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  • 1.
    Bergh, Cecilia
    et al.
    Örebro University, School of Health Sciences.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences. Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Department of Medicine, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, UK.
    Shared unmeasured characteristics among siblings confound the association of Apgar score with stress resilience in adolescence2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed)
    Abstract [en]

    AIM: We investigated the association between low Apgar score, other perinatal characteristics and low stress resilience in adolescence. A within-siblings analysis was used to tackle unmeasured shared familial confounding.

    METHODS: We used a national cohort of 527,763 males born in Sweden between 1973 and 1992 who undertook military conscription assessments at mean age 18 years (17-20). Conscription examinations included a measure of stress resilience. Information on Apgar score and other perinatal characteristics was obtained through linkage with the Medical Birth Register. Analyses were conducted using ordinary least squares and fixed-effects linear regression models adjusted for potential confounding factors.

    RESULTS: Infants with a prolonged low Apgar score at five minutes had an increased risk of low stress resilience in adolescence compared to those with highest scores at one minute, with an adjusted coefficient and 95% confidence interval of -0.26 (-0.39, -0.13). The associations were no longer statistically significant when using within-siblings models. However, the associations with stress resilience and birthweight remained statistically significant in all analyses.

    CONCLUSION: The association with low Apgar score seems to be explained by confounding due to shared childhood circumstances among siblings from the same family, while low birthweight is independently associated with low stress resilience.

  • 2.
    Brunner, Eric
    et al.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Hiyoshi, Ayako
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Cable, Noriko
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Honjo, Kaori
    Global Collaboration Center, Osaka University, Suita, Osaka, Japan.
    Iso, Hiroyasu
    Osaka University, Suita, Osaka, Japan.
    Social epidemiology and Eastern wisdom2012In: Journal of Epidemiology, ISSN 0917-5040, E-ISSN 1349-9092, Vol. 22, no 4, p. 291-294Article, review/survey (Refereed)
    Abstract [en]

    Social epidemiology is the field of study that attempts to understand the social determinants of health and the dynamics between societal settings and health. In the past 3 decades, large-scale studies in the West have accumulated a range of measures and methodologies to pursue this goal. We would like to suggest that there may be conceptual gaps in the science if Western research models are applied uncritically in East Asian studies of socioeconomic, gender, and ethnic inequalities in health. On one hand, there are common concerns, including population aging and gendered labor market participation. Further, international comparison must be built on shared concepts such as socioeconomic stratification in market economies. On the other hand, some aspects of health, such as common mental disorders, may have culturally specific manifestations that require development of perspectives (and perhaps novel measures) in order to reveal Eastern specifics. Exploring and debating commonalities and differences in the determinants of health in Oriental and Occidental cultures could offer fresh inspiration and insight for the next phase of social epidemiology in both regions.

  • 3.
    Cable, N.
    et al.
    Department of Epidemiology and Public Health, University College London, London, UK.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Kondo, N.
    Department of Health and Social Behavior, School of Public Health, University of Tokyo, Tokyo, Japan.
    Aida, J.
    Division of International and Community Oral Health, Graduate School of Dentistry, Tohoku University, Miyagi, Japan.
    Sjöqvist, Hugo
    Kondo, K.
    Center for Preventive Medical Science, Chiba University, Chiba, Japan.
    Identifying Frail-Related Biomarkers among Community-Dwelling Older Adults in Japan: A Research Example from the Japanese Gerontological Evaluation Study2018In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 5362948Article in journal (Refereed)
    Abstract [en]

    We examined correlating clinical biomarkers for the physical aspect of frailty among community-dwelling older adults in Japan, using Japanese Gerontological Evaluation Study (JAGES). We used information from the JAGES participants (N = 3,128) who also participated in the community health screening in 2010. We grouped participants' response to the Study of Osteoporotic Fracture (SOF) Frailty Index into robust (=0), intermediate frail (=1), and frail (=2+) ones to indicate physical aspect of frailty. Independent of sex and age, results from multinomial logistic regression showed above normal albumin and below normal HDL and haemoglobin levels were positively associated with intermediate frail (RRR = 1.99, 95% CI = 1.22-3.23; RRR = 1.36, 95% CI = 1.33-1.39; RRR = 1.36, 95% CI = 1.23-1.51, resp.) and frail cases (RRR = 2.27, 95% CI = 1.91-2.70; RRR = 1.59, 95% CI = 1.51-1.68; RRR = 1.40, 95% CI = 1.28-1.52, resp.). Limited to women, above normal Hb1Ac level was similarly associated with intermediate frail and frail cases (RRR = 1.18, 95% CI = 1.02, 1.38; RRR = 2.56, 95% CI = 2.23-2.95, resp.). Use of relevant clinical biomarkers can help in assessment of older adults' physical aspect of frailty.

  • 4.
    Fukuda, Yoshiharu
    et al.
    Department of Community Health and Medicine, Yamaguchi University School of Medicine, Ube, Japan.
    Hiyoshi, Ayako
    Department of Epidemiology and Public Health, University College London, London, UK.
    Association of income with symptoms, morbidities, and healthcare usage among Japanese adults2011In: Environmental Health and Preventive Medicine, ISSN 1342-078X, E-ISSN 1347-4715, Vol. 17, no 4, p. 299-306Article in journal (Refereed)
    Abstract [en]

    Objectives: Socioeconomic inequalities in healthcare services are major public health and healthcare concerns. We have examined the association of income with symptoms, morbidities and healthcare usage in a national sample of the Japanese population.

    Methods: For this study, data compiled on 21,929 men and 24,620 women from the Comprehensive Survey of the Living Conditions of People on Health and Welfare in 2007 were assessed. Among the survey respondents with symptoms, we compared the prevalences of symptoms and treatments and the number of respondents who received treatments for 16 groups of symptoms and disorders according to household income, from the highest to the lowest, using the relative index of inequalities (RII). The RIIs were computed by age groups [25–59 years (young group) and 60+ years (senior group)].

    Results: People with lower incomes had higher prevalences of symptoms and treatments for most of the disorders examined. The RIIs of symptoms and treatments were 1.19 [95% confidence interval (CI) 1.09–1.31] and 1.04 (95% CI 0.93–1.16) for the young group and 1.69 (1.53–1.87) and 1.51 (1.36–1.67) for the senior group, respectively. In terms of treatment prevalence among those with symptoms, the RII was not significantly lower than 1.0 except for a few disorders in the young group.

    Conclusions: Our results indicate that income inequalities can be related to the prevalences of various symptoms and morbidities in our Japanese sample population and that these inequalities were greater in the senior group than in the young group. Our results also suggest that lower income is not a substantial barrier to the use of healthcare services by older Japanese individuals, while it is related to lower healthcare usage by individuals of working age.

  • 5.
    Fukuda, Yoshiharu
    et al.
    Department of Community Health and Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
    Hiyoshi, Ayako
    Department of Epidemiology and Public Health, University College London, London, UK.
    Associations of household expenditure and marital status with cardiovascular risk factors in Japanese adults: analysis of nationally representative surveys2013In: Journal of Epidemiology, ISSN 0917-5040, E-ISSN 1349-9092, Vol. 23, no 1, p. 21-7Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic inequalities in health and social determinants of health are important issues in public health and health policy. We investigated associations of cardiovascular risk factors with household expenditure (as an indicator of socioeconomic status) and marital status in Japan.

    Methods: We combined data from 2 nationally representative surveys-the Comprehensive Survey of Living Conditions and the National Health and Nutrition Survey, 2003-2007-and analyzed sex-specific associations of household expenditure quartiles and marital status with cardiovascular risk factors, including obesity, hypertension, dyslipidemia, and diabetes, among 6326 Japanese adults (2664 men and 3662 women) aged 40 to 64 years.

    Results: For men, there was no statistically significant association between household expenditure and cardiovascular risk factors. For women, lower household expenditure was significantly associated with obesity, hypertension, diabetes, and the presence of multiple risk factors: the ORs for the lowest versus the highest quartile ranged from 1.39 to 1.71. In a comparison of married and unmarried participants, the prevalence of cardiovascular risk factors was higher among married women and lower among married men.

