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  • 101. Atkinson, Jo-An
    et al.
    Prodan, Ante
    Livingston, Michael
    Knowles, Dylan
    O'Donnell, Eloise
    Room, Robin
    La Trobe University, Australia.
    Indig, Devon
    Page, Andrew
    McDonnell, Geoff
    Wiggers, John
    Impacts of licensed premises trading hour policies on alcohol-related harms2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 7, p. 1244-1251Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIM: Evaluations of alcohol policy changes demonstrate that restriction of trading hours of both 'on'- and 'off'-licence venues can be an effective means of reducing rates of alcohol-related harm. Despite this, the effects of different trading hour policy options over time, accounting for different contexts and demographic characteristics, and the common co-occurrence of other harm reduction strategies in trading hour policy initiatives, are difficult to estimate. The aim of this study was to use dynamic simulation modelling to compare estimated impacts over time of a range of trading hour policy options on various indicators of acute alcohol-related harm.

    METHODS: An agent-based model of alcohol consumption in New South Wales, Australia was developed using existing research evidence, analysis of available data and a structured approach to incorporating expert opinion. Five policy scenarios were simulated, including restrictions to trading hours of on-licence venues and extensions to trading hours of bottle shops. The impact of the scenarios on four measures of alcohol-related harm were considered: total acute harms, alcohol-related violence, emergency department (ED) presentations and hospitalizations.

    RESULTS: Simulation of a 3 a.m. (rather than 5 a.m.) closing time resulted in an estimated 12.3 ± 2.4% reduction in total acute alcohol-related harms, a 7.9 ± 0.8% reduction in violence, an 11.9 ± 2.1% reduction in ED presentations and a 9.5 ± 1.8% reduction in hospitalizations. Further reductions were achieved simulating a 1 a.m. closing time, including a 17.5 ± 1.1% reduction in alcohol-related violence. Simulated extensions to bottle shop trading hours resulted in increases in rates of all four measures of harm, although most of the effects came from increasing operating hours from 10 p.m. to 11 p.m.

    CONCLUSIONS: An agent-based simulation model suggests that restricting trading hours of licensed venues reduces rates of alcohol-related harm and extending trading hours of bottle shops increases rates of alcohol-related harm. The model can estimate the effects of a range of policy options.

  • 102.
    Atti, Anna Rita
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Forlani, Claudia
    de Ronchi, Diana
    Palmer, Katie
    Casadio, Paola
    Dalmonte, Edoardo
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Cognitive Impairment after Age 60: clinical and Social Correlates in the "Faenza Project"2010In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 21, no 4, p. 1325-1334Article in journal (Refereed)
    Abstract [en]

    A total of 7,389 dementia-free elderly (60–102 years old) enrolled in the "Faenza Project" (Northern Italy) were clinically evaluated by nurses and physicians with the aim of detecting the independent and combined association of medical and social factors with cognitive status. Cognitive Impairment No Dementia (CIND) was defined for MMSE scores ⩽ 2 standard deviations than the age- and education-corrected mean score obtained by the non-demented persons of the Faenza cohort. Logistic Regression analysis was used to estimate Odds Ratios and 95% Confidence Intervals (OR, 95%CI) for CIND. The diagnostic procedure identified 402 (5.4%) CIND cases. Diabetes (OR, 95%CI=1.6, 1.2–2.2), stroke (OR, 95%CI=1.9, 1.4–2.6), and depressive symptoms (OR, 95%CI=1.9, 1.4–2.7) emerged as the most relevant medical comorbidities of CIND. Low education (OR, 95%CI=1.8, 1.1–2.9), low Socio Economic Status (SES) (OR, 95%CI=1.5, 1.1–2.1), and unmarried status (OR, 95%CI=1.7, 1.2–2.5) were associated with CIND. Medical and social factors were independently related to CIND occurrence. In comparison to subjects without any of the above mentioned conditions, subjects with one medical and one social factor had an OR, 95%CI for CIND equal to 6.0, 2.9–12.4. The strength of the association increased when more of those conditions occurred in combination, suggesting a synergistic effect. Despite some methodological limitations, data from this cross-sectional population-based Italian study show that low education, low SES, unmarried status together with diabetes, stroke, and depressive symptoms are related to cognitive impairment in the general population. The interaction of medical and social factors further increases the probability of CIND.

  • 103. Atzendorf, Josefine
    et al.
    Apfelbacher, Christian
    Gomes de Matos, Elena
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Hungary.
    Piontek, Daniela
    Patterns of multiple lifestyle risk factors and their link to mental health in the German adult population: a cross-sectional study2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 12, article id e022184Article in journal (Refereed)
    Abstract [en]

    Objectives Lifestyle risk factors, such as drinking or unhealthy diet, can expotentiate detrimental health effects. Therefore, it is important to investigate multiple lifestyle risk factors instead of single ones. The study aims at: (1) identifying patterns of lifestyle risk factors within the adult general population in Germany and (2) examining associations between the extracted patterns and external factors.

    Design Cross-sectional study.

    Setting General German adult population (aged 18–64 years).

    Participants Participants of the 2015 Epidemiological Survey of Substance Abuse (n=9204).

    Primary outcome measures Lifestyle risk factors (daily smoking, at-risk alcohol consumption, unhealthy diet, low physical activity, weekly use of pharmaceuticals, as well as consumption of cannabis and other illicit drugs).

    Results A latent class analysis was applied to identify patterns of lifestyle risk factors, and a multinomial logistic regression was carried out to examine associations between the extracted classes and external factors. A total of four classes were extracted which can be described as healthy lifestyle (58.5%), drinking lifestyle (24.4%), smoking lifestyle (15.4%) and a cumulate risk factors lifestyle (1.7%). Individuals who were male, at younger age and single as well as individuals with various mental health problems were more likely to show multiple lifestyle risk factors.

    Conclusions Healthcare professionals should be aware of correlations between different lifestyle risk factors as well as between lifestyle risk groups and mental health. Health promotion strategies should further focus especially on younger and single men.

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

  • 104. Atzendorf, Josefine
    et al.
    Aschenbrenner, Annika Berit
    de Matos, Elena Gomes
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. FT Institut für Therapieforschung, Germany; Eötvös Loránd University, Hungary.
    Kroeger, Christoph
    Delle, Simone
    Piontek, Daniela
    E-Zigaretten: Einschätzung vonGesundheitsgefahren undNutzung zur Tabakentwöhnung2018In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, ISSN 1436-9990, Vol. 61, no 11, p. 1415-1421Article in journal (Refereed)
    Abstract [de]

    BackgroundThe perception that e-cigarettes are less harmful than traditional tobacco products can influence the consumption of e-cigarettes.ObjectivesThree questions were examined: (1)How do different population groups perceive health risks of e-cigarettes? (2)Do sociodemographic variables explain differences in the risk assessment of e-cigarettes? (3)Does the perception of health risks predict the use of e-cigarettes for smoking cessation?MethodsData came from the 2015 Epidemiological Survey of Substance Abuse (ESA) with asample size of n=9204 participants, aged 18 to 64years (response rate 52.2%). Data were collected by telephone, online, or by written questionnaires. Assessments of risk perception of e-cigarettes and conventional cigarettes (more harmful, just as harmful, less harmful, do not know) were compared. Descriptive statistics and logistic regressions were performed.ResultsIndividuals with lower education rated e-cigarettes as more harmful. Older people and women perceived e-cigarettes as just as harmful. Smokers considered e-cigarettes to be more harmful than or just as harmful as conventional tobacco products. The likelihood of using e-cigarettes for smoking cessation was higher if people thought they were less harmful than conventional cigarettes.ConclusionsOnly one-third of the population knows that e-cigarettes are less harmful to health than conventional cigarettes. The perception of health risks is related to the usage of e-cigarettes for smoking cessation.

  • 105. Atzendorf, Josefine
    et al.
    Gomes de Matos, Elena
    Kröger, Christoph
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Hungary.
    Piontek, Daniela
    Die Nutzung von E-Zigaretten in der deutschen Bevölkerung – Ergebnisse des Epidemiologischen Suchtsurvey 20152019In: Das Gesundheitswesen, ISSN 0941-3790, E-ISSN 1439-4421, Vol. 81, no 02, p. 137-143Article in journal (Refereed)
    Abstract [en]

    Aim Estimates of e-cigarette consumption in Germany vary considerably. The use of e-cigarettes for tobacco cessation is critically discussed. Based on current data, the distribution of the consumption of e-cigarettes and their use in the adult general population of Germany will be presented.

    Methods The 2015 Epidemiological Survey of Substance Abuse, a nationwide survey of 18 to 64 year-old people in Germany (n=9,204, response rate: 52,2%), was used as data basis.

    Results E-cigarettes were known to most of the respondents (85,3%, 43,5 Mio.), whereas only 2,9% (1,5 Mio.) used e-cigarettes in the last 30 days. Higher risk of consuming e-cigarettes was seen in younger people (OR=0,95, 95%-KI=(0,93; 0,97)), men (OR=1,45, 95%-KI=(1,02; 2,07)) and smokers (OR=12,53, 95%-KI=(8,71; 18,03)). About a third of smokers and ex-smokers of conventional cigarettes (36,6%) who consumed e-cigarettes used these for tobacco cessation of which one fifth (21,3%) was able to quit smoking.

    Conclusion E-cigarette users seem to be more likely to be male, younger and smokers of conventional cigarettes. In addition to curiosity, the change in smoking behavior is an important motive for consumption. The results indicate that the use of e-cigarettes can contribute to tobacco cessation, the majority of users, however, continue to consume conventional and/or e-cigarettes.

