg
    Lagstrom, Hanna
    Waling, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Talvia, Sanna
    Olafsdottir, Anna S.
    Composition of school meals in Sweden, Finland and Iceland: Official guidelines and comparison with practice and availability2018Ingår i: Journal of School Health, ISSN 0022-4391, E-ISSN 1746-1561, Vol. 88, nr 10, s. 744-753Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Nutritious and attractive school meals can improve health equality and public health. Current official guidelines and recommendations on food and nutrient composition of school meals in 3 Nordic countries; Sweden, Finland, and Iceland, are described and compared with actual practice, ie, availability of foods and nutrients in served reference meals in 3 selected areas in each country.

    METHODS: A country comparison was made between official guidelines, and actual practice was studied in participating schools. Reference portions of school meals (N = 170) provided in 24 compulsory schools were photographed and weighed. Food and nutrient availability were compared with official guidelines in each country.

    RESULTS: Emphasis of recommendations on whole‐grain bread in Sweden, whole grains in Finland, and fish in Iceland were reflected in food availability. The energy content of the meals provided was lower than guidelines and there was a large variation in energy content between days.

    CONCLUSIONS: The guidelines regarding food availability were quite well followed, but the large variation in energy and nutrient content of provided school meals between days indicates a need for standardization.

  • 10.
    Kautto, Ethel
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Alex, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    An on-going gendered endeavour in silence: young women struggling with celiac diseaseManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Women with celiac disease are in the literature described as feeling exposed to negative emotions and experiences related to the treatment of celiac disease - the gluten-free diet. In order to explore the daily experiences of being diagnosed to celiac disease we interviewed seven Swedish young women diagnosed to celiac disease by screening in early adolescence. The semi structured interviews were analysed inductively by using content analysis. The analysis showed that the young women continued to strive with their treatment and their relations toward others, even years after diagnosis. The young women found themselves in an environment where their strict adherence to the dietary treatment was an obstacle and could prevent the feeling of connectedness. We argue that the emphasized/normative femininity that these young women relate to complicates their daily life diagnosed with celiac disease.

  • 11.
    Kautto, Ethel
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Aléx, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Living with celiac disease seen from a male perspectiveManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Men diagnosed with celiac disease are in earlier scientific studies known to be less troubled by their experiences of living with disease than women with celiac disease. Previous studies, concentrating on men with celiac disease have been mostly quantitative, and the studies has dealt with physiology and pathology. The aim of this study was to give voice to young men with screening-detected celiac disease and to highlight the situations that they encounter in their daily lives five years after the screening. Seven Swedish young men were interviewed. They had been diagnosed with celiac disease as 12-13 years-olds through a large Swedish school based celiac screening-study. The semi-structured interviews were analyzed from a gender perspective using content analysis. The findings resulted in a main theme, conquering the disease and becoming a man, which was underpinned by several themes and sub-themes. The analysis showed that the young men’s experiences of living with celiac disease in their daily life, largely depended on their use of characteristics known to be in accordance with dominating masculinity; such as being self-assured, demanding, and behaving authoritative. In food situations, when the young men had the ability to make use of such characteristics in their informal group, they experienced much less negative aspects of the disease. If the young men did not have a position in their informal group where they could develop those features, their situation was expressed as being tough, they were bullied and withdrew from social meals. It seemed important for the young men to dissociate themselves from being seen as a person who had a life-long chronic disease.

  • 12.
    Kautto, Ethel
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lyon, Phil
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Alex, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Living with celiac disease: norms of femininity and the complications of everyday life2017Ingår i: International Journal of Celiac Disease, ISSN 2334-3427, Vol. 5, nr 3, s. 115-124Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Women with celiac disease are often described as being exposed to negative emotions and experiences related to the treatment of celiac disease, the gluten-free diet. To explore the daily consequences of diagnosis and their daily experiences of living with celiac disease, interviews were conducted with seven Swedish young women who had been diagnosed with celiac disease by screening in early adolescence. The semi-structured interview transcripts were content analysed using a gender perspective. The analysis showed that these young women`s daily experiences were coloured by the conjunction of their dietary treatment, their social relationships, and social norms. This means that recurrent food situations often clash with the normative constructions of femininity and social norms of eating with an adverse effect on dietary compliance.

