Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 54-58).

During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.

One of the issues regarding the misclassification in case-control studies is whether the misclassification error rates are the same for both cases and controls. Currently, a common practice is to assume that the rates are the same (“non-differential” assumption). However, it is suspicious that this assumption is valid in many case-control studies. Unfortunately, no test is available so far to test the validity of the assumption of non-differential misclassification when the validation data are not available. We propose the first such method to test the validity of non-differential assumption in a case-control study with 2 × 2 contingency table. First, the Exposure Operating Characteristic curve is defined. Next, two non-parametric methods are applied to test the assumption of non-differential misclassification. Three examples from practical applications are used to illustrate the methods and a comparison is made.

Tyrimo tikslas. Aprašyti salmoneliozės epidemiologinius dėsningumus Vilniaus mieste ir apskrityje 1998–2007 metais ir įvertinti rizikos veiksnius Vilniaus mieste. Metodai. Salmoneliozės epidemiologinių dėsningumų įvertinimui naudotas aprašomasis epidemiologinis tyrimas. Aprašyta sergamumo daugiametė dinamika, sergamumas atskirose amžiaus grupėse, pagal kontingentą, lytį, sergamumo sezoniškumas, etiologinė struktūra, vyraujantys serotipai, plitimo būdai, užsikrėtimo vieta, protrūkiai. Salmoneliozės rizikos veiksnių nustatymui tarp Vilniaus miesto gyventojų naudotas atvejo – kontrolės tyrimas. Duomenų suvedimui ir analizei panaudotos Microsoft Exel 2007, WINPEPI moduliai Describe (v. 2.08) ir Compare (v. 2.11), EpiInfo 2008 (v.3.5.1) programos. Skaičiuoti rodikliai bei naudoti testai: regresijos koeficientas, 95 proc. pasikliautinieji intervalai (95% PI), šansų santykis (OR), Pearson'o chi-kvadrato kriterijus, Fisher'io tikslusis metodas, Mantel – Haenszel, Edwards‘o, Ratchet‘o ir Hewett‘o testai. Duomenys laikyti statistiškai reikšmingi, kai p<0,05. Rezultatai. Sergamumas salmonelioze visais metais Vilniaus mieste ir apskrityje buvo didesnis nei šalyje. Iš visų Vilniaus apskrities regionų, Vilniaus rajone nustatyta statistiškai reikšminga sergamumo didėjimo tendencija. Sergamumas įvairaus amžiaus grupėse ir tiriamuoju periodu labai svyravo. Vaikų tarpe salmonelioze dažniausiai serga lopšelinio amžiaus vaikai. Lopšelinių ir darželinių vaikų, nelankančių ikimokyklinių įstaigų... [toliau žr. visą tekstą] / The aim of the study was to describe epidemiology of salmonellosis in Vilnius and in Vilnius County in 1998–2007, also to assess salmonellosis risk factors in Vilnius. Methods. Descriptive epidemiological research was used to explore epidemiology of salmonellosis. Long-term dynamics of the incidence, incidence in different age groups, incidence according to the continent, gender, seasonality, etiological structure, predominant serotypes, manners of agent circulation, place of getting infection were assessed. Risk factors were evaluated using matched case –control study. Microsoft Excel 2007, Winpepi modules Describe (v. 2.08) and Compare (v. 2.11), EpiInfo 2008 (v. 3.5.1) statistical packages and programmes were used for data processing and analysis. The following indices were calculated and tests used: regression coefficients, 95% confidence intervals (CI), odds ratio (OR), Pearson's chi-square, Fisher's exact, Mantel – Haenszel, Edward’s, Ratchet’s and Hewett’s. Data considered significant, when p<0,05. Results. Incidence of salmonellosis over the period of analysis was higher in Vilnius city and County if compared to the country’s rates. Significantly increasing trend of incidence was detected in Vilnius rural district. Incidence varied a lot in different age groups, and in different years of analysis. Among children, salmonellosis was more often detected in 1-3 years age group. Higher rates of disease were found among those children, who were not attending preschools... [to full text]

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In a case-control study comprising 589 cases of male lung cancer in northern Sweden longitudinal data concerning occupations, employments and smoking habits were collected by questionnaires. Pipe smoking was as common as cigarette smoking and gave very similar relative risk. The pipe smoking cases, however, had significantly higher mean age and mean smoking years at the time of diagnosis than the cigarette smoking cases. In ex- smokers, the relative risk gradually decreased from 5 years after smoking cessation but this decrease was much less pronounced in ex-pipe smokers than in ex-cigarette smokers. High relative risks were obtained for small cell and squamous cell carcinomas. For adenocarcinoma the relative risk was considerably lower but still significantly increased. The population etiologic fraction attributable to smoking was about 80% in this series. Some occupational groups (underground miners, copper smelter workers, electricians and plumbers) exposed to previously known lung carcinogenic agents had considerably increased odds ratios, which persisted after adjustment for smoking. A slightly elevated odds ratio was observed in a group of blue collar workers potentially exposed to lung carcinogenic agents but this elevation generally disappeared after adjustment for smoking. For two specific subgroups, asphalt and concrete workers and pulp workers, the overrisk persisted after adjustment for smoking. Farmers and foresters had strikingly low odds ratios, which could only partly be explained by their more moderate smoking habits. The population etiologic fraction attributable to occupation was in the reported material assessed to 9 per cent. Professional drivers had higher average tobacco consumption than non-drivers, which explained the slightly increased crude odds ratio found for the occupational group as a whole. Smoking drivers in an upper age group (70 and over), however, had a high relative risk of lung cancer, while in a lower age group (under 70) no significant increase was found. The results in the older age group suggested a multiplicative effect between smoking and the occupational exposure. The study clearly verified the increased lung cancer risk in underground miners. An obvious dose-response relation was found with high risk after long time exposure. All analyses concerning underground miners suggested an interaction of a multiplicative type between underground mining and smoking in the causation of lung cancer. The cases of small cell carcinoma among the underground miners had shorter average latency time and in contrast to the other part of the material, shorter average age than the cases with epidermoid cancer. / <p>S. 1-40: sammanfattning, s. 41-136: 6 uppsatser</p> / digitalisering@umu

