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Wennerholm, C., Bromley, C., Johansson, A., Nilsson, S., Frank, J. & Faresjö, T. (2017). Two tales of cardiovascular risks-middle-aged women living in Sweden and Scotland: a cross-sectional comparative study. BMJ Open, 7(8), Article ID e016527.
Open this publication in new window or tab >>Two tales of cardiovascular risks-middle-aged women living in Sweden and Scotland: a cross-sectional comparative study
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2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 8, article id e016527Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To compare cardiovascular risk factors as well as rates of cardiovascular diseases in middle-aged women from urban areas in Scotland and Sweden.

DESIGN: Comparative cross-sectional study.

SETTING: Data from the general population in urban areas of Scotland and the general population in two major Swedish cities in southeast Sweden, south of Stockholm.

PARTICIPANTS: Comparable data of middle-aged women (40-65 years) from the Scottish Health Survey (n=6250) and the Swedish QWIN study (n=741) were merged together into a new dataset (n=6991 participants).

MAIN OUTCOME MEASURE: We compared middle-aged women in urban areas in Sweden and Scotland regarding risk factors for cardiovascular disease (CVD), CVD diagnosis, anthropometrics, psychological distress and lifestyle.

RESULTS: In almost all measurements, there were significant differences between the countries, favouring the Swedish women. Scottish women demonstrated a higher frequency of alcohol consumption, smoking, obesity, low vegetable consumption, a sedentary lifestyle and also more psychological distress. For doctor-diagnosed coronary heart disease, there were also significant differences, with a higher prevalence among the Scottish women.

CONCLUSIONS: This is one of the first studies that clearly shows that Scottish middle-aged women are particularly affected by a worse profile of CVD risks. The profound differences in CVD risk and outcome frequency in the two populations are likely to have arisen from differences in the two groups of women's social, cultural, political and economic environments.

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2017
Keywords
cardiovascular risk factors, comparative study, lifestyle, middle-aged women, psychological distress, public health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-140935 (URN)10.1136/bmjopen-2017-016527 (DOI)000411802700172 ()28790040 (PubMedID)2-s2.0-85027162863 (Scopus ID)
Note

Funding agencies: Swedish Heart and Lung Association [E136-15/E106/13]; Clinic ALF funds, Region Ostergotland, Sweden [LiO-446241]; Research and PhD studies Committee (FUN), Linkoping University, Sweden [LiU-2014-020251]

Available from: 2017-09-18 Created: 2017-09-18 Last updated: 2018-05-03Bibliographically approved
Ruiz, M., Goldblatt, P., Morrison, J., Porta, D., Forastiere, F., Hryhorczuk, D., . . . Pikhart, H. (2016). Impact of Low Maternal Education on Early Childhood Overweight and Obesity in Europe. Paediatric and Perinatal Epidemiology, 30(3), 274-284
Open this publication in new window or tab >>Impact of Low Maternal Education on Early Childhood Overweight and Obesity in Europe
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2016 (English)In: Paediatric and Perinatal Epidemiology, ISSN 0269-5022, E-ISSN 1365-3016, Vol. 30, no 3, p. 274-284Article in journal (Refereed) Published
Abstract [en]

BackgroundComparable evidence on adiposity inequalities in early life is lacking across a range of European countries. This study investigates whether low maternal education is associated with overweight and obesity risk in children from distinct European settings during early childhood. MethodsProspective data of 45 413 children from 11 European cohorts were used. Childrens height and weight obtained at ages 4-7 years were used to assess prevalent overweight and obesity according to the International Obesity Task Force definition. The Relative/Slope Indices of Inequality (RII/SII) were estimated within each cohort and by gender to investigate adiposity risk among children born to mothers with low education as compared to counterparts born to mothers with high education. Individual-data meta-analyses were conducted to obtain aggregate estimates and to assess heterogeneity between cohorts. ResultsLow maternal education yielded a substantial risk of early childhood adiposity across 11 European countries. Low maternal education yielded a mean risk ratio of 1.58 (95% confidence interval (CI) 1.34, 1.85) and a mean risk difference of 7.78% (5.34, 10.22) in early childhood overweight, respectively, measured by the RII and SII. Early childhood obesity risk by low maternal education was as substantial for all cohorts combined (RII = 2.61 (2.10, 3.23)) and (SII = 4.01% (3.14, 4.88)). Inequalities in early childhood adiposity were consistent among boys, but varied among girls in a few cohorts. ConclusionsConsiderable inequalities in overweight and obesity are evident among European children in early life. Tackling early childhood adiposity is necessary to promote childrens immediate health and well-being and throughout the life course.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
Keywords
child; preschool; child development; cohort studies; comparative study; Czech Republic; epidemiology; Europe; Finland; France; Greece; health inequalities; Italy; maternal educational status; meta-analysis; Netherlands; obesity; overweight; Portugal; Spain; Sweden; United Kingdom; Ukraine
National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-127547 (URN)10.1111/ppe.12285 (DOI)000373623800008 ()26945670 (PubMedID)
Note

