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Vogt T, Lindkvist M, Ivarsson A, Silfverdal SA, Vaezghasemi M. Temporal trends and educational inequalities in obesity, overweight and underweight in pre-pregnant women and their male partners: a decade (2010-2019) with no progress in Sweden. Eur J Public Health 2024:ckae052. [PMID: 38507547 DOI: 10.1093/eurpub/ckae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Trends in overweight and obesity among expectant parents can provide useful information about the family environment in which children will grow up and about possible social inequalities that may be passed on to them. Therefore, we aimed to assess whether the prevalence of underweight, overweight and obesity changed over time in pre-pregnant women and their male partners in northern Sweden, and if there were any educational inequalities. METHODS This study is based on cross-sectional data from a repeated survey of the population in Västerbotten, Sweden. The study population included 18,568 pregnant women and 18,110 male partners during the period 2010-2019. Multinomial logistic regression models were fitted separately for pregnant women and male partners to assess whether the prevalence of age-adjusted underweight, normal weight, overweight and obesity had evolved between 2010 and 2019, and whether trends differed by educational level. RESULTS Among women, obesity prevalence increased from 9.4% in 2010 to 11.7% in 2019. Among men, it went from 8.9 to 12.8%. Educational inequalities were sustained across the study period. In 2019, the prevalence of obesity was 7.8 percentage points (pp) (CI = 4.4-11.3) higher among women with low compared to high education. The corresponding figure for men was 6.4 pp (CI = 3.3-9.6). CONCLUSIONS It is not obvious that the prevalence of obesity among parents-to-be will decrease under current dispositions. Public health policies and practice should therefore be strengthened.
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Affiliation(s)
- Thomas Vogt
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Masoud Vaezghasemi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Vaezghasemi M, Pulkki-Brännström AM, Lindkvist M, Silfverdal SA, Lohr W, Ivarsson A. Social inequalities in social-emotional problems among preschool children: a population-based study in Sweden. Glob Health Action 2023; 16:2147294. [PMID: 36722260 PMCID: PMC9897742 DOI: 10.1080/16549716.2022.2147294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Social-emotional ability is important for overall health and wellbeing in early childhood. Recognizing preschool children in need of extra support, especially those living in unfavourable conditions, can have immediate positive effects on their health and benefit their wellbeing in the long-term. OBJECTIVES The aim of this study is to investigate whether there are social inequalities in preschool children's social-emotional problems, and whether inequalities differ between boys and girls. METHOD This study utilized repeated measures from cross-sectional population-based surveys of three-year old children (2014-2018). The final study population comprised of 9,099 children which was 61% of all the eligible children in Västerbotten County during the study period. The Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) 36-month interval was used to measure children's social-emotional ability. Social inequalities were studied with respect to parents' income, education, and place of birth, for which data was obtained from Statistics Sweden. Multiple logistic and ordered regressions were used. RESULTS Among 3-year-olds, social-emotional problems were more common in the most vulnerable social groups, i.e. parents in the lowest income quintile (OR: 1.45, p < 0.001), parents with education not more than high school (OR: 1.51, p < 0.001), and both parents born outside Sweden (OR: 2.54, p < 0.001). Notably, there was a larger difference in social-emotional problems between the lowest and highest social categories for girls compared to boys. Higher odds of social-emotional problems were associated with boys not living with both parents and girls living in the areas of Skellefteå and Umeå, i.e. more populated geographical areas. CONCLUSION Already at 3-years of age social-emotional problems were more common in children with parents in the most vulnerable social groups. This does not fulfil the ambition of an equitable start in life for every child and might contribute to reproduction of social inequalities across generations.
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Affiliation(s)
- Masoud Vaezghasemi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden,CONTACT Masoud Vaezghasemi Department of Epidemiology and Global Health, Umeå University, Umeå, SE-901 87, Sweden
| | | | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Wolfgang Lohr
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Lwin MW, Timby E, Ivarsson A, Eurenius E, Vaezghasemi M, Silfverdal SA, Lindkvist M. Abnormal birth weights for gestational age in relation to maternal characteristics in Sweden: a five year cross-sectional study. BMC Public Health 2023; 23:976. [PMID: 37237290 DOI: 10.1186/s12889-023-15829-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Abnormal birth weight - small for gestational age (SGA) and large for gestational age (LGA) - are important indicators for newborn health. Due to changes in lifestyle in recent decades, it is essential to keep up-to-date with the latest information on maternal factors linked to abnormal birth weight. The aim of this study is to investigate SGA and LGA in relation to maternal individual, lifestyle and socioeconomic characteristics. . METHODS This is a register-based cross-sectional study. Self-reported data from Sweden's Salut Programme maternal questionnaires (2010-2014) were linked with records in the Swedish Medical Birth Register (MBR). The analytical sample comprised 5089 singleton live births. A Swedish standard method using ultrasound-based sex-specific reference curves defines the abnormality of birth weight in MBR. Univariable and multivariable logistic regressions were used to examine crude and adjusted associations between abnormal birth weights and maternal individual, lifestyle and socioeconomic characteristics. A sensitivity analysis, using alternative definitions of SGA and LGA under the percentile method, was undertaken. RESULTS In multivariable logistic regression, maternal age and parity were associated with LGA (aOR = 1.05, CI = 1.00, 1.09) and (aOR = 1.31, CI = 1.09, 1.58). Maternal overweight and obesity were strongly associated with LGA (aOR = 2.28, CI = 1.47, 3.54) and (aOR = 4.55, CI = 2.85, 7.26), respectively. As parity increased, the odds of delivering SGA babies decreased (aOR = 0.59, CI = 0.42, 0.81) and preterm deliveries were associated with SGA (aOR = 9.46, CI = 5.67, 15.79). The well-known maternal determinants of abnormal birthweight, such as unhealthy lifestyles and poor socioeconomic factors, were not statistically significant in this Swedish setting. CONCLUSIONS The main findings suggest that multiparity, maternal pre-pregnancy overweight and obesity are strong determinants for LGA babies. Public health interventions should address modifiable risk factors, especially maternal overweight and obesity. These findings suggest that overweight and obesity is an emerging public health threat for newborn health. This might also result in the intergenerational transfer of overweight and obesity. These are important messages for public health policy and decision making.
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Affiliation(s)
- Min Wai Lwin
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Erika Timby
- Department of Clinical Science, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Eva Eurenius
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Masoud Vaezghasemi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
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Sampaio F, Häggström J, Ssegonja R, Eurenius E, Ivarsson A, Pulkki-Brännström AM, Feldman I. Health and economic outcomes of a universal early intervention for parents and children from birth to age five: evaluation of the Salut Programme using a natural experiment. Cost Eff Resour Alloc 2023; 21:29. [PMID: 37143113 PMCID: PMC10158322 DOI: 10.1186/s12962-023-00439-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/15/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the health and economic outcomes of a universal early intervention for parents and children, the Salut Programme, from birth to when the child completed five years of age. METHODS This study adopted a retrospective observational design using routinely collected linked register data with respect to both exposures and outcomes from Västerbotten county, in northern Sweden. Making use of a natural experiment, areas that received care-as-usual (non-Salut area) were compared to areas where the Programme was implemented after 2006 (Salut area) in terms of: (i) health outcomes, healthcare resource use and costs around pregnancy, delivery and birth, and (ii) healthcare resource use and related costs, as well as costs of care of sick child. We estimated total cumulative costs related to inpatient and specialised outpatient care for mothers and children, and financial benefits paid to mothers to stay home from work to care for a sick child. Two analyses were conducted: a matched difference-in difference analysis using the total sample and an analysis including a longitudinal subsample. RESULTS The longitudinal analysis on mothers who gave birth in both pre- and post-measure periods showed that mothers exposed to the Programme had on average 6% (95% CI 3-9%) more full-term pregnancies and 2% (95% CI 0.03-3%) more babies with a birth weight ≥ 2500 g, compared to mothers who had care-as-usual. Savings were incurred in terms of outpatient care costs for children of mothers in the Salut area ($826). The difference-in-difference analysis using the total sample did not result in any significant differences in health outcomes or cumulative resource use over time. CONCLUSIONS The Salut Programme achieved health gains, as a health promotion early intervention for children and parents, in terms of more full-term pregnancies and more babies with a birth weight ≥ 2500 g, at reasonable cost, and may lead to lower usage of outpatient care. Other indicators point towards positive effects, but the small sample size may have led to underestimation of true differences.
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Affiliation(s)
- Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, Uppsala, 751 22, Sweden.
| | - Jenny Häggström
- Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden
| | - Richard Ssegonja
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, Uppsala, 751 22, Sweden
- Department of Medical Sciences, Respiratory-, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
| | - Eva Eurenius
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, Uppsala, 751 22, Sweden
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Cappelen H, Ivarsson A, Jormfeldt H. The Effects of an Equine-Assisted Therapeutic Intervention on Well-Being in Persons Diagnosed with Schizophrenia. A Pilot Study. Issues Ment Health Nurs 2023; 44:104-111. [PMID: 36649626 DOI: 10.1080/01612840.2022.2158408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The process of personal recovery among persons diagnosed with schizophrenia may be facilitated through innovative health promotion interventions targeting multidimensional aspects of subjective well-being. The current pilot study aims to test the use of self-rated questionnaires as a means of evaluation of the effects of an equine-assisted intervention for persons diagnosed with schizophrenia. Twenty adults diagnosed with schizophrenia were offered a 12-week EAT intervention performed six times once every 14 days by a licensed mental health nurse. Two validated self-rated questionnaires, HSCL-25 and SHIS were used as outcome measurements at baseline and at post-treatment, additionally the self-rated questionnaire PANAS was completed twice a week starting 1 week before the 12 week-EAT intervention. Only six of the 20 participants managed to complete the validated questionnaires. Despite the low response rate of approximately 30%, a significant difference was found between pre and post scores for positive affect and well-being. Effect sizes, ranging from small to large for pre-to-post treatment scores indicated less depression and anxiety, more positive affect, less negative affect, and reinforced well-being. Results suggest that EAT interventions may have beneficial effects among persons diagnosed with schizophrenia and that a varied range of research methods are needed to create a solid evidence base for EAT interventions intended for the target group.