  • 13.
    Kautto, Ethel
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lyon, Phil
    School of Arts, Social Sciences and Management, Queen Margaret University, UK.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Alex, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Seeking a new normality: masculinity, interaction and a gluten free diet2016Ingår i: International Journal of Celiac Disease, ISSN 2334-3486, Vol. 4, nr 4, s. 138-145Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    From earlier studies, men diagnosed with celiac disease are known to be less troubled by their experiences of living with the disease than are diagnosed women. Previous studies, concentrating on men with celiac disease have been mostly quantitative, and have a bio-medical emphasis. The aim of this study was to explore the social experience of young men with screening-detected celiac disease and to highlight daily life situations five years after diagnosis. Seven young men, diagnosed with celiac disease when they were 13 years-olds through a large Swedish school-based celiac screening-study, were interviewed. The semi-structured interviews were analyzed from a gender perspective which resulted in three themes; being subjected to changes, striving for normality and emphasizing commitment. These were underpinned by several sub-themes. The young men dissociated themselves from being seen as a person with a life-long chronic disease. The analysis also showed that the young men’s daily experiences of living with celiac disease largely depended on their use of characteristics known to be associated with masculinity: such as being self-assured, demanding, and behaving authoritatively. In food situations, where the young men had the ability to make use of such characteristics in their informal group, they experienced fewer negative aspects of the disease. If the young men did not hold a strong position in their informal group, their situation was insecure and vulnerable and this could lead to avoidance of contacts and social meal situations.

  • 14.
    Kautto, Ethel
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Rydén, Petra
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Högberg, Lotta
    Carlsson, Annelie
    Hagfors, Linda
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    What happens to food choices when a gluten-free diet is required?: A prospective longitudinal population-based study among Swedish adolescent with coeliac disease and their peers2014Ingår i: Journal of Nutritional Science, ISSN 2048-6790, E-ISSN 2048-6790, Vol. 3, nr e2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A dietary survey was performed during a large screening study in Sweden among 13-year-old adolescents. The aim was to study how the intake of food groups was affected by a screening-detected diagnosis of celiac disease (CD) and its gluten-free (GF) treatment. Food intake, was reported using a food frequency questionnaires (FFQ) and intake reported by the adolescents who was screened to CD was compared with the intake of two same-aged referent groups: i) adolescents diagnosed to CD prior screening and ii) adolescents without CD.. The food intake groups were measured at baseline before the screening-detected cases were aware of their CD, and 12-18 months later.

    The result showed that the food intakes are affected by a screen detected CD and its dietary treatment. Many flour-based foods were reduced such as pizza, fish fingers, and pastries. The result also indicated that the bread intake was lower before the screened diagnosis compared to the other studied groups, but increased afterwards. Specially manufactured GF-products (e.g. pasta and bread) were frequently used in the screened CDgroup after changing to a GF-diet. Our results suggest that changing to a GF-diet reduces the intake of some popular foods, and the ingredients on the plate are altered, but this do not necessarily include a change of food groups. The availability of manufactured GF-replacement products makes it possible for adolescents to keep many of their old food habits when diagnosed with CD in Sweden.

  • 15.
    Ljung, Sofia
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Rask, Merith
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Patient Experiences of a Theory-Based Lifestyle-Focused Group Treatment in the Prevention of Cardiovascular Diseases and Type 2 Diabetes2013Ingår i: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 20, nr 3, s. 378-384Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Cardiovascular disease and type 2 diabetes are two of the most common public health diseases, and up to 80 % of the cases may be prevented by lifestyle modification. The physiological effects of lifestyle-focused treatment are relatively well studied, but how patients actually experience such treatments is still rather unclear.

    PURPOSE: The aim of this study was to explore how patients experience lifestyle-focused group treatment in primary and secondary prevention of cardiovascular disease and type 2 diabetes.

    METHOD: Qualitative interviews were conducted with 19 patients attending lifestyle-focused group treatment based on social cognitive theory at a behavioral medicine clinic in northern Sweden. The interviews were transcribed verbatim and analyzed according to Malterud's systematic text condensation.

    RESULTS: The study shows that patients participating in this kind of group-based lifestyle treatment went through a process of self-development which deepened their understanding of own responsibility for health and improved their skills in finding support in others. The process could be tracked through three different themes (the holistic view, personal responsibility, and group treatment) which together reflected the most essential parts of the informants' experience and showed the patient as an active decision maker struggling to adopt the principles of behavioral change.

    CONCLUSION: Lifestyle-focused group treatment, based on social cognitive theory, was shown to stimulate different components that strengthen patients' self-efficacy for long-term behavioral change.

  • 16.
    Mattsson Sydner, Ylva
    et al.
    Uppsala universitet.
    Andersson, Agneta
    Uppsala universitet.
    Nydahl, Margareta
    Uppsala universitet.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    En dietistutbildning i tiden: öppet brev till D2013Ingår i: Dietistaktuellt, ISSN 1102-9285, Vol. 22, nr 3, s. 30-31Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 17.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sandström, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. olof.sandstrom@pediatri.umu.se.
    Maternal and perinatal conditions and the risk of developing celiac disease during childhoodManuskript (preprint) (Övrigt vetenskapligt)
  • 18.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sandström, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. olof.sandstrom@pediatri.umu.se.
    Season and region as risk factors for celiac disease: a key to the etiology?Manuskript (preprint) (Övrigt vetenskapligt)
  • 19.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sandström, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Season and region of birth as risk factors for coeliac disease a key to the aetiology?2016Ingår i: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 101, nr 12, s. 1114-1118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Coeliac disease (CD) incidence has increased in recent decades, characterised by variations according to sex, age at diagnosis, year of birth, month of birth and region of birth. Genetic susceptibility and exposure to gluten are the necessary factors in CD aetiology, although several environmental factors are considered.