Funding Agencies|European Union [278350]; Ministry of Education of the Czech Republic [LM2011028, LO1214]; Grant Agency of the Masaryk University [MUNI/M/1075/2013]; Academy of Finland; Biocenter, University of Oulu, Finland; European Commission (EUROBLCS) [QLG1-CT-2000-01643]; EU [EurHEALTHAgeing-277849]; Medical Research Council, UK (PrevMetSyn/SALVE); MRC; Netherlands Organization for Health Research and Development (ZonMw) [40-00812-98-11010]; Juvenile Diabetes Research Foundation; Swedish Child Diabetes Foundation; Research Council of Southeast Sweden

Available from: 2016-05-04 Created: 2016-05-03 Last updated: 2018-01-10
Rahmqvist, M., Gjessing, K. & Faresjö, T. (2016). Influenca-like illness among children: Young children suffer, primary care takes the strain, society bears the cost. In: : . Paper presented at Nordic Vaccine Meeting, Reykjavik Iceland, April 28-29 2016.
Open this publication in new window or tab >>Influenca-like illness among children: Young children suffer, primary care takes the strain, society bears the cost
2016 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Conclusions

Our results demonstrated a significant increase in the burden of disease during the peak influenza season with increased direct medical costs, especially in primary care. The largest impact of ILI was identified among the youngest children (2-4 years). Increased absence from work due to parents' care of ill children correlates strongly with the ILI encounters in health care. This loss of productivity represents a large indirect cost for society.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-130721 (URN)
Conference
Nordic Vaccine Meeting, Reykjavik Iceland, April 28-29 2016
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2018-03-22
Karlén, J., Ludvigsson, J., Hedmark, M., Olsen Faresjö, Å., Theodorsson, E. & Faresjö, T. (2015). Early Psychosocial Exposures, Hair Cortisol Levels, and Disease Risk. Pediatrics, 135(6), E1450-E1457
Open this publication in new window or tab >>Early Psychosocial Exposures, Hair Cortisol Levels, and Disease Risk
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2015 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 135, no 6, p. E1450-E1457Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Early psychosocial exposures are increasingly recognized as being crucial to health throughout life. A possible mechanism could be physiologic dysregulation due to stress. Cortisol in hair is a new biomarker assessing long-term hypothalamic-pituitary-adrenal axis activity. The objective was to investigate whether early-life adverse psychosocial circumstances influence infant cortisol levels in hair and health outcomes in children prospectively until age 10. METHODS: A cohort study in the general community using a questionnaire covering 11 psychosocial items in the family during pregnancy and the cumulative incidence of diagnoses until age 10 years in 1876 children. Cortisol levels in hair were measured by using a radioimmunoassay in those with sufficient hair samples at age 1, yielding a subsample of n = 209. RESULTS: Children with added psychosocial exposures had higher infant cortisol levels in hair (B = 0.40, P less than .0001, adjusted for gender and size for gestational age) in a cumulative manner and were significantly more often affected by 12 of the 14 most common childhood diseases, with a general pattern of increasing odds ratios. CONCLUSIONS: The findings support the model of physiologic dysregulation as a plausible mechanism by which the duration and number of early detrimental psychosocial exposures determine health outcomes. The model indicates that the multiplicity of adversities should be targeted in future interventions and could help to identify children who are at high risk of poor health. Furthermore, given the prolonged nature of exposure to a stressful social environment, the novel biomarker of cortisol in hair could be of major importance.

