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  • 1. Akre, O
    et al.
    Ekbom, A
    Sparén, Pär
    Södertörns högskola, Avdelning 4, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Tretli, S
    Body size and testicular cancer2000Ingår i: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 92, nr 13, s. 1093-1096Artikel i tidskrift (Refereegranskat)
  • 2. Bergström, R.
    et al.
    Sparén, Pär
    Södertörns högskola, Avdelning 4, SCOHOST (Stockholm Centre on Health of Societies in Transition). Karolinska Institute.
    Adami, H. -O
    Trends in cancer of the cervix uteri in Sweden following cytological screening1999Ingår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 81, nr 1, s. 159-166Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Trends in cervical cancer incidence following the introduction of screening have mostly been studied using cross-sectional data and not analysed separately for squamous cell cancer and adenocarcinomas. Using Swedish nationwide data on incidence and mortality, we analysed trends during more than 3 decades and fitted Poisson-based age-period-cohort models, and also investigated whether screening has reduced the incidence of adenocarcinomas of the cervix. The incidence of reported cancer in situ increased rapidly during 1958-1967. Incidence rates of squamous cell cancer, fairly stable before 1968, decreased thereafter by 4-6% yearly in women aged 40-64, with a much smaller magnitude in younger and older women. An age-cohort model indicated a stable 70-75% reduction in incidence for women born 1940 and later compared with those born around 1923. The incidence of adenocarcinomas doubled during the 35-year study period. The mortality rate increased by 3.6% before 1968 and decreased by 4.0% yearly thereafter. Although a combination of organized and opportunistic screening can reduce the incidence of squamous cell cancer substantially, the incidence of adenocarcinomas appears uninfluenced by screening.

  • 3.
    Hultman, C M
    et al.
    Karolinska Institutet / University of Uppsala.
    Sparén, Pär
    Södertörns högskola, Avdelning 4, SCOHOST (Stockholm Centre on Health of Societies in Transition). Karolinska Institutet.
    Cnattingius, S
    Karolinska Institutet.
    Perinatal risk factors for infantile autism2002Ingår i: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 13, nr 4, s. 417-423Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Etiologic hypotheses in infantile autism suggest a strong genetic component, as well as possible environmental risks linked to early fetal development. We evaluated the association of maternal, pregnancy, delivery, and infant characteristics and risk of infantile autism. Methods. We conducted a case-control study nested within a population-based cohort (all Swedish children born in 1974-1993). We used prospectively recorded data from the Swedish Birth Register, which were individually linked to the Swedish Inpatient Register. Cases were 408 children (321 boys and 87 girls) discharged with a main diagnosis ion infantile autism from any hospital in Sweden before 10 years of age in the period 1987-1994, plus 2,040 matched controls. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results. The risk of autism was associated with daily smoking in early pregnancy (OR = 1.4; CI = 1.1-1.8), maternal birth outside Europe and North America (OR - 3.0; CI = 1.7-5.2), cesarean delivery (OR = 1.6; CI = 1.1-2.3), being small for gestational age (SGA; OR = 2.1; CI = 1.1-3.0), a 5-minute Apgar score below 7 (OR = 3.2, CI = 1.2-8.2), and congenital malformations (OR = 1.8, CI = 1.1-3.1). No association was found between autism and head circumference, maternal diabetes, being a twin, or season of birth. Conclusions. Our findings suggest that intrauterine and neonatal factors related to deviant intrauterine growth or fetal distress are important in the pathogenesis of autism.

  • 4.
    Jukkala, Tanya
    et al.
    Södertörns högskola, Institutionen för samhällsvetenskaper, Sociologi. Södertörns högskola, Institutionen för samhällsvetenskaper, SCOHOST (Stockholm Centre for Health and Social Change).
    Stickley, Andrew
    Södertörns högskola, Institutionen för samhällsvetenskaper, Sociologi. Södertörns högskola, Institutionen för samhällsvetenskaper, SCOHOST (Stockholm Centre for Health and Social Change).
    Mäkinen, Ilkka Henrik
    Uppsala University.
    Baburin, Aleksei
    National Institute for Health Development, Tallinn, Estonia.
    Sparén, Pär
    Karolinska Institutet.
    Age, period and cohort effects on suicide mortality in Russia, 1956-20052017Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, nr 1, artikel-id 235Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Russian suicide mortality rates changed rapidly over the second half of the twentieth century. This study attempts to differentiate between underlying period and cohort effects in relation to the changes in suicide mortality in Russia between 1956 and 2005.