    Conclusions: Lower socioeconomic status, as indicated by household expenditure, was associated with cardiovascular risk factors in Japanese women. Socioeconomic factors should be considered in health promotion and prevention of cardiovascular disease.

  • 6.
    Fukuda, Yoshiharu
    et al.
    Department of Community Health and Medicine, Yamaguchi University School of Medicine, Yamaguchi, Japan.
    Hiyoshi, Ayako
    Department of Epidemiology and Public Health, University College London, London, UK.
    High quality nutrient intake is associated with higher household expenditures by Japanese adults2012In: Bioscience trends, ISSN 1881-7823, Vol. 6, no 4, p. 176-82Article in journal (Refereed)
    Abstract [en]

    There is little evidence of socioeconomic differences in dietary intake in the Japanese population. This study examined the association between household expenditures and dietary intake using nationally representative surveys of Japan. We analyzed data from the Comprehensive Survey of Living Conditions and National Health and Nutrition Survey, 2003-2007. For subjects ages 18 to 74 years (11,240 men and 11,472 women), the sex-specific association between household expenditure quartiles and selected nutrient intake was examined using comparison of means and prevalence of a healthy intake. Higher household expenditures were associated with an increase in the mean levels of total energy, fat, protein, carbohydrates, calcium, vitamins A and C, niacin, and fiber for both men and women and salt for men. Prevalence comparison indicated that most of the recommendations for dietary intake were met for people with higher household expenditures than for those with lower household expenditures. There was no clear association between fat intake and expenditures. Higher household expenditures were associated with a healthy and balanced nutrient intake in Japanese adults. The findings suggest that socioeconomic differences in dietary patterns contribute to socioeconomic inequalities in mortality and morbidity in Japan.

  • 7.
    Fukuda, Yoshiharu
    et al.
    Department of Community Health and Medicine, Yamaguchi University School of Medicine, Ube, Japan.
    Hiyoshi, Ayako
    Department of Epidemiology and Public Health, University College London, London, United Kingdom .
    Influences of income and employment on psychological distress and depression treatment in Japanese adults2011In: Environmental Health and Preventive Medicine, ISSN 1342-078X, E-ISSN 1347-4715, Vol. 17, no 1, p. 10-17Article in journal (Refereed)
    Abstract [en]

    Objectives: Psychological distress is a health issue of critical importance, especially in people of working age in developed countries, including Japan. This study examined the relationships of income and employment arrangement with psychological distress and treatment of depression in a national sample of Japanese adults.

    Methods: Data for 10,959 men and 11,655 women 25–59 years of age, obtained from the Comprehensive Survey of the Living Conditions of People on Health and Welfare in 2007, were examined. Health outcomes were psychological distress measured by the Japanese version of the K6, subjective complaints and medical treatment of depression. Explanatory variables included marital status, employment arrangement, and household income. The relationships between health outcomes and explanatory variables were examined using multiple logistic regression analyses.

    Results: Lower income and unemployment were associated with a higher prevalence of psychological distress and treatment of depression. The association between psychological distress and income showed a threshold: the lowest income quintile had an especially high prevalence, while other quintiles had similar prevalences. The prevalence of depression treatment in those with psychological distress was significantly lower in the highest income quintile than in all the other income groups, and the prevalence was also significantly lower in employed than in unemployed respondents.

    Conclusions: This study showed clear relationships of lower income and unemployment with psychological distress and depression treatment. It has been suggested that people with higher socioeconomic status and full-time work may be reluctant to consult professionals and receive medical treatment, despite their psychological distress. Comprehensive mental health interventions are required to prevent psychological distress in all socioeconomic strata of the population.

  • 8.
    Han, Hedong
    et al.
    Department of Health Statistics, Second Military Medical University, Shanghai, China.
    Fang, Xin
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Wei, Xin
    Mount Sinai St. Luke's and West Medical Center, New York NY, United States.
    Liu, Yuzhou
    Mount Sinai St. Luke's and West Medical Center, New York NY, United States.
    Jin, Zhicao
    Department of Health Statistics, Second Military Medical University, Shanghai, China.
    Chen, Qi
    Department of Health Statistics, Second Military Medical University, Shanghai, China.
    Fan, Zhongjie
    Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
    Aaseth, Jan
    Faculty of Public Health, Hedmark University of Applied Sciences, Elverum, Norway; Innlandet Hospital Trust, Kongsvinger Hospital Division, Kongsvinger, Norway.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    He, Jia
    Department of Health Statistics, Second Military Medical University, Shanghai, China.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dose-response relationship between dietary magnesium intake, serum magnesium concentration and risk of hypertension: a systematic review and meta-analysis of prospective cohort studies2017In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 16, article id 26Article, review/survey (Refereed)
    Abstract [en]

    Background: The findings of prospective cohort studies are inconsistent regarding the association between dietary magnesium intake and serum magnesium concentration and the risk of hypertension. We aimed to review the evidence from prospective cohort studies and perform a dose-response meta-analysis to investigate the relationship between dietary magnesium intake and serum magnesium concentrations and the risk of hypertension.

    Methods: We searched systematically PubMed, EMBASE and the Cochrane Library databases from October 1951 through June 2016. Prospective cohort studies reporting effect estimates with 95% confidence intervals (CIs) for hypertension in more than two categories of dietary magnesium intake and/or serum magnesium concentrations were included. Random-effects models were used to combine the estimated effects.

    Results: Nine articles (six on dietary magnesium intake, two on serum magnesium concentration and one on both) of ten cohort studies, including 20,119 cases of hypertension and 180,566 participates, were eligible for inclusion in the meta-analysis. We found an inverse association between dietary magnesium intake and the risk of hypertension [relative risk (RR) = 0.92; 95% CI: 0.86, 0.98] comparing the highest intake group with the lowest. A 100 mg/day increment in magnesium intake was associated with a 5% reduction in the risk of hypertension (RR = 0.95; 95% CI: 0.90, 1.00). The association of serum magnesium concentration with the risk of hypertension was marginally significant (RR = 0.91; 95% CI: 0.80, 1.02).

    Conclusions: Current evidence supports the inverse dose-response relationship between dietary magnesium intake and the risk of hypertension. However, the evidence about the relationship between serum magnesium concentration and hypertension is limited.

  • 9.
    Hiyoshi, Ayako
    et al.
    Örebro University, School of Medical Sciences.
    Fall, Katja
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Bergh, Cecilia
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Comorbidity trajectories in working age cancer survivors: A national study of Swedish men2017In: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 48, p. 48-55, article id S1877-7821(17)30039-5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A large proportion of cancer survivors are of working age, and maintaining health is of interest both for their working and private life. However, patterns and determinants of comorbidity over time among adult cancer survivors are incompletely described. We aimed to identify distinct comorbidity trajectories and their potential determinants.

    METHODS: In a cohort study of Swedish men born between 1952 and 1956, men diagnosed with cancer between 2000 and 2003 (n=878) were matched with cancer-free men (n=4340) and followed over five years after their first year of survival. Comorbid diseases were identified using hospital diagnoses and included in the analysis using group-based trajectory modelling. The association of socioeconomic and developmental characteristics were assessed using multinomial logit models.

    RESULTS: Four distinct comorbidity trajectories were identified. As many as 84% of cancer survivors remained at very low levels of comorbidity, and the distribution of trajectories was similar among the cancer survivors and the cancer-free men. Increases in comorbidity were seen among those who had comorbid disease at baseline and among those with poor summary disease scores in adolescence. Socioeconomic characteristics and physical, cognitive and psychological function were associated with types of trajectory in unadjusted models but did not retain independent relationships with them after simultaneous adjustment.

    CONCLUSIONS: Among working-age male cancer survivors, the majority remained free or had very low levels of comorbidity. Those with poorer health in adolescence and pre-existing comorbid diseases at cancer diagnosis may, however, benefit from follow-up to prevent further increases in comorbidity.

