The aim of this study was to examine which sources people turn to in order to find information about food and diets. Another aim was to find out how reliable people thought the various sources to diet – related information was. The method used to collect data was a web-based survey which was published on the writers private Facebook page. The total number of respondents was 48, between the ages of 18 and 55. The results showed that the most reliable source of information, was not the most likely first hand choice that the respondents would turn to, in order to find information. The conclusion of this study was that it is necessary to continue research among the public regarding their views on credibility of their sources of information, not least on the internet / Studiens syfte var att undersöka vilken typ av källa deltagarna vänder sig till för att få information om kost och livsmedel. Syftet var också att ta reda på hur trovärdiga de ansåg att olika källor till kostrelaterad information var. Undersökningen gjordes i form av en web-baserad enkät som publicerades via uppsatsskrivarens privata sida på Facebook. Det totala antalet deltagare var 48 stycken, 34 kvinnor och 14 män, dock så slutförde inte alla deltagare hela enkäten. Resultatet från studien visade att den källa som respondenterna ansåg vara den mest trovärdiga, inte självklart var den källa man vände sig till i första hand för att få information om kost och livsmedel. Störst andel av deltagarna vände sig i första hand till vänner och familj i sökandet efter information. På frågan vilken källa som ansågs vara mest pålitlig så hamnade Statens Livsmedelsverk högst upp bland deltagarna men endast 2 av 29 svarande vände sig till denna källa i första hand. Vart deltagarna vände sig i sista hand svarade flest dagstidningar vilket också var den källan som ansågs vara minst trovärdig bland de olika alternativen i enkäten. Slutsatsen är att det krävs mer forskning för att undersöka hur människor resonerar och förhåller sig till källkritik och kunskapssökande. Inte minst kring de källor och information som finns online.

Psykisk ohälsa är ett globalt ökande folkhälsoproblem bland den unga befolkningen och i synnerhet bland flickor. Det har blivit allt vanligare att barn och unga söker vård för besvär som huvudvärk, magont, oro och ångest, men även för allvarligare former av psykisk ohälsa som depression har ökat. Detta belyser ett behov av insatser som ämnar främja barn och ungas psykiska hälsa. Stress har synliggjorts som en orsak till den ökade psykiska ohälsan. Således är syftet med denna studie att undersöka förekomst, könsskillnader samt potentiella samband mellan stress och psykisk ohälsa, i form av psykosomatiska besvär och depressiva symptom, bland ungdomar i Västmanlands län. Sekundärdata från enkätundersökningen Liv och Hälsa Ung 2012 användes och studien genomfördes med en kvantitativ ansats. Känsla av sammanhang (KASAM) och krav-kontroll-stödmodellen användes som två teoretiska verktyg för att förstå sambandet mellan stress och psykisk ohälsa. Resultatet visar att psykosomatiska besvär, depressiva symptom och stress är vanligt förekommande bland ungdomar i Västmanland, med överrepresentation bland flickor. Det finns också signifikanta samband mellan att ofta vara stressad och ökade psykosomatiska besvär respektive depressiva symptom. En slutsats som kan dras är att stress och psykisk ohälsa är ett utbrett problem bland ungdomar i Västmanland och i synnerhet bland flickor. / Mental illness is a worldwide growing public health problem among the young population and particularly among girls. It has become increasingly common for children and young people seeking care for health problems such as headaches, stomach pain, worry and anxiety, but also more serious forms of mental illness such as depression have increased. This highlights the need for interventions that intend to promote children's and young people's mental health. Stress, mainly school-related, has been highlighted as a cause for the increase in mental illness. Thus, the purpose of this study was to investigate the prevalence, gender differences and the potential relation between stress and mental illness, in the form of psychosomatic problems and depressive symptoms, among adolescents in Västmanland. Secondary data from the Survey of Adolescent Life in Västmanland 2012 was used and the study was performed using a quantitative approach. Sense of coherence (SOC) and demand- control-support model was used as two theoretical tools to understand the relation between stress and mental illness. The results show that psychosomatic problems, depressive symptoms and stress are common among adolescents in Västmanland, where girls are overrepresented in all respects. The results also show significant relations between often being stressed and increased psychosomatic problems and depressive symptoms. One conclusion that can be drawn is that stress and mental illness is a widespread problem among young people in Västmanland and especially among girls.