  • 106. Atzendorf, Josefine
    et al.
    Rauschert, Christian
    Seitz, Nicki-Nils
    Lochbühler, Kirsten
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Eötvös Loránd University, Hungary.
    The Use of Alcohol, Tobacco, Illegal Drugs and Medicines: An Estimate of Consumption and Substance-Related Disorders in Germany2019In: Deutsches Ärzteblatt International, ISSN 1866-0452, E-ISSN 1866-0452, Vol. 116, no 35-36, p. 577-584Article in journal (Refereed)
    Abstract [en]

    Background: Prevalence estimates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications and of substance-related disorders enable an assessment of the effects of substance use on health and society.Methods: The data used for this study were derived from the 2018 Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey, ESA). The sample of the German adult population comprised 9267 persons aged 18 to 64 (response rate, 42%). Population estimates were obtained by extrapolation to a total resident population of 51 544 494 people.Results: In the 30 days prior to the survey, 71.6% of the respondents (corresponding to 36.9 million persons in the population) had consumed alcohol, and 28.0% (14.4 million) had consumed tobacco. 4.0% reported having used e-cigarettes, and 0.8% reported having used heat-not-burn products. Among illegal drugs, cannabis was the most commonly used, with a 12-month prevalence of 7.1% (3.7 million), followed by amphetamines (1.2%: 619 000). The prevalence of the use of analgesics without a prescription (31.4%) was markedly higher than that of the use of prescribed analgesics (17.5%, 26.0 million); however, analgesics were taken daily less commonly than other types of medication. 13.5% of the sample (7.0 million) had at least one dependence diagnosis (12-month prevalence).Conclusion: Substance use and the consumption of psychoactive medications are widespread in the German population. Substance-related disorders are a major burden to society, with legal substances causing greater burden than illegal substances.

  • 107. Au, Lauren E.
    et al.
    Zhu, Sonya M.
    Nhan, Lilly A.
    Plank, Kaela R.
    Frongillo, Edward A.
    Laraia, Barbara A.
    Gurzo, Klara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Ritchie, Lorrene D.
    Household Food Insecurity Is Associated with Higher Adiposity among US Schoolchildren Ages 10-15 Years: The Healthy Communities Study2019In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 149, no 9, p. 1642-1650Article in journal (Refereed)
    Abstract [en]

    Background: Limited research exists on the relationship between food insecurity and children's adiposity and diet and how it varies by demographic characteristics in the United States. Objective: The aim of this study was to assess the relationship between household food insecurity and child adiposityrelated outcomes, measured as BMI (kg/m(2)) z score (BMI-z), weight status, andwaist circumference, and diet outcomes, and examined if the associations differ by age, sex, and race/ethnicity. Methods: Data collected in 2013-2015 from 5138 US schoolchildren ages 4-15 y from 130 communities in the cross-sectional Healthy Communities Study were analyzed. Household food insecurity was self-reported using a validated 2-item screener. Dietary intake was assessed using the 26-item National Cancer Institute's Dietary Screener Questionnaire, and dietary behaviors were assessed using a household survey. Data were analyzed using multilevel statistical models, including tests for interaction by age, sex, and race/ethnicity. Results: Children from food-insecure households had higher BMI-z (beta: 0.14; 95% CI: 0.06, 0.21), waist circumference (beta: 0.91 cm; 95% CI: 0.18, 1.63), odds of being overweight or obese (OR: 1.17; 95% CI: 1.02, 1.34), consumed more sugar from sugar-sweetened beverages (beta : 1.44 g/d; 95% CI: 0.35, 2.54), and less frequently ate breakfast (beta: -0.28 d/wk; 95% CI: -0.39, -0.17) and dinner with family (beta(:) -0.22 d/wk; 95% CI: -0.37, -0.06) compared to children from food-secure households. When examined by age groups (4-9 and 10-15 y), significant relationships were observed only for older children. There were no significant interactions by sex or race/ethnicity. Conclusions: Household food insecurity was associated with higher child adiposity-related outcomes and several nutrition behaviors, particularly among older children, 10-15 y old.

  • 108. Auguer, Nathalie
    et al.
    Le Serbon, Emelie
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Leaving Sweden behind: gains in life expectancy in Canada2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 4, p. 340-347Article in journal (Refereed)
    Abstract [en]

    Aims: Sweden and Canada are known for quality of living and exceedingly high life expectancy, but recent data on how these countries compare are lacking. We measured life expectancy in Canada and Sweden during the past decade, and identified factors responsible for changes over time. Methods: We calculated life expectancy at birth for Canada and Sweden annually from 2000 to 2010, and determined the ages and causes of death responsible for the gap between the two countries using Arriaga's method. We determined how population growth, ageing, and mortality influenced the number of deaths over time. Results: During 2000-2010, life expectancy in Canada caught up with Sweden for men, and surpassed Sweden by 0.4 years for women. Sweden lost ground owing to a slower reduction in circulatory and tumour mortality after age 65 years compared with Canada. Nonetheless, population ageing increased the number of deaths in Canada, especially for mental and nervous system disorders. In Sweden, the number of deaths decreased. Conclusions: In only one decade, life expectancy in Canada caught up and surpassed Sweden due to rapid improvements in circulatory and tumour mortality. Population ageing increased the number of deaths in Canada, potentially stressing the health care system more than in Sweden.

  • 109.
    Aust, Christina
    et al.
    Stockholm University, Faculty of Social Sciences, Specialpedagogiska institutionen.
    Tallkvist, Anna
    Stockholm University, Faculty of Social Sciences, Specialpedagogiska institutionen.
    Idrott för barn och ungdomar med funktionsnedsättning2008Student thesis
  • 110. Avdic, Daniel
    et al.
    Hägglund, Pathric
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Lindahl, Bertil
    Johansson, Per
    Sex differences in sickness absence and the morbidity-mortality paradox: a longitudinal study using Swedish administrative registers2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 8Article in journal (Refereed)
    Abstract [en]

    Objective To analyse whether gender-specific health behaviour can be an explanation for why women outlive men, while having worse morbidity outcomes, known as the morbidity-mortality or gender paradox. Setting The working population in Sweden. Participants Thirty per cent random sample of Swedish women and men aged 40-59 with a hospital admission in the 1993-2004 period were included. The sample for analysis consists of 233274 individuals (115430 men and 117844 women) and in total 1 867013 observations on sickness absence. Intervention Hospital admission across 18 disease categories. Main outcome measures The main outcome measures were sickness absence (morbidity) and mortality. Longitudinal data at the individual level allow us to study how sickness absence changed after a hospital admission in men and women using a difference-in-differences regression analysis. Cox regression models are used to study differences in mortality after the admission. Results Women increased their sickness absence after a hospital admission by around five more days per year than men (95% CI 5.25 to 6.22). At the same time, men had higher mortality in the 18 diagnosis categories analysed. The pattern of more sickness absence in women was the same across 17 different diagnosis categories. For neoplasm, with a 57% higher risk of death for men (54.18%-59.89%), the results depended on the imputation method of sickness for those deceased. By using the premortality means of sickness absence, men had an additional 14.47 (-16.30- -12.64) days of absence, but with zero imputation women had an additional 1.6 days of absence (0.05-3.20). Analyses with or without covariates revealed a coherent picture. Conclusions The pattern of increased sickness absence (morbidity) and lower mortality in women provides evidence on the more proactive and preventive behaviour of women than of men, which could thus explain the morbidity-mortality paradox.

  • 111. Avendano, Mauricio
    et al.
    Moustgaard, Heta
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). University of Helsinki, Finland; The Max Planck Institute for Demographic Research, Germany.
    Are some populations resilient to recessions? Economic fluctuations and mortality during a period of economic decline and recovery in Finland2017In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 32, no 1, p. 77-85Article in journal (Refereed)
    Abstract [en]

    This paper uses individual-level longitudinal data on working-age Finns to examine the health effects of economic fluctuations during a period of economic decline (1989-1996) and recovery (1997-2007) in Finland. We used a nationally representative, longitudinal sample formed by linking population, employment and mortality registers (n = 698,484; 7,719,870 person-years). We implemented a region fixed-effect model that exploits within-regional variations over time in the unemployment rate to identify the effect of economic fluctuations on mortality, controlling for individual employment transitions. Unemployment rates increased from 5.2 % in 1989 to 19.8 % in 1996, declining gradually thereafter and reaching 9.7 % in 2007. Results indicate that these large fluctuations in the economy had no impact on the overall mortality of most working age Finns. The exception was highly educated men, who experienced an increase of 7 % (Rate ratio = 1.07, 95 % confidence interval 1.04, 1.10) for every one-point increase in the regional unemployment rate during the period 1989-1996 due to increased mortality from cardiovascular disease and suicide. This increase, however, was not robust in models that used the employment to population ratio as measure of the economy. Unemployment rates were unrelated to mortality among females, lower educated men, and among any group during economic recovery (1997-2007). For most Finns, we found no consistent evidence of changes in mortality in response to contractions or expansions in the economy. Possible explanations include the weak impact of the recession on wages, as well as the generous unemployment insurance and social benefit system in Finland.