  • 10.
    Hiyoshi, Ayako
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fall, Katja
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Netuveli, G.
    International Centre for Life Course Studies in Society and Health, University College London, London, United Kingdom: Institute for Health and Human Development (IHHD), University of East London, London, United Kingdom.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Remarriage after divorce and depression risk2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 141, p. 109-114Article in journal (Refereed)
    Abstract [en]

    As marriage is associated with lower depression rates compared with being single in men, we aimed to examine if remarriage compared with remaining divorced is also associated with a reduced depression risk. Swedish register data were used to define a cohort of men who were born between 1952 and 1956 and underwent a compulsory military conscription assessment in adolescence. This study population comprised men who were divorced in 1985 (n = 72,246). The risk of pharmaceutically treated depression from 2005 to 2009 was compared for those who remarried or remained divorced between 1986 and 2004. Cox proportional hazards analysis was used to estimate hazard ratios for the risk of depression identified by pharmaceutical treatment, with adjustment for a range of potential confounding factors including childhood and adulthood socioeconomic circumstances, cognitive, physical, psychological and medical characteristics at the conscription assessment. The results showed that, even though divorced men who remarried had markers of lower depression risk in earlier life such as higher cognitive and physical function, higher stress resilience and socioeconomic advantages than men who remained divorced, remarriage was associated with a statistically significant elevated risk of depression with an adjusted hazard ratio (and 95% confidence interval) of 1.27(1.03 1.55), compared with men who remained divorced. Remarriage following divorce is not associated with a reduced risk of depression identified by pharmaceutical treatment, compared with remaining divorced. Interpersonal or financial difficulties resulting from remarriage may outweigh the benefits of marriage in terms of depression risk.

  • 11.
    Hiyoshi, Ayako
    et al.
    Örebro University Hospital. Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Fukuda, Yoshiharu
    Department of Community Health and Medicine, Yamaguchi University School of Medicine, Yamaguchi, Japan.
    Shipley, Martin J.
    Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Bartley, Mel
    Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Brunner, Eric J.
    Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    A new theory-based social classification in Japan and its validation using historically collected information2013In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 87, p. 84-92Article in journal (Refereed)
    Abstract [en]

    Studies of health inequalities in Japan have increased since the millennium. However, there remains a lack of an accepted theory-based classification to measure occupation-related social position for Japan. This study attempts to derive such a classification based on the National Statistics Socio-economic Classification in the UK. Using routinely collected data from the nationally representative Comprehensive Survey of the Living Conditions of People on Health and Welfare, the Japanese Socioeconomic Classification was derived using two variables - occupational group and employment status. Validation analyses were conducted using household income, home ownership, self-rated good or poor health, and Kessler 6 psychological distress (n ≈ 36,000). After adjustment for age, marital status, and area (prefecture), one step lower social class was associated with mean 16% (p < 0.001) lower income, and a risk ratio of 0.93 (p < 0.001) for home ownership. The probability of good health showed a trend in men and women (risk ratio 0.94 and 0.93, respectively, for one step lower social class, p < 0.001). The trend for poor health was significant in women (odds ratio 1.12, p < 0.001) but not in men. Kessler 6 psychological distress showed significant trends in men (risk ratio 1.03, p = 0.044) and in women (1.05, p = 0.004). We propose the Japanese Socioeconomic Classification, derived from basic occupational and employment status information, as a meaningful, theory-based and standard classification system suitable for monitoring occupation-related health inequalities in Japan.

  • 12.
    Hiyoshi, Ayako
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Fukuda, Yoshiharu
    Department of Community Health and Medicine, Yamaguchi University School of Medicine, Ube, Japan.
    Shipley, Martin J
    Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Brunner, Eric J
    Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Health inequalities in Japan: the role of material, psychosocial, social relational and behavioural factors2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 104, p. 201-209Article in journal (Refereed)
    Abstract [en]

    The extent that risk factors, identified in Western countries, account for health inequalities in Japan remains unclear. We analysed a nationally representative sample (Comprehensive Survey of Living Conditions surveyed in 2001 (n = 40,243)). The cross-sectional association between self-rated fair or poor health and household income and a theory-based occupational social class was summarised using the relative index of inequality [RII]. The percentage attenuation in RII accounted for by candidate contributory factors - material, psychosocial, social relational and behavioural - was computed. The results showed that the RII for household income based on self-rated fair or poor health was reduced after including the four candidate contributory factors in the model by 20% (95% CI 2.1, 43.6) and 44% (95% CI 18.2, 92.5) in men and women, respectively. The RII for the Japanese Socioeconomic Classification [J-SEC] was reduced, not significantly, by 22% (95% CI -6.3, 100.0) in men in the corresponding model, while J-SEC was not associated with self-rated health in women. Material factors produced the most consistent and strong attenuation in RII for both socioeconomic indicators, while the contributions attributable to behaviour alone were modest. Social relational factors consistently attenuated the RII for both socioeconomic indicators in men whereas they did not make an independent contribution in women. The influence of perceived stress was inconsistent and depended on the socioeconomic indicator used. In summary, social inequalities in self-rated fair or poor health were reduced to a degree by the factors included. The results indicate that the levelling of health across the socioeconomic hierarchy needs to consider a wide range of factors, including material and psychosocial factors, in addition to the behavioural factors upon which the current public health policies in Japan focus. The analyses in this study need to be replicated using a longitudinal study design to confirm the roles of different factors in health inequalities.

  • 13.
    Hiyoshi, Ayako
    et al.
    Örebro University Hospital. Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Fukuda, Yoshiharu
    Department of Community Health and Medicine, Yamaguchi University School of Medicine, Ube, Japan.
    Shipley, Martin J.
    Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Brunner, Eric J.
    Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Inequalities in self-rated health in Japan 1986-2007 according to household income and a novel occupational classification: national sampling survey series2013In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 67, no 11, p. 960-5Article in journal (Refereed)
    Abstract [en]

    Background: Japan, for the past two decades, has seen economic stagnation and substantial social change. We examined whether health inequalities increased over this period.

    Methods: Using eight triennial waves of a series of large nationally representative surveys between 1986 and 2007 (n=398 303), temporal trends in relative and slope indices of inequality (RII, SII, respectively) were tested based on self-rated health in relation to theory-based social class and household income.

    Results: Age-standardised prevalence of self-rated fair or poor health showed V-shaped time trends in both sexes with the lowest prevalence in early/mid-1990s. In 1986, RII and SII in household social class and income were significant for both sexes. In men, RII and SII according to income showed significant narrowing of temporal trends in poor health (-1.4% and -0.1% annually, respectively), but these were stable in women. After multilevel multiple imputation for missing income data, the findings in men were not altered but narrowing trends became evident and significant in women (-1% and -0.1% annually, respectively). Inequality indices for social class remained constant over the study period in both sexes.

    Conclusions: Relative and absolute health inequalities for social class and income based on self-rated fair or poor health narrowed or remained stable between 1986 and 2007, despite the economic stagnation and adverse social changes. Overall population health across socioeconomic groups initially improved but then worsened. The positive finding regarding the health inequality trend seen in the Japanese context is informative for the wider international community during this period of economic uncertainty.

  • 14.
    Hiyoshi, Ayako
    et al.
    Örebro University, School of Medical Sciences. Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.
    Kondo, Naoki
    School of Public Health, The University of Tokyo, Bunkyo-ku, Japan.
    Rostila, Mikael
    Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden.
    Increasing income-based inequality in suicide mortality among working-age women and men, Sweden, 1990-2007: is there a point of trend change?2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 11, p. 1009-1015Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Income inequalities have risen from the 1990s to 2000s, following the economic recession in 1994, but little research has investigated socioeconomic inequalities in suicide mortality for working-age men and women (aged between 30 and 64 years) over the time using longitudinal data in Sweden.

    METHODS: Using Swedish national register data between 1990 and 2007 as a series of repeated cohort studies with a 3-year follow-up (sample sizes were approximately 3.7 to 4.0 million in each year), relative and slope indices of inequality (RII and SII respectively) based on quintiles of individual disposable income were calculated and tested for temporal trends.