    METHODS: A nationwide prospective cohort longitudinal study was conducted consisting of 1 912 204 children aged 0-14.9 years born in Sweden from 1991 to 2009. A total of 6569 children were diagnosed with biopsy-verified CD from 47 paediatric departments. Using Cox regression, we examined the association between CD diagnosis and season of birth, region of birth and year of birth.

    RESULTS: Overall, CD risk was higher for children born during spring, summer and autumn as compared with children born during winter: adjusted HR for spring 1.08 (95% CI 1.01 to 1.16), summer 1.10 (95% CI 1.03 to 1.18) and autumn 1.10 (95% CI 1.02 to 1.18). Increased CD risk was highest if born in the south, followed by central Sweden when compared with children born in northern Sweden. Children diagnosed at <2 years had an increased CD risk if born in spring while those diagnosed at 2-14.9 years the risk was increased for summer and autumn births. The birth cohort of 1991-1996 had increased CD risk if born during spring, for the 1997-2002 birth cohort the risk increased for summer and autumn births, while for the birth cohort of 2003-2009 the risk was increased if born during autumn.

    CONCLUSIONS: Season of birth and region of birth are independently and jointly associated with increased risk of developing CD during the first 15 years of life. Seasonal variation in infectious load is the likely explanation.

  • 20.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Myléus, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Högberg, Ulf
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sandström, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Maternal and perinatal conditions and the risk of developing celiac disease during childhood.2016Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 16, artikel-id 77Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Celiac disease (CD) is increasing worldwide, which might be due to the changing environmental and lifestyle exposures. We aimed to explore how conditions related to maternity, delivery and the neonatal period influence CD onset during childhood.

    METHODS: Using Sweden's national registers we had access to information on 1 912 204 children born between 1991 and 2009, 6 596 of whom developed CD before 15 years of age. Logistic regression analyses were performed to determine how CD is associated with maternity, delivery and the neonatal period.

    RESULTS: Regardless of sex, a reduction in CD risk was observed in children born to mothers aged ≥35 years (odds ratio [OR] 0.8; 95 % confidence interval [CI] 0.7-0.9) and with high maternal income (OR 0.9; 95 % CI 0.8-0.9). Being a second-born child, however, was positively associated with CD. Among boys, elective caesarean delivery increased the risk of CD (OR 1.2; 95 % CI 1.0-1.4), while maternal overweight (OR 0.9; 95 % CI 0.8-0.9), premature rupture of the membrane (OR 0.4; 95 % CI 0.2-0.8) and low birth weight showed a negative association. Girls had an increased CD risk compared to boys and in girls the risk was increased by repeated maternal urinary tract infections (OR 1.1; 95 % CI 1.0-1.2).

    CONCLUSIONS: Elective caesarean delivery and repeated maternal urinary tract infections during pregnancy are associated with increased risk of CD onset during childhood, suggesting the role of dysbiosis during early life. High maternal age and high income reduced the risk of CD, which might be due to infant-feeding practices and life style.

  • 21.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sandström, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. olof.sandstrom@pediatri.umu.se.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Celiac disease risk varies between birth cohorts, generating hypotheses about causality: evidence from 36 years of population-based follow-up2014Ingår i: BMC Gastroenterology, ISSN 1471-230X, E-ISSN 1471-230X, Vol. 14, artikel-id 59Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Celiac disease (CD) is a major public health problem with estimated 1-3% prevalence in the general population. In recent years an increase in CD prevalence has been reported both in Sweden and worldwide. This study aimed at examining the annual incidence rate of biopsy-proven celiac disease among children in Sweden over a 36-year period, to assess variations by age, sex and birth cohort, and to assess the clinical impact of these changes.

    METHODS: The National Swedish Childhood CD Register was used to identify 9107 children aged 0-14.9 years who were diagnosed with CD during the period 1973 to 2009. From 1973 to 1990 the register covered 15% of the nation, this increased to 40% during 1991-1997; a full national coverage was obtained from 1998 onwards. Estimations for the annual incidence rate, cumulative incidence and clinical impact by age groups, calendar month and birth cohorts were made.

    RESULTS: CD incidence is continuing to increase in the child population aged 2-14.9 years. A continued variation in CD incidence was observed in children aged 0-1.9 years, characterized by a marked decrease in most recent years. The median age at diagnosis has increased from 1.0 year in the 1970s to 6.8 years in 2009. The average number of new cases has risen from ~200 during 1973-1983 to ~600 during 2004-2009. In the birth cohorts of 2000-2002 the cumulative incidence even exceeded that of the epidemic cohorts at comparable ages. The highest cumulative incidence was observed in the birth cohorts of 1985-1995 and 2000-2002.