Background: Androgens are important in prostate cancer development but how circulating levels of androgens affect risk of prostate cancer of different aggressiveness is not clear. Being childless has been associated with a lower risk of prostate cancer, but it is not clear if this association is causal or a result of residual confounding. Fathering of dizygotic twins, a marker of high fertility, has not been studied in relation to risk of prostate cancer. Another marker of life-long hormonal exposure is height, which has been associated with increased risk of cancer and cancer death. However, the association to separate cancer sites has not been consistent. The aims of this thesis were to study hormonal factors (paper I), and proxies of hormonal factors (paper II and III), and risk of prostate cancer; as well as height and risk of cancer and cancer death by separate sites (paper IV). Methods: Study designs were i) case-control studies, nested within the Västerbotten Intervention Project (paper I), and in Prostate Cancer database Sweden 2.0 (PCBaSe 2.0) (paper II and III), and ii) cohort study, in the Metabolic Syndrome and Cancer project (Me-Can) (paper IV). Results, prostate cancer: In paper I, increasing levels of serum androgens were not associated with risk of prostate cancer overall or in tumor risk categories. In paper II, childless men had a lower risk of prostate cancer, overall and in all risk categories, compared to fathers, an association which was in part explained by differences in marital status and educational level.  In paper III, fathers of dizygotic twins did not have an increased risk of prostate cancer, either overall or in risk categories, when compared to fathers of singletons. Results, cancer overall: In paper IV, height was associated with an increased risk of cancer and cancer death overall in both women and men. The strongest association for cancer was to malignant melanoma in both women and men, and for cancer death to post-menopausal breast cancer in women and renal cell carcinoma in men. Conclusions: These studies indicate that hormonal factors, when studied as serum levels or when studied using proxies of fertility, do not have a major impact on the risk of prostate cancer. The association between height and an increased risk of cancer appears robust for total cancer and cancer death, as well as for several separate cancer sites.

No description available.

Tularemia is a zoonosis caused by the small, fastidious, gram-negative rod Francisella tularensis that appears over almost the entire Northern Hemisphere. In Sweden, tularemia has appeared mainly in restricted areas in northern parts of central Sweden. The disease can be transmitted through several routes: direct contact with infected animals, by vectors, through contaminated food or water or through inhalation of aerosolized bacteria. Distinct clinical forms of the disease are seen, depending on the route of transmission. During the last years, tularemia has emerged in new areas in central Sweden, south of the endemic area. The emergence of tularemia in the County of Örebro prompted the investigations presented in this thesis. We performed a case-control study, using a mailed questionnaire, to identify risk factors for acquiring tularemia in Sweden (Paper I). After multivariate analysis, mosquito bites and cat ownership could be associated with tularemia in all studied areas while farming appeared as a risk factor only in endemic areas. In Paper II, we evaluated a PCR analysis, targeting the tul4 gene, used on samples from primary lesions in patients with ulceroglandular tularemia. The method performed well, with a sensitivity of 78% and a specifi city of 96%. The clinical characteristics of tularemia in an emergent area in Sweden were studied Paper III), using case fi les and a questionnaire. Of 278 cases of tularemia reported during the years 2000 to 2004, 234 had been in contact with a doctor from the Department of Infectious Diseases at Örebro University Hospital, and were thus included. The ulceroglandular form of the disease was seen in 89% of the cases, with the primary lesion, in most cases, on the lower leg. An overwhelming majority of cases occurred during late summer and early autumn, further supporting transmission by mosquitoes. Erythemas overlying the affected lymph node areas were seen in 19% of patients with forms of tularemia affecting peripheral lymph nodes. Late skin manifestations, of various appearances, were seen in 30% of the cases, predominantly in women. A raised awareness of tularemia among physicians in the county during the course of the outbreak was found, as documented by the development of shorter doctor’s delay and less prescription of antibiotics inappropriate in tularemia. Finally, we developed a simplifi ed whole-blood lymphocyte stimulation test, as a diagnostic tool in tularemia (Paper IV). The level of IFN-γ, as a proxy for lymphocyte proliferation, was measured after 24-h stimulation. Additionally, a tularemia ELISA with ultra-purifi ed LPS as the antigen was evaluated, showing a high sensitivity. The lymphocyte stimulation test, when performed on consecutive samples from subjects with ongoing tularemia was able to detect the disease earlier in the course of the disease than both the new ELISA and the tube agglutination test. Furthermore, all tularemia cases became positive in the lymphocyte stimulation test within 12 days of disease. In conclusion, this thesis describes risk factors for acquiring tularemia as well as the clinical characteristics of the disease in Sweden. Additionally, a Francisella PCR analysis and a tularemia ELISA based on highly purifi ed LPS is evaluated, and a simplified lymphocyte stimulation test, for early confirmation of the disease, is developed.

Familial aggregation of prostate cancer has been demonstrated in studies conducted in a number of countries prior to the widespread adoption of prostate-specific antigen (PSA) testing for prostate cancer detection. PSA testing leads to over-diagnosis of asymptomatic disease that may not have become clinically significant within a man’s normal lifetime. This increase in the number of asymptomatic men diagnosed might alter the magnitude of familial risk estimates and the importance of a prostate cancer family history. (For complete abstract open document)