    RESULTS: SII for the risk of suicide mortality ranged from 27.6 (95% CI 19.5 to 35.8) to 44.5 (36.3 to 52.6) in men and 5.2 (0.2 to 10.4) to 16.6 (10.7 to 22.4) in women (per 100 000 population). In men, temporal trends in suicide inequalities were stable in SII but increasing in RII by 3% each year (p=0.002). In women, inequalities tended to increase in both RII and SII, especially after the late-1990s, with 10% increment in RII per year (p<0.001).

    CONCLUSIONS: Despite universal social security and generous welfare provision, income inequalities in suicide were considerable and have widened, especially in women. The steeper rise in women may be partially related to higher job insecurity and poorer working conditions in the female dominated public sector after the recession. To reduce health consequences following an economic crisis and widened income inequalities, additional measures may be necessary in proportion to the levels of financial vulnerability.

  • 15.
    Hiyoshi, Ayako
    et al.
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Bottai, Matteo
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Hoven, Emma I.
    Division of Childhood Cancer Research, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
    Trajectories of Income and Social Benefits for Mothers and Fathers of Children With Cancer: A National Cohort Study in Sweden2018In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 124, no 7, p. 1492-1500Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The contribution of different income sources from work and social benefits to trajectories of income for the parents of children with cancer has not been empirically investigated.

    METHODS: Using Swedish registers, parents of children with an incidence cancer diagnosis between 2004 and 2009 were identified and matched with parents of children without cancer (reference parents). A total of 20,091 families were followed from the year before the diagnosis to a maximum of 8 years. Generalized linear models estimated the ratios of mean incomes from work and social benefits and of its total.

    RESULTS: Around the time of the child's cancer diagnosis, the total income was on average up to 6% higher among the mothers of children with cancer compared with reference mothers, but no differences were noted among fathers. Income from work dropped to the lowest level around the time of a cancer diagnosis, with swift recovery noted for fathers but not for mothers. Sickness and childcare-related benefits were up to 6 times larger for the parents of children with cancer than reference parents. As social benefits diminished after approximately 3 years, the total income of mothers of children with cancer became lower than that of reference mothers, and the gap widened over time.

    CONCLUSIONS: Social benefits appeared to ease the financial burden during the years around a cancer diagnosis. However, mothers experienced persistently lower income after benefits diminished. Experiences differed by single-parent versus dual-parent households, the survival of the child with cancer, and other relevant characteristics. Further investigation is needed for potential long-term consequences for mothers, including their career and future pension in retirement.

  • 16.
    Hiyoshi, Ayako
    et al.
    Örebro University, School of Medical Sciences.
    Sabet, Julia A.
    Örebro University, School of Medical Sciences.
    Sjöqvist, Hugo
    Örebro University, Örebro University School of Business.
    Melinder, Carren
    Örebro University, School of Medical Sciences.
    Brummer, Robert Jan
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK .
    Precursors in adolescence of adult-onset bipolar disorder2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 218, p. 353-358Article in journal (Refereed)
    Abstract [en]

    Background: Although the estimated contribution of genetic factors is high in bipolar disorder, environmental factors may also play a role. This Swedish register-based cohort study of men examined if physical and psychological characteristics in late adolescence, including factors previously linked with bipolar disorder (body mass index, asthma and allergy), are associated with subsequent bipolar disorder in adulthood. Unipolar depression and anxiety are analysed as additional outcomes to identify bipolar disorder-specific associations.

    Methods: A total of 213,693 men born between 1952 and 1956, who participated in compulsory military conscription assessments in late adolescence were followed up to 2009, excluding men with any psychiatric diagnoses at baseline. Cox regression estimated risk of bipolar disorder, depression and anxiety in adulthood associated with body mass index, asthma, allergy, muscular strength stress resilience and cognitive function in adolescence.

    Results: BMI, asthma and allergy were not associated with bipolar disorder. Higher grip strength, cognitive function and stress resilience were associated with a reduced risk of bipolar disorder and the other disease outcomes.

    Limitations: The sample consisted only of men; even though the characteristics in adolescence pre-dated disease onset, they may have been the consequence of prodromal disease.

    Conclusions: Associations with body mass index and asthma found by previous studies may be consequences of bipolar disorder or its treatment rather than risk factors. Inverse associations with all the outcome diagnoses for stress resilience, muscular strength and cognitive function may reflect general risks for these psychiatric disorders or intermediary factors.

  • 17.
    Hiyoshi, Ayako
    et al.
    Epidemiology and Public Health, University College London, London, UK.
    Shipley, Martin
    Epidemiology and Public Health, University College London, London, UK.
    Fukuda, Yoshiharu
    Community Health and Medicine, Yamaguchi University School of Medicine, Yamaguchi, Japan.
    Brunner, Eric
    Epidemiology and Public Health, University College London, London, UK.
    Message from the healthiest country: from narrowing to expanding gap. Trend of inequalities in self-rated health in Japan, 1986-20072011In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 65, no Suppl. 2, p. A36-A36Article in journal (Other academic)
  • 18.
    Hiyoshi, Ayako
    et al.
    Epidemiology and Public Health, UCL, London, UK.
    Shipley, M.J.
    Epidemiology and Public Health, UCL, London, UK.
    Fukuda, Y.
    Community Health and Medicine, Yamaguchi University school of Medicine, Yamaguchi, Japan.
    Brunner, E. J.
    Epidemiology and Public Health, UCL, London, UK.
    Health inequalities in Japan 1986 to 2007 based on self-rated health, household income and a novel occupational classification2012In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no Suppl. 1, p. A13-A13Article in journal (Refereed)
  • 19.
    Hiyoshi, Ayako
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Udumyan, Ruzan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Osika, Walter
    Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Centre for Social Sustainability (CSS), Department of Neurobiology, Care Sciences and Society, Karolinska Institute Huddinge, Stocholm, Sweden.
    Bihagen, Erik
    Swedish Institute for Social Research (SOFI), Stockholm University, Stockholm, Sweden.
    Fall, Katja
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Stress resilience in adolescence and subsequent antidepressant and anxiolytic medication in middle aged men: Swedish cohort study2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 134, p. 43-49Article in journal (Refereed)
    Abstract [en]

    It is unclear whether psychological resilience to stress in adolescence represents a persistent characteristic relevant to the subsequent risk for depression and anxiety in later adulthood. We aimed to test whether low psychological stress resilience assessed in adolescence is associated with an increased risk of receiving medication for depression and anxiety in middle age. We utilized Swedish register-based cohort study. Men born between 1952 and 1956 (n = 175,699), who underwent compulsory assessment for military conscription in late adolescence were followed to examine subsequent risk of pharmaceutically-treated depression and anxiety in middle age, from 2006 to 2009 corresponding to ages between 50 and 58 years, using Cox regression. The associations of stress resilience with prescription of antidepressant and anxiolytics medication through potential mediating factors cognitive and physical function and adult socioeconomic factors were calculated. Low stress resilience was associated with elevated risks for antidepressant (hazard ratio (HR):1.5 (95% CI 1.4 1.6)) and anxiolytics (HR:2.4 (CI 2.0 2.7)) medication. Adjustment for measures of childhood living circumstances attenuated the associations somewhat. Around a third of association with low stress resilience, and a half of that with moderate resilience, was mediated through cognitive and physical function in adolescence and adult socioeconomic factors. The magnitude of the inverse association of higher cognitive function with antidepressant medication was eliminated among those with low stress resilience. These results indicate that low stress resilience in adolescence is associated with an increased risk for antidepressant and anxiolytics medication over 30 years later, in part mediated through developmental factors in adolescence and socioeconomic circumstances in adulthood, and low stress resilience can diminish or eliminate the inverse association of higher cognitive function with antidepressant medication.