Place, publisher, year, edition, pages
American Academy of Pediatrics, 2015
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:liu:diva-119795 (URN)10.1542/peds.2014-2561 (DOI)000355557400012 ()25941311 (PubMedID)
Note

Funding Agencies|Swedish Child Diabetes Foundation (Barndiabetesfonden); Research Council of Southeast Sweden [FORSS-87771, FORSS-36321]; Swedish Medical Research Council [K99-72X-11242-05A]; Wallenberg Foundation [K 98-99D-12813-01A]; County Council of Ostergotland project grant, Linkoping, Sweden

Available from: 2015-06-26 Created: 2015-06-26 Last updated: 2018-01-11Bibliographically approved
Tsiantou, V., Moschandreas, J., Bertsias, A., Papadakaki, M., Saridaki, A., Agius, D., . . . Lionis, C. (2015). General Practitioners intention to prescribe and prescribing patterns in selected European settings: The OTCSOCIOMED project. Health Policy, 119(9), 1265-1274
Open this publication in new window or tab >>General Practitioners intention to prescribe and prescribing patterns in selected European settings: The OTCSOCIOMED project
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2015 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 119, no 9, p. 1265-1274Article in journal (Refereed) Published
Abstract [en]

The aim of this paper is to explore general practitioners (GPs) prescribing intentions and patterns across different European regions using the Theory of Planned Behavior (TPB). A cross-sectional study was undertaken in selected geographically defined Primary Health Care areas in Cyprus, Czech Republic (CZ), France, Greece, Malta, Sweden and Turkey. Face-to-face interviews were conducted using a TPB-based questionnaire. The number of GP participants ranged from 39 to 145 per country. Possible associations between TPB direct measures (attitudes, subjective norms (SN) and perceived behavioral control (PBC)) and intention to prescribe were assessed by country. On average, GPs thought positively of, and claimed to be in control of, prescribing. Correlations between TPB explanatory measures and prescribing intention were weak, with TPB direct measures explaining about 25% of the variance in intention to prescribe in Malta and CZ but only between 3% and 5% in Greece, Sweden and Turkey. SN appeared influential in GPs from Malta; attitude and PBC were statistically significant in GPs from CZ. GPs prescribing intentions and patterns differed across participating countries, indicating that country-specific interventions are likely to be appropriate. Irrational prescribing behaviors were more apparent in the countries where an integrated primary care system has still not been fully developed and policies promoting the rational use of medicines are lacking. Demand-side measures aimed at modifying GPs prescribing behavior are deemed necessary. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2015
Keywords
General practitioner; Primary care; Prescribing; Theory of Planned Behavior
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-121902 (URN)10.1016/j.healthpol.2015.06.006 (DOI)000361403000014 ()26188356 (PubMedID)
Note

Funding Agencies|European Commission [223654 - 06/05/08]

Available from: 2015-10-13 Created: 2015-10-12 Last updated: 2018-01-11
Nätt, D., Johansson, I., Faresjö, T., Ludvigsson, J. & Thorsell, A. (2015). High cortisol in 5-year-old children causes loss of DNA methylation in SINE retrotransposons: a possible role for ZNF263 in stress-related diseases. Clinical Epigenetics, 7(1), Article ID 91.
Open this publication in new window or tab >>High cortisol in 5-year-old children causes loss of DNA methylation in SINE retrotransposons: a possible role for ZNF263 in stress-related diseases
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2015 (English)In: Clinical Epigenetics, E-ISSN 1868-7083, ISSN 1868-7083, Vol. 7, no 1, article id 91Article in journal (Refereed) Published
Abstract [en]

