| 1. |
- Bjerkeli, Pernilla J., et al.
(författare)
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Sociodemographic patterns in pharmacy dispensing of medications for erectile dysfunction in Sweden
- 2018
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Ingår i: European Journal of Clinical Pharmacology. - : Springer. - 0031-6970 .- 1432-1041. ; 74:2, s. 209-218
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this study is to investigate the relationship between sociodemographic factors and pharmacy dispensing of medications for erectile dysfunction (ED) in the general population of middle-aged and elderly men. By considering a number of medical conditions that could promote or contraindicate use of ED medication, the analysis could help capture prescription patterns that might not be explained by medical needs.METHODS: Individual-level pharmacy dispensing data from 2006 for a population-based cohort of 216,148 men aged 45-79 years in the county Scania, Sweden, were analysed. Multiple logistic regression was applied, and area under the receiver operating characteristic curve (AUC) was calculated to quantify the discriminatory accuracy (DA) of the associations. National trends in pharmacy dispensing of ED medication between 2006 and 2016 were also analysed.RESULTS: Pharmacy dispensing of ED medication increased between 2006 and 2016, particularly among men aged 65-79 years (from 6.8 to 9.2%). Dispensing of ED medication was positively associated with higher socioeconomic position, and divorced and widowed men were more likely to fill a prescription with ED medication than married men. These associations remained after adjusting for medical conditions. The DA of the associations was, however, rather low (AUC = 0.69 among 45-64 year olds and AUC = 0.65 among 65-79 year olds).CONCLUSIONS: Pharmacy dispensing of ED medication seem linked to the individuals socioeconomic position, age and marital status suggesting sociodemographic disparities in the pharmacy dispensing targeting sexual function. However, the low DA of the associations shows the limited capacity of these factors to predict ED medication use at the individual level.
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| 2. |
- Olsson, Linda, et al.
(författare)
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The genetic landscape of paediatric de novo acute myeloid leukaemia as defined by single nucleotide polymorphism array and exon sequencing of 100 candidate genes
- 2016
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Ingår i: British Journal of Haematology. - Chichester : Wiley-Blackwell. - 0007-1048 .- 1365-2141. ; 174:2, s. 292-301
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Tidskriftsartikel (refereegranskat)abstract
- Cytogenetic analyses of a consecutive series of 67 paediatric (median age 8 years; range 0-17) de novo acute myeloid leukaemia (AML) patients revealed aberrations in 55 (82%) cases. The most common subgroups were KMT2A rearrangement (29%), normal karyotype (15%), RUNX1-RUNX1T1 (10%), deletions of 5q, 7q and/or 17p (9%), myeloid leukaemia associated with Down syndrome (7%), PML-RARA (7%) and CBFBMYH11 (5%). Single nucleotide polymorphism array (SNP-A) analysis and exon sequencing of 100 genes, performed in 52 and 40 cases, respectively (39 overlapping), revealed >= 1 aberration in 89%; when adding cytogenetic data, this frequency increased to 98%. Uniparental isodisomies (UPIDs) were detected in 13% and copy number aberrations (CNAs) in 63% (median 2/case); three UPIDs and 22 CNAs were recurrent. Twenty-two genes were targeted by focal CNAs, including AEBP2 and PHF6 deletions and genes involved in AML-associated gene fusions. Deep sequencing identified mutations in 65% of cases (median 1/case). In total, 60 mutations were found in 30 genes, primarily those encoding signalling proteins (47%), transcription factors (25%), or epigenetic modifiers (13%). Twelve genes (BCOR, CEBPA, FLT3, GATA1, KIT, KRAS, NOTCH1, NPM1, NRAS, PTPN11, SMC3 and TP53) were recurrently mutated. We conclude that SNP-A and deep sequencing analyses complement the cytogenetic diagnosis of paediatric AML.
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| 3. |
- Persmark, Anna, et al.
