| 1. |
- Andersson White, Pär, 1983-
(författare)
-
Social Inequalities in Child Health : Type 1 Diabetes, Obesity, Cardiovascular Risk Factors and the Role of Self-control
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish Commission on Health Inequality defined health inequality as systematic differences in health between groups in society with different social positions. All avoidable socioeconomic health inequalities are unfair, and as stated by WHO's Commission on the Social Determinants of Health, we have a moral obligation to try to reduce them. "Putting these inequities right is a matter of social justice. Reducing health inequities is, for the Commission on Social Determinants of Health, an ethical imperative." This ethical imperative is especially apparent regarding the health of children and adolescents. Children’s right to the highest attainable standard of health is also enshrined in Article 24 of the Convention on the Rights of the Child. To reach the goal of a reduction of health inequalities, research is necessary to describe the social gradients of health. Research is also needed to better understand why these gradients occur. A better understanding and knowledge about health inequalities can lead to policies that reduce these inequalities and ensure children’s right to health.This thesis investigates social inequality in child health using data from a Swedish population-based prospective birth cohort, the All Babies in Southeast Sweden (ABIS) cohort. Social inequality in obesity in the ABIS cohort is also compared with other birth cohorts participating in the Elucidating Pathways to Child Health Inequality (EPOCH) collaboration which includes cohorts from six high-income countries; Sweden, the Netherlands, Canada (one national and one cohort from Quebec), UK, Australia, and USA.In Paper 1 we show that health inequalities in overweight and obesity are detectable already at two years of age and that these inequalities increase during childhood. In adolescents, low socioeconomic status increases the risk of becoming overweight and the risk of components of the metabolic syndrome, including high blood pressure and dyslipidemia (low high-density cholesterol).The level of inequality in obesity in the Swedish ABIS cohort was lower than in the other participating countries in the EPOCH collaboration (Paper 2). Inequality was lower in absolute and relative terms when SES was measured by household income. Inequality was also lower in absolute, but not relative, terms when SES was measured by maternal education. This finding indicates that some of the policies implemented in Sweden may attenuate social inequalities in obesity in children. Examples of such policies with evidence for reducing social inequality in obesity implemented in Sweden include universal preschools and free school meals.This thesis also investigates health inequalities in autoimmune disease (Paper 3). In this study, we found that low socioeconomic status increased the risk of Type 1 Diabetes but not the other autoimmune diseases investigated. Path analysis indicated that part of the increased risk in children with low SES of Type 1 Diabetes might be mediated by a higher body mass index and an elevated risk of serious life events.In the final paper, this thesis tests the hypothesis that differences in maternal and child self-control mediate social inequalities in obesity. Two measures of self-control were used; for mothers, the self-control variable was based on behaviors related to self-control (smoking during pregnancy, smoking during the child’s first year of life, breastfeeding duration, and participating in the ABIS study with biological samples). For the children, the self-control variable was based on questionnaire data on the impulsivity subscale of the Strengths and Difficulties Questionnaire (SDQ). The results showed that the two measures of self-control mediated 87.5 % of the increased risk of obesity at age 19 years in children with low maternal education and 93 % of the risk if maternal BMI was also included in the selfcontrol variable.In the discussion part of this thesis, the conclusions that can be deduced from understanding the mechanisms of social inequality in child health are discussed. A theory with a central role of self-control for health inequality predicts that social inequality will increase without interventions. In an environment with rising numbers of stimuli of the human reward system, stimuli that also have negative long-term consequences (socalled Limbic traps), child and adolescent health, in general, will decrease. Because of the mechanisms related to SES and self-control, children with low SES will be disproportionally affected. The result of this development will be increasing levels of social inequalities in child health.The discussion also includes implications for policies that may improve health and reduce inequalities. These policies should reduce the exposure of children and adolescents to harmful behaviors/limbic traps. Examples of policies that have this effect include universal preschools for all children, free healthy meals in preschools and schools, increased after-school activities for all children, and longer school days for adolescents with increased hours for physical activity, music, and art. Mobile phones and social media restrictions in schools and policies to reduce use at home should also be implemented. Finally, policies should be implemented to reduce residential and school segregation in the community.
|
|
| 2. |
- Andersson, Pär-Yngve, 1954-
(författare)
-
Flyktighet som bevarar: Studier i Lars Englunds lyrik : [Fleeting Moments That Preserve: Studies in the Poetry of Lars Englund]
- 2023
-
Bok (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish author Lars Englund (1917-1959) was an appreciated poet in the 1940s and 50s, but according to contemporary works in literary history, he almost seems to be forgotten. The aim of this study is to call attention to his short poems by close reading. Besides, I also discuss authors and traditions that were important to Englund, and I read his poetry in comparison with literary movements in his days. Among the subjects discussed are also the question whether he was chiefly a modernist or a romantic poet. His poems often start with a view of a northern landscape. It can be the sea with seagulls at a distance and a sandy beach. The sun is rising in an early summer morning. In other poems he describes such as blooming trees or bushes in summer evenings with darkness very slowly coming. A loved one is often present. I propose that Englund is a writer whose poems often start with realistic descriptions like these, but they often widen or open to some suggested transcendence and a significant silence without being entirely symbolic. He surely appreciates the romantic tradition, but he has learned a lot from the modernist movement, not least from the early modernists in Finland, who were writing in Swedish. In his free verse he is fully aware of the importance of rhythm and typography to emphasize the semantic meaning.