Background: Childhood stress leads to increased risk of many adult diseases, such as major depression and cardiovascular disease. Studies show that adults with experienced childhood stress have specific epigenetic changes, but to understand the pathways that lead to disease, we also need to study the epigenetic link prospectively in children. Results: Here, we studied a homogenous group of 48 5-year-old children. By combining hair cortisol measurements (a well-documented biomarker for chronic stress), with whole-genome DNA-methylation sequencing, we show that high cortisol associates with a genome-wide decrease in DNA methylation and targets short interspersed nuclear elements (SINEs; a type of retrotransposon) and genes important for calcium transport: phenomena commonly affected in stress-related diseases and in biological aging. More importantly, we identify a zinc-finger transcription factor, ZNF263, whose binding sites where highly overrepresented in regions experiencing methylation loss. This type of zinc-finger protein has previously shown to be involved in the defense against retrotransposons. Conclusions: Our results show that stress in preschool children leads to changes in DNA methylation similar to those seen in biological aging. We suggest that this may affect future disease susceptibility by alterations in the epigenetic mechanisms that keep retrotransposons dormant. Future treatments for stress-and age-related diseases may therefore seek to target zinc-finger proteins that epigenetically control retrotransposon reactivation, such as ZNF263.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keywords
Stress; DNA methylation; ZNF263; Children; Retrotransposon; Cortisol; Transcription factor; EGR1; Blood; Hair
National Category
Biochemistry and Molecular Biology
Identifiers
urn:nbn:se:liu:diva-122055 (URN)10.1186/s13148-015-0123-z (DOI)000360619500001 ()26339299 (PubMedID)
Note

Funding Agencies|Centre for Systems Neurobiology at Linkoping University; Swedish Research Council [K2005-72X-11242-11A, K2008-69X-20826-01-4]; Swedish Child Diabetes Foundation; JDRF Wallenberg Foundation [K 98-99D-12813-01A]; Medical Research Council of Southeast Sweden (FORSS); Swedish Council for Working Life and Social Research [FAS2004-1775]

Available from: 2015-12-18 Created: 2015-10-19 Last updated: 2019-03-05
Rahmqvist, M., Gjessing, K. & Faresjö, T. (2015). Influenza-like illness: Young children, working parents and primary care take the strain. In: : . Paper presented at European Society for Paediatric Infectious Diseases. 33rd Annual Meeting, Leipzig, May 12-16 2015.
Open this publication in new window or tab >>Influenza-like illness: Young children, working parents and primary care take the strain
2015 (English)Conference paper, Oral presentation only (Refereed)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-119296 (URN)
Conference
European Society for Paediatric Infectious Diseases. 33rd Annual Meeting, Leipzig, May 12-16 2015
Available from: 2015-06-12 Created: 2015-06-12 Last updated: 2015-07-01
Karlén, J., Ludvigsson, J., Hedmark, M., Olsen Faresjö, Å., Theodorsson, E. & Faresjö, T. (2014). Impact of prenatal psychosocial exposures on hair cortisol levels and child health: cohort study.
Open this publication in new window or tab >>Impact of prenatal psychosocial exposures on hair cortisol levels and child health: cohort study
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2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background Early psychosocial exposures are increasingly recognized as crucial for health throughout life. A possible mechanism could be physiologic dysregulation due to stress. Cortisol in hair is a new biomarker, assessing long-term HPA axis activity. The objective was to investigate whether prenatal adverse psychosocial circumstances influence infant cortisol levels in hair and health outcome in children prospectively until age 10.

Methods True prospective cohort study in the general community with a questionnaire covering 11 psychosocial items in the family during pregnancy formed a composite scale of prenatal psychosocial vulnerability, and cumulative incidence of diseases through diagnoses until age 10 in n=1876 children. At age 1, cortisol levels in hair were measured using a competitive radioimmunoassay on a subsample of n=209.

Results Children with added prenatal psychosocial exposures had higher infant cortisol levels in hair (B=0.40, p<0.0001, adjusted for gender and size for gestational age) in a cumulative manner and were more often (p≤0.05) affected by 12 of the 14 most common childhood diagnoses with a general pattern of rising ORs.

Conclusions These findings support the model of physiologic dysregulation as a plausible mechanism in how the duration and number of early detrimental psychosocial exposures determine health outcome. It indicates that the multiplicity of adversities should be targeted in future interventions and could help to identify children who are at high risk of poor health. Furthermore, given the prolonged nature of exposure to a stressful social environment, the novel biomarker of cortisol in hair could be of major importance.