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Affiliation(s)
- H Cappelen
- Institute of Psychology Universiteit Leiden, Leiden, The Netherlands
| | - A Ivarsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - H Jormfeldt
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Vaezghasemi M, Vogt T, Lindkvist M, Pulkki-Brännström AM, Richter Sundberg L, Lundahl L, Silfverdal SA, Feldman I, Ivarsson A. Multifaceted determinants of social-emotional problems in preschool children in Sweden: An ecological systems theory approach. SSM Popul Health 2023; 21:101345. [PMID: 36785550 PMCID: PMC9918800 DOI: 10.1016/j.ssmph.2023.101345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/03/2023] [Accepted: 01/20/2023] [Indexed: 01/23/2023] Open
Abstract
Social-emotional problems occurring early in life can place children at future risk of adverse health, social and economic outcomes. Determinants of social-emotional problems are multi-layered and originate from different contexts surrounding children, though few studies consider them simultaneously. We adopted a holistic approach by using Bronfenbrenner's process-person-context-time model as a structuring device. We aimed to assess what characteristics of families and children from pregnancy, over birth, and up to 3 years of age are associated with social-emotional problems in boys and girls. This study used regional data from the Salut Programme, a universal health promotion programme implemented in Antenatal and Child Health Care, and data from national Swedish registers. The study population included 6033 3-year-olds and their parents during the period 2010-2018. Distinct logistic regression models for boys and girls were used to assess associations between the family social context, parents' lifestyle, parent's mental health, children's birth characteristics, and indicators of proximal processes (the independent variables); and children's social-emotional problems as measured by the parent-completed Ages and Stages Questionnaire: Social-Emotional between 33 and 41 months of age (the outcome). Overall, a less favourable family social context, detrimental lifestyle of the parents during pregnancy, and parents' mental illness from pregnancy onwards were associated with higher odds of social-emotional problems in 3-year-olds. Higher screentime and infrequent shared book-reading were associated with higher odds of social-emotional problems. The multifaceted determinants of children's social-emotional problems imply that many diverse targets for intervention exist. Additionally, this study suggests that Bronfenbrenner's process-person-context-time theoretical framework could be relevant for public health research and policy.
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Affiliation(s)
- Masoud Vaezghasemi
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden,Corresponding author. Norrlands universitetssjukhus Epidemiologi och Global Hälsa, Umeå University, B, Målpunkt P, Försörjningsvägen 7 B, 90185, Umeå, Sweden.
| | - Thomas Vogt
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| | | | | | - Lisbeth Lundahl
- Department of Applied Educational Science, Umeå University, 901 87, Umeå, Sweden
| | - Sven-Arne Silfverdal
- Department of Clinical Science, Pediatrics, Umeå University, 901 87, Umeå, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, 751 22, Uppsala, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
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Takeuchi H, Lee SH, Ivarsson A. Towards optimising children's capability and tackling relative child poverty in high-income countries: the cases of Japan, Sweden and the UK since 2000. Glob Health Action 2022; 15:2084230. [PMID: 35848789 PMCID: PMC9297718 DOI: 10.1080/16549716.2022.2084230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background We question why child poverty still prevails even in high-income countries, such as Japan, Sweden and the United Kingdom. We address the intersection between social relations and individual experiences that should be considered when optimising children’s capability. Objectives The study is therefore aimed at exploring compensatory societal actions taken to optimise children’s capability among these affluent countries. In order to do so, we operationalised children’s capability by including key societal domains along with statistical indicators and variables from relevant sources. Methods A secondary quantitative method was adopted by drawing upon data sources from 2000 up to almost 2020 from the Organisation for Economic Co-operation and Development, the World Bank and the United Nations Children’s Fund, with these being complemented by governmental data. Given a lack of currently available and comparable data for those three countries, four key societal domains were explored in an absolute descriptive analysis. Results It is obvious that child poverty prevailed over the focal 20 years in these three high-income countries. Also, the exploratory data analysis revealed a lack of sufficient supporting social services in each societal domain. This demonstrates that optimising children’s capability should not just be about subsidising economic resources, but also supporting all initiatives aimed at addressing the lack of interactions between each domain of children’s capability. Conclusions The study shows how essential it is to consider societal compensatory measures along with supporting the financial circumstances. We therefore argue that optimising children’s capability should not only be about subsidising economic resources, but also ensuring adequate social resources and relations.
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Affiliation(s)
- Hajime Takeuchi
- School of Social Welfare, Bukkyo University, Kyoto, Japan.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Sung-Hee Lee
- Department of Social Sciences, University of Derby, Derby, UK
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Johansson K, Norström F, Green PHR, Ivarsson A, Richter Sundberg L, Själander A, Myleus A. Celiac disease and upper secondary school achievement in Sweden A retrospective cohort study. BMC Pediatr 2022; 22:709. [PMID: 36503420 PMCID: PMC9743674 DOI: 10.1186/s12887-022-03773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Both undiagnosed celiac disease and some chronic childhood diseases are associated with lower academic achievement. However, there is little knowledge of achievements in those diagnosed with celiac disease. Our aim was to investigate school achievements in upper secondary school among Swedish adolescents with celiac disease. METHODS We performed a retrospective cohort study using register data. We analyzed choice of upper secondary school program, completion of upper secondary school including achievements of basic eligibility for college/university, and final grade in individuals with celiac disease diagnosed before 15 years of age, born 1991-97. We compared with the Swedish population of the same birth years. Analyses were adjusted for sex, year of birth, living region at 17 years of age, and parental education as well as income. RESULTS The cohort included 734 074 individuals, whereof 3 257 (62% females) with celiac disease. There was no significant difference in choice of upper secondary school program. No significant difference was found in completion or achieving basic eligibility for college/university in adjusted analyses. The mean final grade in the celiac disease group was 13.34 (standard deviation 4.85) compared to 12.78 (standard deviation 5.01) in the reference population (p < 0.001), out of a maximum of 20. The effect of celiac disease on final grade remained in adjusted analyses (p = 0.012). CONCLUSIONS We found that diagnosed celiac disease does not negatively affect school achievements in upper secondary school. This finding suggests the diagnosis, treatment and follow-up programs of celiac disease could reverse potential deleterious academic processes.
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Affiliation(s)
- Katarina Johansson
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Umeå University, 901 87 Sundsvall, Sweden
| | - Fredrik Norström
- grid.12650.300000 0001 1034 3451Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Peter H. R. Green
- grid.21729.3f0000000419368729Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Anneli Ivarsson
- grid.12650.300000 0001 1034 3451Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Linda Richter Sundberg
- grid.12650.300000 0001 1034 3451Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Anders Själander
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Umeå University, 901 87 Sundsvall, Sweden
| | - Anna Myleus
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
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Sampaio F, Häggström J, Ssegonja R, Eurenius E, Ivarsson A, Pulkki-Brännström AM, Feldman I. Evaluation of a universal early intervention for parents and children from birth to age five. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This study aimed to investigate the health and economic outcomes of a universal early intervention for parents and children, the Salut Programme, from birth to when the child completed five years of age.
Methods
This study adopted a retrospective observational design using routinely collected register data with respect to both exposures and outcomes from a county in northern Sweden. Areas that received care-as-usual (non-Salut area) were compared to areas where the Programme was implemented after 2006 (Salut area) in terms of: i) health outcomes, healthcare resource use and related costs around pregnancy, delivery and birth, and ii) healthcare resource use and related costs, as well as costs related to care of sick child. Costs were estimated for inpatient care and specialised outpatient care for mothers and children. Two analyses were conducted: a matched difference-in difference analysis using the total sample and an analysis including a longitudinal subsample.
Results
The longitudinal analysis on mothers who had given birth in both the pre- and post-measure periods showed that those that had been exposed to the Salut Programme, had on average 6% (95% CI 3-9%) more full-term pregnancies and 2% (95% CI 0.03-3%) more babies born within normal weight range, compared to mothers who had only care-as-usual. Savings were incurred in terms of outpatient care related costs for children of mothers in the Salut area ($826). The difference-in-difference analysis using the total sample did not result in any significant differences in health outcomes or cumulative resource use over time.
Conclusions
The Salut Programme achieved health gains at a reasonable cost for children and parents, and may lead to lower usage of outpatient care. Other indicators point towards positive effects but the small sample size may have led to underestimation of true differences. The current findings support the continuous investment in this early childhood programme.
Key messages
• The Salut Programme improves the health of children and parents at a low cost.
• The Salut Programme as a health promotion early intervention is value for money and should be included in the local policy investment agenda.
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Affiliation(s)
- F Sampaio
- Department of Public Health and Caring Sciences, Uppsala University , Uppsala, Sweden
| | - J Häggström
- Department of Statistics, Umeå University , Umeå, Sweden
| | - R Ssegonja
- Department of Public Health and Caring Sciences, Uppsala University , Uppsala, Sweden
- Department of Medical Sciences, Uppsala University , Uppsala, Sweden
| | - E Eurenius
- Department of Epidemiology and Global Health, Umeå University , Umeå, Sweden
| | - A Ivarsson
- Department of Epidemiology and Global Health, Umeå University , Umeå, Sweden
| | | | - I Feldman
- Department of Public Health and Caring Sciences, Uppsala University , Uppsala, Sweden
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Sandström O, Norström F, Carlsson A, Högberg L, van der Palz M, Stenhammar L, Webb C, Ivarsson A, Myléus A. Five-year follow-up of new cases after a coeliac disease mass screening. Arch Dis Child 2022; 107:596-600. [PMID: 34921003 PMCID: PMC9125362 DOI: 10.1136/archdischild-2021-322755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We previously performed a population-based mass screening of coeliac disease in children aged 12 years in two birth cohorts resulting in 296 seropositive children, of whom 242 were diagnosed with coeliac disease after duodenal biopsies. In this follow-up study, we wanted to identify new cases in the screening population that tested negative-either converting from potential coeliac disease (seropositive but normal duodenal mucosa) or converting from seronegative at screening to diagnosed coeliac disease. METHODS All seropositive children were invited to a follow-up appointment 5 years after the screening with renewed serological testing and recommended endoscopic investigation if seropositive. Seronegative children in the screening study (n=12 353) were linked to the National Swedish Childhood Coeliac Disease Register to find cases diagnosed in healthcare during the same period. RESULTS In total, 230 (77%) came to the follow-up appointment, including 34 of 39 with potential coeliac disease. Of these, 11 (32%) had converted to coeliac disease. One new case was found in the National Swedish Childhood Coeliac Disease Register who received the diagnosis through routine screening in children with type 1 diabetes. CONCLUSIONS There is a high risk of conversion to coeliac disease among those with potential disease. However, a negative screening test was associated with a very low risk for a clinical diagnosis within a follow-up period of 5 years.