  • 112. Axelsson, J.
    et al.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Gustavsson, P.
    Rudman, A.
    Selection into shift and night work2013Conference paper (Refereed)
  • 113.
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sleep, appearance and social interactions2014Conference paper (Other academic)
  • 114.
    Axelsson, John
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sömn och fysisk aktivitet2016In: FYSS 2017: fysisk aktivitet i sjukdomsprevention och sjukdomsbehandling, Stockholm: Läkartidningen förlag AB , 2016, 3, p. 171-183Chapter in book (Other academic)
  • 115.
    Axelsson, John
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Tigerström, L
    Does rapid eye movement (REM) sleep prepare the brain for wakening?2014In: Journal of sleep research, Special issue: 22nd Congress of the European Sleep Research Society, 16-20 September, 2014, Tallinn, Estonia, 2014Conference paper (Other academic)
  • 116.
    Axelsson, John
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lasselin, Julie
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Man flu is related to health communication rather than symptoms and suffering2018In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 360, article id k450Article in journal (Other academic)
  • 117.
    Axelsson, John
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Karshikoff, B.
    Hedman, E.
    Is health anxiety related to disease avoidance?2015In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 49, article id e47Article in journal (Refereed)
  • 118.
    Axelsson, John
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Rehman, Javaid-ur
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ekman, Rolf
    Miller, Gregory E.
    Höglund, Caroline Olgart
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska institutet, Sweden.
    Effects of Sustained Sleep Restriction on Mitogen-Stimulated Cytokines, Chemokines and T Helper 1/ T Helper 2 Balance in Humans2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 12, article id e82291Article in journal (Refereed)
    Abstract [en]

    Background: Recent studies suggest that acute sleep deprivation disrupts cellular immune responses by shifting T helper (Th) cell activity towards a Th2 cytokine profile. Since little is known about more long-term effects, we investigated how five days of sleep restriction would affect pro-inflammatory, chemotactic, Th1- and Th2 cytokine secretion. Methods: Nine healthy males participated in an experimental sleep protocol with two baseline sleep-wake cycles (sleep 23.00 - 07.00 h) followed by 5 days with restricted sleep (03.00 - 07.00 h). On the second baseline day and on the fifth day with restricted sleep, samples were drawn every third hour for determination of cytokines/chemokines (tumor necrosis factor alpha (TNF-alpha), interleukin (IL) -1 beta, IL-2, IL-4 and monocyte chemoattractant protein-1 (MCP-1)) after in vitro stimulation of whole blood samples with the mitogen phytohemagglutinin (PHA). Also leukocyte numbers, mononuclear cells and cortisol were analysed. Results: 5-days of sleep restriction affected PHA-induced immune responses in several ways. There was a general decrease of IL-2 production (p<.05). A shift in Th1/Th2 cytokine balance was also evident, as determined by a decrease in IL2/IL4 ratio. No other main effects of restricted sleep were shown. Two significant interactions showed that restricted sleep resulted in increased TNF-alpha and MCP-1 in the late evening and early night hours (p's<.05). In addition, all variables varied across the 24 h day. Conclusions: 5-days of sleep restriction is characterized by a shift towards Th2 activity (i.e. lower 1L-2/IL-4 ratio) which is similar to the effects of acute sleep deprivation and psychological stress. This may have implications for people suffering from conditions characterized by excessive Th2 activity like in allergic disease, such as asthma, for whom restricted sleep could have negative consequences.

  • 119.
    Axelsson, John
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Sundelin, Tina
    Olsson, Mats J.
    Sorjonen, Kimmo
    Axelsson, Charlotte
    Lasselin, Julie
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Universitätsklinikum Essen, Germany.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Identification of acutely sick people and facial cues of sickness2018In: Proceedings of the Royal Society of London. Biological Sciences, ISSN 0962-8452, E-ISSN 1471-2954, Vol. 285, no 1870, article id 20172430Article in journal (Refereed)
    Abstract [en]

    Detection and avoidance of sick individuals have been proposed as essential components in a behavioural defence against disease, limiting the risk of contamination. However, almost no knowledge exists on whether humans can detect sick individuals, and if so by what cues. Here, we demonstrate that untrained people can identify sick individuals above chance level by looking at facial photos taken 2 h after injection with a bacterial stimulus inducing an immune response (2.0 ng kg-1 lipopolysaccharide) or placebo, the global sensitivity index being d' = 0.405. Signal detection analysis (receiver operating characteristic curve area) showed an area of 0.62 (95% confidence intervals 0.60-0.63). Acutely sick people were rated by naive observers as having paler lips and skin, a more swollen face, droopier corners of the mouth, more hanging eyelids, redder eyes, and less glossy and patchy skin, as well as appearing more tired. Our findings suggest that facial cues associated with the skin, mouth and eyes can aid in the detection of acutely sick and potentially contagious people.

  • 120.
    Axelsson, Martin
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    HR-medarbetares upplevelser kring spelprevention och policyimplementering på arbetsplatsen2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The complex concept regarding harmful use of different nature, could be related to the use of alcohol, drugs or gambling. Such activities could affect the efficiency and productivity of an employee in a workplace environment in a negative way. At the request of the Public Health Agency of Sweden, a group of scientist was given the task to evaluate a project regarding education concerning problematic gambling. The purpose of the current study is to evaluate a project regarding education concerning gambling and gambling prevention, and was carried out by the organization Alna. Thematic analysis was used and collection of data was done with semi structured interviews, with ten HR-employees whose five organisations was included in the project Gambling and gambling preventive efforts directed towards the labour market. The results show that the methods and tools used by Alna is perceived as efficient and valuable by the participants. Some obstacles which works against efficient implementation of updated policies and guidelines were identified and these could consist of time constraints, under staffing or subordinated priority of the gambling issue per se. Furthermore it seems that the education project regarding gambling prevention performed by Alna has contributed to the development of policies and guidelines regarding harmful use of different kinds with focus on the gambling issue.  

  • 121.
    B. Almquist, Ylva
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Grotta, Alessandra
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Stenberg, Sten-Åke
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Cohort Profile Update: The Stockholm Birth Cohort Study2019In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685Article in journal (Refereed)
  • 122. Babor, Thomas
    et al.
    Caulkins, Jonathan
    Fischer, Benedikt
    Foxcroft, David
    Humphreys, Keith
    Medina-Mora, María Elena
    Obot, Isidore
    Rehm, Jürgen
    Reuter, Peter
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). University of Melbourne, Australia; AER Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Australia.
    Rossow, Ingeborg
    Strang, John
    Drug Policy and the Public Good2018 (ed. 2)Book (Refereed)
    Abstract [en]

    Drug Policy and the Public Good presents the accumulated scientific knowledge of direct relevance to the development of drug policy on local, national, and international levels. The book explores both illicit drug use and non-medical use of prescription medications within a public health perspective. A conceptual basis for a rational drug policy is presented, along with new epidemiological data on the global dimensions of drug misuse, significant trends in drug epidemics, and the global burden of disease attributable to drug misuse. The markets for both illicit and legally prescribed psychoactive substances are described, showing that these two sources of drug supply are becoming increasingly connected in many countries. The core of the book is a critical review of the cumulative scientific evidence in five general areas of drug policy: primary prevention programmes in schools and other settings; treatment interventions and harm reduction approaches; attempts to control the supply of illicit drugs, including drug interdiction and law enforcement; decriminalization and penal approaches; and control of the legal market through prescription drug regimes. The final chapters discuss the trend toward legalization of some psychoactive substances in different parts of the world and describe the need for a new approach to drug policy that is evidence-based, realistic, and coordinated. The evidence reviewed in this book suggests that an integrated and balanced approach to evidence-informed drug policy is more likely to benefit the public good than are uncoordinated efforts to reduce drug supply and demand.

  • 123. Babor, Thomas F.
    et al.
    Caulkins, Jonathan
    Fischer, Benedikt
    Foxcroft, David
    Medina-Mora, María Elena
    Obot, Isidore
    Rehm, Jürgen
    Reuter, Peter
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Rossow, Ingeborg
    Strang, John
    Drug Policy and the Public Good: a summary of the second edition2019In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 114, no 11, p. 1941-1950Article in journal (Refereed)
    Abstract [en]

    The second edition of Drug Policy and the Public Good presents up-to-date evidence relating to the development of drug policy at local, national and international levels. The book explores both illicit drug use and non-medical use of prescription medications from a public health perspective. The core of the book is a critical review of the scientific evidence in five areas of drug policy: (1) primary prevention programs in schools and other settings; (2) treatment interventions and harm reduction approaches; (3) attempts to control the supply of illicit drugs, including drug interdiction and law enforcement; (4) penal approaches, decriminalization and other alternatives; and (5) control of the legal market through prescription drug regimens. It also discusses the trend towards legalization of some psychoactive substances in some countries and the need for a new approach to drug policy that is evidence-based, realistic and coordinated. The accumulated evidence provides important information about effective and ineffective policies. Shifting the emphasis towards a public health approach should reduce the extent of illicit drug use, prevent the escalation of new epidemics and avoid the unintended consequences arising from the marginalization of drug users through severe criminal penalties.

