| 1. |
- Novak, Masuma, 1969-
(författare)
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Social inequity in health : Explanation from a life course and gender perspective
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: A boy child born in a Gothenburg suburb has a life expectancy that is nine years shorter than that of another child just 23 km away, and among girls the difference is five years. There is no necessary biological reason to this observed difference. In fact, like life length, most diseases follow a social gradient, even in a country like Sweden where many believe there is no class inequity. This social inequity in health tells us that some of us are not achieving our potential in health or in life length compared to our more fortunate fellow citizens. Aim: This thesis attempts to explore the patterns of health inequities and the pathways by which health inequities develop from a life course and gender perspective. In particular focuses on the importance of material, behavioural, health related and psychosocial circumstances from adolescence to adulthood in explaining social inequity in musculoskeletal disorders (MSDs), obesity, smoking, and social mobility. Method: All four papers of this thesis were based on quantitative analyses of data from a 14-year follow-up study. The baseline survey was conducted in 1981 in Luleå, Sweden. The survey included all 16-year-old pupils born in 1965. A total of 1081 pupils (575 boys and 506 girls) were surveyed. They were followed up at ages 18, 21 and 30 years with comprehensive self-administered questionnaires. The response rate was 96.5% throughout the 14-year follow-up. In addition to the questionnaires data, school records, and interviews with nurse and teachers’ were used. Results: There were no class or gender differences in MSDs and in obesity during adolescence, but significantly more girls than boys were smokers. Class and gender differences had emerged when they reached adulthood with more women reporting to have MSDs but more men being overweight and obese. Women continued to be smokers at a higher rate than men through to adulthood. When an intersection between class and gender was considered, a more complex picture emerged. For example, not all women had higher prevalence of MSDs or smoked more than men, rather men with high socioeconomic position (SEP) had lower prevalences of MSDs and smoking than women with high SEP; and these high SEP women had lower prevalences than men with low SEP. The worst-off group was women with low SEP. The obesity pattern was quite the contrary, where women with high SEP had a lower prevalence of obesity than women with low SEP; and these low SEP women had a lower prevalence than men with high SEP. The worst-off group was men with low SEP. Regarding social mobility, health status (other than height in women) and ethnic background were not associated with mobility either for men or women. The results indicated that unequal distribution of material, psychosocial, health and health related behavioural factors during adolescence, young adulthood and adulthood accounted for the observed social gradients and social mobility. However, several factors from adolescence appeared to be more important for women while recent factors were more important for men. Important adolescent factors for social inequity and downward mobility were: unfavourable material circumstances defined as low SEP of parent, unemployed family member, and had no own room during upbringing; unfavourable psychosocial circumstances defined as parental divorce, poor contact with parents, being less liked in school, and low school control; and poor health related behaviour defined as smoking and physical inactivity. Among these factors, being less liked in school showed consistent association with all outcome measures of this thesis. Being less liked by the teachers and students was found to be more common among adolescents whose parents had low SEP. Men and women who were less liked in school during their adolescence were more likely as adults to be smokers, obese (only women), and downwardly mobile. The dominant adult life factor that contributed to class inequity in MSDs for men and women was physical heavy working conditions, which attributed to an estimated 46.9% (women) and 49.5% (men) of the increased risk in MSDs of the lower SEP group. High alcohol consumption among men with low SEP was an additional factor that contributed to class inequities in health and social mobility. Conclusion: Social patterning of health in this cohort was gendered and age specific depending on the outcome measures. Unfavourable school environment in early years had long lasting negative influence on later health, health behavior and SEP. The thesis supports the notion of accumulation of risk that social inequities in health occurs due to accumulation of multiple adverse circumstances among the lower SEP group throughout their life course. Schools should be used as a setting for interventions aimed at reducing socioeconomic inequities in health. The detailed policy implications for reduction of social inequities in health among men and women are discussed.
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| 2. |
- Jemberie, Wossenseged Birhane, 1985-, et al.
(författare)
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Substance Use Disorders and COVID-19 : Multi-Faceted Problems Which Require Multi-Pronged Solutions
- 2020
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and well-being. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.