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Affiliation(s)
- Olof Sandström
- Department of Clinical Sciences, Paediatrics, Umea University, Umea, Sweden
| | - Fredrik Norström
- Department of Epidemiology and Global Health, Umea University, Umea, Sweden
| | - Annelie Carlsson
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden
| | - Lotta Högberg
- 4Department of Clinical and Experimental Medicine, Paediatrics, Linköping University, Linkoping, Östergötland, Sweden
| | - Maria van der Palz
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden
| | - Lars Stenhammar
- 4Department of Clinical and Experimental Medicine, Paediatrics, Linköping University, Linkoping, Östergötland, Sweden
| | - Charlotta Webb
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umea University, Umea, Sweden
| | - Anna Myléus
- Department of Public Health and Clinical Medicine, Family Medicine, Umea University, Umea, Sweden
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Vaezghasemi M, Eurenius E, Ivarsson A, Richter Sundberg L, Silfverdal SA, Lindkvist M. The Ages and Stages Questionnaire: Social-Emotional-What Is the Optimal Cut-Off for 3-Year-Olds in the Swedish Setting? Front Pediatr 2022; 10:756239. [PMID: 35223687 PMCID: PMC8864154 DOI: 10.3389/fped.2022.756239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/14/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Expressions of emotional and behavioral symptoms in preschool age can predict mental health problems in adolescence and adulthood. The Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) has been successful in detecting social and emotional problems in young children in some countries but had not been tested in Sweden. The objective of this study was to determine the optimal cut-off for the ASQ:SE instrument when administered to 3-year-old children in a northern Swedish setting, using the Strengths and Difficulties Questionnaire (SDQ) as the reference. METHODS The ASQ:SE (36-month interval, first edition) was administered at routine 3-year-olds' visits to Child Health Care centers in Region Västerbotten, Sweden. During the study period (September 2017 to March 2018) parents were invited to also fill out the SDQ (2-4 year version). In the final analyses 191 children fulfilled the criteria for inclusion in the study sample. Non-parametric Receiver Operating Characteristic analysis was performed to quantify the discriminatory accuracy of ASQ:SE based on SDQ. RESULTS The Pearson correlation between ASQ:SE and SDQ indicated strong correlation between the two instruments. The Receiver Operating Characteristic curve showed good accuracy of ASQ:SE in relation to SDQ. However, our results suggest that the existing ASQ:SE cut-off score of 59 was not optimal in the Swedish context. Changing the cut-off from 59 to 50 would allow us to detect 100% (n = 14) of children with problems according to SDQ, compared to 64% (n = 9) when the cut-off was 59. However, the proportion of false positives would be higher (9% compared to 3%). CONCLUSION The main finding was that for 3-year-olds in Sweden a decreased ASQ:SE cut-off score of 50 would be optimal. This would increase the detection rate of at-risk children according to SDQ (true positive), thus prioritizing sensitivity. Our conclusion is that, although this change would result in more false positives, this would be justifiable.
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Affiliation(s)
- Masoud Vaezghasemi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Eva Eurenius
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | | | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Eurenius E, Mohamed AF, Lindkvist M, Ivarsson A, Öhlund I, Vaezghasemi M. Social-Emotional Problems Among 3-Year-Olds Are Associated With an Unhealthy Lifestyle: A Population-Based Study. Front Public Health 2021; 9:694832. [PMID: 34869138 PMCID: PMC8634957 DOI: 10.3389/fpubh.2021.694832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction: Little attention has been paid to the association between preschool children's social-emotional problems and lifestyle at the population level. Objective: This study aimed to overcome this knowledge gap by investigating to what extent children's social-emotional problems are associated with their lifestyle and if there are any gender differences. Methods: This cross-sectional, population-based study used data from the regional Salut Register in northern Sweden, including 7,179 3-year-olds during 2014–2017. Parents responded to a questionnaire including the 36-month interval of the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) and questions regarding family and lifestyle characteristics. Single and multiple logistic regression were used to assess the association between children's social-emotional problems and multiple family lifestyle characteristics. Results: More reports of social-emotional problems were found among children who did not have parents living together or had markers of an unhealthy lifestyle. Children who ate vegetables less frequently, whose parent/-s brushed their teeth less often and did not read to them regularly were more likely to have social-emotional problems. Playing outdoors <3 h during weekdays and >1 h of sedentary screen time during weekends increased the risk of social-emotional problems among boys only, while >1 h of sedentary screen time during weekdays increased the risk among girls. When it comes to lifestyle and gender differences, a high proportion of the 3-year-olds had an unhealthy lifestyle, more so for boys than for girls. The dietary quality and tooth brushing were somewhat more adequate for the girls than for the boys, but boys spent more time playing outdoors compared to the girls. Conclusions: This study provides us with an important overview picture of the family life situation of three-year-olds, including those with social-emotional problems. Such problems were significantly associated with markers of unhealthy lifestyle, with significant gender differences. Therefore, this study suggests that in order to maintain children's social-emotional ability and support children at risk of problems, public health intervention programs should have a broader perspective on improving children's lifestyle rather than merely focusing on their social and emotional problems, and the gender differences found may be taken in account.
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Affiliation(s)
- Eva Eurenius
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Inger Öhlund
- Department of Clinical Science, Pediatrics, Umeå University, Umeå, Sweden
| | - Masoud Vaezghasemi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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13
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Lindvall K, Vaezghasemi M, Feldman I, Ivarsson A, Stevens KJ, Petersen S. Feasibility, reliability and validity of the health-related quality of life instrument Child Health Utility 9D (CHU9D) among school-aged children and adolescents in Sweden. Health Qual Life Outcomes 2021; 19:193. [PMID: 34344386 PMCID: PMC8336397 DOI: 10.1186/s12955-021-01830-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background This study was conducted in a general population of schoolchildren in Sweden, with the aim to assess the psychometric properties of a generic preference-based health related quality of life (HRQoL) instrument, the Swedish Child Health Utility 9D (CHU9D), among schoolchildren aged 7–15 years, and in subgroups aged 7–9, 10–12 and 13–15 years.
Methods In total, 486 school aged children, aged 7–15 years, completed a questionnaire including the CHU9D, the Pediatric quality of life inventory 4.0 (PedsQL), KIDSCREEN-10, questions on general health, long-term illness, and sociodemographic characteristics. Psychometric testing was undertaken of feasibility, internal consistency reliability, test–retest reliability, construct validity, factorial validity, concurrent validity, convergent validity and divergent validity. Results The CHU9D evidenced very few missing values, minimal ceiling, and no floor effects. The instrument achieved satisfactory internal consistency (Cronbach’s Alfa > 0.7) and strong test–retest reliability (r > 0.6). Confirmatory factor analyses supported the proposed one-factor structure of the CHU9D. For child algorithm, RMSEA = 0.05, CFI = 0.95, TLI = 0.94, and SRMR = 0.04. For adult algorithm RMSEA = 0.04, CFI = 0.96, TLI = 0.95, and SRMR = 0.04. The CHU9D utility value correlated moderately or strongly with KIDSCREEN-10 and PedsQL total scores (r > 0.5–0.7). The CHU9D discriminated as anticipated on health and on three of five sociodemographic characteristics (sex, age, and custody arrangement, but not socioeconomic status and ethnic origin). Conclusions This study provides evidence that the Swedish CHU9D is a feasible, reliable and valid measure of preference-based HRQoL in children. The study furthermore suggests that the CHU9D is appropriate for use among children 7–15 years of age in the general population, as well as among subgroups aged 7– 9, 10–12 and 13–15 years.
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Affiliation(s)
- Kristina Lindvall
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
| | - Masoud Vaezghasemi
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| | - Inna Feldman
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.,Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| | - Katherine J Stevens
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Solveig Petersen
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
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14
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Norström F, Myléus A, Nordyke K, Carlsson A, Högberg L, Sandström O, Stenhammar L, Ivarsson A, Lindholm L. Is mass screening for coeliac disease a wise use of resources? A health economic evaluation. BMC Gastroenterol 2021; 21:159. [PMID: 33836647 PMCID: PMC8034082 DOI: 10.1186/s12876-021-01737-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/25/2021] [Indexed: 11/21/2022] Open
Abstract
Background Living with undiagnosed symptomatic coeliac disease is connected with deteriorated health, and persons with coeliac disease often wait a long time for their diagnosis. A mass screening would lower the delay, but its cost-effectiveness is still unclear. Our aim was to determine the cost-effectiveness of a coeliac disease mass screening at 12 years of age, taking a life course perspective on future benefits and drawbacks. Methods The cost-effectiveness was derived as cost per quality-adjusted life-year (QALY) using a Markov model. As a basis for our assumptions, we mainly used information from the Exploring the Iceberg of Celiacs in Sweden (ETICS) study, a school-based screening conducted in 2005/2006 and 2009/2010, where 13,279 12-year-old children participated and 240 were diagnosed with coeliac disease, and a study involving members of the Swedish Coeliac Association with 1031 adult participants. Results The cost for coeliac disease screening was 40,105 Euro per gained QALY. Sensitivity analyses support screening based on high compliance to a gluten-free diet, rapid progression from symptom-free coeliac disease to coeliac disease with symptoms, long delay from celiac disease with symptoms to diagnosis, and a low QALY score for undiagnosed coeliac disease cases. Conclusions A coeliac disease mass screening is cost-effective based on the commonly used threshold of 50,000 Euro per gained QALY. However, this is based on many assumptions, especially regarding the natural history of coeliac disease and the effects on long-term health for individuals with coeliac disease still eating gluten. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01737-1.
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Affiliation(s)
- Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
| | - Anna Myléus
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Katrina Nordyke
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| | - Annelie Carlsson
- Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lotta Högberg
- Department of Paediatrics, Norrköping Hospital, Linköping University, Norrköping, Sweden
| | - Olof Sandström
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.,Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Lars Stenhammar
- Department of Paediatrics, Norrköping Hospital, Linköping University, Norrköping, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
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15
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Norström F, Namatovu F, Carlsson A, Högberg L, Ivarsson A, Myléus A. Family socio-economic status and childhood coeliac disease seem to be unrelated-A cross-sectional screening study. Acta Paediatr 2021; 110:1346-1352. [PMID: 32885467 PMCID: PMC7983879 DOI: 10.1111/apa.15562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022]
Abstract
Aim The aim of our study was to examine whether there is a difference in coeliac disease prevalence in regard to parents' education level and occupation, and whether this differs between screened and clinically diagnosed children at the age of 12 years. Methods The study, Exploring the Iceberg of Celiacs in Sweden (ETICS), was a school‐based screening study of 12‐year‐old children that was undertaken during the school years 2005/2006 and 2009/2010. Data on parental education and occupation were reported from parents of the children. Specifically, by parents of 10 710 children without coeliac disease, 88 children diagnosed with coeliac disease through clinical care, and 231 who were diagnosed during the study. Results There were no statistically significant associations between occupation and coeliac disease for either the clinically detected (prevalence ratio 1.16; confidence interval 0.76‐1.76) or screening‐detected coeliac disease cases (prevalence ratio 0.86; confidence interval 0.66‐1.12) in comparison with children with no coeliac disease. Also, there were no statistically significant associations for parental education and coeliac disease diagnosis. Conclusion There was no apparent relationship between coeliac disease and socio‐economic position. Using parents' socio‐economic status as a tool to help identify children more likely to have coeliac disease is not recommended.