    METHODS: Sex- and age-specific suicide mortality data were analyzed using an age-period-cohort (APC) approach. Descriptive analyses and APC modeling with log-linear Poisson regression were performed.

    RESULTS: Strong period effects were observed for the years during and after Gorbachev's political reforms (including the anti-alcohol campaign) and for those following the break-up of the Soviet Union. After mutual adjustment, the cohort- and period-specific relative risk estimates for suicide revealed differing underlying processes. While the estimated period effects had an overall positive trend, cohort-specific developments indicated a positive trend for the male cohorts born between 1891 and 1931 and for the female cohorts born between 1891 and 1911, but a negative trend for subsequent cohorts.

    CONCLUSIONS: Our results indicate that the specific life experiences of cohorts may be important for variations in suicide mortality across time, in addition to more immediate effects of changes in the social environment.

  • 5.
    Jukkala, Tanya
    et al.
    Södertörns högskola, Institutionen för samhällsvetenskaper, Sociologi. Södertörns högskola, Institutionen för samhällsvetenskaper, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Stickley, Andrew
    Södertörns högskola, Institutionen för samhällsvetenskaper, Sociologi. Södertörns högskola, Institutionen för samhällsvetenskaper, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Mäkinen, Ilkka Henrik
    Södertörns högskola, Institutionen för samhällsvetenskaper, Sociologi. Södertörns högskola, Institutionen för samhällsvetenskaper, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Sparén, Pär
    Karolinska institutet.
    Age, period and cohort effects on suicide mortality in Russia, 1956-2007Manuskript (preprint) (Övrigt vetenskapligt)
  • 6. Koupil, Ilona
    et al.
    Shestov, Dmitri B.
    Sparén, Pär
    Plavinskaja, Svetlana
    Parfenova, Nina
    Vågerö, Denny
    Södertörns högskola, Institutionen för samhällsvetenskaper, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Blood pressure, hypertension and mortality from circulatory disease in men and women who survived the siege of Leningrad2007Ingår i: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 22, nr 4, s. 223-234Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The population of Leningrad suffered from severe starvation, cold and psychological stress during the siege in 1941–1944. We investigated long-term effects of the siege on cardiovascular risk factors and mortality in surviving men and women. 3905 men born 1916–1935 and 1729 women born 1910–1940, resident in St Petersburg (formerly Leningrad) between 1975 and 1982, of whom a third experienced the siege as children, adolescents or young adults,were examined for cardiovascular risk factors in 1975–1977 and 1980–1982 respectively and followed till end 2005. Effects of siege exposure on bloodpressure, lipids, body size, and mortality were studied in multivariate analysis stratified by gender and period of birth, adjusted for age, smoking, alcohol and social characteristics. Women who were 6–8 years old and men who were 9–15 years-old at the peak of starvation had higher systolic blood pressure compared to unexposed subjects born during the same period of birth (fully adjusted difference 8.8, 95% CI:0.1–17.5 mm Hg in women and 2.9, 95% CI: 0.7–5.0 mm Hg in men). Mean height of women who were exposed to siege as children appeared to be greater than that of unexposed women. Higher mortality from ischaemic heart disease and cerebrovascular disease was noted in men exposed at age 6–8 and 9–15, respectively. The experience of severe stress and starvation in childhood and puberty may have long-term effects on systolic blood pressure and circulatory disease in surviving men and women with potential gender differences in the effect of siege experienced at pre-pubertal age.