Keywords
Psychosocial stress, antenatal programming, child health and development, cortisol in hair, health disparities
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-111093 (URN)
Available from: 2014-10-07 Created: 2014-10-07 Last updated: 2015-06-11Bibliographically approved
Rajmil, L., Fernandez de Sanmamed, M.-J., Choonara, I., Faresjö, T., Hjern, A., L. Kozyrskyj, A., . . . Taylor-Robinson, D. (2014). Impact of the 2008 Economic and Financial Crisis on Child Health: A Systematic Review. International Journal of Environmental Research and Public Health, 11(6), 6528-6546
Open this publication in new window or tab >>Impact of the 2008 Economic and Financial Crisis on Child Health: A Systematic Review
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2014 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 11, no 6, p. 6528-6546Article, review/survey (Refereed) Published
Abstract [en]

The aim of this study was to provide an overview of studies in which the impact of the 2008 economic crisis on child health was reported. Structured searches of PubMed, and ISI Web of Knowledge, were conducted. Quantitative and qualitative studies reporting health outcomes on children, published since 2007 and related to the 2008 economic crisis were included. Two reviewers independently assessed studies for inclusion. Data were synthesised as a narrative review. Five hundred and six titles and abstracts were reviewed, from which 22 studies were included. The risk of bias for quantitative studies was mixed while qualitative studies showed low risk of bias. An excess of 28,000-50,000 infant deaths in 2009 was estimated in sub-Saharan African countries, and increased infant mortality in Greece was reported. Increased price of foods was related to worsening nutrition habits in disadvantaged families worldwide. An increase in violence against children was reported in the U.S., and inequalities in health-related quality of life appeared in some countries. Most studies suggest that the economic crisis has harmed childrens health, and disproportionately affected the most vulnerable groups. There is an urgent need for further studies to monitor the child health effects of the global recession and to inform appropriate public policy responses.

Place, publisher, year, edition, pages
MDPI, 2014
Keywords
adolescent; child health; economic and financial crisis; inequalities
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-109271 (URN)10.3390/ijerph110606528 (DOI)000338662600062 ()
Available from: 2014-08-12 Created: 2014-08-11 Last updated: 2017-12-05Bibliographically approved
Gjessing, K., Torgé, C. J., Hammar, M., Dahlberg, J. & Faresjö, T. (2014). Improvement of quality and safety in health care as a new interprofessional learning module – evaluation from students. Journal of Multidisciplinary Healthcare (7), 341-347
Open this publication in new window or tab >>Improvement of quality and safety in health care as a new interprofessional learning module – evaluation from students
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2014 (English)In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, no 7, p. 341-347Article in journal (Refereed) Published
Abstract [en]

Background: Interprofessional teamwork is in many ways a norm in modern health care, and needs to be taught during professional education.

Description: This study is an evaluation of a newly introduced and mandatory learning module where students from different health profession programs used Improvement of Quality and Safety as a way to develop interprofessional competence in a real-life setting. The intention of this learning module was to integrate interprofessional teamwork within the students' basic education, and to give students a basic knowledge about Improvement of Quality and Safety. This report focuses on evaluations from the participating students (n=222), mainly medical and nursing students.

Materials and methods: To evaluate this new learning module, a questionnaire was developed and analyzed using a mixed methods design, integrating both qualitative and quantitative methods. The evaluation addressed learning concepts, learning objectives, and interprofessional and professional development.

Results and conclusion: A majority of students responded positively to the learning module as a whole, but many were negative towards specific parts of the learning module and its implementation. Medical students and male students were less positive towards this learning module. Improvements and alterations were suggested. 

Place, publisher, year, edition, pages
Dove Press, 2014
Keywords
interprofessional education, quality improvement, IQS, problem-based learning
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-109088 (URN)10.2147/JMDH.S62619 (DOI)25125983 (PubMedID)2-s2.0-84907373088 (Scopus ID)
Available from: 2014-08-07 Created: 2014-08-07 Last updated: 2017-12-05Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4224-1032

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