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Affiliation(s)
- Fredrik Norström
- Department of Epidemiology and Global Health Umeå University Umeå Sweden
| | - Fredinah Namatovu
- Department of Historical, Philosophical and Religious Studies Umeå University Umeå Sweden
| | - Annelie Carlsson
- Department of Pediatrics Clinical Sciences Skåne University Hospital Lund University Lund Sweden
| | - Lotta Högberg
- Department of Paediatrics Norrköping Hospital Linköping University Norrköping Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health Umeå University Umeå Sweden
| | - Anna Myléus
- Department of Epidemiology and Global Health Umeå University Umeå Sweden
- Department of Public Health and Clinical Medicine Family Medicine Umeå University Umeå Sweden
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16
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Ivarsson A. Somali-Swedish Research Cooperation for Health (SSRCH) - a joint initiative by Somali and Swedish Universities to guide the Somali health system recovery process. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
In the fragile Somali state, there is a research imperative to effectively guide health systems recovery, which is crucial in the national rebuilding process for societal stability and peace. Our collaboration has its roots in the early 1980's, was cut short by the civil war and revived in 2014 to meet the need for health research capacity in Somalia today. Somali universities, representing different regions (East Africa University, University of Hargeisa, Galkayo University, Benadir University, Puntland Health Science University, Amoud University, and recently Somali National University) formed a consortium with Swedish universities (Umeå, Lund, Uppsala, Karolinska Institutet and Dalarna) and Somali diaspora professionals. Most recently we joined forces with the Public Health Agency of Sweden, linking us to the National Institute of Health Somalia (NIHS). A joint action programme for capacity building in health research has been developed, as outlined in the article “Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative” (Glob Health Action, 2017;10:1;1348693). We have a model for working collaboratively across regions and cultural barriers, creating hope for real change. As a first step, priority was given to research capacity development of faculty staff at the Somali universities' health faculties and Ministries of Health. A 'training of trainers' course in health research methodology was carried out during 2016-2018, supported by WHO-based Alliance for Health Policy and Systems Research. This has fostered health research as an integral component of these universities' academic development process. Institutional and research capacity in public health has a key role in rebuilding national health services for better health and wellbeing and to reach the SDGs (goals 3, 5, 10, 16).
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Affiliation(s)
- A Ivarsson
- Department of Epidemiology and Public Health Sciences, Umeå University, Umeå, Sweden
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17
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Lindvall K, Koistinen S, Ivarsson A, van Dijken J, Eurenius E. Health counselling in dental care for expectant parents: A qualitative study. Int J Dent Hyg 2020; 18:384-395. [PMID: 32794308 PMCID: PMC7693080 DOI: 10.1111/idh.12461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 06/25/2020] [Accepted: 07/20/2020] [Indexed: 11/27/2022]
Abstract
Objectives Interventions during pregnancy and early childhood have been shown to impact dental health. Thus, Antenatal Care and Dental Care collaborated in an intervention called Health Counselling in Dental Care (HCDC). HCDC was offered free of charge to first‐time expectant parents and was aimed at reducing the frequency of dental caries in children and their parents. However, the intervention reached less than 50% of the parents. The aim of this study was to explore facilitators of, barriers to, and suggestions for increased participation in HCDC. Methods Data were collected through semi‐structured, face‐to‐face interviews with expectant parents. Participants were purposively sampled based on having been invited to HCDC and to achieve a variation in socio‐demographics. Interviews were audio recorded, transcribed verbatim and analysed using conventional qualitative content analysis. Results In total, 16 interviews were conducted (10 women, 6 men). Six categories representing three facilitators and three barriers for participation emerged. The facilitators were the midwife’s crucial role for disseminating information about HCDC and motivating participation, that the parents perceived HCDC as valuable for themselves and their offspring, and a desire for new or more knowledge. The barriers included a shortage of information regarding the counselling, a perceived lack of value for the parents and offspring, and the timing of the counselling during pregnancy. Conclusions The midwives were crucial in providing information and motivation for HCDC participation. To increase attendance, sufficient information regarding the benefits of counselling is required, and the timing needs to be flexible and family‐centred.
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Affiliation(s)
- Kristina Lindvall
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Eva Eurenius
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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18
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Westerlund A, Ivarsson A, Richter-Sundberg L. Evidence-based practice in child and adolescent mental health services - The challenge of implementing national guidelines for treatment of depression and anxiety. Scand J Caring Sci 2020; 35:476-484. [PMID: 32323362 DOI: 10.1111/scs.12859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mental health problems are one of the most pressing public health concerns of our time. Sweden has seen a sharp increase in mental disorders among children and youth during the last decade. The evidence base for treatment of psychiatric conditions has developed strongly. Clinical practice guidelines aim to compile such evidence and support healthcare professionals in evidence-based clinical decision-making. In Sweden, the national guidelines for the treatment of depression and anxiety disorders in children and adolescents were launched in 2010. The aim of this study was two folded, (i) to explore to what extent these guidelines were known and adhered to by health professionals in Child and Adolescent Mental Health Services and (ii) to investigate factors influencing implementation of the guidelines informed by the Consolidated Framework for Implementation Research. METHODS A qualitative approach was used, and data were collected through interviews with 18 health professionals in Child Mental Health Services in Sweden and a combination of conventional and directed content analyses was used. The Consolidated Framework for Implementation Research guided and structured data collection and analysis. RESULTS The guidelines were largely unknown by health professionals in Child Mental Health Services in all the clinics investigated. Adherence to guideline recommendations was reported as very low. Barriers to implementation were found in relation to the characteristics of the intervention, outer setting, inner setting and characteristics of the individuals involved. CONCLUSIONS The government initiative to develop and disseminate the guidelines seems to have made very little impact on health professionals' clinical practice. The guidelines were poorly aligned with the health professionals' knowledge and beliefs about effective mental health services for children and youth with depression and anxiety disorders. Suggestions for future efforts to improve the development and implementation of guidelines in Child Mental Health Services settings are given.
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Affiliation(s)
- Anna Westerlund
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Linda Richter-Sundberg
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Department of Clinical Science, Unit of Child and Adolescent Psychiatry, Umeå University, Umeå, Sweden
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19
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Pulkki-Brännström AM, Lindkvist M, Eurenius E, Häggström J, Ivarsson A, Sampaio F, Feldman I. The equity impact of a universal child health promotion programme. J Epidemiol Community Health 2020; 74:605-611. [PMID: 32303594 PMCID: PMC7337232 DOI: 10.1136/jech-2019-213503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/24/2020] [Accepted: 03/01/2020] [Indexed: 12/02/2022]
Abstract
Background Real-world evaluations of complex interventions are scarce. We evaluated the effect of the Salut Programme, a universal child health promotion intervention in northern Sweden, on income-related inequalities in positive birth outcomes and healthcare utilisation up to 2 years after delivery. Methods Using the mother’s place of residence at delivery, the child and the mother were classified as belonging to either the control area (received care-as-usual) or the intervention area (where the intervention was implemented from 2006) and either the premeasure (children born between 2002 and 2004) or the postmeasure (children born between 2006 and 2008) period. Parents’ earned income was used as the socioeconomic ranking variable. The Relative Concentration Index was computed for six binary birth outcome indicators and for inpatient and day patient care for children and their mothers. Changes in inequality over time were compared using a difference-in-difference approach. Results Income-related inequalities in birth outcomes and child healthcare utilisation were absent, except that full-term pregnancies were concentrated among the poor at premeasure in the intervention area. In contrast, mothers’ healthcare utilisation was significantly pro-poor in the control area. The extent of inequality changed differentially between premeasure and postmeasure for two birth outcomes: full-term pregnancies and infants with normal birth weight. Inequalities in healthcare utilisation did not change significantly in either area over time. Conclusion In northern Sweden, income-related inequalities in birth outcomes and child healthcare utilisation are largely absent. However, relative inequalities in mothers’ healthcare utilisation are large. We found no evidence that the Salut Programme affected changes in inequality over time.
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Affiliation(s)
| | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Eva Eurenius
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Jenny Häggström
- Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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20
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Vaezghasemi M, Eurenius E, Ivarsson A, Richter Sundberg L, Silfverdal SA, Lindkvist M. Social-emotional problems among Swedish three-year-olds: an Item Response Theory analysis of the Ages and Stages Questionnaires: Social-Emotional. BMC Pediatr 2020; 20:149. [PMID: 32247313 PMCID: PMC7126409 DOI: 10.1186/s12887-020-2000-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/25/2020] [Indexed: 11/12/2022] Open
Abstract
Background There is enough evidence to believe that young children’s social-emotional problems can have a long-term effect if extra support is not given early. Therefore, early identification of such problems and any differences between boys and girls are of importance. We utilized the 36-month interval of the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) among 3-year-olds aiming: 1) to report the normative values of social-emotional problems for Swedish boys and girls; 2) to identify ASQ:SE items that are most commonly endorsed by children with high level of social-emotional problems (high score on ASQ:SE); 3) to assess whether certain ASQ:SE items differ between boys and girls at the same level of social-emotional problems; and 4) to examine whether ASQ:SE performs well in identifying children with high level of social-emotional problems (high score on ASQ:SE). Method During 2014–2017, data were collected from 7179 three-year-old children (boys = 3719, girls = 3460) through Child Health Care in the Region Västerbotten in the northern part of Sweden. Unidimensionality was assessed by Confirmatory Factor Analysis and goodness-of-fit was reported. Item Response Theory was used to answer the aims of the study. Results Items regarding interest in sexual words, too little sleep, disinterest in things around, unhappiness and self-injury were more commonly endorsed by children with high levels of social-emotional problems, as reported by their parents. For the same level of social-emotional problem, girls were more likely to demonstrate difficulties in occupying themselves, clinging behaviour and repetitive behaviour. On the other hand, boys were more likely to score high in items regarding destruction of things on purpose, difficulty to name friends and to express feelings. We have also found that the ASQ:SE is suitable for identifying children with high level of social-emotional problems. Conclusion The salient point of our study was to increase knowledge about Swedish children’s social-emotional problems at 3-years of age based on the psychometric characteristics of the ASQ:SE using Item Response Theory model. The gender differences as well as those items that occurred at high levels of social-emotional problems should be of concern for everyday practice in Child Health Care.
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Affiliation(s)
- Masoud Vaezghasemi
- Department of Epidemiology and Global Health, Umeå University, SE-901 85, Umeå, Sweden.
| | - Eva Eurenius
- Department of Epidemiology and Global Health, Umeå University, SE-901 85, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, SE-901 85, Umeå, Sweden
| | | | | | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, SE-901 85, Umeå, Sweden
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21
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Barclay K, Baranowska-Rataj A, Kolk M, Ivarsson A. Interpregnancy intervals and perinatal and child health in Sweden: A comparison within families and across social groups. Popul Stud (Camb) 2020; 74:363-378. [PMID: 32052701 DOI: 10.1080/00324728.2020.1714701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A large body of research has shown that children born after especially short or long birth intervals experience an elevated risk of poor perinatal outcomes, but recent work suggests this may be explained by confounding by unobserved family characteristics. We use Swedish population data on cohorts born 1981-2010 and sibling fixed effects to examine whether the length of the birth interval preceding the index child influences the risk of preterm birth, low birth weight, and hospitalization during childhood. We also present analyses stratified by salient social characteristics, such as maternal educational level and maternal country of birth. We find few effects of birth intervals on our outcomes, except for very short intervals (less than seven months) and very long intervals (>60 months). We find few differences in the patterns by maternal educational level or maternal country of origin after stratifying by the mother's highest educational attainment.
