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Sökning: WFRF:(Kühlmann Berenzon Sharon)

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1.
  • Rehn, Moa, et al. (författare)
  • Highest Vaccine Uptake after School-Based Delivery - A County-Level Evaluation of the Implementation Strategies for HPV Catch-Up Vaccination in Sweden
  • 2016
  • Ingår i: PLoS ONE. - : Public Library of Science. - 1932-6203. ; 11:3, s. 0149857-0149857
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The Swedish school-based vaccination programme offers HPV vaccine to girls born ≥1999 in 5-6th grade. In 2012, all counties introduced free-of-charge catch-up vaccination campaigns targeting girls born 1993-1998. Varying vaccine uptake in the catch-up group by December 2012 suggested that some implementation strategies were more successful than others. In order to inform future vaccination campaigns, we assessed the impact of different implementation strategies on the county-level catch-up vaccine uptake.METHODS: We conducted an ecological study including all Swedish counties (n = 21), asking regional health offices about the information channels they used and where vaccination of the catch-up target group took place in their counties. The uptake of ≥1 dose by 30 September 2014 was estimated using data from the voluntary national vaccination register. We investigated associations between counties' catch-up vaccine uptake, information channels and vaccination settings by calculating incidence rate ratios (IRR) and 95% confidence intervals (CI), using negative binomial regression models.RESULTS: County level catch-up vaccine uptake varied between 49-84%. All counties offered vaccination through primary health care settings. Apart from this eight (34%) also offered the vaccine in some of their schools, four (19%) in all their schools, and two (10%) in other health care centres. The information channels most frequently used were: information at the national on-line health care consulting web-page (100%), letter/invitations (90%), and advertisement (81%). Counties offering vaccination to girls in all schools and counties offering vaccination in some of their schools, reached higher vaccine uptake compared to counties not offering vaccination in any of their schools (all schools adjusted IRR: 1.3, 95% CI: 1.1-1.5, some schools adjusted IRR: 1.2, 95% CI: 1.1-1.3).CONCLUSION: Counties offering HPV vaccination to catch-up groups in schools reached the highest vaccine uptake. No information channel explained differences in county-level vaccine uptake. Our findings suggest that catch-up vaccination outside the national vaccination program can reach a high uptake at the population level if it is implemented primarily with an organized delivery (e.g. in schools).
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2.
  • Lennell, Anne, et al. (författare)
  • Alcohol-based hand-disinfection reduced children's absence from Swedish day care centers
  • 2008
  • Ingår i: Acta Pædiatrica. - Oslo : Wiley-Blackwell Publishing Ltd. - 1651-2227 .- 0803-5253. ; 97:12, s. 1672-1680
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To determine if the use of alcohol-based hand-disinfection as a complement to regular hand washing at daycare centers (DCCs) can reduce the childhood rate of absenteeism. Methods: Children aged 0-6 years attending DCC were studied in a cluster randomized controlled trial during 30 weeks. Thirty matched pairs of DCCs were included in the study, where one of the DCCs was randomized to intervention and the other to control within each pair. The intervention consisted in children and staff using alcohol-based oily disinfectant gel containing 70% ethanol after regular hand washing. The main outcome was the rate of episodes of absence from DCC due to infection. A regression model was fitted at the individual level and controlling several possible confounders for illness. Absences were reported by the parents. Results: Differences in missing absence reports between the two groups led to only evaluating those 29 DCCs (1431 children) that were able to provide complete reports. In the multivariate regression, the intervention significantly reduced the rate of absenteeism of a child by 12% compared to a child in a control DCC (IRR 95% CI: 0.799-0.965). Conclusion: Hand-disinfection used by children and staff significantly decreased childrens absences due to infections in Swedish DCCs.
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3.