  • 7. Koupil, Ilona
    et al.
    Shestov, Dmitri B.
    Sparén, Pär
    Plavinskaja, Svetlana
    Parfenova, Nina
    Vågerö, Denny
    Södertörns högskola, Institutionen för samhällsvetenskaper, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Blood pressure in men and women who survived the siege of Leningrad [abstract]2005Ingår i: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 58, nr 5, s. 1103-Artikel i tidskrift (Refereegranskat)
  • 8. Lagerlund, M
    et al.
    Hedin, A
    Sparén, Pär
    Södertörns högskola, Avdelning 4, SCOHOST (Stockholm Centre on Health of Societies in Transition). Karolinska Institute.
    Thurfjell, E
    Lambe, M
    Attitudes, beliefs, and knowledge as predictors of nonattendance in a Swedish population-based mammography screening program2000Ingår i: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 31, nr 4, s. 417-428Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. The effectiveness of mammography screening could be improved if factors that influence nonattendance were better understood. Methods. We examined attitudes, beliefs, and knowledge in relation to nonattendance in a population-based mammography screening program, using a case-control design. Data were collected from November 1997 to March 1998 through telephone interviews with 434 nonattenders and 515 attenders identified in a population-based mammography register in central Sweden. The questions asked drew primarily upon the components constituting the Health Belief Model. Results. Multivariate analysis showed that nonattendance was most common among women within the highest quartile of perceived emotional barriers, compared to women within the lowest quartile (OR = 4.81; 95% CI 2.96-7.82). Women who worried most about breast cancer were more likely to attend than those who worried least (OR = 0.09; 95% CI 0.02-0.31). Women with the highest scores of perceived benefits were more likely to attend than women with the lowest ones (OR = 0.35; 95% CI 0.08-0.75). Other factors associated with nonattendance were less knowledge about mammography and breast cancer, lack of advice from a health professional to participate, and very poor trust in health care. Conclusions, Our findings suggest that increased participation in outreach mammography screening programs can be achieved through enhancement of breast cancer awareness and possibly by reducing some of the modifiable barriers.

  • 9. Lagerlund, M
    et al.
    Sparén, Pär
    Södertörns högskola, Avdelning 4, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Thurfjell, E
    Ekbom, A
    Lambe, M
    Predictors of non-attendance in a population-based mammography screening programme; socio-demographic factors and aspects of health behaviour2000Ingår i: European Journal of Cancer Prevention, ISSN 0959-8278, E-ISSN 1473-5709, Vol. 9, nr 1, s. 25-33Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to identify predictors of non-attendance in a population-based mammography-screening programme in central Sweden, on the basis of telephone interviews with 434 non-attendees and 515 attendees identified in a mammography register, Non-attendance was studied in relation to sociodemographic factors, indicators of general health behaviour, self-rated health and experience of cancer in others and own cancer or breast problems. Being single or being non-employed were the only important socio-demographic predictors of non-attendance. Non-attendance was more likely among women who never visited a dentist, had not visited a doctor in 5 years, had never used oral contraceptives or hormone replacement therapy, had never had cervical smear tests, never drank alcohol, smoked regularly, reported no breast cancer in family or friends or own breast problems, We conclude that socio-demographic factors alone do not appear to constitute strong predictors of non-attendance, General health behaviour and previous experience of cancer and breast disease seem to be more important factors. Our results suggest that in the setting of population-based outreach mammography programmes, previous contacts with the health care system and encouragement from health professionals represent determinants of attendance.

  • 10. Osby, U
    et al.
    Correia, N
    Brandt, L
    Ekbom, A
    Sparén, Pär
    Södertörns högskola.
    Mortality and causes of death in schizophrenia in Stockholm County, Sweden2000Ingår i: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 45, nr 1-2, s. 21-28Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A study of mortality for all patients with a first hospital diagnosis of schizophrenia in Stockholm County, Sweden, during 1973 to 1995 was performed, by linking the in-patient register with the national cause-of-death register. Overall and cause-specific standardized mortality ratios (SMR) were calculated by 5-year age classes and 5-year calendar time periods. The number of excess deaths was calculated by reducing the observed number of deaths by those expected. Our results confirmed a marked increase in mortality in schizophrenia both in males and females. Natural (somatic) causes of death was the main cause of excess deaths, with more than half of the excess deaths in females, and almost half of the excess deaths in males. Suicide was the specific cause of the largest number of excess deaths in males, while in females it was cardiovascular disease. SMRs were increased in both natural and unnatural causes of death, with 2.8 for males and 2.4 for females for all deaths, but were highest in suicide with 15.7 for males and 19.7 for females, and in unspecified violence with 11.7 for males and 9.9 for females. SMRs in suicide were especially high in young patients in the first year after the first diagnosis.