    CONCLUSIONS: CD risk varies between birth cohorts, suggesting cyclic environmental and/or lifestyle risk factors in CD etiology. More research on underlying risk factors is required in order to move forward with preventive strategies.

  • 22.
    Namatovu, Fredinah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Strömgren, Magnus
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för geografi och ekonomisk historia.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindgren, Urban
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för geografi och ekonomisk historia.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sandström, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Neighborhood conditions and celiac disease risk among children in Sweden2014Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, nr 7, s. 572-580Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To investigate celiac disease (CD) clustering at different geographical levels and to examine the association between neighborhood demographic and socioeconomic conditions and the risk of neighborhood CD.

    Methods: We included 2080 children diagnosed with CD between 1998 and 2003, identified from 43 of the 47 reporting hospitals in Sweden. A total of 8036 small area market statistics (SAMS) areas were included; these were nested in 253 municipalities that were further nested into eight ‘nomenclature of territorial units for statistics’ (NUTS) 2 regions. We performed multilevel logistic regression analyses.

    Results: We found the highest geographical variation in CD incidence at the municipality level, compared to the region level. The probability of having CD increased in the statistical areas of (SAMS) areas with higher average annual work income, with an odds ratio (OR) of 2.24 and 95% CI of 1.76–2.85. Reduced CD risk in neighborhoods was associated with higher average age (OR 0.96; 95% CI 0.95–0.97), higher proportion of residents with a university education (OR 0.98; 95% CI 0.97–0.99), and higher level of industrial and commercial activity (OR 0.59; 95% CI 0.44–0.82). We found no significant association between CD risk and population density, proportion of Nordic to non-Nordic inhabitants, nor share of the population with only a compulsory education.

    Conclusions: Neighborhood composition influences CD risk. This is one of the first attempts to identify factors explaining geographical variation in CD.

  • 23.
    Nordyke, Katrina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    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 global hälsa.
    Epidemiological research drives a paradigm shift in complementary feeding: the celiac disease story and lessons learnt2010Ingår i: Drivers of Innovation in Pediatric Nutrition / [ed] Koletzko B,Koletzko S,Ruemmele F, S. Karger, 2010, s. 65-79Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Breast milk is the initial natural food for infants, but already during the second half year complementary feeding is essential. Epidemiological research, first on celiac disease and later on atopic diseases, has driven a paradigm shift with respect to most favorable age to introduce complementary feeding. Simplified, this implies a shift from later to earlier introduction, which is now taken into account in recommendations on infant feeding. Complementary feeding, including all foods, should not be initiated for any infant before 4 months of age, and not later than around 6 months, including infants with elevated disease risk (e.g. for celiac disease or atopic diseases). Motivating reasons could be that ongoing breastfeeding provides an 'immunological umbrella' and/ or a different age interval gives a 'window of opportunity' for developing oral tolerance towards gluten and other food antigens. This will for some infants be in conflict with recent WHO recommendations on exclusive breastfeeding for 6 months. Epidemiology has evolved over time and could, if increasingly used, contribute even more to innovations in pediatric nutrition and other phenomena related to population health.

  • 24.
    Nylander, Annica
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Kurs i taket: spelet som inspirerar till kvalitetssäkring av kurser2013Ingår i: Reformation, revolution, evolution: universitetslärandet ur ett tidsperspektiv / [ed] Erik Lindenius, Umeå: Umeå universitet , 2013, s. 91-93Konferensbidrag (Refereegranskat)
  • 25. Olafsdottir, Anna S.
    et al.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hedelin, Marlene
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Waling, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Gunnarsdottir, Ingibjorg
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Development and Validation of a Photographic Method to Use for Dietary Assessment in School Settings2016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 10, artikel-id e0163970Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To develop and validate a photographic method aimed at making assessment of dietary intake in school canteens non-obstrusive, practical and feasible. Methods The study was conducted in two elementary schools representing two different school canteen systems; main dish being served by canteen staff (Iceland), and complete self-serving (Sweden). Food items in serving and leftovers were weighed and photographed. Trained researchers estimated weights of food items by viewing the photographs and comparing them with pictures of half and full reference portions with known weights. Plates of servings and leftovers from 48 children during five school days (n = 448 plates) and a total of 5967 food items were estimated. The researchers' estimates were then compared with the true weight of the foods and the energy content calculated. Results Weighed and estimated amounts correlated across meals both in grams and as total energy (0.853-0.977, p<0.001). The agreement between estimated energy content in school meals was close to the true measurement from weighed records; on average 4-19 kcal below true values. Organisation of meal service impacted the efficacy of the method as seen in the difference between countries; with Iceland (served by canteen staff) having higher rate of acceptable estimates than Sweden (self-serving), being 95% vs 73% for total amount (g) in serving. Iceland more often had serving size between or above the half and full reference plates compared with Sweden. Conclusions The photographic method provides acceptable estimates of food and energy intake in school canteens. However, greater accuracy can be expected when foods are served by canteen staff compared with self-serving.