Background Mass screening for celiac disease (CD) as a public health intervention is controversial. Before implementation, a suitable screening strategy should be outlined, and the acceptability of the screening scrutinized. Also, the benefits of early detection and possible negative consequences should be explored and compared. The overall aim of this thesis was to evaluate different strategies for finding 12-year-olds with undiagnosed CD in the general population, and to explore the experiences of those receiving the diagnosis in a mass screening. Methods A school-based CD screening of 12-year-olds was conducted in five study sites across Sweden. Out of 10041 children who were invited, 7208 had a blood sample analyzed for CD-marker tissue transglutaminase of isotype IgA (tTG-IgA) and 7161 for total serum IgA (s-IgA). If the s-IgA value was low, tTG-IgG was also measured. Additional analysis of endomysial antibodies (EMA) was performed if borderline values of tTG were found. In total, 192 had elevated CD-markers, 184 underwent a small intestinal biopsy and 153 eventually had CD diagnosed. Before receiving knowledge about their CD status, children and their parents filled in questionnaires regarding symptoms and CD-associated conditions. Questionnaires were returned by 7054 children (98%) and 6294 parents (88%). Later, all adolescents who had been diagnosed with CD more than one year ago (n=145), and their parents, were invited to a mixed-method follow-up study in which they shared their experiences in questionnaires, written narratives and focus group discussions. In total, we have information on 117 (81%) of these adolescents, either from the adolescents themselves (n=101) and/or from their parent/s (n=125). Data were analyzed using a combination of descriptive and analytical quantitative and qualitative methodologies. Results We found that information on symptoms and CD-associated conditions were poor predictors for finding undiagnosed CD in the study population. Questionnaire-based case-finding by asking for CD-associated symptoms and conditions would have identified 52 cases (38% of all cases) at a cost of blood-sampling 2282 children (37% of the study population). The tTG-IgA test had an excellent diagnostic accuracy with the area under the receiver operating characteristic curve of 0.988. If using the recommended cut-off for tTG-IgA (>5 U/mL) 151 had fulfilled biopsy criteria and 134 CD cases had been identified. The strategy of lowering the cut-off to tTG-IgA>4 U/mL, and adding the EMA analysis in those with tTG-IgA between 2-4 U/mL, identified another 17 cases (a 12% increase) at the cost of performing 32 additional biopsies. Measuring total s-IgA in 7161 children discovered only two additional cases at the cost of performing 5 additional biopsies. The positive predictive value of our screening strategy was 80%.  Results from the follow-up study of the screening-detected CD cases illustrated that 54% reported health improvement after initiated treatment, but also that these health benefits had to be balanced against social sacrifices. We also found that although the screening-detected diagnosis was met with surprise and anxiety, the adolescents and their parents were grateful for being made aware of the diagnosis. A majority of parents (92%) welcomed a future screening, but both adolescents and parents suggested that it should be conducted earlier in life. Conclusion Obtaining information on symptoms and CD-associated conditions was not a useful step in finding undiagnosed CD cases in a general population. The serological marker tTG-IgA, however, had excellent diagnostic accuracy also when lowering the cut-off. The diagnosis had varying impact on adolescents’ quality of life, and their perceived change in health had to be balanced against the social sacrifices resulting from the diagnosis. Overall, CD mass screening seemed acceptable to most of those who were diagnosed and their parents.

Background: Russia has undergone tremendous socioeconomic transformations. Particularly detrimental was the period of 1990-s that evidenced hazardous trends in public health. Alcohol consumption was suggested to be responsible for the negative health trends in the society. Male alcohol consumption attracted disproportional attention leaving female alcohol consumption, its predictors and influence on women’s health disregarded and uninvestigated. Aim: To describe the practices of female alcohol consumption and socio-demographic predictors of drinking, to explore the impact that drinking might have on the self-rated health of Russian women. Method: Cross-sectional analysis of data drawn from the Russia Longitudinal Monitoring Survey, round 20th. The association tests between the measures of alcohol consumption and covariates were run. Ordinal regression model tested the predictors of self-rated health.      Results: A Russian female drinker is middle-aged, high-educated, married/ cohabiting or divorced, resides from the urban area and is infrequent drinker. The frequency of drinking increases when she is young, high-educated, married/ cohabiting, resides from urban area. U-shaped relation between drinking and self-rated health was demonstrated: never drinkers and regular drinkers report poorer health than seldom-drinkers.  Conclusion: Predictors of female drinking in Russia are poorly investigated due to overrepresentation of research focused on men’s drinking. More studies are needed in order to explore the impact of drinking on self-rated health of  Russian women.