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
- Andersson White, Pär, et al.
(författare)
-
Low maternal education increases the risk of Type 1 Diabetes, but not other autoimmune diseases: a mediating role of childhood BMI and exposure to serious life events
- 2023
-
Ingår i: Scientific Reports. - : NATURE PORTFOLIO. - 2045-2322. ; 13:1
-
Tidskriftsartikel (refereegranskat)abstract
- The objective of this paper was to investigate if socioeconomic status (SES), measured by maternal education and household income, influenced the risk of developing autoimmune disease (Type 1 Diabetes, Celiac disease, Juvenile Idiopathic Arthritis, Crohns disease, Ulcerative colitis, and autoimmune thyroid disease), or age at diagnosis, and to analyse pathways between SES and autoimmune disease. We used data from the All Babies in Southeast Sweden (ABIS) study, a population-based prospective birth cohort, which included children born 1997-1999. Diagnoses of autoimmune disease was collected from the Swedish National Patient Register Dec 2020. In 16,365 individuals, low maternal education, but not household income, was associated with increased risk of Type 1 Diabetes; middle education RR 1.54, 95% CI 1.06, 2.23; P 0.02, low education RR 1.81, 95% CI 1.04, 3.18; P 0.04. Maternal education and household income was not associated with any other autoimmune disease and did not influence the age at diagnosis. Part of the increased risk of Type 1 Diabetes by lower maternal education was mediated by the indirect pathway of higher BMI and higher risk of Serious Life Events (SLE) at 5 years of age. The risk of developing Type 1 Diabetes associated to low maternal education might be reduced by decreasing BMI and SLE during childhood.
|
|
| 6. |
- Holmberg, Jonas, 1976-, et al.
(författare)
-
Influence of Local Electropolishing Conditions on Ferritic–Pearlitic Steel on X-Ray Diffraction Residual Stress Profiling
- 2023
-
Ingår i: Journal of materials engineering and performance (Print). - : Springer. - 1059-9495 .- 1544-1024.
-
Tidskriftsartikel (refereegranskat)abstract
- Layer removal with electropolishing is a well-established method when measuring residual stress profiles with lab-XRD. This is done to measure the depth impact from processes such as shot peening, heat treatment, or machining. Electropolishing is used to minimize the influence on the inherent residual stresses of the material during layer removal, performed successively in incremental steps to specific depths followed by measurement. Great control of the material removal is critical for the measured stresses at each depth. Therefore, the selection of size of the measurement spot and electropolishing parameters is essential. The main objective in this work is to investigate how different electrolytes and electropolishing equipment affect the resulting surface roughness, geometry, microstructure, and consequently the measured residual stress. A second objective has been to establish a methodology of assessing the acquired electropolished depth. The aim has been to get a better understanding of the influence of the layer removal method on the accuracy of the acquired depth. Evaluation has been done by electropolishing one ground and one shot peened sample of a low-alloy carbon steel, grade 1.1730, with different methods. The results showed a difference in stresses depending on the electrolyte used where the perchloric acid had better ability to retain the stresses compared to the saturated salt. Electropolishing with saturated salt is fast and results in evenly distributed material removal but has high surface roughness, which is due to a difference in electropolishing of the two phases, ferrite, and pearlite. Perchloric acid electropolishing is slower but generates a smooth surface as both ferrite and pearlite have the same material removal rates but may cause an increased material removal for the center of the electropolished area. In this work, it is suggested to use perchloric acid electropolishing for the final layer removal step. © 2023, The Author(s).
|
|
| 7. |
|
|
| 8. |
- Andersson White, Pär, et al.