  • 26.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Celiac disease in Swedish children and adolescents: variations in incidence and essentials of gluten-free eating with a youth perspective2008Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background Sweden has experienced a unique epidemic of celiac disease (CD) in children younger than 2 years of age. The epidemic was partly explained by changes over time in infant feeding and indicated a multifactorial aetiology.

    In CD, a strict lifelong gluten-free diet (GFD) is crucial for health but noncompliance is often reported among adolescents. Knowledge is limited regarding their own perspectives and experiences of managing the disease and adhering to GFD.

    Objectives To analyse the incidence of CD in epidemic and post epidemic birth cohorts, and explore and understand how adolescents with CD perceive and manage their everyday lives in relation to the GFD.

    Methods A population-based incidence register of CD in children covering the entire nation from 1998 to 2003, and part of the country back to 1973. ESPGHAN diagnostic criteria for CD and NUTS classification of regions were used. Incidence rates for each year of diagnosis, age group, gender and region, and cumulative incidence by age for each birth cohort were calculated.

    Ten focus groups were conducted with 47 CD adolescents aged 15-18 years. Transcribed interviews were analysed to illustrate and explain adolescents’ own perspectives concerning life with a GFD, and to search for recurrent stigma-related themes across the groups.

    Results A considerable gap in the cumulative incidence of CD at comparable ages was demonstrated between birth cohorts of the epidemic and post-epidemic periods. The gap persisted during pre-school years, although it decreased somewhat with age. During the final years of follow-up there was again a gradual increase in incidence rate among children younger than 2 years of age. The childhood populations in ‘West Sweden’ and ‘Småland and the islands’ had a significantly higher incidence rate compared to ‘North Middle Sweden’ and ‘Stockholm’.

    CD adolescents described an awareness of being different from others produced by meal appearance and the poor availability of gluten-free (GF) food. Eating in public had the effect of making an invisible condition visible and thereby creating a context for felt or enacted stigma. Maintaining invisibility avoided the negative consequences of stigma. The probability of compliance with the GFD was compromised by insufficient knowledge of significant others, problems with the availability and sensory acceptance of GF food, insufficient social support and their perceived dietary deviance. Three different approaches to the GFD emerged: compliers, occasional non-compliers, and non-compliers.

    Conclusions The difference in CD risk between birth cohorts at comparable ages may suggest an opportunity for primary prevention. Based on post-epidemic incidence trends, the Swedish epidemic might not have been as unique as previously thought, even though its magnitude was striking. The regional variation in CD risk supports multifactorial aetiology. Continued efforts are warranted to define factors besides gluten exposure that modulate CD risk.

    CD adolescents experience various dilemmas related to the GFD. It can produce stigma experiences in adolescence, and dietary compliance (or lack of) can be understood in terms of dealing with GFD concealment and disclosure. The increase in CD prevalence over time and unmet needs in young celiacs require resources to attain adequate levels of dietetic provision, regulated subsidies for covering additional costs for GF food, evidence-based practice, and increased general CD awareness for optimum clinical outcomes.

  • 27.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Glutenfri kost - normbrytande att inte kunna äta allt2010Ingår i: Nordisk Nutrition, ISSN 1654-8337, nr 2, s. 31-32Artikel i tidskrift (Övrigt vetenskapligt)
  • 28.
    Olsson, Cecilia
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lönnberg, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Difference in celiac disease risk between Swedish birth cohorts suggests an opportunity for primary prevention2008Ingår i: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 122, nr 3, s. 528-34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Sweden experienced a unique epidemic of celiac disease in children <2 years of age. The epidemic was partly explained by changes in infant feeding over time and indicated a multifactorial pathogenesis. The main aim of this study was to analyze celiac disease risk in epidemic and postepidemic birth cohorts up to preschool age, to explore further the opportunity for primary prevention. METHODS: A population-based incidence register of celiac disease in children covering the entire nation from 1998 to 2003 and part of the country back to 1973 was analyzed. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria for celiac disease were used. The annual incidence rate for each age group and the cumulative incidence according to age for each birth cohort were calculated. RESULTS: A considerable difference in cumulative incidences of celiac disease at comparable ages was demonstrated between birth cohorts from the epidemic and postepidemic periods. The difference persisted during the preschool years, although it decreased somewhat with age. During the last years of the follow-up period, there was again a successive increase in incidence rate among children <2 years of age. CONCLUSIONS: The difference in celiac disease risk between birth cohorts at comparable ages suggests an opportunity for primary prevention. This highlights the importance of further exploring the role of infant feeding and exogenous factors besides dietary gluten that might initiate or prevent disease development. Moreover, on the basis of postepidemic incidence trends, we speculate that the Swedish epidemic might not have been as unique as thought previously, although its magnitude was striking.