(författare)
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Precision public health: mapping socioeconomic disparities in opioid dispensations at Swedish pharmacies by Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)
- 2019
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; , s. 1-21
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn light of the opioid epidemic in the United States, there is growing concern about the use of opioids in Sweden as it may lead to misuse and overuse and, in turn, severe public health problems. However, little is known about the distribution of opioid use across different demographic and socioeconomic dimensions in the Swedish general population. Therefore, we applied an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), to obtain an improved mapping of the risk heterogeneity of and socioeconomic inequalities in opioid prescription receipt. Methods and FindingsUsing data from 6,846,106 residents in Sweden aged 18 and above, we constructed 72 intersectional strata from combinations of gender, age, income, cohabitation status, and presence or absence of psychological distress. We modelled the absolute risk (AR) of opioid prescription receipt in a series of multilevel logistic regression models distinguishing between additive and interaction effects. By means of the Variance Partitioning Coefficient (VPC) and the area under the receiver operating characteristic curve (AUC), we quantified the discriminatory accuracy (DA) of the intersectional strata for discerning those who received opioid prescriptions from those who did not. The AR of opioid prescription receipt ranged from 2.77% (95% CI 2.69¬–2.86) among low-income men aged 18–34, living alone, without psychological distress, to 28.25% (95% CI 27.95–28.56) among medium-income women aged 65 and older, living alone, with psychological distress. In a model that conflated both additive and interaction effects, the intersectional strata had a fair DA for discerning opioid users from non-users (VPC=13.2%, AUC=0.68). However, in the model that decomposed total effects into additive and interaction effects, the VPC was very low (0.42%) indicating the existence of small interaction effects for a number of the intersectional strata. ConclusionsThe intersectional MAIHDA approach aligns with the aims of precision public health, through improving the evidence base for health policy by increasing understanding of both health inequalities and individual heterogeneity. This approach is particularly relevant for socioeconomically conditioned outcomes such as opioid prescription receipt. We have identified intersections of social position within the Swedish population at greater risk for opioid prescription receipt.
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| 4. |
- Zettermark, Sofia
(författare)
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Coming of Contraceptive Age: An Interdiciplinary Analysis of Hormonal Contraceptives and Mental Health
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis emanates from the discursive gap between a medical discourse andexperience-driven knowledges in mental health aspects of hormonal contraceptives.The tensions and fractures between a medical discourse focusing on contraceptiveeffectiveness and largely refuting any significant adverse outcomes, and experiencebasednarratives of commonplace detrimental, or at least unwelcome and unpleasant,mental health effects, is apparent. Although hormonal contraceptives are widely usedand side effects on mood and mental health are often reported, little is known aboutthe link between hormonal contraceptives and mental health effects and, what ismore, the discourses, narratives, and experiences such a link is inescapably andimportantly enmeshed in.Against this backdrop of increasing awareness of possible mental health side effectsof hormonal contraceptives, an interdisciplinary approach with four studies utilizingdifferent approaches to explore mental health aspects of hormonal contraceptives wasconducted. Two nationwide prospective cohort studies were carried out, the secondutilizing an intersectional multilevel approach, where significant associationsbetween hormonal contraceptive use and subsequent use of psychotropic orantidepressant drugs was found. Two qualitative studies, one critical discourseanalysis of contraceptive information directed at the public, and one in-depthinterview with women using, or having used, hormonal contraceptives exploreddiscourses of contraception and reproduction that are being drawn upon andreproduced in Sweden, along with experience-based narratives and knowledges. Thestudies in this thesis show that 1) depressive and other mental health side effects arelikely more common than previously acknowledged, particularly among youngwomen; 2) these mental health effects are affected by interacting power dimensionsof oppression; 3) women are expected to choose and change (hormonal)contraceptive methods for years and plan pregnancies perfectly; together with 4)navigating often conflicting discourses on hormonal methods as either a simple andeffective solution to all reproductive issues, or exogenous hormones as unnaturalpoison, obliging constant negotiation and self-surveillance.11Using reproductive justice as a jumping off point, this thesis argue that hormonalcontraceptive use is a form of modern fertility work dependent on biomedicalization,and that mental health is at the core of this effort. I also show how hormonalcontraceptives and discourses thereof are not value-neutral, but act as normativeregulators of reproduction in a broader sense. Finally, I argue that hormonalcontraceptive effects can be conceptualized as neither purely biochemical nor purelycultural, but rather as a contextual and interconnected result of different powerimbuedprocesses. While availability of hormonal contraceptives is one importantpart of reproductive autonomy, it becomes clear that the medical discourse onhormonal contraception often obscures the arduous and fundamentally genderedfertility work, entrenched in a unequal society, that hormonal contraceptive use is.A more explorative approach by the medical community, in patient contact and inresearch on psychological side effects of hormonal contraceptives, could possibly startbridging the divide created by the unfeasibility of reducing complex human emotion,experience, and knowledge, to dichotomous variables.