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| 3. |
- Mackay, Heather, 1976-
(författare)
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Food Sources and Access Strategies in Ugandan Secondary Cities : An Intersectional Analysis
- 2019
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Ingår i: Environment & Urbanization. - : SAGE Publications. - 0956-2478 .- 1746-0301. ; 31:2, s. 375-396
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Tidskriftsartikel (refereegranskat)abstract
- This article arises from an interest in African urbanization and in the food, farming and nutritional transitions that some scholars present as integral to urban life. The paper investigates personal urban food environments, food sources and access strategies in two secondary Ugandan cities, Mbale and Mbarara, drawing on in-depth interviews and applying an intersectional lens. Food sources were similar across dimensions of difference but food access strategies varied. My findings indicate that socioeconomic circumstance (class) was the most salient influence shaping differences in daily food access strategies. Socioeconomic status, in turn, interacted with other identity aspects, an individual’s asset base and broader structural inequalities in influencing urban food environments. Rural land and rural connections, or multispatiality, were also important for food-secure urban lives. The work illuminates geometries of advantage and disadvantage within secondary cities, and highlights similarities and differences between food environments in these cities and Uganda’s capital, Kampala.
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| 4. |
- Mackay, Heather, 1976-
(författare)
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A feminist geographic analysis of perceptions of food and health in Ugandan cities
- 2019
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Ingår i: Gender, Place and Culture. - : Routledge. - 0966-369X .- 1360-0524. ; 26:11, s. 1519-1543
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Tidskriftsartikel (refereegranskat)abstract
- This article contributes to a feminist geographic analysis of how urban food and health environments and non-communicable disease experience may be being constructed, and contested, by healthcare professionals (local elites) in two secondary Ugandan cities (Mbale and Mbarara). I use thematic and group interaction analysis of focus group data to explore material and discursive representations. Findings make explicit how healthcare professionals had a tendency to prescribe highly classed and gendered assumptions of bodies and behaviours in places and in daily practices. The work supports the discomfort some have felt concerning claims of an African nutrition transition, and is relevant to debates regarding double burden malnutrition. I argue that a feministic analysis, and an intersectional appreciation of people in places, is advantageous to food and health-related research and policy-making. Results uncover and deconstruct a dominant patriarchal tendency towards blaming women for obesity. Yet findings also exemplify the co-constructed and malleable nature of knowledge and understandings, and this offers encouragement.
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| 5. |
- Mackay, Heather
(författare)
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Food, farming and health in Ugandan secondary cities
- 2019
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This research contributes to countering a large city research bias by focusing on the food, farming and health experiences of two secondary cities of Uganda: Mbale and Mbarara. It is not an apocalyptic story. Like anywhere in the world, for some residents things were going well; for others, less well. My research explores the varied geometries of advantage and disadvantage in diets, food security, and livelihood circumstances to shed light on why things were more secure for some than for others. I used multiple methods including a household survey, focus groups with local healthcare professionals, and in-depth interviews with varied city residents. A geographic perspective explored intersections of food, farming and health with aspects of identity (such as gender, class, tribe), and with place (the city itself, but also with rural areas, or other urban areas). The starting point was the theorised food system, nutritional and epidemiologic transitions predicted to occur with urban development, often called nutrition transition theory. My research suggests caution with dominant models of how urban life shifts food and farming systems towards a food system and diet pattern focused around large retailer supermarkets, processed foods, fast foods, more meat, less agriculture, less movement. Nutrition transition theory postulates these changes causing a shift in epidemiology from infectious to non-infectious diseases in urban areas. Instead of the suggestion from nutrition transition theory, my work presents evidence of non-communicable disease (obesity, diabetes, hypertension) experience in Mbale and Mbarara’s residents, but without evidence of advanced change in food and farming systems. Findings revealed relatively low dietary diversities and common food insecurity. Diets remained predominantly traditional, as did the main food sources (traditional markets and neighbourhood shops), across diverse residents. The more food secure had regular salaried employment and strong relational links with rural farms and family, supporting work on multi-spatial livelihoods. This contrasts with earlier ideas of who farms the African city, or retains farming livelihoods. Most vulnerable to food insecurity and low diet diversity were those who were most dependent on purchasing all their food. In conclusion, this research suggests that food system, nutritional and epidemiologic transitions in Mbale and Mbarara may be less linked than previously thought, or linked in more complex ways. Other drivers of epidemiologic change are likely. Findings highlight the importance of local data and specific city investigations.