  • 29.
    Olsson, Cecilia
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Teens with celiac disease and gluten-free eating2010Ingår i: Real life with celiac disease: Troubleshooting and thriving gluten free / [ed] Dennis, M. & Leffler, D.A., AGA Press , 2010, s. 213-216Kapitel i bok, del av antologi (Övrig (populärvetenskap, debatt, mm))
  • 30.
    Olsson, Cecilia
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    The importance of school meal systems on overall healthiness of the diet and learning in a Nordic context - the ProMeal project2013Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, nr 1, s. 73-73Artikel i tidskrift (Övrigt vetenskapligt)
  • 31.
    Olsson, Cecilia
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Sydner Mattsson, Ylva
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    The everyday life of adolescent coeliacs: issues of importance for compliance with the gluten-free diet2008Ingår i: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 21, nr 4, s. 359-367Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Noncompliance with the gluten-free diet is often reported among adolescents with coeliac disease. However, knowledge is limited regarding their own perspectives and experiences of managing the disease and the prescription of a gluten-free diet. The aim of this study was to explore how adolescents with coeliac disease perceive and manage their everyday lives in relation to a gluten-free diet. Methods in total, 47 adolescents with coeliac disease, divided into 10 focus groups, were interviewed. In the qualitative analysis, themes emerged to illustrate and explain the adolescents' own perspectives on life with a gluten-free diet. Results The probability of compliance with the gluten-free diet was comprised by insufficient knowledge of significant others, problems with the availability and sensory acceptance of gluten-free food, insufficient social support and their perceived dietary deviance. Three different approaches to the gluten-free diet emerged: compliers, occasional noncompliers, and noncompliers. Each approach, as a coping strategy, was rational in the sense that it represented the adolescents' differing views of everyday life with coeliac disease and a prescription of a gluten-free diet. Conclusions Adolescents with coeliac disease experience various dilemmas related to the gluten-free diet. The study demonstrated unmet needs and implies empowerment strategies for optimum clinical outcomes.

  • 32.
    Olsson, Cecilia
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lönnberg, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    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.
    The Swedish epidemic of celiac disease: a follow up2006Ingår i: The XIIth International Celiac Disease Symposium, 2006Konferensbidrag (Övrig (populärvetenskap, debatt, mm))
  • 33.
    Olsson, Cecilia
    et al.
    Umeå universitet, Samhällsvetenskaplig fakultet, Kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskaplig fakultet, Kostvetenskap.
    Sydner Mattsson, Ylva
    Umeå universitet, Samhällsvetenskaplig fakultet, Kostvetenskap.
    New food products and what they symbolise for students and teachers in the discipline of 'Food and Nutrition'2004Ingår i: 8th Nordic Nutrition Conference: Public Health Nutrition, 2004Konferensbidrag (Övrig (populärvetenskap, debatt, mm))
  • 34.
    Olsson, Cecilia
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lyon, Phil
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Mattsson Sydner, Ylva
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Food that makes you different: the stigma experienced by adolescents with celiac disease2009Ingår i: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, nr 7, s. 976-984Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    For adolescents with celiac disease (CD), a gluten-free diet(GFD) is crucial for health, but compliance is problematic andnoncompliance is common even among those aware of the risks.To better understand their lives with the disease, Swedish CDadolescents were invited to take part in focus group discussions.Data were analyzed for recurrent stigma-related themes acrossthe groups. Adolescents described an awareness of being differentfrom others that was produced by meal appearance and the pooravailability of gluten-free food. The GFD often required discussionsand special requests, so eating in public had the effect ofmaking an invisible condition visible, and thereby creatinga context for felt or enacted stigma. Maintaining invisibilityavoided negative consequences of stigma, and other strategieswere used to reduce the costs of visibility. The results ofthe study show that the GFD can produce stigma experiences inadolescence, and that dietary compliance (or lack thereof) canbe understood in terms of dealing with GFD concealment and disclosure.

  • 35.
    Olsson, Cecilia
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Mellberg, Sandra
    Waling, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Food and meals at residential care homes for unaccompanied children in Sweden: a pilot study2016Konferensbidrag (Refereegranskat)
  • 36.
    Olsson, Cecilia
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    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 global hälsa.
    Regional variation in celiac disease risk within Sweden revealed by the nationwide prospective incidence register.2009Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, nr 2, s. 337-342Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To determine if there is any regional celiac disease (CD) risk variation in the Swedish childhood population. METHODS: Prospective nationwide Swedish incidence register of CD in children 0-15 years of age, with the present analysis covering the period from 1998 to 2003. ESPGHAN diagnostic criteria for CD were used. Regions were classified according to the Nomenclature of Territorial Units for Statistics. The incidence rate for each region, gender, age group and year of diagnosis was calculated. RESULTS: A regional variation in CD risk was demonstrated. The childhood populations in 'West Sweden' and 'Småland and the islands', situated in the southern part of the country, had a significantly higher incidence rate compared to in 'North Middle Sweden' and 'Stockholm', situated in the central part. This regional variation was not explained by variations in risk by gender, age at diagnosis or year of diagnosis. CONCLUSION: The Swedish regional variation in CD risk supports multifactorial disease aetiology. Continued efforts are warranted to define factors, besides gluten exposure, that modulate CD risk.