  • 124. Babor, Thomas
    et al.
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Health services: Treatment of substance use disorders within health services2010In: ATLAS on substance use (2010): Resources for the prevention and treatment of substance use disorders / [ed] Wolrd Health Organization, WHO Library Cataloguing-in-Publication Data , 2010, p. 23-25Chapter in book (Other academic)
    Abstract [en]

    http://www.who.int/substance_abuse/publications/treatment/en/index.html

  • 125. Bagattini, Francesco
    et al.
    Karlsson, Isak
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Rebane, Jonathan
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Papapetrou, Panagiotis
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    A classification framework for exploiting sparse multi-variate temporal features with application to adverse drug event detection in medical records2019In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 19, article id 7Article in journal (Refereed)
    Abstract [en]

    Background: Adverse drug events (ADEs) as well as other preventable adverse events in the hospital setting incur a yearly monetary cost of approximately $3.5 billion, in the United States alone. Therefore, it is of paramount importance to reduce the impact and prevalence of ADEs within the healthcare sector, not only since it will result in reducing human suffering, but also as a means to substantially reduce economical strains on the healthcare system. One approach to mitigate this problem is to employ predictive models. While existing methods have been focusing on the exploitation of static features, limited attention has been given to temporal features.

    Methods: In this paper, we present a novel classification framework for detecting ADEs in complex Electronic health records (EHRs) by exploiting the temporality and sparsity of the underlying features. The proposed framework consists of three phases for transforming sparse and multi-variate time series features into a single-valued feature representation, which can then be used by any classifier. Moreover, we propose and evaluate three different strategies for leveraging feature sparsity by incorporating it into the new representation.

    Results: A large-scale evaluation on 15 ADE datasets extracted from a real-world EHR system shows that the proposed framework achieves significantly improved predictive performance compared to state-of-the-art. Moreover, our framework can reveal features that are clinically consistent with medical findings on ADE detection.

    Conclusions: Our study and experimental findings demonstrate that temporal multi-variate features of variable length and with high sparsity can be effectively utilized to predict ADEs from EHRs. Two key advantages of our framework are that it is method agnostic, i.e., versatile, and of low computational cost, i.e., fast; hence providing an important building block for future exploitation within the domain of machine learning from EHRs.

  • 126.
    Balk, Fabian G. P.
    et al.
    Stockholm University, Faculty of Science, Department of Environmental Science and Analytical Chemistry. Swiss Federal Institute of Aquatic Science and Technology, Switzerland.
    Winkens Pütz, Kerstin
    Stockholm University, Faculty of Science, Department of Environmental Science and Analytical Chemistry. Swedish Museum of Natural History, Sweden.
    Ribbenstedt, Anton
    Stockholm University, Faculty of Science, Department of Environmental Science and Analytical Chemistry.
    Gomis, Melissa I.
    Stockholm University, Faculty of Science, Department of Environmental Science and Analytical Chemistry. Université Paris-Saclay, France.
    Filipovic, Marko
    Stockholm University, Faculty of Science, Department of Environmental Science and Analytical Chemistry. NIRAS Sweden AB, Sweden.
    Cousins, Ian T.
    Stockholm University, Faculty of Science, Department of Environmental Science and Analytical Chemistry.
    Children's exposure to perfluoroalkyl acids - a modelling approach2019In: Environmental Science: Processes & Impacts, ISSN 2050-7887, E-ISSN 2050-7895, Vol. 21, no 11, p. 1875-1886Article in journal (Refereed)
    Abstract [en]

    Adults are mainly exposed to per- and polyfluoroalkyl substances (PFASs) via ingestion of food, inhalation of air and ingestion of dust, whereas for children the exposure to PFASs is largely unknown. This study aimed to reconstruct the serum concentrations of perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS) and perfluorohexane sulfonic acid (PFHxS) in children after infancy up to 10.5 years of age and to test if dietary intake is the major exposure pathway for children to PFOA, PFOS and PFHxS after infancy. For this work, a dataset from a Finnish child cohort study was available, which comprised serum concentrations of the studied perfluoroalkyl acids (PFAAs) and PFAS concentration measurements in dust and air samples from the children's bedrooms. The calculated PFAA intakes were used in a pharmacokinetic model to reconstruct the PFAA serum concentrations from 1 to 10.5 years of age. The calculated PFOA and PFOS intakes were close to current regulatory intake thresholds and diet was the major exposure medium for the 10.5 year-olds. The one-compartment PK model reconstructed median PFOA and PFOS serum concentrations well compared to corresponding measured median serum concentrations, while the modelled PFHxS serum concentrations showed a constant underestimation. The results imply that children's exposure to PFOA and PFOS after breastfeeding and with increasing age resembles the exposure of adults. Further, the children in the Finnish cohort experienced a rather constant exposure to PFOA and PFOS between 1 and 10.5 years of age. The PFHxS exposure sources and respective pharmacokinetic parameter estimations need further investigation.

  • 127. Ball, Frank
    et al.
    Britton, Tom
    Stockholm University, Faculty of Science, Department of Mathematics.
    House, Thomas
    Isham, Valerie
    Mollison, Denis
    Pellis, Lorenzo
    Tomba, Gianpaolo Scalia
    Seven challenges for metapopulation models of epidemics, including households models2015In: Epidemics, ISSN 1755-4365, E-ISSN 1878-0067, Vol. 10, p. 63-67Article in journal (Refereed)
    Abstract [en]

    This paper considers metapopulation models in the general sense, i.e. where the population is partitioned into sub-populations (groups, patches,...), irrespective of the biological interpretation they have, e.g. spatially segregated large sub-populations, small households or hosts themselves modelled as populations of pathogens. This framework has traditionally provided an attractive approach to incorporating more realistic contact structure into epidemic models, since it often preserves analytic tractability (in stochastic as well as deterministic models) but also captures the most salient structural inhomogeneity in contact patterns in many applied contexts. Despite the progress that has been made in both the theory and application of such metapopulation models, we present here several major challenges that remain for future work, focusing on models that, in contrast to agent-based ones, are amenable to mathematical analysis. The challenges range from clarifying the usefulness of systems of weakly-coupled large sub-populations in modelling the spread of specific diseases to developing a theory for endemic models with household structure. They include also developing inferential methods for data on the emerging phase of epidemics, extending metapopulation models to more complex forms of human social structure, developing metapopulation models to reflect spatial population structure, developing computationally efficient methods for calculating key epidemiological model quantities, and integrating within- and between-host dynamics in models.

  • 128. Balldin, Jan
    et al.
    Berglund, Kristina J.
    Berggren, Ulf
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Fahlke, Claudia
    TAQ1A1 Allele of the DRD2 Gene Region Contribute to Shorter Survival Time in Alcohol Dependent Individuals When Controlling for the Influence of Age and Gender. A Follow-up Study of 18 Years2018In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 53, no 3, p. 216-220Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the influence of the A1 allele of the TAQ1A polymorphism in the dopamine D2 receptor (DRD2) gene region on mortality in adult individuals with alcohol dependence. Methods: The study sample consisted of 359 alcohol-dependent individuals treated for severe alcohol withdrawal symptoms in 1997. Years of survival was studied in an 18-year follow-up. In the analyses, gender and age were controlled for. Results: At the 18-year follow-up, 53% individuals had deceased. The analyses showed that older age (P < 0.001), male gender (P < 0.05) and carrying the A1 allele (P < 0.01) all significantly and independently contributed to shorten years of survival. Among the deceased individuals, the genotype A1+ was the only significant contributor to shorten years of survival. Conclusions: An important contribution of the present study is that in alcohol dependence the Taq1A1 allele of the DRD2 gene region is a risk factor for premature death of similar importance as the well-known risk factors of age and gender. Short Summary: We investigated the influence of A1 allele of the TAQ1A polymorphism in DRD2 receptor gene region on mortality in alcohol-dependent individuals in an 18-year follow-up. Age, gender and the A1 allele contributed to shorten years of survival. Among the deceased, the A1+ was the only contributor to shorten years of survival.

  • 129.
    Banerjee, Albert
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    James, Robert
    McGregor, Margaret
    Lexchin, Joel
    Nursing Home Physicians Discuss Caring for Elderly Residents: An Exploratory Study2018In: Canadian Journal on Aging, ISSN 0714-9808, E-ISSN 1710-1107, Vol. 37, no 2, p. 133-144Article in journal (Refereed)
    Abstract [en]

    Despite the increasing complexity of nursing home care, the role of physicians caring for residents is largely unexplored. This international, exploratory study sought to learn about physicians' roles, responsibilities, and tasks as well as investigate the unique qualities of medical practice in nursing homes. We conducted interviews with 18 physicians, who reported making important contributions to the quality of resident care, including clarifying the goals of care, working to reduce unnecessary medication and hospitalization, as well as contributing to staff education. Nursing home practice involved physicians in networks of relations that were instrumental to the quality of medical care and physicians' job satisfaction. The importance of these relationships disrupts the oft-drawn boundary between the medical and the social, suggesting that good medical practice depends on good social practice. Reflecting the exploratory nature of the study, we recommend research to better understand and support the relational dimensions of nursing home medicine.