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Affiliation(s)
- Kieron Barclay
- Max Planck Institute for Demographic Research.,Stockholm University
| | | | - Martin Kolk
- Stockholm University.,Institute for Futures Studies
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Pulkki-Brännström AM, Lindkvist M, Eurenius E, Häggström J, Ivarsson A, Sampaio F, Feldman I. The equity impact of a universal child health promotion programme. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
We aimed to evaluate whether the Salut Programme, a universal child health promotion intervention, aimed to strengthen healthy lifestyles in northern Sweden, had any effect on income-related inequalities in positive birth outcomes for children and on healthcare use for children and their mothers.
Methods
Mother’s residence and child’s date of birth determined whether the child and the mother belonged to the control group (areas that received care-as-usual) or the intervention group (areas with the intervention implemented from 2005), during the pre-measure period (children born 2002-2004) and the post-measure period (children born 2006-2008). The sum of parents’ taxable income was used for socioeconomic ranking. We computed the standard concentration index for six binary indicators of positive birth outcomes, and for inpatient and day patient care for children and mothers during the two years after delivery. Using a difference-in-difference approach, we assessed whether the extent of inequality changed over time between areas.
Results
Income-related inequalities in child health status at birth and in child healthcare use were absent, except that full-term pregnancies were concentrated among the poor at pre-measure in the intervention group. However, mothers’ healthcare use was significantly pro-poor in the control group. The extent of inequality changed between pre- and post-measure periods for two outcomes: the pro-poor concentration of full-term pregnancies in the intervention group at pre-measure disappeared at post-measure; and an increase in pro-poor concentration of normal birth weight in the control group was not matched by a similar increase in the intervention group. Inequalities in healthcare use did not change significantly.
Conclusions
Birth outcomes and child healthcare use seemed to be equitably distributed. However, the results raise concerns whether the intervention may have reduced the pro-poor concentration of positive birth outcomes.
Key messages
There are concerns that participation in universal health promotion programmes differs by socioeconomic status, although few public health interventions have been evaluated from an equity perspective. Birth outcomes and child healthcare use in Northern Sweden seemed to be equitably distributed across different socioeconomic groups.
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Affiliation(s)
| | - M Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - E Eurenius
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - J Häggström
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - A Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - F Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - I Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Vaezghasemi M, Eurenius E, Sundberg LR, Ivarsson A, Silfverdal SA, Lindkvist M. Social-emotional problems among Swedish three-year-olds: an Item Response Theory Analysis. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Young children’s social-emotional problems can have a long-term effect if not treated early. In order to deepen our knowledge about children’s social and emotional functioning, we utilized the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) among 3-year-olds in Sweden aiming: 1) to identify ASQ:SE items that are most commonly endorsed by children with high level of social-emotional problems; and 2) to assess whether certain ASQ:SE items differs between boys and girls at the same level of social-emotional problems.
Methods
During 2014-2017 data was collected from 7179 three-year-old children through Child Health Care in a northern county of Sweden within the Salut Child Health Promotion Programme. Item Characteristic Curve (ICC) and Differential Item Functioning (DIF) were used to identify the characteristics of children with high social-emotional problems and to determine whether an item exhibit uniform between boys and girls at the same level of social-emotional problems.
Results
Items regarding interest in sexual words, too little sleep, disinterest in things around, unhappiness and self-injury were more commonly endorsed by children with high levels of social-emotional problems. Additionally, on the same level of social-emotional problem girls were more likely to score high in items regarding difficulties to occupy herself, clinging behaviour and repetitive behaviour while boys were more likely to score high in items regarding difficulty to name friends, difficulty to express feelings and destruction of things on purpose.
Conclusions
This study has increased our knowledge about Swedish young children’s social emotional functioning already at the age of three by detecting which items are most closely connected to high level of social-emotional problems and differences between boys and girls. However, whether the results detected in this analysis are reflecting their parents’ expectations more than child behaviour requires further investigations.
Key messages
Children with high level of social-emotional problems were rated high on items regarding interest in sexual words, too little sleep, disinterest in things around, unhappiness and self-injury. On equal levels of social-emotional problems, girls were more often reported with internalizing problematic behaviours and boys were more often reported with externalizing problematic behaviours.
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Affiliation(s)
- M Vaezghasemi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - E Eurenius
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - L R Sundberg
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - A Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - S-A Silfverdal
- Depatment of Clinical Science, Pediatrics, Umeå University, Umeå, Sweden
| | - M Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Statistics, USBE, Umeå University, Umeå, Sweden
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Eriksson M, Lindgren U, Ivarsson A, Ng N. The effect of neighbourhood social capital on child injuries: A gender-stratified analysis. Health Place 2019; 60:102205. [DOI: 10.1016/j.healthplace.2019.102205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/22/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
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Eurenius E, Richter Sundberg L, Vaezghasemi M, Silfverdal S, Ivarsson A, Lindkvist M. Social-emotional problems among three-year-olds differ based on the child's gender and custody arrangement. Acta Paediatr 2019; 108:1087-1095. [PMID: 30496622 PMCID: PMC6590218 DOI: 10.1111/apa.14668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/13/2018] [Accepted: 11/26/2018] [Indexed: 12/03/2022]
Abstract
AIM The aim of this study was to investigate mental health with respect to social-emotional problems among three-year-olds in relation to their gender, custody arrangements and place of residence. METHODS A cross-sectional population-based design was used, encompassing 7179 three-year-olds in northern Sweden during the period 2014-2017 from the regional Salut Register. Descriptive and comparative analyses were performed based on parents' responses on the Ages and Stages Questionnaires: Social-Emotional, supplemented with items on gender, custody arrangement and place of residence. RESULTS Parental-reported social-emotional problems were found in almost 10% of the children. Boys were reported to have more problems (12.3%) than girls (5.6%; p < 0.001). Parents were most concerned about children's eating habits and interactions at mealtimes. Parents not living together reported more problems among their children than those living together (p < 0.001). When stratifying by custody arrangement, girls in rural areas living alternately with each parent had more problems compared to those in urban areas (p < 0.008). CONCLUSION Gender and custody arrangements appear to be important factors for social-emotional problems among three-year-olds. Thus, such conditions should receive attention during preschool age, preferably by a systematic preventive strategy within Child Health Care.
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Affiliation(s)
- Eva Eurenius
- Department of Public Health and Clinical Medicine, Epidemiology and Global HealthUmeå UniversityUmeåSweden
| | - Linda Richter Sundberg
- Department of Public Health and Clinical Medicine, Epidemiology and Global HealthUmeå UniversityUmeåSweden
| | - Masoud Vaezghasemi
- Department of Public Health and Clinical Medicine, Epidemiology and Global HealthUmeå UniversityUmeåSweden
- Department of Social WorkUmeå UniversityUmeåSweden
| | | | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global HealthUmeå UniversityUmeåSweden
| | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global HealthUmeå UniversityUmeåSweden
- Department of StatisticsUmeå UniversityUmeåSweden
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Myléus A, Stenhammar L, Högberg L, Browaldh L, Daniels I, Fagerberg UL, Gudjónsdóttir AH, Malmquist M, Sandström O, Ivarsson A. Questionnaire showed that Swedish paediatric clinics complied well with the revised European guidelines for diagnosing coeliac disease. Acta Paediatr 2019; 108:1140-1143. [PMID: 30496613 DOI: 10.1111/apa.14669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 11/08/2018] [Accepted: 11/26/2018] [Indexed: 12/23/2022]
Abstract
AIM In 2012, revised criteria for diagnosing childhood coeliac disease were published by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and incorporated into the revised Swedish guidelines the same year. These made it possible, in certain cases, to diagnose coeliac disease without taking small bowel biopsies. This survey assessed the extent to which the new guidelines were implemented by Swedish paediatric clinics two years after their introduction. METHODS In October 2014, we distributed a paper questionnaire including five questions on diagnostic routines to the 40 paediatric clinics in university or regional hospitals in Sweden that perform small bowel biopsies. RESULTS All 36 (90%) clinics that responded used anti-tissue transglutaminase antibodies as the initial diagnostic test and some also used serological markers. Most clinics (81%) used endoscopy and took multiple duodenal biopsies, whereas only a few (19%) occasionally employed a suction capsule. Almost all clinics (86%) omitted taking small bowel biopsies in symptomatic children with repeatedly high coeliac serology and positive genotyping, thereby avoiding the need for invasive endoscopy under anaesthesia. CONCLUSION The 2012 Swedish Paediatric Coeliac Disease Diagnostic Guidelines had been widely accepted and implemented in routine health care two years after their introduction.