  • 37.
    Ottosson, Sandra
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar. Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Laurell, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    The experience of food, eating and meals following radiotherapy for head and neck cancer: a qualitative study2013Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, nr 7-8, s. 1034-1043Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectives. To describe the experience of food, eating and meals following radiotherapy in patients with head and neck cancer.

    Background. Eating problems are common in patients with head and neck cancer and may remain for a long period of time after treatment.

    Design. A qualitative study design using in-depth semi-structured interviews.

    Methods. Interviews were conducted nine months after the termination of radiotherapy. A purposive sample of thirteen patients with head and neck cancer participated in the study. The interviews were tape-recorded, transcribed verbatim and analysed using content analysis.

    Results. The experience of food, eating and meals up to nine months after radiotherapy was captured in six categories: ‘Along journey – taking small steps to an uncertain future’, ‘A new way of eating’, ‘Eating without satisfaction’, ‘Challenging meals outside the family’, ‘Support and information – the key to a successful journey’ and ‘The creation and acceptance of a new normal’.

    Conclusion. This study provides new information on the long-term aspects of food, eating and meals in patients with head and neck cancer. Head and neck cancer signifies a long journey with problems affecting physical, psychological and social aspects of food. Information and support and the use of strategies are important for patients with head and neck cancer to adapt to new possibilities for living after cancer treatment. Relevance to clinical practice. All members of the multiprofessional team need to be aware of the struggles with food and eating experienced by patients with head and neck cancer during the convalescent period. It is therefore important that the follow-up focuses on all aspects of food, eating and meals as a part of a holistic approach.

  • 38.
    Rydén, Petra
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Kautto, Ethel
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Högberg, L
    Department of Clinical and Molecular Medicine, Linköping University.
    Carlsson, A
    Department of Pediatrics, Lund University.
    Hagfors, Linda
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    What happens with the healthiness of the diet among Swedish adolescent  boys and girls when a gluten-free diet is required?Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Objectives To explore how diagnosis of celiac disease (CD) in early adolescence affects overall food intake and healthiness of the diet in comparison with age- and sex matched controls and children with CD diagnosed in early childhood.

    Methods This is a longitudinal dietary sub-study of a school-based CD-screening of 12-year-olds (ETICS - Exploring the Iceberg of Coeliacs in Sweden), a part of the PreventCD project. The dietary study was conducted in 2005-2008 and included the following groups resulting from the screening: I) screening-detected CD cases (n=80), II) previously diagnosed CD cases (n=28), and III) two samples of age- and sex matched non-CD children (admission, n=619; follow-up, n=447). All CD cases completed two food-frequency-and-amount-questionnaires (FFQ), covering the previous four weeks; one at admission and one at a follow-up 18-24 months later. The screening-detected CD cases completed the first FFQ before a gluten free diet was initiated. The non-CD children consisted of a cross-sectional sample at each time point, and thus only completed one FFQ each (i.e. either at admission or follow-up). The Goldberg cut-off method was used to validate reported energy intake. The food choices at admission and follow-up were compared among the three groups, and the healthiness of the diet evaluated using two Swedish dietary indexes.

    Results and Conclusion Intakes of most food groups were similar at baseline. The adolescents diagnosed with CD did only minor changes in their overall food choices. Visible changes were reductions within food groups where gluten-free alternatives are not readily available, such as pastries and pizza. In contrast, total intake of bread and pasta did not change. All three groups scored fairly low on the dietary indexes at both time points, and there is an obvious need to improve the healthiness of the adolescent diet, whether CD is present or not.

  • 39. Talvia, Sanna
    et al.
    Lagstrom, Hanna
    Laurinen, Maarit
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Waling, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Gunnarsdottir, Ingibjorg
    Wergedahl, Hege
    Olafsdottir, Anna Sigriour
    Assessing School Meals intake by Digital Photograph Method in the Nordic Contexts (the Promeal study)2015Ingår i: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 67, s. 258-258Artikel i tidskrift (Övrigt vetenskapligt)
  • 40.
    Waling, Maria
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Olafsdottir, Anna S
    School of Education, University of Iceland, Reykjavik, Iceland .
    Lagström, Hanna
    Turku Institute of Child and Youth Research, 20014 University of Turku, Finland.
    Wergedahl, Hege
    Faculty of Education, Bergen University College, Norway.
    Jonsson, Bert
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Fossgard, Eldbjørg
    Faculty of Education, Bergen University College, Norway.
    Holthe, Asle
    Faculty of Education, Bergen University College, Norway.
    Talvia, Sanna
    Turku Institute of Child and Youth Research, 20014 University of Turku, Finland.
    Gunnarsdottir, Ingibjorg
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    School meal provision, health and cognitive function in a Nordic setting – the ProMeal-study: description of methodology and the Nordic context2016Ingår i: Food and Nutrition Research, ISSN 1654-661X, Vol. 60, artikel-id 30468Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: School meals, if both nutritious and attractive, provide a unique opportunity to improve health equality and public health.