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| 6. |
- Karltun, Linley Chiwona, et al.
(författare)
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Migration and the Food Environment
- 2017
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Ingår i: Ending Childhood Obesity. - Uppsala, Sweden. ; , s. 20-25
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Annan publikation (övrigt vetenskapligt/konstnärligt)
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| 7. |
- Higueras-Fresnillo, Sara, et al.
(författare)
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Low prevalence of ideal cardiovascular health in the general Swedish population: Results from the Swedish CArdioPulmonary bioImage Study (SCAPIS)
- 2023
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 51:4, s. 527-530
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the current study was to examine the prevalence of ideal cardiovascular health (iCVH) in the general Swedish middle-aged population. To address this aim, we utilised data from the Swedish CArdioPulmonary bioImage Study (SCAPIS) which is a large Swedish population-based study (N=30,154) that combined comprehensive state-of-the-art imaging technology with clinical examinations and included all iCVH components. A total iCVH score was calculated as the number of iCVH metrics at an ideal level for the seven components and classified as: ideal (> 5 ideal components), intermediate (3-4 ideal components) and poor (<= 2 ideal components). Our results showed that only 18.2% of the population reached ideal status (i.e. > 5 components at the ideal level), whereas 51.9% were classified as intermediate status and 29.9% as poor status of iCVH. Women had a higher prevalence of iCVH status (23.9% vs. 12.0%) and a lower prevalence of poor iCVH status (23.5% vs. 36.8%). Our data may serve as benchmarks for future national and international comparisons and motivate efforts to promote cardiovascular health in the general population, given the strong link between iCVH with all-cause and cardiovascular disease mortality and morbidity.
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| 8. |
- Virtanen, Marianna, et al.
(författare)
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Long working hours and alcohol use : systematic review and meta-analysis of published studies and unpublished individual participant data.
- 2015
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Ingår i: BMJ (Clinical research ed.). - : BMJ. - 1756-1833 .- 0959-8138. ; 350, s. Art. no. g7772-
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To quantify the association between long working hours and alcohol use.DESIGN: Systematic review and meta-analysis of published studies and unpublished individual participant data.DATA SOURCES: A systematic search of PubMed and Embase databases in April 2014 for published studies, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies.REVIEW METHODS: The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression.RESULTS: Cross sectional analysis was based on 61 studies representing 333 693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100 602 participants from nine countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1.20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours and ≥55 hours a week were 1.13 (1.02 to 1.26; adjusted difference in incidence 0.8 percentage points) and 1.12 (1.01 to 1.25; adjusted difference in incidence 0.7 percentage points), respectively, compared with working standard 35-40 hours (incidence of new onset risky alcohol use 6.2%). There was no difference in these associations between men and women or by age or socioeconomic groups, geographical regions, sample type (population based v occupational cohort), prevalence of risky alcohol use in the cohort, or sample attrition rate.CONCLUSIONS: Individuals whose working hours exceed standard recommendations are more likely to increase their alcohol use to levels that pose a health risk.
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| 9. |
- Falk Erhag, Hanna, et al.
(författare)
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Concluding Remarks
- 2022
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Ingår i: A Multidisciplinary Approach to Capability in Age and Ageing. - Chem : Springer. - 9783030780654 ; 18:2, s. 143-144
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 10. |
- Nyström, Monica, et al.
(författare)
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Locally based research and development units as knowledge brokers and change facilitators in health and social care of older people in Sweden
- 2015
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Ingår i: Evidence & Policy. - : Policy Press. - 1744-2648 .- 1744-2656. ; 11:1, s. 57-80
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Tidskriftsartikel (refereegranskat)abstract
- This article investigates the role of locally based research and development units (R&Ds) focusing on health and social services. Nearly 300 Local R&Ds are funded by the Swedish government with the intention to facilitate knowledge transfer and development of high quality and effective health and social care organisations. Based on analyses of archival data on aims, activities and outputs of R&Ds focusing on care for older people the authors argue that Local R&Ds have potentials to act as knowledge brokers, change agents and researchers, but these overlapping roles need clarified strategies and enactment of a variety of skills.
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