  • 130. Bao, Cuiping
    et al.
    Yang, Rongrong
    Pedersen, Nancy
    Xu, Weige
    Xu, Hui
    Song, Ruixue
    Qi, Xiuying
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Tianjin Medical University, China.
    Overweight in midlife and risk of cancer in late life: A nationwide Swedish twin study2019In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 144, no 9, p. 2128-2134Article in journal (Refereed)
    Abstract [en]

    Our study examined whether midlife overweight (body mass index [BMI] >= 25) is associated with late-life cancer risk and explored the role of genetic and early-life environmental factors in this association. The study included 14,766 individuals from the Swedish Twin Registry, whose midlife (30-50 years) height and weight were recorded. Information on cancer diagnoses in late life (>65 years) was derived from the National Patient Registry and Cancer Registry. Generalized estimating equation (GEE) models were used to analyze unmatched case-control data (controlled for the clustering of twins within a pair). A co-twin matched case-control analysis used conditional logistic regression to compare cancer-discordant twins. Of all participants, 3968 (26.9%) were overweight and 4253 (28.8%) had cancer. In multi-adjusted GEE models using normal-weight (BMI 18.5-24.9) participants as the reference group, overweight was related to higher risk of colon cancer (OR 1.36, 95% CI: 1.00-1.84, p = 0.049), liver cancer (OR 2.00, 95% CI: 1.11-3.62), cervix uteri cancer (OR 2.86, 95% CI: 1.19-6.91) and corpus uteri cancer (OR 1.78, 95% CI: 1.14-2.78) but lower risk of nonmelanoma skin cancer (OR 0.77, 95% CI: 0.66-0.90). In conditional logistic regression analysis, these associations were attenuated becoming nonsignificance. The difference in ORs from the unmatched and matched analyses was not significant. In conclusion, midlife overweight is associated with increased risk of late-life colon, liver and uterine cancer but reduced risk of late-life nonmelanoma skin cancer. Further investigations are warranted to explore the role of genetic and early-life environmental factors in these associations.

  • 131. Barbosa, Cristina
    et al.
    Feio, Paulo
    Fernandes, Ana
    Thorslund, Mats
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    GOVERNANCE STRATEGIES TO AN AGEING SOCIETY - LOCAL ROLL IN MULTI LEVEL PROCESSES2016In: Journal of Comparative Politics, ISSN 1337-7477, E-ISSN 1338-1385, Vol. 9, no 1, p. 4-18Article in journal (Refereed)
    Abstract [en]

    Demographic ageing marks strategic orientations and public policies. It's a challenge to societies, public and private institutions and Welfare State. The goal of this study is to understand the local governance strategies to an ageing population and the role of the local in multilevel governance processes. A qualitative methodology it was followed that supports analysis and understanding of both local ageing policies. The samples are case studies of two contexts, Portugal and Sweden, respectively city councils of Lisbon and Nacka, where stakeholders were interviewed. Different concepts and visions influence local ageing policies. Vertical coordination is easier to follow in Portugal, but without concrete laws, and in Sweden, horizontal coordination is emphasized between providers and municipalities. Local public intervention in ageing seeks renewed actions and this study allows to conclude that a perfect local policy doesn't exist. However in many aspects, can be complementary.

  • 132.
    Barclay, Kieron
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. London School of Economics and Political Science, UK; Max Planck Institute for Demographic Research, Germany.
    Myrskylä, Mikko
    Tynelius, Per
    Berglind, Daniel
    Rasmussen, Finn
    Birth order and hospitalization for alcohol and narcotics use in Sweden2016In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 167, p. 15-22Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies have shown that birth order is an important predictor of later life health as well as socioeconomic attainment. In this study, we examine the relationship between birth order and hospitalization for alcohol and narcotics use in Sweden. Methods: We study the relationship between birth order and hospitalization related to alcohol and narcotics use before and after the age of 20 using Swedish register data for cohorts born 1987-1994. We apply Cox proportional hazard models and use sibling fixed effects, eliminating confounding by factors shared by the siblings. Results: Before age 20 we find that later born siblings are hospitalized for alcohol use at a higher rate than first-borns, and there is a monotonic increase in the hazard of hospitalization with increasing birth order. Second-borns are hospitalized at a rate 47% higher than first-borns, and third-borns at a rate 65% higher. Similar patterns are observed for hospitalization for narcotics use. After age 20 the pattern is similar, but the association is weaker. These patterns are consistent across various sibling group sizes. Conclusions: Later born siblings are more likely to be hospitalized for both alcohol and narcotics use in Sweden. These birth order effects are substantial in size, and larger than the estimated sex differences for the risk of hospitalization related to alcohol and drug use before age 20, and previous estimates for socioeconomic status differences in alcohol and drug abuse.

  • 133. Barghadouch, Amina
    et al.
    Kristiansen, Maria
    Smith Jervelund, Signe
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Montgomery, Edith
    Norredam, Marie
    Refugee children have fewer contacts to psychiatric healthcare services: an analysis of a subset of refugee children compared to Danish-born peers2016In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 51, no 8, p. 1125-1136Article in journal (Refereed)
    Abstract [en]

    Studies show a high level of mental health problems among refugee children. This study examined whether a subset of refugee children living in Denmark accessed psychiatric healthcare services more than those born in the country. This study compared 24,427 refugee children from Asia, The Middle East, Sub-Saharan Africa and former Yugoslavia, who obtained residency in Denmark between 1 January 1993 and 31 December 2010 with 146,562 Danish-born children, matched 1:6 on age and sex. The study looked at contacts with psychiatric hospitals as well as psychologists and psychiatrists in private practice. Between 1 January 1996 and 30 June 2012, 3.5 % of the refugee children accessed psychiatric healthcare services compared to 7.7 % of the Danish-born children. The rate ratio of having any first-time psychiatric contact was 0.42 (95 % CI 0.40-0.45) among refugee boys and 0.35 (95 % CI 0.33-0.37) among refugee girls, compared to Danish-born children. Figures were similar for those accessing private psychologists or psychiatrists, emergency room, inpatient and outpatient services. Refugee children used fewer psychiatric healthcare services than Danish-born children. This may indicate that refugee children experience barriers in accessing psychiatric healthcare systems and do not receive adequate assessment of their mental health and subsequent referral to specialist services.

  • 134.
    Barrett, Damon
    Stockholm University, Faculty of Law, Department of Law. University of Essex, UK.
    Re: ‘Access to treatment with controlled medicines: rationale and recommendations for neutral, precise, and respectful language’2018In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 160, p. 156-156Article in journal (Other academic)
  • 135.
    Barrett, Damon
    Stockholm University, Faculty of Law, Department of Law. University of Essex, UK.
    The Child's Right to Protection from Drugs: Understanding History to Move Forward2017In: Health and Human Rights: An International Journal, ISSN 1079-0969, E-ISSN 2150-4113, Vol. 19, no 1, p. 263-268Article in journal (Refereed)
  • 136.
    Bartonek, Frida
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The role of self-esteem for the relation between school performance and psychosomatic health in adolescence: Sex differences and gender theoretical interpretations2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    While socioeconomic inequalities in health seem to level out during adolescence, circumstances related to school appears to have increased in importance. Such circumstances include, for example, school performance. The primary aim of this study is to examine the relationship between school performance and psychosomatic health. The moderating role of self-esteem and the presence of any sex differences will additionally be investigated. Data from the Stockholm School Survey in 2004, covering a total sample of 5 135 adolescents in 9th grade, were used. Based on linear regression, a significant association between school marks and psychosomatic health was found where higher school performance was linked to better health. Moreover, lower self-esteem was linked to more health complaints. Self-esteem moderated the association between school marks and psychosomatic health but only among boys, for whom the effect of having both high marks and high self-esteem was not as beneficial for health as expected. While differences by sex were found in the distribution of school marks, self-esteem and psychosomatic health, none were found in the associations between self-esteem and school performance and psychosomatic health (the only exception being the moderating role of self-esteem among boys).

  • 137. Baudin, Clémence
    et al.
    Lefèvre, Marie
    Selander, Jenny
    Babisch, Wolfgang
    Cadum, Ennio
    Carlier, Marie-Christine
    Champelovier, Patricia
    Dimakopoulou, Konstantina
    Huithuijs, Danny
    Lambert, Jacques
    Laumon, Bernard
    Pershagen, Göran
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Velonaki, Venetia
    Hansell, Anna
    Evrard, Anne-Sophie
    Saliva cortisol in relation to aircraft noise exposure: pooled-analysis results from seven European countries2019In: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 18, article id 102Article in journal (Refereed)
    Abstract [en]

    Background: Many studies have demonstrated adverse effects of exposure to aircraft noise on health. Possible biological pathways for these effects include hormonal disturbances. Few studies deal with aircraft noise effects on saliva cortisol in adults, and results are inconsistent.

    Objective: We aimed to assess the effects of aircraft noise exposure on saliva cortisol levels and its variation in people living near airports.

    Methods: This study focused on the 1300 residents included in the HYENA and DEBATS cross-sectional studies, with complete information on cortisol sampling. All the participants followed a similar procedure aiming to collect both a morning and an evening saliva cortisol samples. Socioeconomic and lifestyle information were obtained during a face-to-face interview. Outdoor aircraft noise exposure was estimated for each participant's home address. Associations between aircraft noise exposure and cortisol outcomes were investigated a priori for male and female separately, using linear regression models adjusted for relevant confounders. Different approaches were used to characterize cortisol levels, such as morning and evening cortisol concentrations and the absolute and relative variations between morning and evening levels.

    Results: Statistically significant increases of evening cortisol levels were shown in women with a 10-dB(A) increase in aircraft noise exposure in terms of LA(eq, 16h) (exp(beta) = 1.08; CI95% = 1.00-1.16), L-den (exp(beta) = 1.09; CI95% = 1.01-1.18), L-night (exp(beta) = 1.11; CI95% = 1.02-1.20). A statistically significant association was also found in women between a 10-dB(A) increase in terms of L-night and the absolute variation per hour (exp(beta) = 0.90; CI95% = 0.80-1.00). Statistically significant decreases in relative variation per hour were also evidenced in women, with stronger effects with the L-night (exp(beta) = 0.89; CI95% = 0.83-0.96) than with other noise indicators. The morning cortisol levels were unchanged whatever noise exposure indicator considered. There was no statistically significant association between aircraft noise exposure and cortisol outcomes in men.