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| 5. |
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| 6. |
- Zettermark, Sofia, et al.
(författare)
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Hormonal contraception increases the risk of psychotropic drug use in adolescent girls but not in adults : A pharmacoepidemiological study on 800 000 Swedish women
- 2018
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:3
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Tidskriftsartikel (refereegranskat)abstract
- The burden of depression and anxiety disorders is greater in women, and female sex hormones have been shown to affect mood. Psychological side effects of hormonal contraception (HC) are also a common complaint in the clinic, but few previous studies have investigated this subject. We therefore wanted to investigate whether use of HC was associated with adverse psychological health outcomes, and whether this association was modified by age. All women aged 12-30 years on 31 December 2010, residing in Sweden for at least four years and with no previous psychiatric morbidity (n = 815 662), were included. We followed the women from their first HC use (or 31 December 2010, if they were non-users) at baseline, until a prescription fill of psychotropic drugs or the end of the one-year follow-up. We performed age-stratified logistic regression models and estimated odds ratios (OR) to measure the association between different HC methods and psychotropic drug use, as well as the area under the receiver operating curve to estimate discriminatory accuracy of HC in relation to psychotropic drugs. Overall, we found an association between HC and psychotropic drugs (adjusted OR 1.34, 95% confidence interval [CI] 1.30-1.37). In the age-stratified analysis, the strongest association was found in adolescent girls (adjusted OR 3.46, 95% CI 3.04-4.94 for age 12 to 14 years), while it was non-existent for adult women. We conclude that hormonal contraception is associated with psychotropic drug use among adolescent girls, suggesting an adverse effect of HC on psychological health in this population.
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| 7. |
- Zettermark, Sofia, et al.
(författare)
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I Could Visit Her Blog Just Because She’s so Stupid : A Study of how Gendered Norms and Discourses Surrounding Girls’ Blogging Habits are Created and how the Girls’ Negotiate Around Them
- 2012
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Ingår i: Invisible Girl: "Ceci n'est pas une fille". - 9789174594621 ; , s. 215-223
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Bokkapitel (refereegranskat)abstract
- General introduction This publication is the end product of the Invisible Girl project, an international, Swedishbased and multidisciplinary research project in which the interplay of power relations, gender, and age was the primary object of study. The project was global in its scope and included researchers and artists from Australia, Canada, Croatia, The Czech Republic, Estonia, India, Israel, Italy, Kenya, Madagascar, Nigeria, Serbia, South Africa, Sweden and The UK. The name of the project is inspired by Ralph Ellison’s novel Invisible Man from 1952. Just like Ellison portrays black Americans as being socially invisible, it is possible to view girls as invisible in the sense that their actions and competences cannot be adequately described with the existing malenormative terminology. Is she made socially and linguistically invisible and not seen as a real person? Another inspiration is the philosophy behind Magritte’s (1929) painting “Ceci n’est pas une pipe” [This is not a pipe], often interpreted as pointing out that the painting is not a pipe but an image of a pipe. The same metaphor illuminates the philosophical essence of the Invisible Girl. When we talk about blogging girls, gamer girls, helpless girls, outofcontrolontheinternet girls, girls as foolish innocents who invite sexual predation is this girls’ reality or images of it? Are girls hidden in the notion of the gendered “Other”, in the general idea of a girl category?This body of work forms a counter story including the voice of marginalized groups with the explicit aim to challenge privileged discourses. From a normcritical perspective the aim is to question accepted worldviews or implicit agreements about girls, how they are mediated by i.e. images, movies and stories, which produce sexist stereotypes, at different societal levels. Stories, which contradict and present the world from different perspectives, are important for exposing stereotyping practices and how they are developed. The overarching research approach of the Invisible Girl Project is critical and derives from the tension between common notions about girlhood, girls’ own experiences and contemporary research. We suggest that the understanding of the concepts ‘girls’ and ‘girlhood’ are socially constructed and that their associated meanings are continually shaped and reshaped by social actors