  • 11. Osby, U
    et al.
    Hammar, N
    Brandt, L
    Wicks, S
    Thinsz, Z
    Ekbom, A
    Sparén, Pär
    Södertörns högskola.
    Time trends in first admissions for schizophrenia and paranoid psychosis in Stockholm County, Sweden2001Ingår i: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 47, nr 2-3, s. 247-254Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Several studies have reported decreasing time trends in first diagnosed schizophrenia patients. The aim of this: study was to analyze time trends for first admissions with a diagnosis of schizophrenia or a diagnosis of either schizophrenia or paranoid psychosis during 1978-1994 in Stockholm County, Sweden, with a population of around 1.8 million. Information about first psychiatric admission with the diagnosis schizophrenia or paranoid psychosis for residents of Stockholm County was obtained from the Swedish population-based psychiatric inpatient register. Age-adjusted average yearly changes in first hospitalization rates were estimated in a Poisson regression model. Time trends in first admission rates were calculated from 1978 to 1994, while admissions during 1971 to 1977 were observed only to eliminate later re-admissions. First admissions for schizophrenia declined by 1.9% annually for females and by 1.3% for males, while first admissions for schizophrenia and paranoid psychosis together were unchanged over the study period for both genders. Our results indicate that the incidence of schizophrenia and paranoid psychosis taken together was essentially the same over the studied time period in Stockholm County, and that the apparent decline in first admission rates for schizophrenia may be an effect of changes in clinical diagnosis over time.

  • 12.
    Sparén, Pär
    et al.
    Södertörns högskola, Avdelning 4, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Vågerö, Denny
    Stockholm University.
    Stagnation, sammanbrott och social nyordning - rötterna till den ryska folkhälsokrisen2000Ingår i: Sociologisk forskning, ISSN 0038-0342, Vol. 37, nr 1, s. 127-149Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Long term trends of deteriorating health status in Soviet Union and Eastern Europe during the last two decades of communism were followed by a new crisis in health, after the collapse of its social system. In contrast, the perestroika period coincided with strongly improved public health. Explanations for the latest Russian health crisis are discussed. It is concluded that explanations based on poor medical care, excessive alcohol consumption or nutrional deprivation are, at best, insufficient. The collapse of the social system itself has lead to a narrowing of individual and collective decision latitudes; we speculate that historical factors, such as vulnerability of specific birth cohorts or segments of the population, may be part of the unexpected and very steep rise of mortality during the first half of the 1990s.

  • 13. Sparén, Pär
    et al.
    Vågerö, Denny
    Södertörns högskola, Institutionen för samhällsvetenskaper, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Shestov, Dmitri B
    Plavinskaja, Svetlana
    Parfenova, Nina
    Hoptiar, Valeri
    Paturot, Dominique
    Galanti, Maria Rosaria
    Long term mortality after severe starvation during the siege of Leningrad: prospective cohort study2004Ingår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 328, nr 7430, s. 11-14AArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To determine whether starvation during periods of increased growth after birth have long term health consequences.Design Analysis of cardiovascular risk factors and mortality in a longitudinal follow up after the 1941-4 siege of Leningrad. Mortality measured from 1975 up to the end of 1999.Setting St Petersburg, Russia (formerly Leningrad).Participants 5000 men born 1916-35 who lived in Leningrad, randomly selected to take part in health examinations in 1975-7. Of the 3905 men who participated, a third had experienced the siege.Main outcome measures Relative risk of ischaemic heart disease and mortality from stroke by siege exposure. Odds ratios and means for several cardiovascular risk factors.Results Three to six decades after the siege, in men who experienced the siege around the age of puberty blood pressure was raised (mean difference in systolic 3.3 mm Hg, in diastolic 1.3 mm Hg) as was mortality from ischaemic heart disease (relative risk 1.39, 95% confidence interval 1.07 to 1.79) and stroke (1.67, 1.15 to 2.43), including haemorrhagic stroke (1.71, 0.90 to 3.22). The effect on mortality was partly mediated via blood pressure but not by any other measured biological, behavioural, or social factor.Conclusions Starvation, or accompanying chronic stress, particularly at the onset of or during puberty, may increase vulnerability to later cardiovascular disease.