Childhood obesity is a serious public health problem. The present study investigated the association of parental educational background and social support with children’s weight status, and assessed whether parental depression influences the association of educational background and social support with children’s weight status. The study included data from 175 children in Stockholm County aged 4–6 years with obesity and a mean body mass index (BMI) standard deviation score (SDS) of 3.2; 45% of the cohort were male. Data included information provided by 98 mothers and 93 fathers. Forty-four percent of mothers had a university education, 66% were overweight or obese, and 77% displayed minimal depression symptoms. Forty-six percent of fathers had a university education, 52% were overweight or obese, and 87% displayed minimal depression symptoms. The association between parental educational background and social support and child BMI SDS was investigated using regression analysis for mothers and fathers. Results showed that educational level reported by fathers was negatively associated with high BMI SDS among children. Even after controlling for covariates, a low level of paternal education remained associated with a high BMI SDS among the children. Neither social support nor parental depression modified the effect of parental education on child BMI SDS.

The aim of this thesis was to expand the knowledge of victimization in children and youth in Sweden. Victimization, prevalence, health and peritraumatic reactions were explored in a cross sectional, representative sample of 5,960 second grade high school students in Sweden. A computerized survey was developed and administered in class room setting. Lifetime victimization was found in 84.1% of the sample (m=83.0%, f=85.2%), and, in relation to the five domains, 66.4% had experienced conventional crime, 24% child maltreatment, 54.4% peer and sibling victimization, 21.8% sexual victimization, and 54% had experienced witness victimization. Females experienced significantly more child maltreatment, peer and sibling victimization, sexual victimization, and witnessed victimization, males more conventional crime (p<0.001). Using logistic regression risk factors for victimization were confirmed by a significant increase OR regarding gender, environment and lack of both parents. Symptoms (TSCC), were clearly associated with both victimizations per se and the number of victimizations. The results indicated a relatively linear increase in symptoms with an increase in number of events experienced. Mental health of the polyvictimized group was significantly worse than that of the non-polyvictimized group, with significantly elevated TSCC scores (t<0.001). Hierarchical regression analysis resulted in beta value reduction when polyvictimization was introduced supporting the independent effect on symptoms. Social anxiety was found in 10.2 % (n = 605) of the total group (n = 5,960). A significant gender difference emerged, with more females than males reporting social anxiety. Elevated PTSS was found in 14.8 % (n=883). Binary logistic regression revealed the highest OR for having had contact with child and adolescent psychiatry was found for the combined group with social anxiety and elevated PTSS (OR = 4.88, 95 % CI = 3.53–6.73, p<001). Significant associations were also found between use of child and adolescent psychiatry and female gender (OR = 2.05, 95 % CI = 1.70–2.45), Swedish birth origin (OR = 1.68, 95 % CI = 1.16–2.42) and living in a small municipality (OR = 1.33, 95 % CI = 1.02–1.73). Mediation models used peritraumatic reactions (PT): total, physiological arousal (PA), peritraumatic dissociation (PD), and intervention thoughts (IT) and JVQ and TSCC. Of the n=5,332 cases, a total of n=4,483 (84.1%) reported at least one victimizing event (m = 83.0%, f = 85.2%). Of these, 74.9% (n=3,360) also experienced a PT reaction of some kind. The effect mediated by PT tot was b= 0.479, BCa CI [0.342 – 0.640], representing a relatively small effect of 7.6%, κ2=0.076, 95% BCa CI [0.054- 0.101]. The mediating effect of JVQ on TSCC was mediated by PD more for males (b=0.394 BCa CI [0.170-0.636]) than for females (b=0.247, BCa CI [0.021-0.469]). The indirect effect of the JVQ on the TSCC tot mediated by the different PT reactions was significant for PD (b=0.355, BCa CI [0.199- 0.523]. In males a mediating effect of PD could be seen in the different models, while females had a more mixed result. IT did not show any indirect effect in males, but had a mixed effect for females. The empirical findings in this thesis lead to the conclusion that victimization is highly prevalent in children and youth and is related to health issues. The association of victimization on symptoms was mediated by peritraumatic reactions. Using a comprehensive instrument such as the JVQ provides the researcher or clinician the opportunity to acquire more complete measurement and also makes it possible to identify polyvictimization, a high-level category of events with severe impact on health.