  • 20.
    Leepe, Khadija Akter
    et al.
    Department of Applied Statistics, School of Business, Örebro University, Örebro, Sweden.
    Li, Mei
    Örebro University, School of Medical Sciences. Örebro University Hospital. Center for Assessment of Medical Technology in Örebro.
    Fang, Xin
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences. Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Acute effect of daily fine particulate matter pollution on cerebrovascular mortality in Shanghai, China: a population-based time series study2019In: Environmental science and pollution research international, ISSN 0944-1344, E-ISSN 1614-7499, Vol. 26, no 25, p. 25491-25499Article in journal (Refereed)
    Abstract [en]

    Numerous studies have investigated the impacts of ambient fine particulate matter (PM2.5) on human health. In this study, we examined the association of daily PM2.5 concentrations with the number of deaths for the cerebrovascular disease on the same day, using the generalized additive model (GAM) controlling for temporal trend and meteorological variables. We used the data between 2012 and 2014 from Shanghai, China, where the adverse health effects of PM2.5 have been of particular concern. Three different approaches (principal component analysis, shrinkage smoothers, and the least absolute shrinkage and selection operator regularization) were used in GAM to handle multicollinear meteorological variables. Our results indicate that the average daily concentration of PM2.5 in Shanghai was high, 55 μg/m3, with an average daily death for cerebrovascular disease (CVD) of 62. There was 1.7% raised cerebrovascular disease deaths per 10 μg/m3 increase in PM2.5 concentration in the unadjusted model. However, PM2.5 concentration was no longer associated with CVD deaths after controlling for meteorological variables. The results were consistent in the three modelling techniques that we used. As a large number of people are exposed to air pollution, further investigation with longer time period including individual-level information is needed to examine the association.

  • 21.
    Lindner, Helen
    et al.
    Örebro University, School of Health Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, Sweden.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Risk of depression following traumatic limb amputation: a general population-based cohort study2018In: Book of Abstracts / [ed] Burger, Helena & Mlakar, Maja, Ljubjana, Slovenia: ISPO Slovena , 2018, p. 9-9Conference paper (Refereed)
    Abstract [en]

    INTRODUCTION: Traumatic limb amputation (TLA) is a sudden event that accompanies life changes in physical functioning, body image and challenges in daily lives. Amputees may experience significant levels of distress and be at risk of depression may be at risk of depression. However, evidence for depression risk after TLA has been limited because of the use of cross-sectional study design of a small or selected sample and the lack of a comparison with non-amputees. Confounding from pre-amputated occupational and individual characteristics was possible but no study has controlled for these.  AIMS: We aimed to examine whether amputation may be associated with an increased risk of depression required inpatient and outpatient hospital treatment. 

    METHODS: Our study population was drawn from a cohort of men (n=284,257) who underwent a compulsory conscription assessment for between 1969 and 1976. Complete data were available for 189,220 men. We followed these men from 1st January 1985, when these men were between age 29 and 34 years until the date of depression. We used the ICD codes in Swedish patient register to identify TLA (primary and secondary diagnosis) and depression after TLA (primary diagnosis). Cox regression was used to calculate hazard ratios and 95% confidence intervals [CI] for the association of amputation with depression. Age was used as the underlying time scale, and the diagnosis of amputation was included as a time-dependent exposure status, with the value zero before amputation and one after the date of amputation. Birth year, region, occupation, cognitive and physical function and stress resilience in adolescence were considered as potential confounding factors and adjusted for in the analysis. 

    RESULTS: In total 401 men experienced amputation between 1985 and 2009, with the mean age of amputation was age 42.5 years (SD 7.4). Those who experience amputation were more likely to have low stress resilience and cognitive function in adolescence and engaged in farming and manual work in 1985.  Cox regression produced unadjusted hazard ratio 2.61 (CI 1.62-4.21, p<0.001), i.e. 2.61 times risk of subsequent depression diagnosis for risk of subsequent depression compared with amputation-free individuals. Moderate and low cognitive function, physical fitness and stress resilience were associated with elevated risk of depression. Working for farms and manual work was also associated with higher depression risk. When the analysis was adjusted for these factors, the risk of depression after amputation changed little, 2.53 (CI 1.57-4.08, p <0.001) times risk of depression remained compared with amputation-free individuals.

    CONCLUSIONS: As we hypothesized, TLA was associated with an increased risk of depression over more than two decades of follow-up of men from age 29 to 57 years. Higher levels of depressive symptoms were noted among working age amputees and our study group also comprised of working age amputees.  Future research may benefit from investigating potential influence of different amputation sites, degree, and prosthesis use involved in order to set intervention target. 

  • 22.
    Lindner, Helen Y.
    et al.
    Örebro University, School of Health Sciences.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Hermansson, Liselotte
    Region Örebro County, Örebro, Sweden.
    Relation between capacity and performance in paediatric myoelectric prosthesis users2017Conference paper (Refereed)
  • 23.
    Lindner, Helen Y
    et al.
    Örebro University, School of Health Sciences.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Hermansson, Liselotte
    Örebro University Hospital. Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Relation between capacity and performance in paediatric upper limb prosthesis users2018In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 42, no 1, p. 14-20Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The International Classification of functioning, disability and health refers capacity to what an individual can do in a standardised environment and describes performance as what an individual really does and whether the individual encounters any difficulty in the real-life environment. Measures of capacity and performance can help to determine if there is any gap between them that may restrict participation. The aim of this study was to explore the relationship between capacity scores obtained in a standardised clinical setting and proportional ease of performance obtained from a real-life environment.

    METHODS: The Assessment of Capacity for Myoelectric Control and the Prosthetic Upper Extremity Functional Index were used to assess capacity and performance in 62 prosthetic users (age 3-17). Spearman coefficient and generalised linear model were used to examine the association between these measures.

    RESULTS: A strong correlation (Spearman = 0.75) was found between the capacity scores and the ease of performance. In both unadjusted and adjusted models, capacity was significantly associated with proportional ease of performance. The adjusted model showed that, by 1 unit increase in the Assessment of Capacity for Myoelectric Control score, the ratio of proportional ease of performance increases by 45%.

    CONCLUSION: This implies that Assessment of Capacity for Myoelectric Control can be a predictor for ease of performance in real-life environment.

    Clinical relevance: The ACMC scores may serve as an indicator to predict the difficulties that the children may encounter in their home environment. This prediction can help the clinician to make decisions, such that if the child requires more control training or is ready to move on to learn more complex tasks.

  • 24.
    Lindner, Helen Y.
    et al.
    Örebro University, School of Health Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, UK.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Public Health Sciences, Stockholm University, Sweden.
    Risk of depression following traumatic limb amputation: a general population-based cohort study2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494819868038Article in journal (Refereed)
    Abstract [en]

    Background: Individuals with traumatic limb amputation (TLA) may be at risk of depression, but evidence of increased depression after TLA from longitudinal studies has been limited. It is also unknown whether physical function, cognitive function, and employment prior to amputation affects depression risk. We aimed to examine longitudinal associations between TLA and depression in working age men, and to explore the role of pre-amputation occupational and individual characteristics.

    Methods: A Swedish national register-based cohort of 189,220 men born between 1952 and 1956, and who attended conscription assessments in adolescence, was followed from 1985 to 2009. Physical, cognitive, and psychological characteristics were measured at the conscription examination, and occupational information was obtained from the 1985 census. Main outcome measures were hospital inpatient and outpatient admissions for depression.

    Results: In total, 401 men underwent TLA; mean age at amputation was 42.5 years (SD 7.4). Cox regression produced an unadjusted hazard ratio (95% confidence interval) of 2.61 (1.62–4.21) for risk of subsequent depression associated with TLA compared with the general population. Adjustment for occupational, physical, cognitive, and psychological characteristics did not change the association much, producing a hazard ratio of 2.53 (1.57–4.08).

    Conclusions: TLA is associated with an increased risk of depression in men over more than two decades of follow up. Occupational and individual characteristics prior to amputation did not greatly change depression risk following amputation. We speculate that a coordinated combination of social support and medical management may help reduce persistent depression risk in men who experience amputation.