in particular situations. Certain historical, social, political, cultural, economic, ethnic, religious and gender values may also inform these meanings. Approaching the invisible girl as a verb rather as a noun this publication may be seen as an exploration of contemporary conditions for how girls become girls and form girl identities. We do not aspire to present a generalized image of The Girl. Providing examples of how to become a girl is an individual experience but also a global phenomenon, the contributions to our publication offer important aspects of what it could mean to become a girl today. What practices are instrumental when girls become girls? And how have these questions been answered in different cultural contexts?.....Excerpt for my chapter:Web blogs and web blogging is a subject of constant debate. Do the blogs change our way of thinking about media and work as a democratic force, or are they simply a waste of time? Why do millions of Swedes want to read about the everyday life of a few spoiled teenage girls? Is the era of the printed word over? In the past few years, all these questions and many others have appeared in different forms in the Swedish mainstream media. This study aims to create a picture of the media climate surrounding girls’ web blogging by examining a number of Swedish news articles concerning blogs, as well as look deeper into how the discourses surrounding this phenomenon are created and prescribed with meaning. I am also interested in how girls understand their blogging practices and relate to contemporary media discourses. Questions about how the bloggers negotiate their understanding of this practice, as well as what gendered norms become visible in their reasoning, will be answered with the help of five girls in a focused group interview. In addition to that, I explore whether feminist standpoints or strategies of resistance can be detected among the girls. As a result of the two different research methods the dynamic power relation between bloggers and mass media becomes visible. This study show how girls are encouraged by a contemporary societal discourse to consume and focus on their appearance, and in doing so creating their own social context, something for which the blog as a medium is well adjusted. On the other hand the girls are invalidated and reprimanded when following the rules of this discourse, as a result of girls’ interests being preconditioned as uninteresting. Mainstream media combines an adult interpretative prerogative which “others” young people, with a focus on the femininely connoted intimacy and subjectivity, which creates a highly derogatory discourse for those who are placed in both constructed categories: young girlsBlogging has, although it exists within a framework of a commercial market, become a major social movement among Swedish girls, where important cultural codes and communities are created. The body of evidence in this study shows how the evergrowing readership and influence over old-style media that blogs retain, while at the same time being defined by the same, points toward a dynamic power relationship where no party is unaffected by the other.
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| 8. |
- Zettermark, Sofia
(författare)
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Invisible, Responsible Women in Sweden–Planning Pregnancies, Choosing Contraceptives
- 2023
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Ingår i: NORA - Nordic Journal of Feminist and Gender Research. - 0803-8740. ; 31:4, s. 349-366
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Tidskriftsartikel (refereegranskat)abstract
- In this study I explore discourses of contraception and reproduction, which are drawn upon and reproduced in Swedish official online sources on contraceptive advice, through the theoretical frameworks of biomedicalization and reproductive justice. The analysis yielded three interwoven themes: 1) women in need of contraceptives have to balance discourses of exogenous hormones as both an “unnatural” threat to their bodies and as desirable, effective regulators of the same “naturally unruly” body; 2) in search of a “perfect contraceptive fit”, it is the woman who needs to accommodate to available methods, rather than the other way around; 3) women are made discursively invisible, while simultaneously being constructed as individually responsible for reproduction. Underpinning all these themes is the discourse of rational, responsible choices, of exerting agency by choosing the right contraceptive. In the era of biomedicalization, finding a “contraceptive fit” becomes a moral and gendered health practice demanding thorough self-surveillance. The rational woman, exercising control over her reproduction and body, by planning her pregnancy with safe contraceptives, emerges as the only possible position. Recognizing that women’s and fertile person’s reproductive choices are made amid a societal context, with differing personal resources and experiences, would bring us even closer to reproductive justice.