Background: Vietnam suffers consequences of global warming. There is limited data of the relationship between weather, extreme heat and potential mental health problems. It is therefore crucial to study heat-related mental illnesses and to establish good solutions with relevant adaptations to global warming. The adaptation measures should give attention to people that live in areas facing annual extreme weather, and protecting health in general and more specifically mental health of citizens. The study aimed to examine relationships between weather patterns, extreme heat or heatwaves, and mental disorders, and to investigate factors contributing to increased vulnerability and susceptibility. Methods: The thesis includes a systematic review and a hospital-based study using data from the Hanoi Mental Hospital for five years (2008 – 2012), with mental disorders diagnosed by ICD10 (F00-99) to estimate the effects of weather variation, seasonality, increased temperatures, and heatwaves on hospital admissions for depression and other mental disorders. A negative binomial regression model accounting for yearly study period, time trends, and day of the week was used to analyze the relationship between seasonality, heatwaves, and monthly and daily mental disorder hospitalizations. Results: Our findings showed (i) a general tendency for more admissions between May and December, with a seasonal bi-annual high between May-June and November-December, and elevated ambient temperature was significantly related to increasing admissions for depressive disorders; (ii) the number of hospital cases for mental disorders increased in the summer seasone specially in June, and two percent of cases emerged during elevated temperature of one degree Celsius; and (iii) when compared with non-heatwave periods, heatwaves amounted to increasing risks for admission for the whole group of mental disorders (F00-79), and admissions for mental disorders among residents in rural communities and in the elderly population increased significantly during heatwaves. Conclusion: There were associations between hospital admissions for depression and other mental disorders and seasonality, weather patterns, elevated temperatures, and heatwaves. The associations grew stronger with the length of the heatwaves and particularly the elderly appeared more sensitive to seasonality, hot weather and heatwaves.

Background Type 2 diabetes is a common chronic disease with a two-fold increased risk for cardiovascular morbidity and mortality and has an increasing prevalence worldwide. This thesis is based on a study conducted in primary health care in Östergötland and Jönköping, Sweden. The aim of the thesis was to evaluate new risk markers to identify patients with high risk of developing cardiovascular disease in middle-aged men and women with type 2 diabetes. Methods Data from the cohort study CArdiovascular Risk in type 2 DIabetes – a Prospective study in Primary care (CARDIPP) was used. In paper III data were also used from CARDIPP-Revisited where all participants in the CARDIPP study were invited four years after the baseline investigation for a re-investigation. In paper IV data were used from CAREFUL which is a control group of 185 subjects without diabetes. The investigation included a standard medical history including data on diabetes duration and on-going medication. Anthropometric data were recorded and both office and ambulatory blood pressure were measured. The patients filled out a detailed questionnaire and physical activity was measured by using waist-mounted pedometers. Pedometer-determined physical activity was classified in four groups: Group 1: <5000 steps/day (‘sedentary’); Group 2: 5000-7499 steps/day (‘low active’); Group 3: 7500-9999 steps/day (‘somewhat active’); Group 4: and ≥10 000 steps/day (‘active’). Blood samples were drawn for routine analyses and also frozen for later analyses. The investigations at the departments of physiology included echocardiography, measurements of the carotid intima-media thickness, applanation tonometry and measurements of  sagittal abdominal diameter. Results Paper 1: Patients with a non-dipping systolic blood pressure pattern showed higher left ventricular mass index and pulse wave velocity (PWV) compared with patients with ≥10% decline in nocturnal systolic blood pressure. Patients with <10% decline in nocturnal systolic blood pressure had higher BMI and sagittal abdominal diameter, lower GFR and higher albumin:creatinine ratio and also higher levels of NT-proBNP than patients with a dipping pattern of the nocturnal blood pressure. Paper 2: The number of steps/day were inversely significantly associated with BMI, waist circumference and sagittal abdominal diameter, levels of CRP, levels of interleukin-6 and PWV. Paper 3: At the 4-year follow-up the change in PWV (ΔPWV) from baseline was calculated. The group with the lowest steps/day had a significantly higher increase in ΔPWV compared with the group with the highest steps/day. The associations between baseline steps/day and ΔPWV remained after further adjustment in a multivariate linear regression statistically significant (p=0.005). 23% of the variation in the study could be explained by our model. Every 1000 extra steps at baseline reduced the change in ΔPWV by 0.103 m/s between baseline and follow-up. Paper 4: Low vitamin D levels were associated with significantly increased risk for premature mortality in men with type 2 diabetes. High levels of parathyroid hormone were associated with significantly increased risk for premature mortality in women with type 2 diabetes. These relationships were still statistically significant also when two other well-established risk markers for mortality, PWV and carotid intima-media thickness, were added to the analyses. Conclusions Ambulatory blood pressure recording can by addressing the issue of diurnal blood pressure variation, explore early cardiovascular organ damage and microvascular complications that goes beyond effects of standardised office blood pressure measurements. Pedometer-determined physical activity may serve as a surrogate marker for inflammation and subclinical organ damage in patients with type 2 diabetes. There is novel support for the durable vascular protective role of a high level of daily physical activity, which is independent of BMI and systolic blood pressure. The use of pedometers is feasible in clinical practice and provides objective information not only about physical activity but also the future risk for subclinical organ damage in middle-aged people with type 2 diabetes. Our results indicate that low vitamin D levels in men or high parathyroid hormone levels in women give independent prognostic information of an increased risk for total mortality.