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Affiliation(s)
- Anna Myléus
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Umeå University Umeå Sweden
- Department of Public Health and Clinical Medicine, Family Medicine Umeå University Umeå Sweden
| | - Lars Stenhammar
- Department of Paediatrics and Department of Clinical and Experimental Medicine Linköping University Norrköping Sweden
| | - Lotta Högberg
- Department of Paediatrics and Department of Clinical and Experimental Medicine Linköping University Norrköping Sweden
| | - Lars Browaldh
- Department of Clinical Science and Education Karolinska Institutet and Paediatric Clinic Södersjukhuset Stockholm Sweden
| | - Ing‐Marie Daniels
- Department of Paediatrics Uppsala University Hospital Uppsala Sweden
| | - Ulrika L. Fagerberg
- Department of Paediatrics Centre for Clinical Research Västmanland Hospital, Västerås and Karolinska Institutet Stockholm Sweden
| | - Audur H. Gudjónsdóttir
- Department of Paediatric Gastroenterology Queen Silvia Children′s Hospital Sahlgrenska University Hospital Gothenburg Sweden
| | - Marianne Malmquist
- Department of Paediatric Gastroenterology Queen Silvia Children′s Hospital Sahlgrenska University Hospital Gothenburg Sweden
| | - Olof Sandström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Umeå University Umeå Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Umeå University Umeå Sweden
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Baroudi M, Petersen S, Namatovu F, Carlsson A, Ivarsson A, Norström F. Preteen children's health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups. BMC Public Health 2019; 19:139. [PMID: 30704442 PMCID: PMC6357483 DOI: 10.1186/s12889-019-6429-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/11/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Assessing disparities in health-related quality of Life (HRQoL) is important as a part of health-related disparities in the society. The aim of this study was to explore HRQoL among 12-year-olds in Sweden in terms of differences between years 2005 and 2009 and disparities related to sociodemographic background. METHODS During the school years 2005 and 2009, a total of 18,325 sixth grade students in Sweden were invited to a celiac disease screening study; 13,279 agreed to participate. Jointly with the celiac screening, the children answered a questionnaire that included EuroQol 5 Dimensions-youth (EQ-5D-Y) and their parents responded to separate questionnaires about their own and their child's country of birth, family structure, their employment status, occupation, and education. In total 11,009 child-parent questionnaires were collected. Logistic regression was used to study differences in HRQoL between 2005 and 2009, and between various sociodemographic subgroups. RESULTS Compared with 2005, children in 2009 reported more pain (OR: 1.20, 95% CI: 1.1-1.3) and more mood problems (OR: 1.35, 95% CI: 1.2-1.5). In general, girls reported more pain and mood problems and had more disparities than boys. There were no significant differences based on parents' occupation, however, children of parents with low or medium education levels reported less "mood problems" than those of parents with high education levels (OR: 0.65, 95% CI: 0.46-0.92) and (OR: 0.84, 95% CI: 0.73-0.96), respectively. A slight variation was seen in HRQoL between children with different migration background. Girls living in small municipalities reported more pain (OR: 1.51, 95% CI: 1.14-2.01), and problems performing usual activities (OR: 3.77, 95% CI: 2.08-6.84), compared to girls living in large municipalities. In addition, children living with two parents had less mood problems than children living in other family constellations. CONCLUSION More children reported pain and mood problems in 2009 compared with 2005. To study future trends, health outcomes among children in Sweden should continue to be reported periodically. More efforts should be invested to increase the awareness of health-related disparities as highlighted in this study especially for girls living in small municipalities and children of parents with high education level.
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Affiliation(s)
- Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Solveig Petersen
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Fredinah Namatovu
- Department of Historical, Philosophical and Religious Studies, Umeå University, Umeå, Sweden
| | - Annelie Carlsson
- Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anneli Ivarsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
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Dalmar AA, Hussein AS, Walhad SA, Ibrahim AO, Abdi AA, Ali MK, Ereg DI, Egal KA, Shirwa AM, Aden MH, Yusuf MW, Abdi YA, Freij L, Johansson A, Mohamud KB, Abdulkadir Y, Emmelin M, Eriksen J, Erlandsson K, Gustafsson LL, Ivarsson A, Klingberg-Allvin M, Kinsman J, Källestål C, Målqvist M, Osman F, Persson LÅ, Sahlén KG, Wall S. Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative. Glob Health Action 2018; 10:1348693. [PMID: 28799463 PMCID: PMC5645673 DOI: 10.1080/16549716.2017.1348693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This paper presents an initiative to revive the previous Somali–Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.
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Affiliation(s)
| | | | - Said Ahmed Walhad
- b College of Health Sciences , Amoud University , Borama , Somaliland
| | | | - Abshir Ali Abdi
- c Faculty of Medicine , East Africa University , Bosasso , Somalia
| | | | | | - Khadra Ali Egal
- d Medical College , University of Hargeisa , Hargeisa , Somaliland
| | | | - Mohamed Hussain Aden
- f Medical College , Puntland University of Science and Technology , Galkayo , Somalia
| | | | | | - Lennart Freij
- g Somali-Swedish Researchers' Association , Stockholm , Sweden
| | | | | | | | - Maria Emmelin
- h Unit of Social Medicine and Global Health , Lund University , Lund , Sweden
| | - Jaran Eriksen
- i Division of Clinical Pharmacology , Karolinska Institutet , Stockholm , Sweden
| | | | - Lars L Gustafsson
- i Division of Clinical Pharmacology , Karolinska Institutet , Stockholm , Sweden
| | - Anneli Ivarsson
- k Unit of Epidemiology and Global Health , Umeå University , Umeå , Sweden
| | | | - John Kinsman
- k Unit of Epidemiology and Global Health , Umeå University , Umeå , Sweden
| | - Carina Källestål
- l Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Mats Målqvist
- l Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | | | - Lars-Åke Persson
- l Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Klas-Göran Sahlén
- k Unit of Epidemiology and Global Health , Umeå University , Umeå , Sweden
| | - Stig Wall
- k Unit of Epidemiology and Global Health , Umeå University , Umeå , Sweden
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Mosquera PA, San Sebastian M, Ivarsson A, Gustafsson PE. Decomposition of gendered income-related inequalities in multiple biological cardiovascular risk factors in a middle-aged population. Int J Equity Health 2018; 17:102. [PMID: 30005665 PMCID: PMC6045866 DOI: 10.1186/s12939-018-0804-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/19/2018] [Indexed: 01/22/2023] Open
Abstract
Background Socioeconomic inequalities in cardiovascular disease seem to widen or endure in Sweden. However, research on inequalities in antecedent cardiovascular risk factors (CVRFs), and particularly what underpins them, is scarce. The present study aimed 1) to estimate income-related inequalities in eight biological cardiovascular risk factors in Swedish middle-aged women and men; and 2) to examine the contribution of demographic, socioeconomic, behavioural and psychosocial determinants to the observed inequalities. Methods Participants (N = 12,481) comprised all 40- and 50-years old women and men who participated in the regional Västerbotten Intervention Programme in Northern Sweden during 2008, 2009 and 2010. All participants completed a questionnaire on behavioural and psychosocial conditions, and underwent measurements with respect to eight CVRFs (body mass index; waist circumference; total cholesterol; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol; triglycerides; systolic/diastolic blood pressure; glucose tolerance). Data on cardiovascular risk, psychosocial and health behaviours were linked to national register data on income and other socioeconomic and demographic factors. To estimate income inequalities in each CVRF concentration indexes were calculated, and to examine the contribution of the underlying determinants to the observed inequalities a Wagstaff-type decomposition analysis was performed separately for women and men. Results Health inequalities ranged from small to substantial with generally greater magnitude in women. The highest inequalities among women were seen in BMI, triglycerides and HDL-cholesterol (Concentration index = − 0.1850; − 0.1683 and − 0.1479 respectively). Among men the largest inequalities were seen in glucose regulation, BMI and abdominal obesity (Concentration index = − 0.1661; − 0.1259 and − 0.1172). The main explanatory factors were, for both women and men socioeconomic conditions (contributions ranging from 54.8 to 76.7% in women and 34.0–72.6% in men) and health behaviours (contributions ranging from 6.9 to 20.5% in women and 9.2 to 26.9% in men). However, the patterns of specific dominant explanatory factors differed between CVRFs and genders. Conclusion Taken together, the results suggest that the magnitude of income-related inequalities in CVRFs and their determinants differ importantly between the risk factors and genders, a variation that should be taken into consideration in population interventions aiming to prevent inequalities in manifest cardiovascular disease.
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Affiliation(s)
- Paola A Mosquera
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden.
| | - Miguel San Sebastian
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Anneli Ivarsson
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Per E Gustafsson
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden
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30
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Namatovu F, Strandh M, Ivarsson A, Nilsson K. Effect of childhood coeliac disease on ninth grade school performance: evidence from a population-based study. Arch Dis Child 2018; 103:143-148. [PMID: 28844065 PMCID: PMC5865510 DOI: 10.1136/archdischild-2017-312830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Coeliac disease might affect school performance due to its effect on cognitive performance and related health consequences that might increase school absenteeism. The aim of this study was to investigate whether children with coeliac disease performed differently on completion of ninth grade in school compared with children without coeliac disease. METHODS Analysis was performed on a population of 445 669 children born in Sweden between 1991 and 1994 of whom 1767 were diagnosed with coeliac disease. School performance at ninth grade was the outcome and coeliac disease was the exposure. Other covariates included sex, Apgar score at 5 min, small for gestational age, year of birth, family type, parental education and income. RESULTS There was no association between coeliac disease and school performance at ninth grade (adjusted coefficient -2.4, 95% CI 5.1 to 0.4). A weak association was established between late coeliac diagnosis and higher grades, but this disappeared after adjusting for parent socioeconomic conditions. Being small for gestational age affected performance negatively (adjusted coefficient -6.9, 95% CI 8.0 to 5.7). Grade scores were significantly lower in children living with a single parent (adjusted coefficient -20.6, 95% CI 20.9 to 20.2), compared with those with married/cohabiting parents. A positive association was found between scores at ninth grade and parental education and income. CONCLUSION Coeliac disease diagnosis during childhood is not associated with poor school performance at ninth grade.
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Affiliation(s)
- Fredinah Namatovu
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Mattias Strandh
- Department of Social Sciences, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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31
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Clement D, Ivarsson A, Tranaeus U, Johnson U, Stenling A. Investigating the influence of intraindividual changes in perceived stress symptoms on injury risk in soccer. Scand J Med Sci Sports 2017; 28:1461-1466. [PMID: 29283451 DOI: 10.1111/sms.13048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Abstract
Research has shown that high levels of stress and stress responsivity can increase the risk of injuries. However, most of the research that has supported this notion has focused on between-person relationships, ignoring the relationships at the within-person level. As a result, the objective of this study was to investigate if within-person changes in perceived stress symptoms over a 1-month time period could predict injury rates during the subsequent 3 months. A prospective design with two measurement points (Time 1-at the beginning of the season and Time 2-1 month into the season) was utilized. A total of 121 competitive soccer players (85 males and 36 females; Mage = 18.39, SD = 3.08) from Sweden and the United States completed the Kessler Psychological Distress Scale (KPDS) and a demographic sheet at Time 1. The KPDS was also completed at Time 2, and all acute injuries that occurred during the subsequent 3-month period were recorded. A Bayesian latent change scores model was used to determine whether within-person changes in stress symptoms could predict the risk of injury. Results revealed that there was a credible positive effect of changes in stress symptoms on injury rates, indicating that an increase in reported stress symptoms was related to an increased risk for injury. This finding highlights the importance of creating caring and supportive sporting environments and relationships and teaching stress management techniques, especially during the earlier portion of competitive seasons, to possibly reduce the occurrence of injuries.