    Objective: To describe the study rationale, data collection, and background of participants in the study 'Prospects for promoting health and performance by school meals in Nordic countries' (ProMeal). The general aim was to determine whether overall healthiness of the diet and learning conditions in children can be improved by school lunches, and to capture the main concerns regarding school lunches among children in a Nordic context.

    Design: A cross-sectional, multidisciplinary study was performed in Finland, Iceland, Norway, and Sweden on pupils (n=837) born in 2003.

    Results: In total 3,928 pictures of school lunches were taken to capture pupils' school lunch intake. A mean of 85% of all parents responded to a questionnaire about socioeconomic background, dietary intake, and habitual physical activity at home. Cognitive function was measured on one occasion on 93% of the pupils during optimal conditions with a Stroop and a Child Operation Span test. A mean of 169 pupils also did an Integrated Visual and Auditory Continuous Performance Test after lunch over 3 days. In total, 37,413 10-sec observations of classroom learning behavior were performed. In addition, 753 empathy-based stories were written and 78 focus groups were conducted. The pupils had high socioeconomic status.

    Conclusions: This study will give new insights into which future interventions are needed to improve pupils' school lunch intake and learning. The study will provide valuable information for policy making, not least in countries where the history of school meals is shorter than in some of the Nordic countries.

  • 41.
    Waling, Maria
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    School lunch as a break or an educational activity: a quantitative study of Swedish teacher perspectives2017Ingår i: Health Education, ISSN 0965-4283, E-ISSN 1758-714X, Vol. 117, nr 6, s. 540-550Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose – The purpose of this paper is twofold: first, to explore to what extent teachers eat together withpupils during school lunches and their attitudes toward using these lunches to reach the educational goalsstated in the Swedish compulsory school curriculum; and second, to study to what degree teachers seethemselves and school meal personnel as role models during school lunches.Design/methodology/approach – A questionnaire was completed by 3,629 teachers in Swedish schools.Findings – In total, 90 percent of the teachers ate lunch together with the pupils one or more days per week.The majority reported that meals were fully (54 percent), or partially (40 percent) subsidized when they wereeating with pupils. In total, 72 percent thought that school lunches should be considered part of the school’seducational activities while 28 percent thought that it should be a time to get a break from educationalactivities. Most teachers thought that school lunches could be useful for learning about the issues of foodwaste and healthy eating while there were more diverse views on using lunches for learningabout fundamental values. A majority of the teachers considered themselves to be role models in theschool meal situation.Practical implications – The authors suggest that the educational component of the schoolmeal per se shouldbe regulated in the Educational Act together with guidelines from the Swedish National Agency for Education.Originality/value – This study is unique since it covers a previously little studied area; teachers’ attitudestoward using the school lunch situation for educational purposes.

  • 42.
    Öhlund, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Öhlund, Inger
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Dietary shortcomings in children on a gluten-free diet2010Ingår i: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 23, nr 3, s. 294-300Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Coeliac disease (CD), or permanent gluten intolerance, is one of the most common chronic food-related diseases among children in Europe and the USA. The treatment is lifelong gluten-free diet (GFD) (i.e. the exclusion of wheat, rye and barley from the diet, which are important sources particularly of iron, dietary fibre and vitamin B). The present study aimed to evaluate dietary intakes of energy and nutrients in children and adolescents on GFD and compare these with intake of comparable age groups on a normal diet as well as current recommendations.

    Methods: Thirty children, 4-17 years of age with confirmed CD and on GFD were agreed to participate in this study at the Department of Pediatrics, Umeå University Hospital. Weight and height were used to calculate individual energy requirement according to Nordic Nutrition Recommendations 2004 (NNR-04). Dietary intake was assessed using 5-day food records and household measures were used for quantities. Twenty-five children completed their dietary record.

    Results: Thirteen of the 25 children did not meet the recommended energy intake and the dietary intakes were inadequate regarding quality of macronutrients and quantity of minerals and vitamins. The mean intakes of sucrose and saturated fatty acids were above and the intakes of dietary fibre, vitamin D, magnesium and selenium below the NNR-04. High intakes of sucrose and saturated fat and a low intake of dietary fibre were also noted in a previous national survey on healthy children on a normal diet. The nutrient density of vitamin D, riboflavin, niacin, thiamine, magnesium and selenium were lower among CD children than healthy children but, for iron and calcium, it was higher in CD children.

    Conclusions: Children on GFD appear to follow the same trends as healthy children on a normal diet, with high intakes of saturated fat and sucrose and low intakes of dietary fibre, vitamin D and magnesium compared to recommendations.

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