Background: As more women of childbearing age engage in the workforceand a lot of new chemicals are available, a growing interest of diagnosing andpreventing reproductive disorders due to occupational and environmentalexposure has occurred. The source location of this thesis is the Rönnskärcopper smelter which is situated in the north of Sweden, in the municipality of Skellefteå. Emissions from the smelter, which have diminished during theperiod 1975-1990 include sulphur dioxide and heavy metals, especially lead,arsenic, cadmium, copper, mercury and zinc. Reproductive studies from the1970s in and around the smelter reported increased risks of spontaneousabortions, malformations and lower birth weight. The aim of this thesis wasto perform a broad and long-term epidemiological assessment of adversereproductive outcome in and around the smelter and to determine if theexposed population suffered from reproductive disturbances during the recentdecades. Subjects and methods: The study involve two main sources of data. Onewas a retrospective cohort formed through record linkage of populationregisters, the medical birth register (1961-90), the register of congenitalmalformations (1973-90) and the cancer register (1961-90). As another source,information on reproductive history, life-style and work related factors wasobtained from a questionnaire study in 1992. An exposed population wasdefined as smelter workers and their children, and also neighbours to thesmelter and their children. Results: In the register study, compared to the reference population, nooverall significant increased risk of malformations, childhood cancer, low birthweight or perinatal death was found in the exposed group. In thequestionnaire study, regarding infertility, no environmental effects were found.Also, no increased risk of a prolonged waiting time to pregnancy or increasedrisk of spontaneous abortions were associated with occupational or environmentalfactors. Conclusion: With the lack of a high statistical power in mind, due to smallsample sizes in some of the studies, the summary of our findings includingseveral outcomes, different epidemiological study designs and studies coveringa long period of time gives no evidence for any increased risk of reproductivehazards due to occupational or environmental exposure. / digitalisering@umu

Background Advances in medical treatment during the last 50 years have resulted in more individuals with congenital heart disease (CHD) and Marfan syndrome reaching childbearing age. The substantial physiological changes during pregnancy result in a high-risk situation, and pregnancy is a major concern in women with these conditions. Aims To describe the socio-demographic characteristics, birth characteristics and reproductive patterns of individuals with CHD and women with Marfan syndrome. To investigate obstetric and neonatal outcomes in the firstborn children of individuals with CHD and women with Marfan syndrome. To study long-term cardiovascular outcomes after childbirth in women with Marfan´syndrome. Methods The studies are population-based register studies. The study population in the first paper included all women born between 1973 and 1983 who were alive and resident in Sweden at the age of 13 (494 692 women, of whom 2 216 were women with CHD). In the second paper, the same definition of the study population was chosen, except that it involved all men born between 1973 and 1983 (522 216 men, of whom 2 689 men with CHD). The third and fourth papers involved a study population of all Swedish women born between 1973 and 1993 who were still living in Sweden at age 13. This population consisted of 1 017 538 women, 273 of whom had been diagnosed with Marfan syndrome. Results and conclusions The individuals studied were more often born preterm, and were small-for-gestational age babies. They were more likely to have been born by cesarean section. In women with CHD, these characteristics were repeated in their firstborn children. No increased risks were found in children of men with CHD or in children of women with Marfan syndrome. There was no increased risk of aortic dissection in women with Marfan syndrome during pregnancy compared to women with Marfan syndrome who did not give birth. Higher frequencies of cardiac arrhythmia and valvular heart disease were found after childbirth in women with Marfan syndrome. Pregnancy in women with CHD is a high-risk situation associated with increased risk of adverse neonatal outcomes for the expected child. Pregnancy in women without CHD, but where the father has CHD is not so associated with increased risk of adverse obstetric or neonatal outcomes. Pregnancy in women with Marfan syndrome is not associated with adverse outcomes for the expected child.