    Conclusions: The results of the present study show statistically significant associations between aircraft noise exposure and evening cortisol levels and related flattening in the (absolute and relative) variations per hour in women. Further biological research is needed to deepen knowledge of the pathway between noise exposure and disturbed hormonal regulation, and specially the difference in effects between genders.

  • 138. Bean, Christopher G.
    et al.
    Virtanen, Marianna
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Berg, Noora
    Hallqvist, Johan
    Hammarström, Anne
    Group activity participation at age 21 and depressive symptoms during boom and recession in Sweden: a 20-year follow-up2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 3, p. 475-481Article in journal (Refereed)
    Abstract [en]

    Background: Organized group activities (e.g. sports or arts clubs) have long been noted as important developmental settings for youth, yet previous studies on the relationships between participation and mental health outcomes have focused on short-term effects among school-aged adolescents. The subsequent period of life, emerging adulthood, has been largely overlooked despite being another important life stage where individuals face new existential challenges and may benefit from group activity participation. The potential for macroeconomic conditions to modify these relationships has also not been considered. Methods: Participants (n = 1654) comprise two cohorts, born in either 1965 (n = 968) or 1973 (n = 686), from the same middle-sized industrial town in Northern Sweden. Both cohorts completed detailed questionnaires at age 21 (macroeconomic boom for Cohort 65, recession for Cohort 73) and approximately 20 years follow-up (age 43 for Cohort 65, age 39 for Cohort 73). General linear models were used to assess concurrent and prospective associations between regular group activity participation and depressive symptoms, as well as the potential interaction with boom/recession. Results: After controlling for sociodemographic factors, regular group activity participation at age 21 was associated with lower depressive symptoms, both concurrently and at follow-up. Those exposed to recession at age 21 reported higher depressive symptoms at the time but there was no interaction between cohort (boom/recession) and group activity participation. Conclusions: Regular group activity participation during emerging adulthood is associated with lower depressive symptoms uniformly in times of boom and recession. Beneficial effects of such participation may contribute to better mental health over 20 years.

  • 139. Beaussant, Yvan
    et al.
    Daguindau, Etienne
    Chauchet, Adrien
    Rochigneux, Philippe
    Tournigand, Christophe
    Aubry, Régis
    Morin, Lucas
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Hospital end-of-life care in haematological malignancies2018In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368, Vol. 8, no 3, p. 314-324Article in journal (Refereed)
    Abstract [en]

    Objective To investigate patterns of care during the last months of life of hospitalised patients who died from different haematological malignancies.

    Methods Nationwide register-based study, including all hospitalised adults >= 20 years who died from haematological malignancies in France in 2010-2013. Outcomes included use of invasive cancer treatments and referral to palliative care. Percentages are adjusted for sex and age using direct standardisation.

    Results Of 46 629 inpatients who died with haematological malignancies, 24.5% received chemotherapy during the last month before death, 48.5% received blood transfusion, 12.3% were under invasive ventilation and 18.1% died in intensive care units. We found important variations between haematological malignancies. The use of chemotherapy during the last month of life varied from 8.6% among patients with chronic myeloid leukaemia up to 30.1% among those with non-Hodgkin's lymphoma (P<0.001). Invasive ventilation was used in 10.2% of patients with acute leukaemia but in 19.0% of patients with Hodgkin's lymphoma (P<0.001). Palliative status was reported 30 days before death in only 14.8% of patients, and at time of death in 46.9% of cases. Overall, 5.5% of haematology patients died in palliative care units.

    Conclusion A high proportion of patients who died from haematological malignancies receive specific treatments near the end of life. There is a need for a better and earlier integration of the palliative care approach in the standard practice of haematology. However, substantial variation according to the type of haematological malignancy suggests that the patients should not be considered as one homogeneous group. Implementation of palliative care should account for differences across haematological malignancies.

  • 140. Beccaria, Franca
    et al.
    Rolando, Sara
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Scavarda, Alice
    From housekeeper to status-oriented consumer and hyper-sexual imagery: images of alcohol targeted to Italian women from the 1960s to the 2000s2018In: Feminist Media Studies, ISSN 1468-0777, E-ISSN 1471-5902, Vol. 18, no 6, p. 1012-1039Article in journal (Refereed)
    Abstract [en]

    Advertisements not only mirror ideals of masculinity and femininity that prevail in a specific place and time, but also contribute to influencing them. This article analyses alcohol-related advertisements published in women’s magazines from 1967 to 2008 in Italy. The main aim is to understand cultural processes that underlie gender differences in drinking and more generally in Italian society. The sample consists of 376 direct and indirect advertisements collected from well-established women’s magazines. The study identifies continuities and changes in women’s subject positions in alcohol-related advertisements. Italian advertisements of the 1960s and 1970s still reflect a female condition that entails no recognition of women’s own desires and tastes. Advertisements from the 1980s and 1990s reflect a more complex representation of female consumers, associating them with their own desires and pleasures. In the 2000s, the focus on women’s physical appearance and social image has become the prevailing feature. In conclusion, the study shows that changes in female representations in advertisements in the last 50 years do not represent a shift toward a more balanced gender representation. The insistence on women’s appearance, with a correlated predominance of bodily pleasures and attractiveness, reproduces old stereotypes about drinking women.

  • 141. Beck, Ingela
    et al.
    Törnquist, Agneta
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Broström, Linus
    Edberg, Anna-Karin
    Having to focus on doing rather than being: nurse assistants' experience of palliative care in municipal residential care settings2012In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 49, no 4, p. 455-464Article in journal (Refereed)
    Abstract [en]

    Background

    Palliative care should be provided, irrespective of setting to all patients facing a life-threatening illness and to their families. The situation and needs of older people differ from those of younger people since they often have several co-existing diseases and health complaints. This implies an extensive need for care and for longer periods of palliative care. The main providers of palliative care for older people are nurse assistants, who are also those with the shortest education.

    Aim

    The aim of this study was to illuminate nurse assistants’ experience of palliative care for older people in residential care.

    Design

    The study had an explorative, descriptive design.

    Settings

    Thirteen residential care units in three different districts in a large city in southern Sweden.

    Participants

    Twenty-five nurse assistants selected to represent variations in age, gender workplace and work experience.

    Methods

    Data were collected from six focus-group interviews and subjected to content analysis to gain an understanding of the phenomenon.

    Results

    The nurse assistants described palliative care as a contrast to the everyday care they performed in that they had a legitimate possibility to provide the care needed and a clear assignment in relation to relatives. Palliative care also meant having to face death and dying while feeling simultaneous that it was unnatural to talk about death and having to deal with their own emotions. They emphasised that they were in need of support and experienced leadership as invisible and opaque, but gained strength from being recognized.

    Conclusion

    In order to support nurse assistants in providing high quality end-of-life care, more focus is needed on the trajectory of older peoples’ dying, on the importance of involving relatives throughout the period of care provision, and on support when encountering death and dying. There is also a need for engaged care leaders, both registered nurses and managers, to recognize the work of nurse assistants and to support care provision for older people within the framework of palliative care philosophy.

  • 142. Beckers, Debby G. J.
    et al.
    Kompier, Michiel A. J.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Härmä, Mikko
    Worktime control: theoretical conceptualization, current empirical knowledge, and research agenda2012In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 38, no 4, p. 291-297Article in journal (Other academic)
  • 143.
    Beckley, Amber L.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Duke University, North Carolina.
    Caspi, Avshalom
    Broadbent, Jonathan
    Harrington, Honalee
    Houts, Renate M.
    Poulton, Richie
    Ramrakha, Sandhya
    Reuben, Aaron
    Moffitt, Terrie E.
    Association of Childhood Blood Lead Levels With Criminal Offending2018In: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 172, no 2, p. 166-173Article in journal (Refereed)
    Abstract [en]

    Importance  Lead is a neurotoxin with well-documented effects on health. Research suggests that lead may be associated with criminal behavior. This association is difficult to disentangle from low socioeconomic status, a factor in both lead exposure and criminal offending.

    Objective  To test the hypothesis that a higher childhood blood lead level (BLL) is associated with greater risk of criminal conviction, recidivism (repeat conviction), conviction for violent offenses, and variety of self-reported criminal offending in a setting where BLL was not associated with low socioeconomic status.

    Design, Setting, and Participants  A total of 553 individuals participated in a prospective study based on a population-representative cohort born between April 1, 1972, and March 31, 1973, from New Zealand; the Dunedin Multidisciplinary Health and Development Study observed participants to age 38 years (December 2012). Statistical analysis was performed from November 10, 2016, to September 5, 2017.

    Exposures  Blood lead level measured at age 11 years.

    Main Outcomes and Measures  Official criminal conviction cumulative to age 38 years (data collected in 2013), single conviction or recidivism, conviction for nonviolent or violent crime, and self-reported variety of crime types at ages 15, 18, 21, 26, 32, and 38 years.

    Results  Participants included 553 individuals (255 female and 298 male participants) who had their blood tested for lead at age 11 years. The mean (SD) BLL at age 11 years was 11.01 (4.62) μg/dL. A total of 154 participants (27.8%) had a criminal conviction, 86 (15.6%) had recidivated, and 53 (9.6%) had a violent offense conviction. Variety scores for self-reported offending ranged from 0 to 10 offense types at each assessment; higher numbers indicated greater crime involvement. Self-reported offending followed the well-established age-crime curve (ie, the mean [SD] variety of self-reported offending increased from 1.99 [2.82] at age 15 years to its peak of 4.24 [3.15] at age 18 years and 4.22 [3.02] at age 21 years and declined thereafter to 1.10 [1.59] at age 38 years). Blood lead level was a poor discriminator between no conviction and conviction (area under the curve, 0.58). Overall, associations between BLL and conviction outcomes were weak. The estimated effect of BLL was lower for recidivism than for single convictions and lower for violent offending than for nonviolent offending. Sex-adjusted associations between BLL reached statistical significance for only 1 of the 6 self-reported offending outcomes at age 15 years (r = 0.10; 95% CI, 0.01-0.18; P = .02).