  • 25. Maruyama, K.
    et al.
    Cable, N.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Shipley, M.
    Kumari, M.
    Iso, H.
    Tabak, A.
    Wardle, J.
    Llewellyn, C.
    Singh-Manoux, A.
    Langenberg, C.
    Wareham, N.
    Boniface, D.
    Hingorani, A.
    Kivimäki, M.
    Brunner, E.
    Association of obesity genotype and appetite-related behaviour with BMI trajectory in midlife: Whitehall II study2017Conference paper (Refereed)
  • 26.
    Melinder, Carren
    et al.
    Örebro University, School of Medical Sciences.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Stress resilience and the risk of inflammatory bowel disease: a cohort study of men living in Sweden2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 1, article id e014315Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine if low psychosocial stress resilience in adolescence (increasing chronic stress arousal throughout life) is associated with an increased inflammatory bowel disease (IBD) risk in adulthood. Subclinical Crohn's disease (CD) and ulcerative colitis (UC) can exist over many years and we hypothesise that psychosocial stress may result in conversion to symptomatic disease through its proinflammatory or barrier function effects.

    DESIGN: National register-based cohort study of men followed from late adolescence to middle age.

    SETTING: A general population cohort of men in Sweden.

    PARTICIPANTS: Swedish population-based registers provided information on all men born between 1952 and 1956 who underwent mandatory Swedish military conscription assessment (n=239 591). Men with any gastrointestinal diagnoses (except appendicitis) prior to follow-up were excluded.

    PRIMARY OUTCOME MEASURES: An inpatient or outpatient diagnosis of CD or UC recorded in the Swedish Patient Register (1970-2009).

    RESULTS: A total of 938 men received a diagnosis of CD and 1799 UC. Lower stress resilience in adolescence was associated with increased IBD risk, with unadjusted HRs (95% CIs) of 1.54 (1.26 to 1.88) and 1.24 (1.08 to 1.42), for CD and UC, respectively. After adjustment for potential confounding factors, including markers of subclinical disease activity in adolescence, they are 1.39 (1.13 to 1.71) and 1.19 (1.03 to 1.37).

    CONCLUSIONS: Lower stress resilience may increase the risk of diagnosis of IBD in adulthood, possibly through an influence on inflammation or barrier function.

  • 27.
    Melinder, Carren
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Hiyoshi, Ayako
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medicine, Örebro University, Sweden. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Stress resilience in adolescence and subsequent inflammatory bowel disease risk in adulthood2015In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 61, p. 27-27Article in journal (Other academic)
    Abstract [en]

    Objective: Psychosocial stress may increase the risk of systemic inflammation. As subclinical inflammatory bowel disease (IBD) – Crohn's disease (CD) and ulcerative colitis (UC) – can exist over many years, stress may result in conversion to symptomatic disease through its inflammatory influence. Low stress resilience may result in a greater risk of chronic stress arousal due to the normal stresses of everyday life. We investigated the association of stress resilience in adolescence with subsequent risk of IBD, independent of other risks.

    Design: Swedish registers provided information on 242,999 men who underwent military conscription assessments in late adolescence (1969 – 1976) with follow-up until 2009 (up to age 57 years). Stress resilience was evaluated through semi-structured interviews. Cox regression assessed the association of stress resilience with CD (n = 1,082) and UC (1,922) in separate models. The models included adjustment for socioeconomic characteristics in childhood and height, BMI and erythrocyte sedimentation rate (indicating inflammation) as indicators of subclinical disease activity in adolescence.

    Results: Low stress resilience in adolescence was associated with increased risk of IBD after adjustment for potential confounding factors, with hazard ratios (95% confidence intervals) of 1.50 (1.24-1.81) and 1.21 (1.06-1.39), for CD and UC respectively. The associations attenuated somewhat by further adjustment for markers of subclinical disease to 1.38 (1.14-1.67) and 1.19 (1.04-1.36).

    Conclusions: low stress resilience is associated with an elevated subsequent IBD risk. Stress may increase the risk of symptomatic IBD, although there is also evidence of a potentially modest effect of subclinical disease activity on stress resilience.

  • 28.
    Melinder, Carren
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hiyoshi, Ayako
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hussein, Oula
    Örebro University, School of Law, Psychology and Social Work.
    Halfvarson, Jonas
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Gastroenterology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ekbom, Anders
    Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Physical Fitness in Adolescence and Subsequent Inflammatory Bowel Disease Risk2015In: Clinical and Translational Gastroenterology, ISSN 2155-384X, E-ISSN 2155-384X, Vol. 6, article id e121Article in journal (Refereed)
    Abstract [en]

    Objectives: Physical fitness may reduce systemic inflammation levels relevant to the risk of symptomatic Crohn's disease (CD) and ulcerative colitis (UC); we assessed if fitness in adolescence is associated with subsequent inflammatory bowel disease (IBD) risk, independent of markers of risk and prodromal disease activity.

    Methods: Swedish registers provided information on a cohort of 240,984 men (after exclusions) who underwent military conscription assessments in late adolescence (1969-1976). Follow-up started at least 4 years after the conscription assessment until 31 December 2009 (up to age 57 years). Cox's regression assessed the association of physical fitness with CD (n=986) and UC (n=1,878) in separate models, with adjustment including: socioeconomic conditions in childhood; physical fitness, height, body mass index, and erythrocyte sedimentation rate (ESR) in adolescence; and subsequent diagnoses of IBD.

    Results: Low fitness was associated with a raised risk of IBD, with unadjusted hazard ratios (and 95% confidence intervals) of 1.62 (1.31-2.00) for CD and 1.36 (1.17-1.59) for UC. The results were attenuated by adjustment, particularly for markers of prodromal disease activity to 1.32 (1.05-1.66) and 1.25 (1.06-1.48), respectively. Raised ESR in adolescence was associated with increased risks for subsequent CD (5.95 (4.47-7.92)) and UC (1.92 (1.46-2.52)).

    Conclusions: The inverse association of physical fitness with IBD risk is consistent with a protective role for exercise. However, evidence of disease activity before diagnosis was already present in adolescence, suggesting that some or all of the association between fitness and IBD may be due to prodromal disease activity reducing exercise capacity and therefore fitness.

  • 29.
    Melinder, Carren
    et al.
    Örebro University, School of Medical Sciences.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Kasiga, Teresa
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Department of Epidemiology and Public Health, University College London, London, UK; Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Resilience to stress and risk of gastrointestinal infections2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 2, p. 364-369Article in journal (Refereed)
    Abstract [en]

    Background: Exposure to psychological stress can elicit a physiological response that may influence characteristics of the gastrointestinal mucosa, including increased intestinal permeability, in turn possibly increasing susceptibility to gastrointestinal infections. We investigated whether low stress resilience in adolescence is associated with an 'increased' risk of gastrointestinal infections in subsequent adulthood.

    Methods: Data were provided by Swedish registers for a cohort of 237 577 men who underwent military conscription assessment in late adolescence (1969-76). As part of the assessment procedure, certified psychologists evaluated stress resilience through semi-structured interviews. The cohort was followed from conscription assessment until 31 December 2009 (up to age 57 years). Cox regression assessed the association of stress resilience with gastrointestinal infections (n = 5532), with adjustment for family background measures in childhood and characteristics in adolescence. Peptic ulcer disease (PUD) in adulthood was modelled as a time-dependent covariate.

    Results: Compared with high stress resilience, lower stress resilience was associated with a 'reduced' risk of gastrointestinal infections after adjustment for family background in childhood, characteristics in adolescence and PUD in adulthood, with hazard ratios (and 95% confidence intervals) of 0.88 (0.81-0.97) and 0.83 (0.77-0.88) for low and moderate stress resilience, respectively.

    Conclusion: Lower stress resilience in adolescence is associated with reduced risk of gastrointestinal infections in adulthood, rather than the hypothesized increased risk.