  • Kuhlmann-Berenzon, S., et al. (författare)
  • Accounting for large-scale factors in the study of understory vegetation using a conditional logistic model
  • 2007
  • Ingår i: Environmental and Ecological Statistics. - 1352-8505 .- 1573-3009. ; 14:2, s. 149-159
  • Tidskriftsartikel (refereegranskat)abstract
    • Local-scale and large-scale factors can affect the presence of a species of understory vegetation in the forest. Local-scale factors may be the influence of surrounding trees, while climate and latitude are typically considered large-scale factors. A model for the presence of a species needs to take into account both scales. A conditional logistic model is proposed for those studies where only the local-scale factors are of interest and that avoids estimating the large-scale parameters. Conditioning is carried out by the number of quadrats in the plot where the vegetation is found. As the latter is a sufficient statistic for the large-scale factors, a model free from these parameters is obtained. Data gathered in the permanent sample plots of the 1985-1986 National Forest Inventory of Finland is used for illustration, where the local-scale factor of interest is the influence of the trees, quantified by an index based on the size and location of the trees. The model fitted to Vaccinium vitis-idaea showed a significant and positive influence of Scots pine on the presence of this species, while for Calamagrostis arundinacea, a decrease in the odds ratio was observed due to the influence of Norway spruce.
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4.
  • Velicko, Inga, et al. (författare)
  • Sexual and testing behaviour associated with Chlamydia trachomatis infection : a cohort study in an STI clinic in Sweden
  • 2016
  • Ingår i: ; 6:8
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Genital chlamydia infection (chlamydia) is the most commonly reported sexually transmitted infection (STI) in Sweden. To guide prevention needs, we aimed to investigate factors associated with chlamydia. Methods: A cohort of visitors aged 20-40 years at an urban STI clinic in Sweden was recruited. Behavioural data were collected using a self-administered questionnaire. Self-sampled specimens were tested for chlamydia by a DNA amplification assay. Statistically significant (p<0.05) and epidemiologically relevant covariates were entered in a multivariate Poisson model adjusted for potential confounders (age and gender). Backward stepwise elimination produced a final model. Multiple imputation was used to account for missing values. Results: Out of 2814 respondents, 1436 were men with a chlamydia positivity rate of 12.6% vs 8.9% in women. Lifetime testing for chlamydia and HIV was high (82% and 60%, respectively). Factors significantly associated with chlamydia were: 20-24 years old (adjusted risk ratio (ARR)=2.10, 95% CI 1.21 to 3.65); testing reason: contact with a chlamydia case (ARR=6.55, 95% CI 4.77 to 8.98) and having symptoms (ARR=2.19, 95% CI 1.48 to 3.24); 6-10 sexual partners (ARR=1.53, 95% CI 1.06 to 2.21); last sexual activity 'vaginal sex and oral sex and anal sex and petting' (ARR=1.84, 95% CI 1.09 to 3.10); alcohol use before sex (ARR=1.98, 95% CI 1.10 to 3.57); men with symptoms (ARR=2.09, 95% CI 1.38 to 3.18); tested for chlamydia (ARR=0.72, 95% CI 0.55 to 0.94). Conclusions: Risk factors associated with chlamydia were consistent with previous reports in similar settings and suggest no major changes over time. Increased risk for chlamydia infection associated with high-risk behaviour (eg, alcohol use, increased number of sexual partners) supports the need for behavioural interventions in this population such as promotion of safer sex behaviour (condom use) and testing.
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5.
  • Andersson, Eva M., 1968, et al. (författare)
  • Predictions by early indicators of the time and height of the peaks of yearly influenza outbreaks in Sweden
  • 2008
  • Ingår i: Scandinavian Journal of Public Health. ; 36:5, s. 475-482
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: Methods for prediction of the peak of the influenza from early observations are suggested. These predictions can be used for planning purposes. Methods: In this study, new robust methods are described and applied to weekly Swedish data on influenza-like illness (ILI) and weekly laboratory diagnoses of influenza (LDI). Both simple and advanced rules for how to predict the time and height of the peak of LDI are suggested. The predictions are made using covariates calculated from data in early LDI reports. The simple rules are based on the observed LDI values, while the advanced ones are based on smoothing by unimodal regression. The suggested predictors were evaluated by cross-validation and by application to the observed seasons. Results: The relationship between ILI and LDI was investigated, and it was found that the ILI variable is not a good proxy for the LDI variable. The advanced prediction rule regarding the time of the peak of LDI had a median error of 0.9 weeks, and the advanced prediction rule for the height of the peak had a median deviation of 28%. Conclusions: The statistical methods for predictions have practical usefulness.