    Conclusions and Relevance  This study overcomes past limitations of studies of BLL and crime by studying the association in a place and time where the correlation was not confounded by childhood socioeconomic status. Findings failed to support a dose-response association between BLL and consequential criminal offending.

  • 144.
    Beckley, Amber L.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Kuja-Halkola, Ralf
    Lundholm, Lena
    Långström, Niklas
    Frisell, Thomas
    Association of height and violent criminality: results from a Swedish total population study2014In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 43, no 3, p. 835-842Article in journal (Refereed)
    Abstract [en]

    Background: Violent criminality is at least moderately heritable, but the mechanisms behind this remain largely unexplained. Height, a highly heritable trait, may be involved but no study has estimated the effect of height on crime while simultaneously accounting for important demographic, biological and other heritable confounders. Methods: We linked nationwide, longitudinal registers for 760 000 men who underwent mandatory military conscription from 1980 through 1992 in Sweden, to assess the association between height and being convicted of a violent crime. We used Cox proportional hazard modelling and controlled for three types of potential confounders: physical characteristics, childhood demographics and general cognitive ability (intelligence). Results: In unadjusted analyses, height had a moderate negative relationship to violent crime; the shortest of men were twice as likely to be convicted of a violent crime as the tallest. However, when simultaneously controlling for all measured confounders, height was weakly and positively related to violent crime. Intelligence had the individually strongest mitigating effect on the height-crime relationship. Conclusions: Although shorter stature was associated with increased risk of violent offending, our analyses strongly suggested that this relationship was explained by intelligence and other confounding factors. Hence, it is unlikely that height, a highly heritable physical characteristic, accounts for much of the unexplained heritability of violent criminality.

  • 145. Beelen, Rob
    et al.
    Hoek, Gerard
    Raaschou-Nielsen, Ole
    Stafoggia, Massimo
    Andersen, Zorana Jovanovic
    Weinmayr, Gudrun
    Hoffmann, Barbara
    Wolf, Kathrin
    Samoli, Evangelia
    Fischer, Paul H.
    Nieuwenhuijsen, Mark J.
    Xun, Wei W.
    Katsouyanni, Klea
    Dimakopoulou, Konstantina
    Marcon, Alessandro
    Vartiainen, Erkki
    Lanki, Timo
    Yli-Tuomi, Tarja
    Oftedal, Bente
    Schwarze, Per E.
    Nafstad, Per
    De Faire, Ulf
    Pedersen, Nancy L.
    Otstenson, Claes-Goran
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Penell, Johanna
    Korek, Michal
    Pershagen, Goran
    Eriksen, Kirsten Thorup
    Overvad, Kim
    Sorensen, Mette
    Eeftens, Marloes
    Peeters, Petra H.
    Meliefste, Kees
    Wang, Meng
    Bueno-de-Mesquita, H. Bas
    Sugiri, Dorothea
    Kramer, Ursula
    Heinrich, Joachim
    de Hoogh, Kees
    Key, Timothy
    Peters, Annette
    Hampel, Regina
    Concin, Hans
    Nagel, Gabriele
    Jaensch, Andrea
    Ineichen, Alex
    Tsai, Ming-Yi
    Schaffner, Emmanuel
    Probst-Hensch, Nicole M.
    Schindler, Christian
    Ragettli, Martina S.
    Vilier, Alice
    Clavel-Chapelon, Francoise
    Declercq, Christophe
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Galassi, Claudia
    Migliore, Enrica
    Ranzi, Andrea
    Cesaroni, Giulia
    Badaloni, Chiara
    Forastiere, Francesco
    Katsoulis, Michail
    Trichopoulou, Antonia
    Keuken, Menno
    Jedynska, Aleksandra
    Kooter, Ingeborg M.
    Kukkonen, Jaakko
    Sokhi, Ranjeet S.
    Vineis, Paolo
    Brunekreef, Bert
    Natural-Cause Mortality and Long-Term Exposure to Particle Components: An Analysis of 19 European Cohorts within the Multi-Center ESCAPE Project2015In: Journal of Environmental Health Perspectives, ISSN 0091-6765, E-ISSN 1552-9924, Vol. 123, no 6, p. 525-533Article, review/survey (Refereed)
    Abstract [en]

    Background: Studies have shown associations between mortality and long-term exposure to particulate matter air pollution. Few cohort studies have estimated the effects of the elemental composition of particulate matter on mortality. Objectives: Our aim was to study the association between natural-cause mortality and long-term exposure to elemental components of particulate matter. Methods: Mortality and confounder data from 19 European cohort studies were used. Residential exposure to eight a priori-selected components of particulate matter ( PM) was characterized following a strictly standardized protocol. Annual average concentrations of copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc within PM size fractions <= 2.5 mu m (PM2.5) and <= 10 mu m (PM10) were estimated using land-use regression models. Cohort-specific statistical analyses of the associations between mortality and air pollution were conducted using Cox proportional hazards models using a common protocol followed by meta-analysis. Results: The total study population consisted of 291,816 participants, of whom 25,466 died from a natural cause during follow-up (average time of follow-up, 14.3 years). Hazard ratios were positive for almost all elements and statistically significant for PM2.5 sulfur (1.14; 95% CI: 1.06, 1.23 per 200ng/m(3)). In a two-pollutant model, the association with PM2.5 sulfur was robust to adjustment for PM2.5 mass, whereas the association with PM2.5 mass was reduced. Conclusions: Long-term exposure to PM2.5 sulfur was associated with natural-cause mortality. This association was robust to adjustment for other pollutants and PM2.5.

  • 146. Beelen, Rob
    et al.
    Raaschou-Nielsen, Ole
    Stafoggia, Massimo
    Andersen, Zorana Jovanovic
    Weinmayr, Gudrun
    Hoffmann, Barbara
    Wolf, Kathrin
    Samoli, Evangelia
    Fischer, Paul
    Nieuwenhuijsen, Mark
    Vineis, Paolo
    Xun, Wei W.
    Katsouyanni, Klea
    Dimakopoulou, Konstantina
    Oudin, Anna
    Forsberg, Bertil
    Modig, Lars
    Havulinna, Aki S.
    Lanki, Timo
    Turunen, Anu
    Oftedal, Bente
    Nystad, Wenche
    Nafstad, Per
    De Faire, Ulf
    Pedersen, Nancy L.
    Östenson, Claes-Göran
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Penell, Johanna
    Korek, Michal
    Pershagen, Göran
    Eriksen, Kirsten Thorup
    Overvad, Kim
    Ellermann, Thomas
    Eeftens, Marloes
    Peeters, Petra H.
    Meliefste, Kees
    Wang, Meng
    Bueno-de-Mesquita, Bas
    Sugiri, Dorothea
    Kraemer, Ursula
    Heinrich, Joachim
    de Hoogh, Kees
    Key, Timothy
    Peters, Annette
    Hampel, Regina
    Concin, Hans
    Nagel, Gabriele
    Ineichen, Alex
    Schaffner, Emmanuel
    Probst-Hensch, Nicole
    Kuenzli, Nino
    Schindler, Christian
    Schikowski, Tamara
    Adam, Martin
    Phuleria, Harish
    Vilier, Alice
    Clavel-Chapelon, Francoise
    Declercq, Christophe
    Grioni, Sara
    Krogh, Vittorio
    Tsai, Ming-Yi
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Galassi, Claudia
    Migliore, Enrica
    Ranzi, Andrea
    Cesaroni, Giulia
    Badaloni, Chiara
    Forastiere, Francesco
    Tamayo, Ibon
    Amiano, Pilar
    Dorronsoro, Miren
    Katsoulis, Michail
    Trichopoulou, Antonia
    Brunekreef, Bert
    Hoek, Gerard
    Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project2014In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 383, no 9919, p. 785-795Article in journal (Refereed)
    Abstract [en]

    Background Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants. Methods We used data from 22 European cohort studies, which created a total study population of 367 251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2.5 mu m (PM2.5), less than 10 mu m (PM10), and between 10 mu m and 2.5 mu m (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and NOx), with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buff er. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects meta-analysis. Findings The total study population consisted of 367 251 participants who contributed 5 118 039 person-years at risk (average follow-up 13.9 years), of whom 29 076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM2.5 of 1.07 (95% CI 1.02-1.13) per 5 mu g/m(3) was recorded. No heterogeneity was noted between individual cohort effect estimates (I-2 p value=0.95). HRs for PM2.5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 mu g/m(3) (HR 1.06, 95% CI 1.00-1.12) or below 20 mu g/m(3) (1.07, 1.01-1.13). Interpretation Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value.