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Affiliation(s)
- D Clement
- College of Physical Activity and Sport Sciences, West Virginia University, Morgantown, West Virginia, UK
| | - A Ivarsson
- Center of Research on Welfare, Health and Sport (CVHI), Halmstad University, Halmstad, Sweden
| | - U Tranaeus
- Performance and Training Unit, The Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden.,The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden.,Musculoskeletal and Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - U Johnson
- Center of Research on Welfare, Health and Sport (CVHI), Halmstad University, Halmstad, Sweden
| | - A Stenling
- Department of Psychology, Umeå University, Umeå, Sweden
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Lundkvist E, Gustafsson H, Davis P, Holmström S, Lemyre N, Ivarsson A. The temporal relations across burnout dimensions in athletes. Scand J Med Sci Sports 2017; 28:1215-1226. [DOI: 10.1111/sms.13000] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 12/11/2022]
Affiliation(s)
- E. Lundkvist
- Department of Child- and Youth Studies; Stockholm University; Stockholm Sweden
- Department of Geography and Sustainable Development; University of St Andrews; St Andrews UK
- Swedish School of Sport and Health Sciences; Stockholm Sweden
| | - H. Gustafsson
- Department of Health Sciences; Karlstad University; Karlstad Sweden
| | - P.A. Davis
- Department of Psychology; Umeå University; Umeå Sweden
| | - S. Holmström
- Department of Psychology; Umeå University; Umeå Sweden
| | - N. Lemyre
- Department of Coaching and Psychology; Norwegian School of Sport Sciences; Oslo Norway
| | - A. Ivarsson
- School of Health and Welfare; Halmstad University; Halmstad Sweden
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Mosquera PA, San Sebastian M, Ivarsson A, Weinehall L, Gustafsson PE. Are health inequalities rooted in the past? Income inequalities in metabolic syndrome decomposed by childhood conditions. Eur J Public Health 2017; 27:223-233. [PMID: 27744345 PMCID: PMC5421500 DOI: 10.1093/eurpub/ckw186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Early life is thought of as a foundation for health inequalities in adulthood. However, research directly examining the contribution of childhood circumstances to the integrated phenomenon of adult social inequalities in health is absent. The present study aimed to examine whether, and to what degree, social conditions during childhood explain income inequalities in metabolic syndrome in mid-adulthood. Methods: The sample (N = 12 481) comprised all 40- and 50-year-old participants in the Västerbotten Intervention Program in Northern Sweden 2008, 2009 and 2010. Measures from health examinations were used to operationalize metabolic syndrome, which was linked to register data including socioeconomic conditions at age 40–50 years, as well as childhood conditions at participant age 10–12 years. Income inequality in metabolic syndrome in middle age was estimated by the concentration index and decomposed by childhood and current socioeconomic conditions using decomposition analysis. Results: Childhood conditions jointed explained 7% (men) to 10% (women) of health inequalities in middle age. Adding mid-adulthood sociodemographic factors showed a dominant contribution of chiefly current income and educational level in both gender. In women, the addition of current factors slightly attenuated the contribution of childhood conditions, but with paternal income and education still contributing. In contrast, the corresponding addition in men removed all explanation attributable to childhood conditions. Conclusions: Despite that the influence of early life conditions to adult health inequalities was considerably smaller than that of concurrent conditions, the study suggests that early interventions against social inequalities potentially could reduce health inequalities in the adult population for decades to come.
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Vaezghasemi M, Sundberg L, Ivarsson A, Eurenius E, Silfverdal S, Lindkvist M. Psychometric analysis of Age and Stages Questionnaire: Social-Emotional (ASQ:SE) among 3-year-olds. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Eriksson M, Lindgren U, Ivarsson A, Ng N. Child health and place: How is neighborhood social capital associated with child health injuries? Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | - N Ng
- Umeå University, Umeå, Sweden
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Häggström J, Sampaio F, Eurenius E, Pulkki-Brännström AM, Ivarsson A, Lindkvist M, Feldman I. Is the Salut Programme an effective and cost-effective universal health promotion intervention for parents and their children? A register-based retrospective observational study. BMJ Open 2017; 7:e016732. [PMID: 28939578 PMCID: PMC5623579 DOI: 10.1136/bmjopen-2017-016732] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/25/2017] [Accepted: 08/09/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study investigates the effectiveness and cost-effectiveness of the Salut Programme, a universal health promotion intervention, compared with care-as-usual, over the periods of pregnancy, delivery and the child's first 2 years of life. METHOD We adopted a register-based retrospective observational design using existing data sources with respect to both exposures and outcomes. Health outcomes and costs were compared between geographical areas that received care-as-usual (non-Salut area) and areas where the programme was implemented (Salut area). We included mothers and their children from both the Salut and non-Salut areas if: (1) the child was born 2002-2004 (premeasure period) or (2) the child was born 2006-2008 (postmeasure period). The effectiveness study adopted two strategies: (1) a matched difference-in-difference analysis using data from all participants and (2) a longitudinal analysis restricted to mothers who had given birth twice, that is, both in the premeasure and postmeasure periods. The economic evaluation was performed from a healthcare and a limited societal perspective. Outcomes were clustered during pregnancy, delivery and birth and the child's first 2 years. RESULTS Difference-in-difference analyses did not yield any significant effect on the outcomes. Longitudinal analyses resulted in significant positive improvement in Apgar scores, reflecting the newborn's physical condition, with more children having a normal Apgar score (1 min +3%, 5 min +1%). The cost of the programme was international dollar (INT$)308/child. From both costing perspectives, the programme yielded higher effects and lower costs than care-as-usual, being thus cost-saving (probability of around 50%). CONCLUSIONS Our findings suggest that the Salut Programme is an effective universal intervention to improve maternal and child health, and it may be good value for money; however, there is large uncertainty around the cost estimates.
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Affiliation(s)
- Jenny Häggström
- Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Eurenius
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anni-Maria Pulkki-Brännström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Chaparro MP, de Luna X, Häggström J, Ivarsson A, Lindgren U, Nilsson K, Koupil I. Childhood family structure and women's adult overweight risk: A longitudinal study. Scand J Public Health 2017; 45:511-519. [PMID: 28482752 DOI: 10.1177/1403494817705997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to investigate whether women's adult overweight and obesity risk was associated with their childhood family structure, measured as their mothers' marital status history, during the women's first 18 years of life. METHODS Using linked register data, we analyzed 30,584 primiparous women born in Sweden in 1975 who were between 19-35 years of age when their height and pre-pregnancy weight was recorded. The outcomes were women's overweight/obesity (body mass index (BMI) ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) and the predictor was mothers' marital status history, which was summarized using sequence analysis. We carried out nested logistic regression models adjusting for women's age and maternal sociodemographic characteristics. RESULTS Mothers' marital status history was summarized into six clusters: stable marriage, stable cohabitation, married then divorcing, cohabiting then separating, varied transitions, and not with father. In fully adjusted models and compared with women whose mothers belonged to the stable marriage cluster: (1) women whose mothers belonged to the other marital status clusters had higher odds of overweight/obesity (odds ratio (OR) ranging 1.15-1.19; p < 0.05); and (2) women whose mothers belonged to the stable cohabitation (OR = 1.31; 95% confidence interval (CI) = 1.14-1.52), cohabiting then separating (OR = 1.23; 95% CI = 1.01-1.49), varied transitions (OR = 1.24; 95% CI = 1.11-1.39), and not with father (OR = 1.24; 95% CI = 1.00-1.54) clusters had higher odds of obesity. CONCLUSIONS Women whose mothers were not in stable marriage relationships had higher odds of being overweight or obese in adulthood. The finding that even women raised in the context of stable cohabitation had higher odds of being overweight or obese is intriguing as these relationships are socially accepted in Sweden.
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Affiliation(s)
- M Pia Chaparro
- 1 Centre for Health Equity Studies (CHESS), Stockholm University & Karolinska Institutet, Stockholm, Sweden.,2 Present affiliation: Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Xavier de Luna
- 3 Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden
| | - Jenny Häggström
- 3 Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- 4 Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
| | - Urban Lindgren
- 5 Department of Geography and Economic History, Umeå University, Umeå, Sweden
| | - Karina Nilsson
- 6 Department of Sociology, Umeå University, Umeå, Sweden
| | - Ilona Koupil
- 1 Centre for Health Equity Studies (CHESS), Stockholm University & Karolinska Institutet, Stockholm, Sweden.,7 Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
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Namatovu F, Lindkvist M, Olsson C, Ivarsson A, Sandström O. Season and region of birth as risk factors for coeliac disease a key to the aetiology? Arch Dis Child 2016; 101:1114-1118. [PMID: 27528621 PMCID: PMC5256417 DOI: 10.1136/archdischild-2015-310122] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 06/14/2016] [Accepted: 06/26/2016] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Fredinah Namatovu
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Cecilia Olsson
- Department of Food and Nutrition, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Olof Sandström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden,Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Feldman I, Eurenius E, Häggström J, Sampaio F, Lindkvist M, Pulkki-Brännström AM, Ivarsson A. Effectiveness of the Salut Program: a universal health promotion intervention for parents & children. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw171.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Edin K, Nilsson B, Ivarsson A, Kinsman J, Norris SA, Kahn K. Perspectives on intimate relationships among young people in rural South Africa: the logic of risk. Cult Health Sex 2016; 18:1010-1024. [PMID: 26986221 DOI: 10.1080/13691058.2016.1155749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper explores how young people in rural South Africa understand gender, dating, sexuality and risk-taking in adolescence. The empirical material drawn upon consists of 20 interviews with young men and women (aged 18-19) and reflects normative gender patterns characterised by compulsory heterosexuality and dating as obligatory, and representing key symbols of normality. However, different meanings of heterosexual relationships are articulated in the interviews, for example in the recurring concept of 'passing time', and these meanings show that a relationship can be something arbitrary: a way to reduce boredom and have casual sex. Such a rationale for engaging in a relationship reflects one of several other normative gender patterns, which relate to the trivialisation of dating and sexual risk-taking, and which entail making compromises and legitimising deviations from the 'ideal' life-script and the hope of a better future. However, risks do not exclusively represent something bad, dangerous or immoral, because they are also used as excuses to avoid sex, HIV acquisition and early pregnancy. In conclusion, various interrelated issues can both undermine and/or reinforce risk awareness and subsequent risk behaviour. Recognition of this tension is essential when framing policies to support young people to reduce sexual risk-taking behaviour.