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6.
  • Andersson, Eva M., 1968, et al. (författare)
  • Predictions by early indicators of the time and height of yearly influenza outbreaks in Sweden
  • 2007
  • Rapport (övrigt vetenskapligt)abstract
    • Aims: Methods for prediction of the peak of the influenza from early observations are suggested. These predictions can be used for planning purposes. Methods: In this study, new robust methods are described and applied on weekly Swedish data on influenza-like illness (ILI) and weekly laboratory diagnoses of influenza (LDI). Both simple and advanced rules for how to predict the time and height of the peak of LDI are suggested. The predictions are made using covariates calculated from data in early LDI reports. The simple rules are based on the observed LDI values while the advanced ones are based on smoothing by unimodal regression. The suggested predictors were evaluated by cross-validation and by application to the observed seasons. Results: The relation between ILI and LDI was investigated and it was found that the ILI variable is not a good proxy for the LDI variable. The advanced prediction rule regarding the time of the peak of LDI had a median error of 0.9 weeks, and the advanced prediction rule for the height of the peak had a median deviation of 28%. Conclusions: The statistical methods for predictions have practical usefulness.
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7.
  • Gherasim, Alin, et al. (författare)
  • Risk factors and potential preventive measures for nephropatia epidemica in Sweden 2011-2012 : a case-control study
  • 2015
  • Ingår i: Infection Ecology & Epidemiology. - 2000-8686 .- 2000-8686. ; 5
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: Nephropatia epidemica (NE), a relatively mild form of hemorrhagic fever with renal syndrome caused by the Puumala virus (PUUV), is endemic in northern Sweden. We aim to study the risk factors associated with NE in this region.METHODS: We conducted a matched case-control study between June 2011 and July 2012. We compared confirmed NE cases with randomly selected controls, matched by age, sex, and place of infection or residence. We analyzed the association between NE and several occupational, environmental, and behavioral exposures using conditional logistic regression.RESULTS: We included in the final analysis 114 cases and 300 controls, forming 246 case-control pairs. Living in a house with an open space beneath, making house repairs, living less than 50 m from the forest, seeing rodents, and smoking were significantly associated with NE.CONCLUSION: Our results could orient public health policies targeting these risk factors and subsequently reduce the NE burden in the region.
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8.
  • Hansdotter, Frida I., et al. (författare)
  • The incidence of acute gastrointestinal illness in Sweden
  • 2015
  • Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 43:5, s. 540-547
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: The aim of this study was to estimate the self-reported domestic incidence of acute gastrointestinal illness in the Swedish population irrespective of route of transmission or type of pathogen causing the disease. Previous studies in Sweden have primarily focused on incidence of acute gastrointestinal illness related to consumption of contaminated food and drinking water. Methods: In May 2009, we sent a questionnaire to 4000 randomly selected persons aged 0-85 years, asking about the number of episodes of stomach disease during the last 12 months. To validate the data on symptoms, we compared the study results with anonymous queries submitted to a Swedish medical website. Results: The response rate was 64%. We estimated that a total number of 2744,778 acute gastrointestinal illness episodes (95% confidence intervals 2475,641-3013,915) occurred between 1 May 2008 and 30 April 2009. Comparing the number of reported episodes with web queries indicated that the low number of episodes during the first 6 months was an effect of seasonality rather than recall bias. Further, the result of the recall bias analysis suggested that the survey captured approximately 65% of the true number of episodes among the respondents. Conclusions: The estimated number of Swedish acute gastrointestinal illness cases in this study is about five times higher than previous estimates. This study provides valuable information on the incidence of gastrointestinal symptoms in Sweden, irrespective of route of transmission, indicating a high burden of acute gastrointestinal illness, especially among children, and large societal costs, primarily due to production losses.
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