  • 14. Stenbeck, M.
    et al.
    Rosén, M. A.
    Sparén, Pär A.
    Södertörns högskola, Avdelning 4, SCOHOST (Stockholm Centre on Health of Societies in Transition). Karolinska Institute.
    Causes of increasing cancer prevalence in Sweden1999Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 354, nr 9184, s. 1093-1094Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The prevalence of cancer in Sweden has increased greatly during the past 30 years. 40-47% of the observed increase can be explained by population dynamics, and 30% by better survival. Hence, only 23-29% is attributable to risk increase.

  • 15.
    Vågerö, Denny
    et al.
    Södertörns högskola, Institutionen för samhällsvetenskaper, SCOHOST (Stockholm Centre for Health and Social Change). CHESS, Stockholm Universtiy / Karolinska Institutet.
    Koupil, Ilona
    CHESS, Stockholm Universtiy / Karolinska Institutet.
    Parfenova, Nina
    Russian Academy of Medicine Science, St. Petersburg, Russia.
    Sparen, Pär
    Karolinska Institutet.
    Long-term health consequences following the siege of Leningrad2013Ingår i: Early life nutrition and adult health and development: lessons from changing dietary patterns, famines and experimental studies / [ed] L.H. Lumey and Alexander Vaiserman, New York: Nova Science Publishers, Inc., 2013, s. 207-225Kapitel i bok, del av antologi (Övrigt vetenskapligt)
    Abstract [en]

    We are interested in the long-term health consequences associated with severe starvation and war trauma, and whether certain "age windows" exist when exposure to such events are particularly harmful.The siege of Leningrad (now St. Petersburg) during World War II provided an opportunity to study this. For 872 days, German troops prevented supplies from reaching Leningrad. Simultaneously, there was a food blockade and a steady and merciless bombardment by shells from guns and from the air. The first winter, 1941/42, represents the most severe food shortage, amounting to mass starvation or semi-starvation. Our late colleague, Professor Dimitri Shestov, had suffered the consequences of the Leningrad siege as a boy and believed that it had taken a toll on people beyond its immediate short- and medium-range consequences. He was particularly concerned about its long-term consequences for circulatory disease. A 1973 US-Soviet agreement, the socalled Lipid Research Clinics Collaboration, gave him an opportunity to study this. From 1975 to 1982 men and women living in Leningrad (now St. Petersburg) were randomly sampled and invited to examine their health and cardiovascular functioning. Dimitri Shestov added a simple question to this examination: "Were you in Leningrad during the blockade?" A third of the participants were. They had experienced peak starvation (in January 1942) at ages 1-31 (women) or 6-26 (men).The mortality follow-up began immediately after the first clinical examinations in 1975 and continued for three decades, until the end of 2005. Our analyses show that the siege of Leningrad, particularly when experienced in puberty, has had long-term effects on blood pressure both in men and women.We also found a raised IHD and stroke risk among those men. This was partly mediated via blood pressure but not by any other measured biological, behavioral, or social factors.Girls experiencing the siege around puberty suffered an elevated risk of dying from breast cancer later in life.The fact that the effect of siege exposure is modified by the age at exposure is highly interesting from a scientific point of view. It may suggest that a reprogramming of physiological systems can occur at specific age windows in response to starvation and/or war trauma. The team that worked from 1975-2005 to collect clinical information and death certificates for participants in the study included Svetlana Plavinskaya, born in Leningrad during the siege. Dimitri Shestov and Svetlana Plavinskaya died in 2010 and 2011, respectively. We dedicate this chapter to their memory.

  • 16.
    Vågerö, Denny
    et al.
    Stockholm University.
    Shestov, Dmitri B.
    Galanti, Maria Rosaria
    Sparén, Pär
    Long term mortality after severe starvation during the siege of Leningrad: authors' reply2004Ingår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 328, nr 7435, s. 346-347Artikel i tidskrift (Refereegranskat)
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