  • 30.
    Melinder, Carren
    et al.
    Örebro University, School of Medical Sciences.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Kasiga, Teresa
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Department of Epidemiology and Public Health, University College London, London, UK; Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Resilience to stress and risk of gastrointestinal infectionsManuscript (preprint) (Other academic)
  • 31.
    Melinder, Carren
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Udumyan, Ruzan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hiyoshi, Ayako
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Brummer, Robert Jan
    Örebro University, School of Medicine, Örebro University, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom .
    Decreased stress resilience in young men significantly increases the risk of subsequent peptic ulcer disease: a prospective study of 233 093 men in Sweden2015In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 41, no 10, p. 1005-1015Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychosocial stress may influence peptic ulcer disease (PUD) risk, but it can be difficult to identify reliably whether stressful exposures pre-dated disease. The association of stress resilience (susceptibility to stress) with subsequent PUD risk has been incompletely investigated.

    AIM: To assess if stress resilience in adolescence is associated with subsequent PUD risk.

    METHODS: The participants comprised of 233 093 men resident in Sweden, born 1952-1956 and assessed for compulsory military conscription during 1969-1976, with data provided by national Swedish registers. Stress resilience was evaluated through semi-structured interviews by a certified psychologist. Cox regression assessed the association between stress resilience in adolescence and the risk of PUD from 1985 to 2009, between ages 28 and 57 years, with adjustment for parental socioeconomic index, household crowding and number of siblings in childhood, as well as cognitive function and erythrocyte sedimentation rate in adolescence.

    RESULTS: In total, 2259 first PUD diagnoses were identified. Lower stress resilience in adolescence is associated with a higher risk of PUD in subsequent adulthood: compared with high resilience, the adjusted hazard ratios (and 95% CI) are 1.84 (1.61-2.10) and 1.23 (1.09-1.38) for low and moderate stress resilience, respectively.

    CONCLUSION: Stress may be implicated in the aetiology of PUD and low stress resilience is a marker of risk.

  • 32.
    Montgomery, Scott
    et al.
    Örebro University Hospital. Örebro University, School of Medical Sciences.
    Bergh, Cecilia
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Sex of older siblings and cognitive function2017Conference paper (Refereed)
    Abstract [en]

    Background : Number of older siblings is associated with lower cognitive function, possibly as marker of material disadvantage. Sex differences may signal an influence of inter-sibling interactions.

    Methods: The study used a national Swedish register-based cohort of men (n=644,603), born between 1970 and 1992 who undertook military conscription assessments in adolescence that included cognitive function measured on a normally-distributed scale of 1-9. Associations with siblings were investigated using linear regression.

    Results: After adjustment for numbers of younger siblings, year of conscription assessment, age/year of birth, sex, European socioeconomic classification for parents and maternal age at delivery; the regression coefficients (and 95% confidence intervals) for cognitive function are -0.26 (-0.27, -0.25), -0.42 (-0.44, -0.40), and -0.72 (-0.76, -0.67) for one, two and three or more male older siblings, respectively, compared with none; and -0.22 (-0.23, -0.21), -0.39 (-.41, -0.37), -0.62 (-0.67, -0.58) for one two and three or more female older siblings, respectively, compared with none. A larger number of younger siblings is not associated with lower cognitive function in the adjusted model.

    Conclusions: Family size is associated with cognitive function: older male siblings may have greater implications than females due to their demands on familial resources or through inter-sibling interactions.

  • 33.
    Montgomery, Scott
    et al.
    Örebro University, School of Medical Sciences.
    Bergh, Cecilia
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Sex of older siblings and cognitive function2017Conference paper (Refereed)
  • 34.
    Montgomery, Scott
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Karolinska Institutet, Stockholm, Sweden; University College London, London, UK.
    Bergh, Cecilia
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Sex of older siblings and stress resilience2018In: Longitudinal and life course studies, ISSN 1124-9064, E-ISSN 1757-9597, Vol. 9, no 4, p. 447-455Article in journal (Refereed)
    Abstract [en]

    The aim was to investigate whether older siblings are associated with development of stress resilience in adolescence and if there are differences by sex of siblings. The study used a Swedish register-based cohort of men (n=664 603) born between 1970 and 1992 who undertook military conscription assessments in adolescence that included a measure of stress resilience: associations were assessed using multinomial logistic regression. Adjusted relative risk ratios (95% confidence intervals) for low stress resilience (n=136 746) compared with high (n=142 581) are 1.33 (1.30, 1.35), 1.65 (1.59, 1.71) and 2.36 (2.18, 2.54) for one, two and three or more male older siblings, compared with none. Equivalent values for female older siblings do not have overlapping confidence intervals with males and are 1.19 (1.17, 1.21), 1.46 (1.40, 1.51) and 1.87 (1.73, 2.03). When the individual male and female siblings are compared directly (one male sibling compared with one female sibling, etc.) and after adjustment, including for cognitive function, there is a statistically significant (p<0.005) greater risk for low stress resilience associated with male siblings. Older male siblings may have greater adverse implications for psychological development, perhaps due to greater demands on familial resources or inter-sibling interactions.

  • 35.
    Montgomery, Scott
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Epidemiology and Public Health, University College London, London, UK; Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Brus, Ole
    Faculty of Medicine and Health, Örebro University, Sweden.
    Hiyoshi, Ayako
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Cao, Yang
    Rider, Jennifer
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.
    Fall, Katja
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Childhood exposures among mothers and Hodgkin's lymphoma in offspring2015In: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 39, no 6, p. 1006-1009Article in journal (Refereed)
    Abstract [en]

    Background: Childhood exposures in mothers, signaled by number of older and younger siblings, have lifelong consequences for aspects of immune function. We hypothesized that these may influence young adult-onset Hodgkin's lymphoma (HL) risk in offspring.

    Materials and methods: Swedish registers identified 2028 cases of young adult onset HL (diagnosed between ages 15-39 years) up to 2012 among those born since 1958; and 18,374 matched controls. Conditional logistic regression was used to assess HL risk associated with number of older and younger siblings of mothers.

    Results: Having a mother with more than two older siblings is associated with lower HL risk, and the association is statistically significant for mothers with three or more siblings, compared with none. The adjusted odds ratios (and 95% confidence intervals) are 1.04 (0.93-1.16); 0.95 (0.81-1.10); and 0.81 (0.66-0.98) for one, two, and three or more older siblings, respectively. There is no association between number of mothers' younger siblings and HL risk.

    Conclusions: Exposures during the childhood of mothers may influence young onset adult HL risk in offspring, perhaps through vertical transmission of infectious agents, or through other long-term influences on maternal immune function.

  • 36.
    Montgomery, Scott
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Karolinska Institutet, Stockholm, Sweden .
    Hassan, Ahmad
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Bahmanyar, Shahram
    Karolinska Institutet, Stockholm, Sweden; Golestan University of Medical Sciences, Gorgan, Iran .
    Brus, Ole
    Örebro University Hospital, Örebro, Sweden.
    Hussein, Oula
    Örebro University Hospital, Örebro, Sweden.
    Hiyoshi, Ayako
    Örebro University Hospital.
    Hillert, Jan
    Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden .
    Olsson, Tomas
    Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden .
    Fall, Katja
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital, Örebro, Sweden.
    Mortality following a brain tumour diagnosis in patients with multiple sclerosis2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 11, article id e003622Article in journal (Refereed)
    Abstract [en]

    Objectives: As brain tumours and their treatment may theoretically have a poorer prognosis in inflammatory central nervous system diseases such as multiple sclerosis (MS), all-cause mortality following a brain tumour diagnosis was compared between patients with and without MS. The potential role of age at tumour diagnosis was also examined.

    Setting: Hospital inpatients in Sweden with assessment of mortality in hospital or following discharge.

    Participants: Swedish national registers identified 20 543 patients with an MS diagnosis (1969–2005) and they were matched individually to produce a comparison cohort of 204 163 members of the general population without MS. Everyone with a primary brain tumour diagnosis was selected for this study: 111 with MS and 907 without MS.

    Primary and secondary outcome measures: 5-year mortality risk following brain tumour diagnosis and age at brain tumour diagnosis.