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Affiliation(s)
- Kerstin Edin
- a Department of Nursing, Midwifery , Umeå University , Umeå , Sweden
- b Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit , Umeå University , Umeå , Sweden
- e MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Bo Nilsson
- c Department of Culture and Media Studies , Umeå University , Umeå , Sweden
| | - Anneli Ivarsson
- b Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit , Umeå University , Umeå , Sweden
- e MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - John Kinsman
- b Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit , Umeå University , Umeå , Sweden
| | - Shane A Norris
- d MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Kathleen Kahn
- b Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit , Umeå University , Umeå , Sweden
- e MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
- f INDEPTH Network , Accra , Ghana
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Feldman I, Eurenius E, Häggström J, Sampaio F, Lindkvist M, Pulkki-Brännström AM, Ivarsson A. Effectiveness and cost-effectiveness of the Salut Programme: a universal health promotion intervention for parents and children-protocol of a register-based retrospective observational study. BMJ Open 2016; 6:e011202. [PMID: 27491668 PMCID: PMC4985974 DOI: 10.1136/bmjopen-2016-011202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/10/2016] [Accepted: 07/14/2016] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION There is inadequate evidence for the effectiveness and cost-effectiveness of health promotion interventions. The Salut Programme aims to reach all parents and children in the Västerbotten County of Sweden with a combination of health promotion interventions initiated during pregnancy and continued over the childhood period. This study protocol describes an effectiveness study and an economic evaluation study, where the ongoing Salut Programme is compared to care-as-usual over the periods of pregnancy, delivery and the child's first 2 years of life. METHODS A register-based retrospective observational study design will be used with existing data sources with respect to exposures and outcomes. Outcomes of interest are clustered at 3 points: around the child's birth, 1 month after the child's birth and 2 years after the child's birth. We will simulate an experiment by retrospectively identifying and comparing children and their parents in the geographical areas where the Salut Programme was implemented since 2006 and onwards, and the areas where the Programme was not implemented before 2009. Outcomes will be analysed and compared for the premeasure period, and the postmeasure period for both groups. Our analysis combines difference-in-difference estimation with matching. A complementary analysis will be carried out on the longitudinal subsample of mothers who gave birth at least once during each of the time periods. The economic evaluation aims to capture the wider societal costs and benefits of the Salut Programme for the first 2 years of the children's lives. Incremental costs will be compared with incremental health gains and the results will be presented as a cost-consequence analysis. ETHICS AND DISSEMINATION The Regional Ethical Review Board in Umeå has given clearance for the Salut Programme research (2010-63-31M). No individual's identity will be revealed when presenting results. This study will provide information that can guide decision-makers to allocate resources optimally.
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Affiliation(s)
- Inna Feldman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Eva Eurenius
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Jenny Häggström
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - Filipa Sampaio
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - Anni-Maria Pulkki-Brännström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Mosquera PA, San Sebastian M, Waenerlund AK, Ivarsson A, Weinehall L, Gustafsson PE. Corrigendum to ‘Income-related inequalities in cardiovascular disease from mid-life to old age in a Northern Swedish cohort: A decomposition analysis’ [Soc. Sci. Med. 149C (2016) 135–144]. Soc Sci Med 2016; 160:128. [DOI: 10.1016/j.socscimed.2016.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Namatovu F, Olsson C, Lindkvist M, Myléus A, Högberg U, Ivarsson A, Sandström O. Maternal and perinatal conditions and the risk of developing celiac disease during childhood. BMC Pediatr 2016; 16:77. [PMID: 27267234 PMCID: PMC4897811 DOI: 10.1186/s12887-016-0613-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/01/2016] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Fredinah Namatovu
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden.
| | - Cecilia Olsson
- Department of Food and Nutrition, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden
| | - Anna Myléus
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden
| | - Ulf Högberg
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden.,Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, Uppsala, Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden
| | - Olof Sandström
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Westerlund A, Garvare R, Nyström ME, Eurenius E, Lindkvist M, Ivarsson A. Managing the initiation and early implementation of health promotion interventions: a study of a parental support programme in primary care. Scand J Caring Sci 2016; 31:128-138. [PMID: 27246248 DOI: 10.1111/scs.12329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 12/11/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Mental health problems are increasing among children and adolescents worldwide, and parental support programmes have been suggested as one preventive intervention. However, the actual impact and low rates of adoption and sustainability of prevention programmes have proven to be a concern, and thus, further studies on their implementation are needed. AIM This study focused on the initial implementation of the International Child Development Programme (ICDP) in primary care. The aim was to investigate the involved actors' views on factors likely to affect implementation and the strategies used to manage them. DESIGN A case study design with a mixed-methods approach combining quantitative and qualitative data from questionnaires and interviews was used. METHODS Eighty-two professionals at different positions in the involved organisations participated. Directed content analysis was used for analyses, focusing on perceived levels of importance and the manifestation of implementation factors. FINDINGS Interviews and questionnaires provided descriptions of factors influencing the initial ICDP implementation. Uncertainty on how to manage important factors and vague change strategies was reported. Discrepancies in the perceived levels of importance versus manifestation were found regarding several factors, including hands-on support, time and resources, communication and information, a comprehensive plan of action, follow-ups, and external and internal collaborations. Manifested factors were a need for change, motivation and the ICDP's compatibility with existing norms, values and practices. CONCLUSIONS Implementing a parental support programme in a complex setting will benefit from being preceded by a thorough examination of the intervention and the target context and the development of clear implementation strategies based on the results of that examination. This study provides insights into how and by whom knowledge on implementation is applied during the launch of a health promotion programme, and these insights might help increase the rate of adoption and the use of such programmes and thereby increase their effectiveness.
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Affiliation(s)
- Anna Westerlund
- Department of Public Health and Clinical Medicine, Epidemiology and Global health, Umeå University, Umeå, Sweden
| | - Rickard Garvare
- Department of Business Administration, Technology and Social Sciences, Luleå University of Technology, Luleå, Sweden
| | - Monica E Nyström
- Department of Public Health and Clinical Medicine, Epidemiology and Global health, Umeå University, Umeå, Sweden.,Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Eva Eurenius
- Department of Public Health and Clinical Medicine, Epidemiology and Global health, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global health, Umeå University, Umeå, Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global health, Umeå University, Umeå, Sweden
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Lindqvist M, Lindkvist M, Eurenius E, Persson M, Ivarsson A, Mogren I. Leisure time physical activity among pregnant women and its associations with maternal characteristics and pregnancy outcomes. Sex Reprod Healthc 2016; 9:14-20. [PMID: 27634659 DOI: 10.1016/j.srhc.2016.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/15/2016] [Accepted: 03/31/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Physical activity during pregnancy is generally considered safe and beneficial for both the pregnant woman and her fetus. The overall aim was to investigate pregnant women's pre-pregnancy and early pregnancy physical activity and its associations with maternal characteristics and pregnancy outcomes. METHODS This cross-sectional study combined data from the Maternal Health Care Register in Västerbotten (MHCR-VB) and the Salut Programme Register (Salut-R). Data were collected from 3,868 pregnant women living in northern Sweden between 2011 and 2012. RESULTS Almost half of the participants (47.1%) achieved the recommended level of physical activity. Compared to the women who did not achieve the recommended level of exercise, these women had lower BMI, very good or good self-rated health, and a higher educational level. No significant associations could be established between physical activity levels and GDM, birth weight, or mode of delivery. CONCLUSIONS Positively, a considerably high proportion of Swedish pregnant women achieved the recommended level of physical activity. Factors associated with recommended physical activity level were BMI ≤30 kg/m(2), very good or good self-rated health, and higher educational level. Our findings emphasize the need for health care professionals to early detect and promote fertile and pregnant women towards health-enhancing physical activity, especially those with low levels of physical activity and overweight/obesity, to improve overall health in this population.
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Affiliation(s)
- Maria Lindqvist
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden.
| | - Marie Lindkvist
- Department of Statistics, Umeå University, 901 87 Umeå, Sweden; Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Eva Eurenius
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | | | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden
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Lindgren U, Nilsson K, de Luna X, Ivarsson A. Data Resource Profile: Swedish Microdata Research from Childhood into Lifelong Health and Welfare (Umeå SIMSAM Lab). Int J Epidemiol 2016; 45:1075-1075g. [PMID: 27170765 DOI: 10.1093/ije/dyv358] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 02/07/2023] Open
Affiliation(s)
| | | | - Xavier de Luna
- Department of Statistics, Umeå School of Business and Economics
| | - Anneli Ivarsson
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Mosquera PA, San Sebastian M, Waenerlund AK, Ivarsson A, Weinehall L, Gustafsson PE. Income-related inequalities in cardiovascular disease from mid-life to old age in a Northern Swedish cohort: A decomposition analysis. Soc Sci Med 2016; 149:135-44. [DOI: 10.1016/j.socscimed.2015.12.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/07/2015] [Accepted: 12/13/2015] [Indexed: 10/22/2022]
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Lindkvist M, Ivarsson A, Silfverdal SA, Eurenius E. Associations between toddlers' and parents' BMI, in relation to family socio-demography: a cross-sectional study. BMC Public Health 2015; 15:1252. [PMID: 26679345 PMCID: PMC4683751 DOI: 10.1186/s12889-015-2602-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 12/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well established that the pregnancy and the first years of life are important for future childhood health and body weight. Even though current evidence suggests that both parents are important for childhood health, the influence that parents' BMI and socio-demography has on toddlers' BMI has so far received little attention. This study aimed to increase our knowledge on the association between toddlers' and parents' BMI, in relation to family socio-demography. Further, the aim was to investigate the interaction between the mothers' and fathers' BMI in relation to their child's BMI. METHODS A total of 697 children with a median age of 18 months (range 16-24 months) participated in the study along with their mothers (n = 697) and fathers (n = 674). As regards representability, our parental sample had a lower proportion of immigrants and the parents were more gainfully employed compared to parents in the rest of Sweden (when the child was 18 months old). The parents completed a questionnaire on parental and child health. Data on parental weight, height, and socio-demographics were recorded along with the child's weight and height measured at an ordinary child health care visit. We used the thresholds for children's BMI that were recommended for surveillance by the Royal College of Paediatrics and Child Health in 2012 based on the WHO reference population. RESULTS Among the toddlers, 33 % had a BMI above the WHO 85(th) percentile and 14 % had a BMI above the WHO 95(th) percentile. The probability of a toddler having a BMI above the WHO 95(th) percentile was significantly increased if either the mother or father was overweight (BMI ≥ 25 kg/m(2)). Furthermore, we found a positive synergistic effect between the mother and father being overweight and their child having a BMI above the WHO 85(th) percentile. No associations were found between the toddlers' BMI and the family's socio-demographics, but there were associations between the parents' BMI and the family's socio-demographics. CONCLUSION High BMI is common even in toddlers in this population. The risk increases if one parent is overweight, and it increases even more if both parents are overweight. The results in this study confirm the importance of considering familial risk factors when examining child health and BMI at ordinary child health care visits already at an early age.
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Affiliation(s)
- Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE, 901 87, Umeå, Sweden. .,Department of Statistics, USBE, Umeå University, SE, 901 87, Umeå, Sweden.
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE, 901 87, Umeå, Sweden.
| | - Sven Arne Silfverdal
- Department of Clinical Science, Paediatrics, Umeå University, SE, 901 87, Umeå, Sweden.
| | - Eva Eurenius
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE, 901 87, Umeå, Sweden.
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Tranaeus U, Ivarsson A, Johnson U. Evaluation of the effects of psychological prevention interventions on sport injuries: A meta-analysis. Sci Sports 2015. [DOI: 10.1016/j.scispo.2015.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Norström F, Ivarsson A, Nordyke K, Sandström O, Carlsson A, Hammarroth S, Högberg L, Stenhammar L, Lindholm L. The Cost-Effectiveness of a Screening for Celiac Disease. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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