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| 9. |
- Zettermark, Sofia, et al.
(författare)
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Population heterogeneity in associations between hormonal contraception and antidepressant use in Sweden : a prospective cohort study applying intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)
- 2021
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: From a reproductive justice framework, we aimed to investigate how a possible association between hormonal contraceptive (HC) and antidepressants use (as a proxy for depression) is distributed across intersectional strata in the population. We aimed to visualise how intersecting power dynamics may operate in combination with HC use to increase or decrease subsequent use of antidepressants. Our main hypothesis was that the previously observed association between HC and antidepressants use would vary between strata, being more pronounced in more oppressed intersectional contexts. For this purpose, we applied an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy approach.DESIGN: Observational prospective cohort study using record linkage of national Swedish registers.SETTING: The population of Sweden.PARTICIPANTS: All 915 954 women aged 12-30 residing in Sweden 2010, without a recent pregnancy and alive during the individual 1-year follow-up.PRIMARY OUTCOME MEASURE: Use of any antidepressant, meaning being dispensed at least one antidepressant (ATC: N06A) during follow-up.RESULTS: Previously mentally healthy HC users had an OR of 1.79 for use of antidepressants compared with non-users, whereas this number was 1.28 for women with previous mental health issues. The highest antidepressant use were uniformly found in strata with previous mental health issues, with highest usage in women aged 24-30 with no immigrant background, low income and HC use (51.4%). The largest difference in antidepressant use between HC users and non-users was found in teenagers, and in adult women of immigrant background with low income. Of the total individual variance in the latent propensity of using antidepressant 9.01% (healthy) and 8.16% (with previous mental health issues) was found at the intersectional stratum level.CONCLUSIONS: Our study suggests teenagers and women with immigrant background and low income could be more sensitive to mood effects of HC, a heterogeneity important to consider moving forward.
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| 10. |
- Zettermark, Sofia
(författare)
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‘They all of a sudden became new people’ : Using reproductive justice to explore narratives of hormonal contraceptive experience in Sweden
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Ingår i: European Journal of Women's Studies. - 1350-5068.
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Tidskriftsartikel (refereegranskat)abstract
- This study explores how Swedish women narrate experiences of hormonal contraceptives through utilizing the frameworks of biomedicalization and reproductive justice, adding a social justice perspective previously lacking. Ten in-depth interviews were conducted with women who had experience of using hormonal contraception. Political narrative analysis illuminated how these women moved narratively both chronologically, from the teenage years to adulthood, and through social positioning, in their contraceptive stories. Two different, often conflicting, discourses of hormonal contraceptives emerged, which the women constantly negotiated. These can be described as (1) a biomedical interpretative prerogative, promoting hormonal methods as an easy fit for everyone, and negating the diverse lived experiences of women, and (2) a simplified critical media and online discourse, painting hormonal methods as an enemy to female health. From a reproductive justice standpoint, these stories illuminate that age is a relevant intersectional location, and even privileged women in a country known for its ‘gender equality agenda’ can experience subtle yet very real, reproductive coercion, when agency becomes constrained to choosing hormonal contraceptives within a dominant biomedical script. Even though critique of the mechanistic prescription of hormonal contraception is rather ubiquitous, the opposition in these narratives does not take the form of rejection of biomedical knowledge, rather the biomedical paradigm is internalized and incorporated into the embodied knowledge. This study shows that upstream factors such as gendered social injustices, reproductive norms, and a biomedical expansion are intricately interwoven with embodied experience of hormonal contraceptive use. It is important to acknowledge that distinct lived experiences of mood or personality change in women using hormonal contraceptives are contextual and dependent on intersectional location. I propose no simple panacea, but when a state-sanctioned biomedical prerogative puts all emphasis on individual reproductive planning behaviour, it obscures structural inequalities and narrows imaginable life trajectories.
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