(författare)
-
Household income and maternal education in early childhood and risk of overweight and obesity in late childhood : Findings from seven birth cohort studies in six high-income countries
- 2022
-
Ingår i: International Journal of Obesity. - : Springer Nature. - 0307-0565 .- 1476-5497. ; 46, s. 1703-1711
-
Tidskriftsartikel (refereegranskat)abstract
- Background/objectives This study analysed the relationship between early childhood socioeconomic status (SES) measured by maternal education and household income and the subsequent development of childhood overweight and obesity. Subjects/methods Data from seven population-representative prospective child cohorts in six high-income countries: United Kingdom, Australia, the Netherlands, Canada (one national cohort and one from the province of Quebec), USA, Sweden. Children were included at birth or within the first 2 years of life. Pooled estimates relate to a total of N = 26,565 included children. Overweight and obesity were defined using International Obesity Task Force (IOTF) cut-offs and measured in late childhood (8-11 years). Risk ratios (RRs) and pooled risk estimates were adjusted for potential confounders (maternal age, ethnicity, child sex). Slope Indexes of Inequality (SII) were estimated to quantify absolute inequality for maternal education and household income. Results Prevalence ranged from 15.0% overweight and 2.4% obese in the Swedish cohort to 37.6% overweight and 15.8% obese in the US cohort. Overall, across cohorts, social gradients were observed for risk of obesity for both low maternal education (pooled RR: 2.99, 95% CI: 2.07, 4.31) and low household income (pooled RR: 2.69, 95% CI: 1.68, 4.30); between-cohort heterogeneity ranged from negligible to moderate (p: 0.300 to < 0.001). The association between RRs of obesity by income was lowest in Sweden than in other cohorts. Conclusions There was a social gradient by maternal education on the risk of childhood obesity in all included cohorts. The SES associations measured by income were more heterogeneous and differed between Sweden versus the other national cohorts; these findings may be attributable to policy differences, including preschool policies, maternity leave, a ban on advertising to children, and universal free school meals.
|
|
| 9. |
- Spencer, Nicholas James, et al.
(författare)
-
Household income and maternal education in early childhood and activity-limiting chronic health conditions in late childhood: findings from birth cohort studies from six countries
- 2022
-
Ingår i: Journal of Epidemiology and Community Health. - : BMJ PUBLISHING GROUP. - 0143-005X .- 1470-2738. ; 76:11, s. 939-948
-
Tidskriftsartikel (refereegranskat)abstract
- Background We examined absolute and relative relationships between household income and maternal education during early childhood (<5 years) with activity-limiting chronic health conditions (ALCHC) during later childhood in six longitudinal, prospective cohorts from high-income countries (UK, Australia, Canada, Sweden, Netherlands, USA). Methods Relative inequality (risk ratios, RR) and absolute inequality (Slope Index of Inequality) were estimated for ALCHC during later childhood by maternal education categories and household income quintiles in early childhood. Estimates were adjusted for mother ethnicity, maternal age at birth, child sex and multiple births, and were pooled using meta-regression. Results Pooled estimates, with over 42 000 children, demonstrated social gradients in ALCHC for high maternal education versus low (RR 1.54, 95% CI 1.28 to 1.85) and middle education (RR 1.24, 95% CI 1.11 to 1.38); as well as for high household income versus lowest (RR 1.90, 95% CI 1.66 to 2.18) and middle quintiles (RR 1.34, 95% CI 1.17 to 1.54). Absolute inequality showed decreasing ALCHC in all cohorts from low to high education (range: -2.85% Sweden, -13.36% Canada) and income (range: -1.8% Sweden, -19.35% Netherlands). Conclusion We found graded relative risk of ALCHC during later childhood by maternal education and household income during early childhood in all cohorts. Absolute differences in ALCHC were consistently observed between the highest and lowest maternal education and household income levels across cohort populations. Our results support a potential role for generous, universal financial and childcare policies for families during early childhood in reducing the prevalence of activity limiting chronic conditions in later childhood.
|
|
| 10. |
- Spencer, Nicholas James, et al.
(författare)
-
Social gradients in ADHD by household income and maternal education exposure during early childhood : Findings from birth cohort studies across six countries
- 2022
-
Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 17:3
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThis study aimed to examine social gradients in ADHD during late childhood (age 9-11 years) using absolute and relative relationships with socioeconomic status exposure (household income, maternal education) during early childhood (<5 years) in seven cohorts from six industrialised countries (UK, Australia, Canada, The Netherlands, USA, Sweden). MethodsSecondary analyses were conducted for each birth cohort. Risk ratios, pooled risk estimates, and absolute inequality, measured by the Slope Index of Inequality (SII), were estimated to quantify social gradients in ADHD during late childhood by household income and maternal education measured during early childhood. Estimates were adjusted for child sex, mother age at birth, mother ethnicity, and multiple births. FindingsAll cohorts demonstrated social gradients by household income and maternal education in early childhood, except for maternal education in Quebec. Pooled risk estimates, relating to 44,925 children, yielded expected gradients (income: low 1.83(CI 1.38,2.41), middle 1.42(1.13,1.79), high (reference); maternal education: low 2.13(1.39,3.25), middle 1.42(1.13,1.79)). Estimates of absolute inequality using SII showed that the largest differences in ADHD prevalence between the highest and lowest levels of maternal education were observed in Australia (4% lower) and Sweden (3% lower); for household income, the largest differences were observed in Quebec (6% lower) and Canada (all provinces: 5% lower). ConclusionFindings indicate that children in families with high household income or maternal education are less likely to have ADHD at age 9-11. Absolute inequality, in combination with relative inequality, provides a more complete account of the socioeconomic status and ADHD relationship in different high-income countries. While the study design precludes causal inference, the linear relation between early childhood social circumstances and later ADHD suggests a potential role for policies that promote high levels of education, especially among women, and adequate levels of household income over childrens early years in reducing risk of later ADHD.
|
|