  • 147. Beelen, Rob
    et al.
    Stafoggia, Massimo
    Raaschou-Nielsen, Ole
    Andersen, Zorana Jovanovic
    Xun, Wei W.
    Katsouyanni, Klea
    Dimakopoulou, Konstantina
    Brunekreef, Bert
    Weinmayr, Gudrun
    Hoffmann, Barbara
    Wolf, Kathrin
    Samoli, Evangelia
    Houthuijs, Danny
    Nieuwenhuijsen, Mark
    Oudin, Anna
    Forsberg, Bertil
    Olsson, David
    Salomaa, Veikko
    Lanki, Timo
    Yli-Tuomi, Tarja
    Oftedal, Bente
    Aamodt, Geir
    Nafstad, Per
    De Faire, Ulf
    Pedersen, Nancy L.
    Östenson, Claes-Göran
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Penell, Johanna
    Korek, Michal
    Pyko, Andrei
    Thorup Eriksen, Kirsten
    Tjonneland, Anne
    Becker, Thomas
    Eeftens, Marloes
    Bots, Michiel
    Meliefste, Kees
    Wang, Meng
    Bueno-de-Mesquita, Bas
    Sugiri, Dorothea
    Kraemer, Ursula
    Heinrich, Joachim
    de Hoogh, Kees
    Key, Timothy
    Peters, Annette
    Cyrys, Josef
    Concin, Hans
    Nagel, Gabriele
    Ineichen, Alex
    Schaffner, Emmanuel
    Probst-Hensch, Nicole
    Dratva, Julia
    Ducret-Stich, Regina
    Vilier, Alice
    Clavel-Chapelon, Francoise
    Stempfelet, Morgane
    Grioni, Sara
    Krogh, Vittorio
    Tsai, Ming-Yi
    Marcon, Alessandro
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Galassi, Claudia
    Migliore, Enrica
    Ranzi, Andrea
    Cesaroni, Giulia
    Badaloni, Chiara
    Forastiere, Francesco
    Tamayo, Ibon
    Amiano, Pilar
    Dorronsoro, Miren
    Katsoulis, Michail
    Trichopoulou, Antonia
    Vineis, Paolo
    Hoek, Gerard
    Long-term Exposure to Air Pollution and Cardiovascular Mortality An Analysis of 22 European Cohorts2014In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 25, no 3, p. 368-378Article in journal (Refereed)
    Abstract [en]

    Background: Air pollution has been associated with cardiovascular mortality, but it remains unclear as to whether specific pollutants are related to specific cardiovascular causes of death. Within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE), we investigated the associations of long-term exposure to several air pollutants with all cardiovascular disease (CVD) mortality, as well as with specific cardiovascular causes of death. Methods: Data from 22 European cohort studies were used. Using a standardized protocol, study area-specific air pollution exposure at the residential address was characterized as annual average concentrations of the following: nitrogen oxides (NO2 and NOx); particles with diameters of less than 2.5 mu m (PM2.5), less than 10 mu m (PM10), and 10 mu m to 2.5 mu m (PMcoarse); PM2.5 absorbance estimated by land-use regression models; and traffic indicators. We applied cohort-specific Cox proportional hazards models using a standardized protocol. Random-effects meta-analysis was used to obtain pooled effect estimates. Results: The total study population consisted of 367,383 participants, with 9994 deaths from CVD (including 4,992 from ischemic heart disease, 2264 from myocardial infarction, and 2484 from cerebrovascular disease). All hazard ratios were approximately 1.0, except for particle mass and cerebrovascular disease mortality; for PM2.5, the hazard ratio was 1.21 (95% confidence interval = 0.87-1.69) per 5 mu g/m(3) and for PM10, 1.22 (0.91-1.63) per 10 mu g/m(3). Conclusion: In a joint analysis of data from 22 European cohorts, most hazard ratios for the association of air pollutants with mortality from overall CVD and with specific CVDs were approximately 1.0, with the exception of particulate mass and cerebrovascular disease mortality for which there was suggestive evidence for an association.

  • 148. Been, Frederic
    et al.
    Bifisma, Lubertus
    Benaglia, Lisa
    Berset, Jean-Daniel
    Botero-Coy, Ana M.
    Castiglioni, Sara
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Zobel, Frank
    Schaub, Michael P.
    Buecheli, Alexander
    Hernandez, Felix
    Delemont, Olivier
    Esseiva, Pierre
    Ort, Christoph
    Assessing geographical differences in illicit drug consumption-A comparison of results from epidemiological and wastewater data in Germany and Switzerland2016In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 161, p. 189-199Article in journal (Refereed)
    Abstract [en]

    Background: Wastewater analysis is an innovative approach that allows monitoring illicit drug use at the community level. This study focused on investigating geographical differences in drug consumption by comparing epidemiological, crime and wastewater data. Methods: Wastewater samples were collected in 19 cities across Germany and Switzerland during one week, covering a population of approximately 8.1 million people. Self-report data and consumption offences for the investigated areas were used for comparison and to investigate differences between the indicators. Results: Good agreement between data sources was observed for cannabis and amphetamine-type stimulants, whereas substantial discrepancies were observed for cocaine. In Germany, an important distinction could be made between Berlin, Dortmund and Munich, where cocaine and particularly amphetamine were more prevalent, and Dresden, where methamphetamine consumption was clearly predominant. Cocaine consumption was relatively homogenous in the larger urban areas of Switzerland, although prevalence and offences data suggested a more heterogeneous picture. Conversely, marked regional differences in amphetamine and methamphetamine consumption could be highlighted. Conclusions: Combining the available data allowed for a better understanding of the geographical differences regarding prevalence, typology and amounts of substances consumed. For cannabis and amphetamine-type stimulants, the complementarity of survey, police and wastewater data could be highlighted, although notable differences could be identified when considering more stigmatised drugs (i.e. cocaine and heroin). Understanding illicit drug consumption at the national scale remains a difficult task, yet this research illustrates the added value of combining complementary data sources to obtain a more comprehensive and accurate picture of the situation.

  • 149. Beer, Netta
    et al.
    Ali, Abdullah S.
    Eskilsson, Helena
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Jansson, Andreas
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Abdul-Kadir, Faiza M.
    Rotllant-Estelrich, Guida
    Abass, Ali K.
    Wabwire-Mangen, Fred
    Björkman, Anders
    Kallander, Karin
    A qualitative study on caretakers' perceived need of bed-nets after reduced malaria transmission in Zanzibar, Tanzania2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, p. 606-Article in journal (Refereed)
    Abstract [en]

    Background: The elimination of malaria in Zanzibar is highly dependent on sustained effective coverage of bed-nets to avoid malaria resurgence. The Health Belief Model (HBM) framework was used to explore the perceptions of malaria and bed-net use after a noticeable reduction in malaria incidence. Methods: Nineteen in-depth interviews were conducted with female and male caretakers of children under five in North A district, Zanzibar. Deductive content analysis was used to identify meaning units that were condensed, coded and assigned to pre-determined elements of the HBM. Results: Awareness of malaria among caretakers was high but the illness was now seen as easily curable and uncommon. In addition to the perceived advantage of providing protection against malaria, bed-nets were also thought to be useful for avoiding mosquito nuisance, especially during the rainy season when the malaria and mosquito burden is high. The discomfort of sleeping under a net during the hot season was the main barrier that interrupted consistent bed-net usage. The main cue to using a bed-net was high mosquito density, and children were prioritized when it came to bed-net usage. Caretakers had high perceived self-efficacy and did not find it difficult to use bed-nets. Indoor Residual Spraying (IRS), which was recognized as an additional means of mosquito prevention, was not identified as an alternative for bed-nets. A barrier to net ownership was the increasingly high cost of bed-nets. Conclusions: Despite the reduction in malaria incidence and the resulting low malaria risk perceptions among caretakers, the benefit of bed-nets as the most proficient protection against mosquito bites upholds their use. This, in combination with the perceived high self-efficacy of caretakers, supports bed-net usage, while seasonality interrupts consistent use. High effective coverage of bed-nets could be further improved by reinforcing the benefits of bed-nets, addressing the seasonal heat barrier by using nets with larger mesh sizes and ensuring high bed-net ownership rates through sustainable and affordable delivery mechanisms.

  • 150. Beijer, Ulla
    et al.
    Scheffel Birath, Christina
    DeMartinis, Valerie
    af Klinteberg, Britt
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology. Karolinska Institutet, Sweden.
    Facets of Male Violence Against Women With Substance Abuse Problems: Women With a Residence and Homeless Women2018In: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, Vol. 33, no 9, p. 1391-1411Article in journal (Refereed)
    Abstract [en]

    The aims of this study were to investigate the type and extent to which women with substance abuse problems have been exposed to male violence during their lifetime, and to examine possible differences between women with a residence (WR) and homeless women (HW). The total sample included 79 women (WR, n = 35; HW, n = 44; M age = 47.8 years). Of the total sample, 72 women (91%) had experienced different kinds of male violence, 88% from former partners, and 26% from male friends or acquaintances. Of the 72 women, 71% further reported “Countless occasions of violent events,” and 36% had been forced to commit criminal acts. Abused women who had been forced to commit criminal acts were significantly more frequently found to be homeless, have reported parental alcohol and/or drug problems, have witnessed domestic violence in childhood, have been victims of sexual violence, have used illicit drugs as a dominant preparation, and have injected illicit drugs. Almost half of the abused women (46%) met criteria for posttraumatic stress disorder (PTSD), where HW showed an almost 4-time higher risk (RR 3.78) than WR. In conclusion there is a particular vulnerability in women with substance abuse to male violence, which has an important impact on their health status. Thus, from a public health perspective, it is suggested that for those women who have experienced male violence, treatment protocols need to include both assessing and addressing the impact of such experience in relation to substance abuse as well as concomitant health concerns.

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