    Results: A non-statistically significant lower mortality risk among patients with MS (lower for those with tumours of high-grade and uncertain-grade malignancy and no notable difference for low-grade tumours) produced an unadjusted HR (and 95% CI) of 0.75 (0.56 to 1.02). After adjustment for age at diagnosis, grade of malignancy, sex, region of residence and socioeconomic index, the HR is 0.91 (0.67–1.24). The change in estimate was largely due to adjustment for age at brain tumour diagnosis, as patients with MS were on average 4.7 years younger at brain tumour diagnosis than those in the comparison cohort (p<0.001).

    Conclusions: Younger age at tumour diagnosis may contribute to mortality reduction in those with highgrade and uncertain-grade brain tumours. Survival following a brain tumour is not worse in patients with MS; even after age at brain tumour diagnosis and grade of malignancy are taken into account.

  • 37.
    Montgomery, Scott
    et al.
    Örebro University, School of Medical Sciences.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Bergh, Cecilia
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Foetal risks for low stress resilience are exacerbated by childhood exposures2017Conference paper (Refereed)
  • 38.
    Montgomery, Scott
    et al.
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Burkill, Sarah
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden; Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Bahmanyar, Shahram
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden; Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden.
    Olsson, Tomas
    Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden.
    Concussion in adolescence and risk of multiple sclerosis2017In: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 82, no 4, p. 554-561Article in journal (Refereed)
    Abstract [en]

    Objective: To assess whether concussion in childhood or adolescence is associated with subsequent multiple sclerosis (MS) risk. Previous research suggests an association, but methodological limitations included retrospective data collection and small study populations.

    Methods: The national Swedish Patient Register (hospital diagnoses) and MS Register were used to identify all MS diagnoses up to 2012 among people born since 1964, when the Patient Register was established. The 7,292 patients with MS were matched individually with 10 people without MS by sex, year of birth, age/vital status at MS diagnosis, and region of residence (county), resulting in a study population of 80,212. Diagnoses of concussion and control diagnoses of broken limb bones were identified using the Patient Register from birth to age 10 years or from age 11 to 20 years. Conditional logistic regression was used to examine associations with MS.

    Results: Concussion in adolescence was associated with a raised risk of MS, producing adjusted odds ratios (95% confidence intervals) of 1.22 (1.05-1.42, p=0.008) and 2.33 (1.35-4.04, p=0.002) for 1 diagnosis of concussion and >1 diagnosis of concussion, respectively, compared with none. No notable association with MS was observed for concussion in childhood, or broken limb bones in childhood and adolescence.

    Interpretation: Head trauma in adolescence, particularly if repeated, is associated with a raised risk of future MS, possibly due to initiation of an autoimmune process in the central nervous system. This further emphasizes the importance of protecting young people from head injuries. Ann Neurol 2017;82:554-561

  • 39.
    Montgomery, Scott
    et al.
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet Solna, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Burkill, Sarah
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet Solna, Stockholm, Sweden; Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet Solna, Stockholm, Sweden.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Bahmanyar, Shahram
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet Solna, Stockholm, Sweden; Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet Solna, Stockholm, Sweden.
    Olsson, Tomas
    Department of Clinical Neuroscience, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
    Reply to "concussion may not cause multiple sclerosis".2017In: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 82, no 4, p. 652-653Article in journal (Refereed)
  • 40.
    Mota Garcia, Teresa
    et al.
    Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences.
    Sjöqvist, Hugo
    Örebro University, Örebro University School of Business.
    Fall, Katja
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, London, UK.
    Acne in late adolescence is not associated with a raised risk of subsequent malignant melanoma among men2017In: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 51, p. 44-48Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To evaluate the association of acne in late adolescence with the risk for subsequent malignant melanoma (MM) in men.

    METHODS: Swedish register-based cohort study of 242,096 males born between 1952 and 1956, who took part in compulsory assessments for Swedish military conscription in late adolescence between 1969 and 1975, with subsequent diagnoses of MM (n=1,058) up to December 31, 2009. Covariates included measures of childhood circumstances and information from adolescence on presence of acne, physical fitness, cognitive function, body mass index (BMI), and a summary of diagnoses. Cox regression was used for the analysis.

    RESULTS: In total 1,058 men were diagnosed with MM. Acne was not associated with subsequent MM, with an adjusted hazard ratio (and 95% confidence interval) of 0.95 (0.61 to 1.49). Men with parents who were agricultural workers, and men who lived in northern Sweden, had lower physical fitness, or lower cognitive function had a lower risk of MM. Overweight and obesity was associated with a raised risk, with an adjusted hazard ratio of 1.39 (1.14, 1.71).

    CONCLUSIONS: Acne in late adolescence is unlikely to represent a raised risk for subsequent MM in men. Overweight or obesity was identified as a raised risk for MM, possibly due to the associated increased skin surface area.

  • 41.
    Noriko, Cable
    et al.
    Department of Epidemiology and Public Health, University College London, London, UK.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Aida, Jun
    Kondo, Naoki
    Identifying frail biomarkers using the Japan Gerontological Evaluation Study2017Conference paper (Refereed)
  • 42.
    Sato, Yuki
    et al.
    Tohoku University, Sendai, Japan.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Melinder, Carren
    Örebro University, School of Medical Sciences.
    Suzuki, Chieko
    Saga University, Saga, Japan.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Karolinska Institutet, Stockholm, Sweden; University College London, London, UK.
    Asthma and atopic diseases in adolescence and antidepressant medication in middle age2018In: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 23, no 6, p. 853-859Article in journal (Refereed)
    Abstract [en]

    This Swedish register-based cohort study examined whether asthma, hay fever and allergic dermatitis in late adolescence identified in the early 1970s are associated with antidepressant medication in middle age, between 2006 and 2009. After adjustment for childhood and adulthood sociodemographic characteristics, psychological, cognitive and physical function, and comorbidity, the magnitude of the associations diminished for asthma, while hay fever and atopic dermatitis retained associations. Hay fever and atopic dermatitis in adolescence have potentially important implications for future mental health, while asthma may already have influenced an individual's ability to cope with stress by late adolescence.

  • 43.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center (UFC), Region Örebro County, Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro University Hospital, Örebro, Sweden.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Theander, Kersti
    Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden; Department of Nursing, Karlstad University, Karlstad, Sweden.
    A three-year follow-up of a nurse-led multidisciplinary pulmonary rehabilitation programme in primary health care: a quasi-experimental study2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 7-8, p. 962-971Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To investigate the effects of a nurse-led multidisciplinary pulmonary rehabilitation programme conducted in primary health care on functional capacity, quality of life and exacerbation frequency over three years among patients with Chronic Obstructive Pulmonary Disease.

    Background: Although Chronic Obstructive Pulmonary Disease is a chronic respiratory disease, it has been established that pulmonary rehabilitation has positive effects on patients' everyday functioning. However, the duration of these functional improvements, especially when the rehabilitation programmes are provided in primary health care settings, remains to be established.

    Design: A quasi-experimental design.

    Method: Primary health care patients with Chronic Obstructive Pulmonary Disease (GOLD stages II and III) were included; 49 in the intervention group and 54 in the control group. The intervention comprised a six-week pulmonary rehabilitation programme. Functional capacity was assessed using a six-minute walking test and quality of life by the Clinical COPD Questionnaire at baseline, after one year and three years. Exacerbation frequency was calculated from one year before to three years after the programme.

    Results: No significant differences between the groups were observed in the six-minute walking-test or the Clinical COPD Questionnaire after one year and three years. On average, there were significant improvements in the six-minute walking-test and the Clinical COPD Questionnaire from baseline to the one-year follow-up. Exacerbation frequency tended to decrease in the intervention group and increase in the control group (interaction test was p = 0·091) but increased again in both groups after three years.

    Conclusion: There was no evidence of the benefit of the nurse-led multidisciplinary pulmonary rehabilitation programme, although the exacerbation frequency tended to decrease in the intervention group after one year. There is a need for support and coaching at regular follow-ups in primary health care.

    Relevance to clinical practice: There is a need to support and coach patients with Chronic Obstructive Pulmonary Disease in primary health care by means of regular follow-ups.

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